Why are so many of our kids being diagnosed with diabetes today?
Diabetes was a very common term in my household growing up. Although I wasn’t exactly sure what it was, I knew two things for certain. One, diabetes was bad and two, there were a lot of family members and friends we knew personally, who were being diagnosed with diabetes. I also thought that only adults were able to develop the illness. As I got older and more familiar with the disease, I learned that this was very far from the truth.
Research has shown that many South Asian families are more susceptible to cardiovascular diseases due to a number of reasons, which include a genetic predisposition, poor diet and a general lack of exercise. What is even more disheartening is the rapidly increasing rate and onset of Type 2 diabetes within adolescents and children. This is no longer a disease that targets adults and only a few children, but is becoming an epidemic among all age generations, most notably within children and adolescents.
Too many kids are showing the warning symptoms of diabetes far too early on in life and to place things in perspective, the Canadian Diabetes Association (CDA) reveals that more than 20 people are diagnosed with diabetes every hour of every day in Canada. Furthermore, Canada has the sixth highest incidence rate of Diabetes Mellitus in children aged 14 years and younger –that’s scary.
Something needs to give in order to curb the devastating effects of this disease and make sure the children of today are not only healthy and fit for tomorrow but for the rest of their lives.
What is Diabetes Mellitus?
Diabetes Mellitus (DM) is a chronic illness in which a person has high blood sugar caused from either their pancreas not producing the hormone insulin or because their body’s cells do not respond appropriately to the insulin that is produced. Insulin, in turn, is a hormone that regulates the body’s blood glucose levels and is necessary for our body’s cells to effectively make use of the building blocks of energy that comes from the foods we eat.
Glucose, which is the end product of carbohydrate digestion, is the chief fuel that the body uses for energy. Therefore, the proper functioning of insulin is impeded as it no longer controls blood glucose levels efficiently, which then leads to a myriad of further health complications.
Types of DM
There are three main types of Diabetes
Mellitus, the first of which is Type 1 Diabetes Mellitus (T1DM) also referred to as Juvenile Onset Diabetes. T1DM is an autoimmune disease in which a person’s insulin-producing cells in the pancreas are targeted and destroyed by one’s own immune system, thus stopping the production of insulin. Scientists believe both genetic and environmental triggers cause T1DM and its onset has nothing to do with diet or lifestyle. It affects children and adults of any age, causes a dependency on injected or pumped insulin for life and there’s currently no way of preventing or curing it.
Type 2 Diabetes Mellitus (T2DM) is characterized as a metabolic disorder, in which a person’s body still produces insulin; however pivotal cells within the body no longer respond to it appropriately. T2DM is usually diagnosed in adults, however as previously mentioned, there is a rising epidemic amongst children and adolescents who are also acquiring the illness much earlier on in life.
According to the Canadian Diabetes Association (CDA), more than 3 million Canadians have been diagnosed with Diabetes Mellitus; approximately 300,000 individuals diagnosed with T1DM, which clearly indicates that T2DM makes up the vast majority.
Lastly Gestational Diabetes, which does resemble T2DM, occurs when pregnant women with a previous diagnosis of diabetes develop a high blood glucose level. This form of diabetes is treatable but requires careful medical supervision throughout the pregnancy with conditions typically improving or diminishing after delivery.
Warning Signs & Symptoms
As diabetes is becoming more widespread with an increase in the number of adults and children being diagnosed with both T1DM and T2DM, being aware of the warning signs and symptoms will prepare you to battle this debilitating illness. Learning about the illness early on and receiving treatment immediately leaves one better suited to manage the illness effectively. Additionally, symptoms may develop rapidly over the course of a few weeks or can build up much more slowly progressing over many months.
The following warning signs and symptoms were provided by the Juvenile Diabetes Research Foundation (JDRF):
Unquenchable Thirst - as blood glucose levels rise, there is an increase in urine production and additional workload placed on the kidneys. As a result, fluid is pulled out of body tissues to compensate for the loss of excess fluids, thus causing increased thirst.
Frequent Urination - an abnormally high number of trips to the bathroom is due to the kidneys filtering blood that is more concentrated with glucose than normal. This impairs the filtering capacity of the kidneys causing excessive urine production that is rich in glucose.
Weight Loss - as the body no longer uses glucose adequately as the source for fuel, excess fat and muscle cells are consumed attributing to weight loss.
Lack of Energy - patients may feel constantly tired because they aren’t able to access glucose appropriately as their principal source of energy.
Hunger Issues - Usually there is an increased hunger as the body continually searches for sources of energy other than glucose, however diminished hunger in patients has also been observed.
Blurred Vision - high blood glucose levels cause fluid pressure to build up in sensitive areas of the body, one of which includes behind the eye lenses. This may lead to blurred vision at first, with blindness possibly being a dire end result. Happens more progressively in unmanaged cases of diabetes.
Diabetic Ketoacidosis/Fruity Odour of the Breath - as the body looks for sources of energy other than glucose, excess fat cells get targeted and broken down for fuel leading to a build-up of by-products called ketones. As these accumulate, they alter the pH of the blood causing additional unfavourable effects and are also responsible for the breath smelling odd like fruit or even nail polish remover.
What are the Risks? Long-Term Effects? Who is at Risk?
Living with diabetes is a constant battle in which the uncontrolled blood glucose levels have ongoing and widespread effects on the body. In addition to the previous warning signs and symptoms mentioned, immediate emergencies can include severe diabetic ketoacidosis resulting in hospitalization, Kussmaul breathing (hyperventilation), nausea, vomiting and relentless abdominal pain.
