Bitter diabetes, sweet truths

November 14 is World Diabetes Day. It is when awareness campaigns are kick-started and free diabetes detection camps held. This is necessary because undiagnosed, uncontrolled diabetes and its complications are one of the leading causes of death in  India.

By Dr Gita Mathai
  • Published 15.11.17
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November 14 is World Diabetes Day. It is when awareness campaigns are kick-started and free diabetes detection camps held. This is necessary because undiagnosed, uncontrolled diabetes and its complications are one of the leading causes of death in  India.

About 7 per cent of the Indian population has diabetes. It is considered a disease of the ageing, so it is more likely to be picked up incidentally in adults. This is a misconception. Newborns (though rare) can also be detected with it and it is found in children as young as nine months. There are two peak ages for diabetes in children — 4-7 years and then 10-14 years. And gestational diabetes complicates one in seven pregnancies.

The symptoms of diabetes appear gradually and are non-specific. There may be weight loss, fatigue, irritability, increased appetite and thirst, frequent urination, itchy dry vagina, velvety black skin in the neck and armpits, blurring of vision and tingling of the hands and feet.

Diabetes in children usually develops suddenly — within days or weeks — even without a family history. The child may become abnormally hungry and thirsty, urinate frequently and revert to bedwetting.

The blood sugar has to be checked to confirm diabetes.

In normal people, the blood sugar remains around 100 even if they have just gorged on a high calorie meal or fasted for hours. This is because as the blood sugar rises, the pancreas senses it and releases insulin. This lowers the blood sugar. If the sugar falls below normal, the insulin level drops and the pancreas releases glucagon, which releases glucose into the blood from body stores. High blood sugar results when the insulin produced is insufficient or the body is resistant to its action.

Diabetes has a multifactorial inheritance and can affect people through many generations. Genetically, a person may be prone to develop diabetes but the age of onset is modified by environmental factors such as diet and physical activity.

Diabetes can occur at any age if the cells in the pancreas that produce insulin are destroyed. This can occur for no discernable reason or follow a mild viral infection of the Coxakie virus, mumps, German measles or a Rotavirus. It has also been linked to children who were introduced to cow’s milk too early.

Overweight children are prone to MODY (maturity onset diabetes of the young). There are several types of MODY, about 27 per cent inherited and 73 per cent in youngsters with no family history. It often goes undiagnosed for years until complications set in. It should be suspected in overweight children and adolescents, especially if they have pot bellies, and dark velvety discolouration of the skin in the neck, axilla and groin, (called acanthosis nigricans), and in girls with irregular periods and polycystic ovaries.

The mainstay of treatment for all diabetes is diet and exercise. If control is not achieved then medication can be started. Drugs can be used if there is some insulin production in the body, otherwise injections have to be administered. To prevent and delay diabetes:

Exercise an hour a day

Maintain ideal body weight

Immunise children at the appropriate age against measles, German measles, Rotavirus and chickenpox. 

The writer is a paediatrician with a family practice at Vellore and author of Staying Healthy in Modern India. If you have any questions on health issues, please write to yourhealthgm@yahoo.co.in

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