DIABETES MELLITUS (DM) IN

CHILDREN

Dr. Shamanthakamani NarendranMD (Pead), PhD (Yoga Science)

How yoga helps?

DIABETES IN CHILDREN

Today, DM in children through out the world is growing with an alarming rate.Has increased 3 times in last 30 years. Type 1 diabetes is growing by 5% per year among pre-school children in India. It is estimated that 70,000 children, who are under 15 years, develop juvenile type 1 diabetes each year (almost 200 children a day!).

20% or more of new patients with diabetes in childhood and adolescence have type 2 diabetes mellitus, a change associated with increased rates of obesity.

Type 1 diabetes

Type 2 diabetes

Gestational diabetes

Classification of Diabetes

Other types of Diabetes Genetic

Malnutrition related Drug induced

Age

Neonatal diabetes, including diagnosis in infants younger than 6 months, is most likely due to an inherited defect.Respond well to sulphonylurea therapy.

Early childhood - 4-6 years Early puberty - 10-14 years.

Mortality/Morbidity

Metabolic control Genetic susceptibility, Lifestyle (eg, smoking, diet, exercise), Pubertal status, and Gender.

Long-term complications includes:RetinopathyCataractsHypertensionProgressive renal failureEarly coronary artery diseasePeripheral vascular diseaseNeuropathy, both peripheral and autonomicIncreased risk of infection

Associated autoimmune diseases are common with type 1 diabetes mellitus, particularly in children who have the human leukocyte antigen DR3 (HLA-DR3). Some conditions may precede development of diabetes; others may develop later. As many as 20% of children with diabetes have thyroid autoantibodies

Age below 30 years Excessive urination Excessive hunger Excessive thirst

Symptoms of Type 1 Diabetes

Bed wetting in children Unexplained weight loss Dehydration Coma

Symptoms

Abdominal pains, headaches and behavior problems along with the usual symptoms of diabetes like weight loss, thirst, tiredness and frequent urination.

MAY PRESENT WITH

• INFECTION

• COMA

• COMPLICATIONS

EXCESS HUNGEREXCESS THIRSTEXCESS URINE

IDDM

IDDM

EATS A LOT BUT DOES NOT GROW

LOSS OF WEIGHT

YOUNG

5 -35 Yrs

Frequent urination Always hungry Cave for extra liquids Sexual dysfunction Unexplained weight

loss Family history

Symptoms of Type 2 Diabetes

Heredity

FOR INSULIN IDENTIFIED (CHROMOSOME 6)

GENE

Values are internationally accepted for plasma glucose Corresponding whole blood glucose values are lower

Diagnostic range of blood sugar (plasma glucose)

>200>140, but <200

<1402 hours after glucose load (mg/dL)

200 at least once

<200<200Between 0-120 min (mg/dL)

>126110-126<110Fasting plasma glucose (mg/dL)

Diabetes mellitus

Impaired glucose tolerance

Normal glucose tolerance

What are the consequences of untreated diabetes?

2 times higher risk of brain stroke

3-4 times higher risk of heart disease

Increase risk of high BP

Cause of leg amputations

Cause of loss of sensations in limbs & other nerve damage17 times of higher risk

of kidney failure – common cause in India

Affects the eye and vision3rd most common causeof blindness in India

Symptoms of type 1 DM secondary to Hyperglycemia, Glycosuria, and Diabetic ketoacidosis (DKA).

KETOACIDOSIS

Blood suger >240 mg/dLKetone bodies in blood> Acidity in blood

Symptoms: Slow, deep breathing with a fruity odor to the breath; confusion; frequent urination (polyuria); poor appetite; loss of consciousness.

Administration

Of intravenous fluids, Insulin, and Glucose

Insulin resistance: Insulin is reduced or blocked in the body. Causes the pancreas to produce extra insulin. After some time the body may stop making insulin.

Signs & symptoms

Hungry all the time. Tired and sluggish

Environmental factors

Viral infection Dietary factors are also relevant. Breastfed infants have a lower risk for insulin-dependent diabetes mellitus (IDDM)

Chemical causes

Rat poison - selectively damage islet cells and can cause type 1 diabetes mellitus.

Management

Education.Medication.Regular physical activity. Balanced diet.Yoga

Medication

Antidiabetic agentsInsulin detemir (Levemir)Insulin lispro (Humalog)Regular insulin (Humulin R, Novolin R)Insulin NPH (Humulin N, Novolin N)Insulin aspart (NovoLog)Insulin glargine (Lantus)Insulin glulisine (Apidra)

Medical Care

Children with type 1 DM (T1DM) require insulin therapy.Children with significant dehydration, persistent vomiting, or metabolic derangement, or with serious intercurrent illness, require inpatient management and intravenous rehydration.A well-organized diabetes care team can provide all necessary instruction and support in an outpatient setting. The only immediate requirement is to train the child or family to check blood glucose levels, to administer insulin injections, and to recognize and treat hypoglycemia. The patient and/or family should have 24-hour access to advice and know how to contact the team.

