Children are presenting with diabetes at an ever increasing rate and at younger and younger ages. Type 1 diabetes (juvenile onset diabetes, insulin dependent diabetes) is the most commonly encountered form of diabetes presenting in children, but type 2 diabetes(adult onset, non-insulin dependent) is now presenting in adolescence and childhood associated with the obesity epidemic and is prevalent in certain ethnic groups.
People with type 1 diabetes require the use of injected insulin from the time of diagnosis, but people with type 2 diabetes may initially be managed by weight loss, exercise and a tablet called metformin. Failing this other tablets may be required (sulphonylureas) or even insulin by injection.
The treatment goals in diabetes are to keep blood sugar levels as close to normal to prevent the devastating short and long-term complications of diabetes.
Typical diabetes symptoms that should prompt further investigation include: increased frequency of urination, urinating at night or new onset bedwetting, excessive thirst, weight loss, blurred vision and tiredness. If early symptoms are missed, diabetic ketoacidosis may develop and has symptoms of rapid breathing, tummy pain, nausea and vomiting and even coma. The index of suspicion needs to remain high when any of the previous symptoms are present.
Children with diabetes should be referred to a paediatric diabetes specialist centre that has a team that specializes in the treatment of children with diabetes because care is very different from adults with diabetes. This encompasses dietary education, lifestyle management and insulin replacement therapies.
The most common regimen is to use multiple daily injections (MDI) with a combination of background or long acting insulins such as Lantus and Levemir, intermediate acting insulins and short acting or meal time insulins such as Humalog, Novorapid and Apidra. The typical MDI regimen consists of 5 injections per day. Injections are no given with pen devices using very short fine 4mm needles that are virtually painless. Other options include continuous subcutaneous insulin infusion pumps- or insulin pumps.
Insulin pumps are a valuable part of the diabetes armamentarium and help motivated well educated patients to achieve and maintain optimal blood glucose control. Insulin pumps need to be managed by specialist diabetes teams at centres accredited and experienced in insulin pump therapy. There are 2 major manufacturers of insulin infusion pumps in South Africa, Medtronic and Roche- Accuchek.
Blood glucose levels are checked at home using home blood glucose meters. There are numerous meters on the market that use tiny drops of blood, give results in a few seconds and do not require coding of their strips. Typically 4-5 blood glucose checks should be performed on a daily basis.
Every 3 months an hemoglobin A1c (HbA1c or A1c) test should be performed. This test provides an estimate of a person’s average blood glucose level over the preceding 3 month period. This test is correlated with the development of long term diabetes complications.
Basic CHO Counting (PDF)
Check Analyze Adjust (PDF)