DIABETES MELLITUS

Diabetes mellitus occurs when specialized cells of the pancreas (a gland located behind the stomach) do not produce adequate amounts of the hormone insulin. Insulin permits the body to process proteins, fat and sugars in food to make body tissues, produce energy and store energy. In people without diabetes, insulin is produced as needed to process food. But in people with diabetes, who have a reduced supply of insulin or none at all, the nutrients cannot be used by the cells but remain in the blood. Without a source of energy, the cells think they are starving. In an attempt to nourish the starving cells, the liver makes sugar from the body stores of protein and fat. This leads to weight loss and weakness, because muscle is being broken down and is not getting the energy it needs. The body tries to flush out the excess sugar circulating in the blood by making more urine. This is why people who have diabetes urinate more frequently and can become very thirsty as they try to replace the loss of fluids. Without insulin, fat breaks down to form ketones, which also are excreted in the urine.

Types of Diabetes

At the present time, there is no way to prevent the development of diabetes. The tendency to develop it is inherited, although most children with insulin-dependent diabetes, called Type 1, don't have any close relatives with the disease. The destruction of the cells that make insulin results from a process in which the body views these cells as foreign invaders and mounts an immune response against them. This autoimmune process starts years before the first symptoms of diabetes show up. The trigger for this process may be viruses or other agents in the environment.

Type 1 diabetes is very different from non-insulin-dependent diabetes (called Type 2), which is much more common and occurs in most adults with diabetes (over 90 percent). Because this kind of diabetes is so different from that which occurs in children, the advice intended for people who have non-insulin-dependent diabetes is not appropriate for children.

Symptoms of Diabetes

Diabetes can appear at any time, even in the first year of life. The diagnosis is often delayed in infants and toddlers until the child is very sick, because the symptoms at this age are not terribly specific. It is important to notify your pediatrician immediately if your child displays any of the following warning signs and symptoms of diabetes:

· Failure to grow or gain weight normally

· Weight loss with either increased appetite and food intake or loss of appetite (more common in the younger child)

· Increased thirst

· Increased urination. A toilet-trained child may start wetting, or a baby in diapers will need more frequent changes.

· Dehydration

· Severe diaper rash that does not respond to the usual treatment

· Vomiting that is persistent, particularly if it is accompanied by weakness or drowsiness

If your child goes to the doctor with any suspicious symptoms, be sure that a urine test is done to determine whether sugar is present. This simple test will provide a clue to diabetes and prevent further deterioration that can be disastrous.

Treatment of Diabetes

When the diagnosis of diabetes is confirmed by blood tests, treatment is immediately undertaken with injections of insulin. When the child does not require intravenous fluids to correct dehydration and vomiting, most specialists do not hospitalize patients with diabetes. A diabetes education team will teach the entire family how to deal with diabetes. You'll learn how to test blood glucose levels from a drop of blood from a finger stick and how to give insulin injections, usually twice a day at the beginning. Your acceptance and ability to carry out these basic tasks will help your child adjust to the treatment with the least amount of anxiety and fear. By the time your child reaches age 7 or 8, he will be playing a part in the management of his diabetes, and by age 11 most children are giving their own insulin injections and doing their own blood tests, under adult supervision.