Monday June 10 2013

Managing diabetes in children



By Christine Katende

Emmanuel Kisembo, 20, a student at Makerere University, was diagnosed with Type 1 Diabetes in January last year. “I think the disease had manifested even before I went to the hospital for check-ups,” he says. “I started losing weight over a certain period of time, had frequent urination, thirst, always felt stressed, and became forgetful in class. But I did not worry about it so much because I never felt sick; my life continued normally,” he narrates.

All this happened while he was still in high school. Kisembo notes that things got worse when he joined university. “It was around that time that I decided to visit a doctor in a clinic in Kajjansi who put me on a dextrose drip but things just worsened. When we consulted Dr David Aligayira of Lift Valley Medical Centre in Salama, he confirmed that it was diabetes.

“My glucose levels were at 33.3mm yet the normal is 6mm. I was given shots of insulin that helped me regain consciousness,” he says. Kisembo says, he had to follow the doctor’s advice if he were to survive. He started a life of having regulated meals, injections, finger pricks and blood tests while at home and at school.

There are many parents out there, with diabetic children, even younger than Kisembo, who are confused about what to do with them. Type 1 Diabetes, commonly known as juvenile onset diabetes according to Dr Silver Bahendeka, an endocrinologist at Nsambya hospital, is a group of diseases that result from the substances that are produced by the body that destroys the pancreas.

Speaking at the Kuongeze- Akili Diabetes camp held at Buziga Country Resort on May 17, Dr Bahendeka said, “Type 1 Diabetes is an immune reaction in children where the pancreas stops producing insulin, a hormone that enables people to get energy from food. Genetics may play a role in this process, and exposure to certain viruses may trigger the disease though this is not common”.

“Once the islet cells are destroyed, there will be little or no insulin produced in the body. Insulin is a hormone that comes from the pancreas, a gland situated behind and below the stomach. The pancreas secretes insulin into the bloodstream; it circulates and enables sugar to enter the cells. It also lowers the amount of sugar in the bloodstream,” he explains.

He notes that with Type 1 Diabetes, there’s no insulin to let glucose into the cells, so sugar builds up in your bloodstream, where it can cause life-threatening complications. The camp that was organised by the Nsambya Diabetes Clinic aimed at empowering diabetic children under the theme, “Empowered we shall achieve”.

Dr Bahendeka asserts that children with diabetes can have a normal growth provided they get insulin in the normal physiological way to enable them have a normal growth from childhood to old age. With Type 1 Diabetes, the doctor adds that children can eat anything provided parents can regulate the amount of insulin given.

“Parents need to take good care of these children if they are to have a healthy growth, they should know what a child needs at what time and in which amounts. The meals should contain 50 per cent of carbohydrates, 20 per cent of protein and 30 per cent of fat. This is different from what happens with grown up adults who have 60 per cent carbohydrates, 10 per cent protein, 10 per cent fat,” explains the doctor.

However, if a child takes in more than the regulated amount of nutrients, Dr Bahendeka says, the body might get overloaded, leading to body complications like pressure, among others. Parents or younger adults with Type 1 Diabetes should know how to plan any meal depending on the glucose levels, to stay health.

The expert notes that diabetic children can also participate in all activities like other children such as bicycle riding and volley ball, as long as the blood glucose levels are checked before the game, in the middle of the game and after. The normal blood glucose levels should be 4-6 mm (units).

“Normally, children receive insulin depending on their weight, so there is need for parents to continue monitoring their growth to know how much insulin they need at a certain time,” says the doctor. He adds that if a child misses a meal and has taken insulin, he or she might end up with hypoglycaemia, which could lead to brain damage. The other thing that might lead to low sugar is missing insulin injections.

The unconsciousness that leads a child into coma may result in death if not attended to. “Diabetes is a very serious disease with long term complications if not managed well. Complications like blindness, kidney failure and heart failure may occur. A child can collapse when the sugar is very low or too high,” cautions Dr Bahendeka.

When the child gets hypoglycaemia, the doctor advises that they should be given glucose, sweets or a glucagon injection. Also check the child’s blood and urine at least a month after birth to ascertain whether the child is diabetic or not.

Meanwhile, Kisembo who is in his second year studying for a degree in architecture says, “Although I got counselling, I still felt stigmatised at campus. Students would make fun of me and it was really hard to open up and tell them that I was sick. Like when I got hypoglycaemia in the middle of the exam. People looked at me and started cracking jokes about the incident,” he says.

Kisembo no longer takes manufactured sugar; he survives on sweeteners (small sugar-free tabs), milk, and ‘diabetic’ bread. However, he can take other foods which he takes before he gets an insulin shot. “I am a dancer and a sports person, so when I sweat, my sugar levels come down, which calls for me to take sweets,” he says. He adds that having diabetes is not the end of the world; children can grow to serve their country and also perform well in class compared to the “normal” students. His passion now is about sensitising people in the bid to fight off the stigma.