The burden of monitoring diabetic child

Sarah Wilson, a mother in Texas, US, considers Ruby part of the family. In an interview with the Huffington Post, the mother of a type 1 diabetic child said the diabetic alert dog came into her daughter’s life about two years ago. And Wilson is confident 3-year-old Faith, who was diagnosed with Type 1 Diabetes at nine months old, wouldn’t be alive without Ruby. The dog is trained to detect when Faith’s blood sugar falls below 100 or above 180. The girl’s blood sugar levels can fluctuate to dangerous levels about 30 times per day, Wilson said. In the UK, the Daily Mail reported in 2010 of Rebecca Farrar, 6-year-old who adores her family’s dog for a particularly special reason. The pet, Shirley, is one of the country’s only ‘hypo-alert’ hounds who smells when Rebecca’s blood sugar reaches dangerously low levels. The youngster said her life is ‘saved’ by the Labrador-golden retriever cross four times a week as she provides early of potential diabetic attacks. The three-year-old dog can detect a change in scent when Rebecca’s blood sugar levels drop dangerously low or high and licks her owner’s hand to alert her. Shirley will even drag a sugar-level testing kit to the youngster’s side to prevent her from slipping into a coma and sleeps faithfully by her side every night. These anecdotes more than spell the trials and tribulations of caring for type 1 diabetic children. For instance, Rebecca must inject herself four times with insulin every day and carry out up to seven sugar-level tests to avoid collapsing. Before the arrival of Shirley, the schoolgirl had to constantly check her sugar levels and was taken to hospital up to four times a week. When sugar levels drop, the body releases a faint scent comparable to nail polish remover. Dogs like Ruby are trained to detect the odour and take action by alerting a guardian. According to Dr Aime Muhimpundu, the head of non-communicable diseases at Rwanda Biomedical Centre, diabetes is common within all populations and it will surprise you that lifestyle habits are associated with the disease. This kind of diabetes is more genetic that is why it may appear in children at an early age,” Muhimpundu says. “For diabetes generally, sufferers mostly fall victim of the disease because of unhealthy diets that contain too much sugar, too much fat, salt and reduced level of physical activity,” she added. Life-long insulin Dr Rachna Pande, an internal medicines specialist at Ruhengeri Hospital, says children with type 1 diabetes are different from other children due to the fact that they need life-long insulin therapy and some diet restrictions. Type 1 diabetes, Dr Pande says, usually occurs due to absolute deficiency of insulin in the body in contrast to type 2 diabetes where insulin is present in body but body cells are resistant to it “Insulin is a hormone produced by cells of pancreas that helps to maintain the glucose metabolism in the body,” she said. “Deficiency of insulin leads to high blood glucose levels as body fails to neutralise and utilise glucose produced by liver. This leads to increased frequency of urination and subsequent thirst and weight loss in spite of increased appetite.” Persistence of high blood glucose levels leads to severe infections, which do not resolve soon like non-healing ulcers and wounds. Long standing high blood glucose levels damage the kidneys, eyes, heart, nerves and blood vessels and increase risk of heart attacks and strokes, she says. “These damaging effects occur more severely with type 1 diabetes and since there is lack of insulin in the body, it needs treatment only by insulin.” Because impaired glucose tolerance (IGT) is directly linked to the transition from normal to diabetic, statistics for IGT prevalence released in 2010 also revealed alarming figures with 344 million, 7.8 per cent individuals with the disorder Provided interventions are not put in place, most of these would end up diabetic. Incidence When it comes to hereditary diabetes, a minority of the population are sufferers while, type 2 constitutes 85 to 95 per cent of all diabetes in high income countries and even higher for low and middle income countries. Recent evolution of diabetes shows that diabetes begins early with type 1 witnessed more in children. Whereas some people develop a type of diabetes – called secondary diabetes -- which is similar to type 1 diabetes, the beta cells in this case are not destroyed by the immune system but by some other factor. A diabetic urinates frequently and as a result you get dehydrated. This is because once sugar builds up in the blood stream; it raises the osmotic potential hence more water is drawn from the body. But since sugar will be lost in urine, the body tries to break down fats as alternative energy source resulting into subsequent weight loss. As more sugars without insulin pile into the blood stream, the body is just set for complications. Over time, the high sugar levels in the blood may damage the nerves and small blood vessels of the eyes, kidneys, and heart and predispose a person to atherosclerosis (hardening) of the large arteries that can cause heart attack and stroke. Increased thirst, increased hunger (especially after eating), dry mouth, abdominal pain, frequent urination, nausea, blurred vision, labored breathing may all result from diabetes. Dr Evariste Ntaganda, a specialist in cardiovascular diseases at Rwanda Biomedical Centre, says there is a linkage between diabetes and heart diseases; individuals with diabetes also end up having heart problems. Care for type 1 diabetic child The main change is learning to frequently check and adjust blood glucose levels (also called “blood sugar”). It may need checking 10 to 12 times a day. How much insulin your child needs will depend on the timing of meals, the types of food eaten, and her activity levels. It can take a bit of math skill to keep blood sugar levels within a healthy range. But it will get easier with practice. Even if you make a mistake, once you learn the symptoms of how your child reacts when her levels are too low or high, you’ll know how to fix it. Dr Pande says with regular treatment and dietary restrictions (low calorie sugar-free diet), any youngster with diabetes can have a good quality life. “Only they have to be vigilant about good personal hygiene and avoiding infections. As soon as possible, the child should be taught to take insulin injections so that in no way his dose is ever missed wherever he is,” she says. “The child should learn to take correct dose of insulin with proper aseptic precautions. They should also be educated about symptoms of low blood glucose and the importance of taking food along with insulin.” Despite what you may have heard, people with type 1 can eat what they want. Sweets are fine, but they need to be tracked. Dr Pande says it is not about restricting, but more to do with counting. However, she cautions that dietary indiscretion will always be wrong. So it is ditto with sports. Kids can play; they just need to check blood sugar levels before and after. Bring snacks along at all times. And with the exception of check-ups, kids with type 1 don’t miss school more often than other kids. The key is stable diabetes control. It is every child’s dream to lead a normal life so do not deny your diabetic child such a right to parties, sleepovers, trick or treating, school trips, and sports. Special attention should be given to days when a child is sick, as blood sugar levels may change more dramatically.

Health

The burden of monitoring diabetic child