Dear Doctor,

I am 26 years old and plan on having a baby sometime soon. However, I would like to know about diabetes and the chances of my child having it. How does a child get it? Are they born diabetic or do they get it along the way? Can I avoid it? If so, how?

Rita

Dear Rita,

Your worry is genuine, because diabetes during pregnancy can cause many problems like abortion, intrauterine deaths, large size baby, e.t.c. Type II diabetes (where treatment involves life style factors and tablets), which occurs around middle age or later, is mostly due to life style factors like obesity, high calorie diet, alcohol and tobacco abuse, physical and mental stress.

Genetics also plays some role.

One individual may have type II diabetes due to life style factors and this may pass on genetically to the next generation who may acquire it if any risk factors are present.

However type I diabetes (where treatment is exclusively insulin) occurs due to predominantly genetic factors. More than 10 types of genes have been implicated.

It is also said to occur as sequel to viral infections. Allergy to some component in cow milk is also implicated in type I diabetes. Apart from this, diseases and tumors of the pancreas, some other endocrine disorders like adrenal diseases or tumors, drugs like corticoids, diuretics, e.t.c can cause diabetes.

Whatever the reason, due to diabetes, insulin produced in the body is either ineffective to neutralise the blood glucose (type II) or is absent to neutralise glucose present in blood (type I diabetes). Thus the blood glucose levels keep on rising leading to many short term and long term complications, like neuropathy, coronary artery disease, kidney failure, e.t.c

Diabetes can be diagnosed easily by simple blood tests done on an empty stomach and within two hours of a major meal. Values higher than normal range strongly suggest diabetes.

Estimation of glycated hemoglobin helps to determine whether over time blood glucose levels have been normal or high. In children, genetic tests or tests estimating antibodies against islet of langerhans of pancreas help to decide whether a child has or shall develop diabetes in the future. If one or more parents has diabetes, the possibility of the child developing diabetes is high. However studies show that the risk is more if the father alone has diabetes, in comparison to the mother being the only parent with it.

A child may be born with diabetes if the mother had gestational diabetes (with high blood glucose levels during pregnancy) or due to some early childhood infection. However if he has genetic susceptibility to acquire the disease he/she may develop it as they grow, particularly if the high risk factors like obesity, alcohol use, e.t.c prevail.

Regular screening for diabetes during pregnancy, avoiding excess weight gain, if one has diabetes good adherence with insulin therapy, minimise the risk of the baby developing diabetes.

Diabetes can be prevented and the severity of the disease minimised by correcting life style factors. Use of low fat high fiber food, regular physical exercise, physical and mental relaxation, avoiding alcohol and other abusive substances can achieve this.

Dr. Rachna is a specialist in internal medicine at Ruhengeri Hospital.