The number of young children with early-onset diabetes (type 1 diabetes, or diabetes mellitus) has soared in the past 20 years. A 2007 study found that cases of type 1 diabetes in under-fives increased fivefold between 1985 and 2004, with one in 1,000 now affected by the disease. The figures suggest more than 3,000 pre-school children are affected, compared with 600 just 20 years ago.
The increase among under-fives was accompanied by a doubling of cases among children under 15 over the same period. It has mystified doctors, who think it has happened too fast to be caused by genetic factors. It has also made it important for carers to understand the disease and what to do.
Type 1 diabetes is an autoimmune condition, where the body attacks the insulin-producing cells in the pancreas. Insulin regulates blood sugar levels. Unlike type 2 diabetes, which is being seen for the first time in American and European children, it is not caused by lifestyle factors such as poor diet, lack of exercise and obesity. It is thought that environmental factors may have driven the surge in type 1 cases.
The symptoms resemble those in diabetic adults and come on over a period of weeks. Children experience thirst, weight loss, tiredness and urinary frequency; they may also suffer thrush, tummy pain, headaches and behaviour problems. Symptoms should be reported to parents immediately, as early treatment is vital.
Handling an emergency
Children with diabetes should have a detailed medical plan from their hospital practitioner, including emergency insulin and insulin gel to be used in the case of very low blood sugar (hypoglycaemia, commonly known as a 'hypo').
Most children have insulin injected twice a day, before breakfast and before an evening meal, but this varies, so it is important for nursery practitioners to be aware of individual needs and how to inject insulin (which usually comes in the form of a pen, rather like an EpiPen, and is injected into the thigh or abdomen).
The most important thing for teachers and practitioners to know is how to deal with a diabetic emergency, or 'hypo'. Hypoglycaemia, the most common short-term complication in diabetes, occurs when blood glucose levels fall too low.
Hypos are likely to happen before meals and can happen as a result of:
- too much insulin
- not enough food to fuel exercise
- too little food at any stage of the day
- a missed or delayed meal or snack
- cold weather
- the child vomiting.
Warning signs include:
- hunger
- sweating
- drowsiness
- glazed eyes
- pallor
- trembling or shakiness
- headache
- lack of concentration
- mood changes, especially angry or aggressive behaviour.
Symptoms can be different for each child and parents can tell you what their child's warning signs are.
It is very important that a hypo is treated quickly. If untreated, the blood glucose level will continue to fall and the child could become unconscious. In the first instance, offer a sugary drink such as Lucozade, fresh fruit juice or a non-diet soft drink, or glucose tablets. Parents should provide a glucose gel (such as Hypostop), which can be massaged inside the cheek if a child won't take a drink. Honey or jam can also be used in an emergency.
Continue to offer sugary food and drinks if a child is still unwell after an attack. Make a note of what the child drinks and eats and when, and ensure parents are aware of any blips, as insulin doses may need to be adjusted. Keep emergency items and contact numbers to hand.
RESOURSES
- An excellent downloadable sheet is available from www.diabetes.org.uk offering advice and information on all types of diabetes in children
- Type 2 diabetes in childhood is believed to be caused by a poor diet and lifestyle, with little or no exercise. For more information on this condition visit diabetes.org.uk or call Diabetes UK Careline: 0845 120 2960, Monday-Friday, 9am-5pm
- An excellent guidebook, with tips on keeping children healthy and happy, is Type 1 Diabetes in Children, Adolescents and Young Adults by Ragnar Hanas (Class Publishing, £11.99)
- Explain the condition to children with The Dinosaur Tamer and Other Stories for Children with Diabetes, by Marica Levine Mazur, Peter Banks and Andrew Keegan (American Diabetes Association, via Amazon, £6.50)