Children

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The BD commitment: diabetes education for all


Keeping insulin cool naturally - the DREAM Trust storage system

DREAM Trust is a non-government organization and registered charity in Nagpur, central India. In this region and indeed throughout the Indian sub-continent and the developing world, covering the medication needs of a child with diabetes requires many families to commit a quarter of their monthly income. The principal objective of DREAM Trust is to respond to these needs by providing insulin, accessories and healthcare free of charge to poor children with type 1 diabetes.

Helping children with diabetes to succeed at school

Diabetes is one of the most common chronic conditions in school-age children. In the USA, about 154 400 young people aged 20 years or younger have diabetes – about one in very 400 to 500. Type 1 diabetes accounts for about 80% of cases. In certain ethnic groups, however, the proportion of type 2 diabetes in young people is much higher. With the epidemic of overweight and obesity, healthcare professionals are finding increasing numbers of young people with risk factors for type 2 diabetes.

Education and public information: preventing diabetic ketoacidosis in Italy

Left untreated, diabetic ketoacidosis has a 100% death rate. Indeed, ketoacidosis is a leading cause of death and disability in children with type 1 diabetes. Severe acidosis often develops during an extended period in which hyperglycaemia-related symptoms are misdiagnosed. Reducing this period may be sufficient to prevent severe acidosis in newly diagnosed children with diabetes.

Preventing type 2 diabetes in children - a role for the whole community

When the author began her career as a paediatric endocrinologist in Los Angeles, USA, 30 years ago, childhood obesity was rare and type 2 diabetes in young people was almost unheard of. Nowadays, however, one in three children in that city is overweight or obese, and a quarter of the children diagnosed with diabetes at her centre have type 2 diabetes. This situation mirrors developments in paediatric health throughout the world; obesity and type 2 diabetes in young people are now regarded as related global epidemics.

Nutrition and diabetes: global challenges for children and parents

Many children around the world are starving or undernourished. In contrast, obesity and type 2 diabetes in children are major problems in many countries. These contradicting nutritional crises strongly affect the way we care for children with diabetes and their families. Recent international guidelines on the care of children with type 1 diabetes and type 2 diabetes recognize that effective nutritional management and the adoption of a healthy lifestyle can improve diabetes outcomes.

The challenge of adolescence: hormonal changes and sensitivity to insulin

Puberty is a period of rapid and radical physical, psychological and social change during which a child, in physiological terms, becomes an adult capable of reproduction. Adolescence refers as much to the psychosocial characteristics of development during puberty as to the physical changes. Adolescents with diabetes, who need to adhere to a complex medical regimen based around self-care throughout this period of development, face a series of particular and considerable challenges.

No more nightmares: treatments to prevent nocturnal hypoglycaemia in children

For many young people and their parents, nocturnal hypoglycaemia is perhaps the most feared short-term complication of diabetes. Intensive diabetes control is beneficial for all people with the condition – maintaining good blood glucose control overnight is critical in reducing the body’s exposure to high glucose levels. But it increases the risk of a dangerous drop in blood glucose levels while people are asleep. David Dunger and Roman Hovorka describe the problem of nocturnal hypoglycaemia and look forward to future developments that might reduce and eventually eradicate the risks.

Young people with diabetes and obesity in Asia: a growing epidemic

For some time now, international agencies have been warning about the rapid increases in the rates of diabetes and other chronic disease in Asian countries. Asia already accounts for a sizeable proportion of the world’s population with diabetes and the prevalence of diabetes in the region looks set to rise dramatically in the coming years. In addition, the age of onset of type 2 diabetes is moving downward. While the condition was historically diagnosed in people over age 65 years, nowadays type 2 diabetes in young adults is not unusual.

What is so different about diabetes in children?

While both type 1 diabetes and type 2 diabetes can occur in children and adolescents, the overwhelming majority of people affected by diabetes worldwide are adults. Consequently, the specific needs of children are often overlooked. Type 1 diabetes, the most common chronic disease in children in developed countries, is growing by 5% among pre-school children and by 3% in children and adolescents each year – 70 000 new cases every year in children aged 14 years and younger worldwide.

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