A child with diabetes can lead a normal, healthy life

By Donya Betancourt

SANUR, Bali (JP): When we eat food -- milk, rice, eggs, fat or protein -- the food is broken down into small molecules such as glucose, amino acids, fatty acids and fiber.

Once the food has been transformed into molecules, the glucose, amino acid and fatty acids will be absorbed into the bloodstream, go to heart and be pumped to the rest of the body organs. Every organ has cells, and it is the cells that use glucose to produce energy for us to grow and function. The pancreas secretes the hormone insulin which is the key to allowing glucose to enter the cells. Glucose is the body's fuel, which make us feel strong, energetic and healthy.

In diabetes, the pancreas doesn't make insulin or doesn't make enough insulin, or the body doesn't use insulin properly. The result is that cells cannot get the glucose they need, the unused glucose builds up in the blood and results in hyperglycemia or diabetes. Cells cannot get glucose when they need insulin and then the body feels weak; a signal is sent to the brain to tell it that it is in need of energy. The brain will tell the body to eat more but because of the lack of insulin or dysfunction of insulin, the cells still cannot obtain glucose and the body begins to burn fat reserves.

When the glucose concentration is too high in the blood, the kidney cannot absorb the excess glucose. Glucose then leaks into the urine and takes water with it; this is why diabetics can suffer from frequent urination and extreme thirst. Other results of high blood sugar in the bloodstream will be blurred vision (high blood sugar damages blood vessels in the eyes), fatigue, weight loss and hunger.

There are two types of diabetes:

* Type 1 diabetes mostly affects young children and results from the body's failure to produce insulin; the patient requires injected daily doses of insulin to stay alive. There are two forms of type 1 diabetes: an autoimmune process in which the body's immune system destroys the insulin-producing cells in the pancreas, or idiopathic diabetes that has no known cause.

* Type 2 diabetes mostly develops after 40 years of age. The risk factors for type 2 diabetes include being overweight, family history, age (over 55) and a high-fat diet. In Type 2 diabetes, the pancreas makes some insulin but not enough or the cells become resistant to insulin. Losing weight, improving nutrition and exercise, or taking medication and/or insulin can control type 2 diabetes.

A fasting plasma glucose test is a simple and reliable way of diagnosing diabetes. After fasting for more than an eight-hour period, most people have a blood sugar level of between 70 and 100 mg/dL (milligrams of glucose per deciliter of blood). A level of 126 mg/dl or higher in two tests is diagnosed as diabetes.

The treatment for type 1 diabetes is insulin. Type 2 is treatable with medication, and both types require self-care. Diets, activity, stress, illness and medications can all affect the blood-sugar level. Patient education is critical; people with diabetes can reduce their complications if they are educated about their risk of developing such complications. If they are educated about their disease, learn and practice the skills necessary to control their blood glucose levels, and have regular checkups from their health care team, they can live a very normal and long life.

The goal of treating diabetes for children is to maintain growth and development, to keep blood sugar levels within the target range and to promote emotional well-being. In order to do this a good plan must be adhered to for eating healthy foods on schedule, checking blood sugar levels regularly and adjusting insulin in accordance with blood sugar level. The plan should also address activities because food raises blood-sugar levels but insulin and exercise lowers them.

There are three conditions that can happen in diabetes that we should be aware of. 1. High blood-sugar level (hyperglycemia), 2. Low blood-sugar level (hypoglycemia) and 3. ketoacidosis.

Hyperglycemia is the condition where the blood-sugar level gets too high and the body gets too little insulin or too much food. Symptoms are excessive thirst, frequent urination, fatigue and blurred vision. Hyperglycemia is treated by giving the body insulin.

Hypoglycemia is where the blood-sugar level gets too low and the body gets too much insulin or too little food. Symptoms include trembling, dizziness, hunger, crying, or headache. It can be treated by giving carbohydrates such as candy, bread, sugar cubes or fruit juices.

Ketoacidosis is caused by very high levels of ketones in the blood and urine. Ketones are waste products that build up when cells are hungry and cannot use glucose for fuel. They then burn up fat for energy and the results are glucose and ketone. In this case the symptoms will be thirst, vomiting, drowsiness, labored breathing, abdominal pain and fruity smelling breath. If ketoacidosis is left untreated, it can lead to a diabetic coma.

When a child has diabetes, everybody who cares for the child should know the symptoms of hyperglycemia, hypoglycemia and ketoacidosis, including teachers at school. With family support, daily care and treatment, your child with diabetes will lead a healthy, active and fun life.

The writer is a pediatrician based in Sanur, Bali. Questions? Contact her atdrdonya@hotmail.com or at features@thejakartapost.com.