Diet

Diabetes is an energy metabolism disorder, and before insulin was discovered, children with diabetes could be kept alive by a diet severely restricted in carbohydrate and energy intake. These measures led to a long tradition of strict carbohydrate control and unbalanced diets. More recent dietary management of diabetes emphasizes a healthy, balanced diet, high in carbohydrates and fiber and low in fat.

The following are among the most recent consensus recommendations:Carbohydrates should provide 50-55% of daily energy intake. (No more than 10% of carbohydrates should be from sucrose or other refined carbohydrates.)Fat should provide 30-35% of daily energy intake.Protein should provide 10-15% of daily energy intake.

Develop a diet plan for each child to suit individual needs and circumstances. Regularly review and adjust the plan to accommodate the patient's growth and lifestyle changes.

Proper diet is very important – Helps control blood sugar, blood cholesterol, and weight

Cut down on fat, oils, sugar, alcohol and red meat.

Eat vegetables daily. Avoid rich fried foods. Take lots of foods like cereals and

pulses

Diabetic Diet Tips

Activity

Type 1 diabetes mellitus requires no restrictions on activity; exercise has real benefits for a child with diabetes.Most children can adjust their insulin dosage and diet to cope with all forms of exercise.The current guidelines are increasingly sophisticated and allow children to compete at the highest levels in sport.

Children and their caretakers must be able to recognize and treat symptoms of hypoglycemia.Hypoglycemia following exercise is most likely after prolonged exercise involving the legs, such as walking, running or cycling. It may occur many hours after exercise has finished and even affect insulin requirements the following day.A large presleep snack is advisable following intensive exercise.

Consultations

Always involve an experienced dietitian in the patient's care, typically as a regular member of the diabetes care team.Ophthalmology review may be needed at diagnosis if a cataract is suspected. Children with diabetes aged 12 years and older need a careful annual eye examination.Access to psychological counseling and support is desirable, preferably from a member of the diabetes care team.

Regular exercise is good for diabetes. Exercise improves sugar and weight

control, and increases a sense of well being

Diabetic Exercise Tips

Do’s Can participate in

active sports Keep sugar or

other carbohydrate source handy.

Don’ts Avoid exercise

soon after injecting insulin

Do not exercise on an empty stomach

Change daily into clean, soft socks or stockings which must neither be too big nor too small.

Keep the feet warm and dry. Preferably wear socks or stockings of cotton and leather shoes.

Never walk barefoot neither indoors nor outdoors.

Always wear shoes that fit. This applies also to sandals

Examine shoe everyday for cracks, pebbles, nails, and other irregularities which may irritate the skin.

Special Attention for Foot

Wash feet daily with lukewarm water and soap, just as wash hands.

Dry feet well, also between the toes. Cut nails straight across. Ingrown nails

and calluses should receive expert attention.

Keep the skin supple with moisturizing lotion, but do not apply it between the toes.

If not diabetic, but at high risk, require to take care of health.

Should watch weight in particular waist line. Exercise regularly. Eat healthy – cut out fat, reduce refined rich

fried food, avoid calorie dense sweets and red meat.

Eat cereals and pulses, vegetables and fruits, avoid or reduce alcohol intake and go for medical checkup regularly.

Avoid excessive psychological and physical stress.

Can Diabetes be prevented ?

All types of diabetes are serious and require full attention.

Insulin is given from outside when insulin producing cells do not produce enough insulin

High blood sugar is toxic to the insulin producing cells.

Improperly controlled diabetes worsens the condition and further damages the already stressed insulin producing cells.

Controlling diabetes is important irrespective of whether one is treated with/without insulin

Is Insulin requiring DM more serious ?

YOGA PRACTICES

Ride your Bumpy Camel

COBRA POSE

ELEPHANT POSE

FISH POSE

Running Train

Air Walk Sliding Board

Birthday Candles

Candle Pose

Deep Relaxation

Jogging Through the Jungle

MEDITATION

PASSIVE YOGIC EXERCISES

Infants below 3 to 4 years.

Children with neurological or muscular disabilities who are unable to do active asanas

There are two ways to live your life.

One is as through nothing is a miracle.

The other is as though everything is a miracle.

Albert Einstein (1879 - 1955)

PASSIVE YOGIC PRACTICES

1 to 4 MonthsGRIP

CHEST CROSS

3 to 4 Months

BICYCLE

5 to 6 Months

PULL-UP ELBOW STAND

7 to 8 Months

TOE TO EAR WHEELBARROW

9 to 11 Months

MOUNTAIN CLIMBING

12 to 22 MonthsLAY-BACK

TOUCH AND HUG

SQUATTING

HIP LIFT

12 to 22 Months

HEAD-TO-TOES

TRAIN TRACKS

BALANCE BEAM WALK

BASIC PUSH-UP

ANGRY CAT

ROWING