According to the JDRF, all types of diabetes amplify the risks of lasting complications such as kidney disease, nerve damage, heart attacks, strokes, amputations and even death. In fact, as stated by the CDA, diabetes is the leading cause of blindness in Canada.
Not only does this place considerable stress on patients and their families, incurring diabetes is also a major financial burden. The CDA estimates Canadians with diabetes incur medical expenses that are up to three times higher than those without diabetes. For example, a person with diabetes can face costs for medication and diabetes supplies ranging from $1,000 to $15,000 a year.
Furthermore, factors such as obesity, being a member of a high risk ethnic group and having a family history of heart disease and high blood pressure increases a child’s risk of developing T2DM. As not all children exhibit the symptoms of diabetes, it is important to practice early prevention and get children screened if they do have several of the risk factors mentioned.
Why is DM Becoming an Epidemic Amongst Children? What are the Concerns?
T2DM, a disease that was primarily seen in adults is now being increasingly diagnosed in children and teenagers at alarming rates due to an increase in childhood obesity. Several factors have contributed to this trend in North American youth, with the principal cause being attributed to children adopting a more sedentary lifestyle (such as spending more time in front of computer screens and video games), as opposed to one which involves daily activity. In combination with consuming processed foods packed with empty calories has compounded the issue and made it that much worse.
Dr. Kashmir K. Singh practices as a community-based pediatrician in Northern California.
“While T1DM is a challenging condition for patients, families and pediatricians to manage, Type 2 diabetes – what we used to call adult-onset diabetes – has become a major source of worry for pediatricians and physicians across all specialities, in both adult and child medicine,” explains Dr. Kashmir K. Singh, who practices as a community-based pediatrician in Northern California.
“We used to see T2DM only in older adults, but in the past 20 years, we have started to see it at younger ages, including in teenagers. This is incredibly concerning to healthcare providers because there are numerous serious complications associated with T2DM, and if the disease is occurring in younger patients, we now have a larger population of sicker patients and will be caring for the complications of this chronic disease for decades to come.
With the rise of pediatric obesity in recent generations, we have seen lots of young patients, including some in their pre-teen years, who show laboratory and physical signs of insulin resistance. Pediatricians have teenagers on medications for blood sugar control and for hypertension, or high blood pressure which is associated with both obesity and diabetes,” says Singh.
Interesting to note is that obesity is prevalent across all ethnic and socio-economic groups and has become a national epidemic in North America. Nonetheless, if a family or certain minority group are placed in lower socio-economic brackets, their ability to find and purchase healthy, safe and affordable fruits, vegetables and proteins in certain cases are diminished.
Moreover, certain minority groups are affected to a greater extent than others and are more susceptible to the consequences of obesity and poor nutrition. As previously mentioned, South Asians have a high incidence of heart disease, high blood pressure and high cholesterol across different socio-economic backgrounds. This is largely attributed to diet, lifestyle and having in certain cases a genetic predisposition to cardiovascular diseases.
The following statistics involving North American children and T2DM were ascertained from the Canadian Diabetes Association:
• There has been a 10-to-30 fold increase in American children with Type 2 diabetes in the past 10 to 15 years. Most of these children are from ethnic groups at high risk for Type 2 diabetes, e.g. African, Hispanic and Asian descent. Given that 77 per cent of new Canadians are from these populations, the rate of Type 2 diabetes in Canada is expected to skyrocket in coming years.
• One in every three American children born in 2000 will likely be diagnosed with diabetes in their lifetime; similar rates are anticipated for Canadian children.
• In the next 15 years, it is anticipated that the global incidence of Type 2 diabetes in children will increase by up to 50 per cent.
Treatment, Management & Prevention
Diabetes is unfortunately a chronic illness that remains with a person throughout their entire life; nonetheless, with constant care and self discipline, the disease can be managed effectively.
Carefully balancing insulin doses via injections or using an infusion pump, in combination with eating healthy and participating in daily exercise will help attune the body into a healthy pattern. Also regularly monitoring blood glucose levels several times throughout the day ensures that an individual’s levels are within an acceptable target range.
According to Singh, one of the largest problems she faces with her patients and their families is changing the small habits that have a large impact, such as limiting juice and soda and making a well-rounded diet that includes more fruits and vegetables.
“Childhood nutrition is more than just looking at the numbers and making sure that kids are growing; it is about building healthy habits and setting children up with the tools to make lifestyle choices that will last with them throughout their teenage and adult years. Diabetes and obesity are chronic illnesses and cannot be fixed overnight, and we need to have both short-term and long-term plans in place to deal with them,” she adds.
Being vigilant early on in a child’s life to maintain proper eating habits and daily exercise will help with prevention of acquiring the illness.
Additional lifestyle changes can include:
• Limiting pop/soda, processed foods and fast food.
• Switching to lower-fat dairy products.
• Incorporating as many fresh fruits and veggies into a balanced, healthy diet in which the entire family can enjoy.
• Increase daily exercise: bike, walk, jog, rollerblade. Drive less.
• Set boundaries for watching television, being on the computer and for playing video games.
• Manage stress effectively and maintain a healthy body weight.
Conclusion
Being proactive is paramount. Diabetes, a terrible and debilitating disease, when managed appropriately can still allow children to enjoy healthy, active and fulfilling lives. Even more importantly, a preventative lifestyle is the best way to remedy the increasing diabetes epidemic. Providing our children with the right tools early on in life means they can get the job done better ahead of time.
As per the CDA, have regular check-ups with your family physician, diabetes team, dentist and eye-care specialist. Take care of your feet and keep your blood glucose, cholesterol and blood pressure within your acceptable target range.
Best of health to and your family.
By Ameet Singh