How to notice the symptoms of diabetes in children in time, what to do so that the child does not get sick, even with severe heredity, and why diabetes is not a sentence, said in an interview the main children’s endocrinologist of the Samara region, Yevgenia Mikhailova.
– How often do Samara children find diabetes?
– Now about 1000 children with diabetes are registered with us, and the annual increase is about 5-7%. More often children get sick, less often teenagers. At the same time, in the past two years we have seen a trend that 32% of newly diagnosed cases of diabetes are children of the first six years of life, that is, diabetes is getting younger. Many children go through all stages of their physical development, puberty, diabetes. Therefore, it is of utmost importance to avoid acute and chronic complications, to select optimal insulin therapy for such children, to teach them how to live with diabetes so that they emerge into adulthood completely full-fledged, ready to work and study.
– What is the reason for such sad statistics?
– It is difficult to say, this is a general trend. I think this is a combination of factors. For example, today the nature of type 1 diabetes is already proven (99% of cases in children and adolescents are diabetes of this type). If we talk about the nature of things, then this is a hereditary predisposition. But it still has to manifest itself under the influence of any factors: it is either a viral infection or improper feeding in the first year of life, early refusal from breastfeeding, early introduction of porridges that contain gluten (including semolina, which was fed before ).
And, of course, environmental factors play a role: technogeneity, which increases every year, gas pollution – all this leads to the realization of heredity. And another factor that has been talked about in recent years is that we all live in vitamin D deficiency. We have very low solar activity, the summer is short, we don’t eat sea fish. This also increases the risk of implementing genetic information.
– You said about the dangers of early rejection of breastfeeding: early is what age?
– Important the first 6 months, especially in those families in which there is a heredity, burdened by diabetes. But if you start to transfer from breastfeeding to something else, then in no case can not use whole milk. We have very many goat milk is considered the best option for feeding, this is a mistake. Everywhere, including cow’s milk, there are milk proteins that are poorly absorbed and are factors for increasing the implementation of hereditary information. Therefore, if a woman for some reason does not have the opportunity to breastfeed, it is imperative to use adapted milk formulas.
– Is it necessary for a child to have diabetes if one of the parents is sick?
– It is not necessary. We have a mean population risk of diabetes of 0.2%. that is, it is actually with such frequency that diabetes develops on average in the population. If we have a dad with diabetes, then the risk increases to 6%, if mom – to 4%. If both parents are sick, then the risk of having a sick child is 34%. And approximately in the region of 10-15%, if the siblings are sick.
But when I voice these risks, I always compare them with the risks of developing any chromosomal diseases. For example, Down’s disease. The risk of developing Down’s disease is 36% in young women and reaches 60% in women after 40 years. The risk of developing diabetes is incomparably lower.
It is now clearly known which genes are responsible for the risk of developing autoimmune diseases. With certain alleles, a person can get diabetes. But! A gene may be found, but it may never be realized in life. Therefore, at the genetic level, it is impossible to decide whether your child is ill or not, if you have a person with diabetes in your family. This is unpredictable. Therefore, when a woman with diabetes, or who has children with diabetes, asks a question – is it worth it or not worth giving birth, we say – of course, it is worth it. Because the risk is incommensurable. 4% that the child will be with diabetes, against 96% that will not. An impressive percentage.
– Is it possible to somehow reduce the risks of developing diabetes in a child at the stage of pregnancy?
– No, at the stage of pregnancy it is impossible to say which genetics a child has. The only thing is that if a mother has diabetes, she should very clearly control her blood sugar level during pregnancy, because this can reduce the risk of intrauterine growth. The use of insulin pumps significantly reduces this percentage of risks, especially pumps with feedback. In this regard, in our country, the reference standard for managing pregnant women with diabetes is considered to be on an insulin pump.
But if a child is already born and you have risks, you should remember to breastfeed him, introduce certain foods in time, temper the child, improve immunity reactions to viral infections.
– How to recognize diabetes in a child? What symptoms need urgently to go to the doctor?
– Diabetes mellitus of the first type – a disease that quickly manifests itself. Thirst appears, urination becomes more frequent (most often the child can drink and go to the toilet at night). A child can start to lose weight dramatically – up to several kg in a week, get tired quickly. Suddenly he began to come from school and immediately go to bed, which had not been observed before. Suddenly, all of a sudden, his academic performance declined. Here you need to sound the alarm.
The main method for diagnosing diabetes is blood sugar testing from a finger. You can take it on an empty stomach in the morning on an empty stomach, after an 8-hour fast, or at any other time of the day, regardless of the meal.
– What is the normal rate?
– Normal blood sugar level on an empty stomach is 3.3-5.5 mm / l. If sugar in the blood taken on an empty stomach is higher than 6.3 mmol / l, it is necessary to consult an endocrinologist to avoid diabetes. If blood was taken at another time, regardless of the intake, write, then sugar is higher than 11 mmol / l – diabetes.
– Does the duration of life affect how soon the parents detect the symptoms and go to the doctor with the child?
– If parents lately paid attention to complaints, and the child was taken to hospital in serious condition, to intensive care unit, with a severe disease, then this does not affect life expectancy, but affects the duration of the so-called “honeymoon”. When the signs of diabetes are first manifested, the pancreas still releases some insulin, but she struggled for a long time, was tired and does it out of her last strength. When we begin to treat the child, the pancreas has a little breathed and for some time will allocate insulin – a year, six months. The earlier we identified diabetes, the earlier the parents went to the doctor, the longer the period of residual pancreatic secretion would be. That is, diabetes will be milder at this time.
But even if we discovered it already in a serious condition, then with the right treatment, the correct selection of insulin dose, training people about how to eat properly, how physical activity affects blood sugar levels, it will not affect the lifespan. The duration is affected by how well people will control their condition throughout their life span. This certainly helps us with modern diabetes treatment technologies: insulin pumps, continuous monitoring of blood glucose, and remote monitoring of CareLink.
– That is, the diagnosis of diabetes is still not the end of the world?
– Soon there will be a hundred years, as they discovered insulin – 1921. People died, the average life expectancy from the moment of diagnosis to the moment of death, if a child fell ill in childhood – from one to three years, on a strict diet. But when in 1921, insulin was discovered, and in 1923 organized its industrial production, people began to survive and live normally with diabetes. Before: ill – died. Now: ill – and live. And if you use all the novelties of modern medicine – it lives well. This year, on November 18th, in collaboration with Medtronic, we held Diabetes Day, the goal of which is to dispel the many myths associated with this disease. Such events provide an excellent opportunity to demonstrate to our patients that diabetes is not a disease, but a way of life and certain limitations, that with the right methods of compensation a person with diabetes can lead an active and healthy lifestyle.