When one talks of diabetes, people tend to think it’s a disease that affects only adults, which is not the case. In fact, according to experts, while Type 2 diabetes dominates with 90 per cent of all diabetes, Type 1 diabetes remains a very serious issue among children.

According to Dr Crispin Gishoma, the director of Rwanda Diabetes Association, there is still a misunderstanding about diabetes when it comes to children.

He says that there is Type 1 which affects children and adolescents; this is from birth to about 25 years of age. It’s also called ‘juvenile diabetes’.

"With Type 1 diabetes, the pancreas does not make insulin. Insulin is a hormone that helps glucose, or sugar, get into your cells to give them energy. Without insulin, too much sugar stays in the blood,” he says.

He says that in Rwanda, there are at least 1,500 children living with Type 1 diabetes countrywide.

How does this come about?

Gishoma explains that it’s the body which attacks the beta cells producing insulin, and once all the beta cells in the body have been destroyed, one can’t produce enough insulin, leading to Type 1 diabetes. This, he says, makes a patient either get insulin outside their body, or risk dying. Therefore, early diagnose and treatment is important.

He, however, notes that it isn’t entirely clear what triggers the development of Type 1 diabetes, but researchers have shown that genes play a role that leads to the auto immune process. However, something must set off the immune system, causing T-cells (T-lymphocyte) to turn against the beta cells.

He says T-cell is a type of white blood cell that is of key importance to the immune system.

To be able to find out if your child has this type of diabetes, Gishoma says parents should notice different signs and symptoms, especially for those children who are still young and can’t express how they feel.

Type 1 diabetes develops gradually, but the symptoms may seem to come on suddenly.

The first sign, according to Edison Rwagasore, the senior officer for diabetes, chronic diseases and other metabolic diseases at Rwanda Biomedical Center (RBC), is frequent urination, and for teenagers, they continue wetting their beds.

Another sign, he says, the child loses weight, feels exhausted all the time and always wants to drink anything found in the house.

Abdominal pain, nausea or vomiting, blurry vision, wounds that don’t heal well, irritability or quick mood changes, changes to (or loss of) menstruation, are also some of the symptoms for diabetes type 1.

"When a parent notices those signs, they should go to hospital so that the child can be checked, and if found to be having diabetes, putting them on treatment immediately will help save their lives,” he says.

Meanwhile, Gishoma points out that this is important because although it varies from person to person, children with type 1 diabetes, poor medication could lead to death if their beta cells are completely destroyed.

Normally, Gishoma says, in Rwanda and Africa in general, there is a misconception that if a child dies abruptly, it is witchcraft and poisoning yet in true sense, a child with type 1 diabetes could die in less than a month if they don’t get immediate treatment.

"This comes about due to lack of treatment and limited knowledge about the disease,” he says.

He adds that to avoid this, there is a lot needed to be done as far as creating awareness is concerned so that parents seek medication before the worst happens.

"In developed countries, they can detect the destruction of the body very early, making it easier to control it if found. But in developing countries including Rwanda, medics come to know about the condition when the child displays the symptoms of the disease, which is a challenge,” Gishoma says.

Treatment and complications

Rwagasore notes that patients with type 1 diabetes mellitus (DM) require lifelong insulin therapy. Most require two or more injections of insulin daily, with doses adjusted on the basis of self-monitoring of blood glucose levels.

Long-term management requires a multi-disciplinary approach that includes physicians, nurses, dietitians, and selected specialists.

"Such patients have to inject insulin for life, which is costly as well as a challenge to the parents of the children with this kind of disease,” he says.

Francis Kazungu, a general practitioner in Kigali says when one injects too much insulin; it can put them in a coma which can result in death as well.

Kazungu says that type 1 complications are the same as type 2 diabetes, but the only difference is that the body of the person with type 1 diabetes doesn’t produce any insulin because the body cells are destroyed (autoimmune disease).

One can also get brain damage, lose sight, and or suffer kidney failure, among others.

Kazungu adds that children can get type 2 diabetes if they are overweight or obese, have a family history of diabetes, or are not active.

"This disease is very hard to control because a very young child might not be able to explain how they feel,” he says.

Rwagasore says that Type 2 diabetes used to be called ‘adult-onset diabetes’. But now it is becoming more common in children and teens due to obesity. With type 2 diabetes, the body does not make or use insulin well.

The need for a nutrition/diet and support groups

Private Kamanzi, a nutritionist at Amazon Complimentary Therapy in Remera, Kigali, says that parents need to manage the blood sugar of the child and the food they eat.

"They need to have a glucose meter to measure the blood sugar and monitor food and exercise if the child is old enough to do that,” he adds.

"As nutritionists, offering evidence-based diet advice while taking into account nutritional requirements, age, maturity, education levels and learning styles is important,” he says.

Additionally, he says providing education and support to other healthcare professionals to ensure appropriate advice is provided to patients and clients is also important when it comes to handling a child with type 1 diabetes.

Once the child is sick, Gishoma says the whole family becomes sick as well. He explains that this is because they all have to understand the medication the child has to take, when to visit the hospital and be aware of what it takes to treat the child, which to him is critical.

He says that for such parents, it’s ideal to join groups that have other parents in similar situations.

"These support groups are important because people learn from each other and understand the challenges. Through expressing themselves and sharing their challenges and how to handle them, they get inspired and it gives them hope to live a positive life,” he says.

He, however, mentions that getting a trusted physician whom a parent can rely on anytime they have a problem is important as well.

For instance, at Rwanda Diabetes Association, they have such groups in Kigali as well in the countryside, organised by hospitals to support parents psychologically and emotionally.

"Such groups need motivation to push them to live life positively, because some of them don’t understand the need to get in touch with people who have the same problem,” Gishoma says.

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experts share tips

Claudine Uwajeneza, nurse at Clinic Galien in Remera

As a parent, ensuring that your child gets annual medical checkups and undergoes all the immunisation required is important. This is vital because physical health is a key factor in children’s growth as they need a healthy start to prevent them from avoidable diseases.

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Joseph Uwiragiye, nutrionist

Parents have the primary responsibility to ensure that their children get good nutrition. Making sure that a child sticks to a balanced diet and does enough exercise will keep them away from most non-communicable diseases, even at a late stage in life.

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Julius Habimana, general practitioner

Having a child with a chronic illness is distressful. They need support socially, psychologically and emotionally to help them cope with the situation they are in. It’s not unheard of for one to give up on their loved one, resulting in poor medical attention as required, but that shouldn’t be the case. They need all the assistance they can get.

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Phiologan Kwizera, medical student

Non-communicable diseases in youngsters result from lifestyle risk factors, such as tobacco and alcohol use, unhealthy diets, lack of physical activity leading to obesity, raised blood pressure, and cholesterol. Staying away from all this is important.

editorial@newtimes.co.rw