Diabetes mellitus in children

Diabetes is a chronic disease that can affect children and adolescents. Its diagnosis is usually a hard blow for the family and the little ones.

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In the blink of an eye your routines become different. Diabetic children, thanks to current advances, can lead a practically normal life, though, with some special care. We will discover the care to follow when a child has diabetes mellitus.

  1. What is it?
  2. Types
  3. Causes
  4. Symptoms and diagnosis
  5. Treatment

Diabetes mellitus what is it?

It is estimated that there are 143 million people in the world with diabetes. The WHO considers that 50% of people who have diabetes are undiagnosed.

In Spain it is estimated that there are 29,000 children under 15 years of age with diabetes mellitus and each year there are about 1,100 new cases.

Diabetes mellitus is its scientific name. Mellitus come from the Latin and means “sweet or honey” and diabetes , meaning that it “passes through or is eliminated”. And why this curious name? Because diabetics have a high level of sugar or very high glucose in the blood and part of this glucose is eliminated in the urine. The doctors of the antiquity, when they suspected this disease, as they did not have analytical, tested the urine. If it was sweet, it was that the body eliminated sugar and, therefore, the patient had diabetes mellitus.

All symptoms of diabetes are a direct cause of high blood sugar levels.

Types of diabetes mellitus

There are two types of diabetes . Although in children the most frequent is type I, it is increasingly being diagnosed in children and adolescents.

  • Type I diabetes
    • It is an autoimmune disease where the body itself destroys the cells of the pancreas that make insulin (pancreatic beta cells), therefore, it makes us unable to metabolize glucose. The damage is irreversible and causes type I or juvenile diabetes, since its diagnosis is frequent to appear in childhood. Its treatment is to administer the insulin that the organism does not manufacture. Insulin is applied subcutaneously.
  • Type II diabetes
    • A few years ago this was the typical diabetes of obese adults. The increase in childhood and juvenile obesity is justifying this increase in the diagnosis of insulin resistance or type II diabetes. It is a multisystemic disorder of heterogeneous nature, in which genetic and environmental factors intervene. Its prevalence has increased in the pediatric age in recent years, in parallel with the increase in obesity. It is characterized by insulin resistance associated with progressive dysfunction of pancreatic cells. In general, the treatment is not giving insulin, because the body makes it, but changes in lifestyle (diet, exerciseand weight loss) and pharmacological treatments that help eliminate insulin resistance. If the disease progresses, administration of insulin may be necessary.

What causes diabetes mellitus?

Insulin is a hormone that is made in a gland called the pancreas. The pancreas is located in the abdomen, behind the stomach and helps in digestion secreting pancreatic juices and also produces insulin depending on the amount of glucose in the blood.

After the intake of food, blood glucose levels rise. At this time, the function of a healthy pancreas is to release insulin so that this glucose (the fuel of the cells) is “introduced” into the body’s cells. Insulin is the key that enables cells to obtain the fuel needed to create energy and perform their functions.

If the insulin is insufficiently produced ( type I diabetes ) or the cells are unable to recognize it ( type II diabetes or insulin resistance), the glucose can not get into the cells, it is not used and it increases its concentration in blood and urine, in an attempt to eliminate the “excess”. The fundamental consequence is that the functioning of the cells is impaired due to lack of energy.

All the symptoms of diabetes derive from this situation.

Type I diabetes mellitus in children: Symptoms and diagnosis

In all medical examinations the following question is very typical: What diagnostic suspicion does a patient have with polydipsia, polyphagia and polyuria?

Let’s decipher the question.

Children with diabetes usually have these symptoms:

  • Polyuria:
    • The child urinates many times and in large quantities. The need to urinate occurs even at night (nocturia). It is very typical for children to start wetting the bed at night when they were, previously, continents.
  • Polydipsia:
    • The child is very thirsty and drinks lots of fluids. This thirst is to compensate for the loss of water through urine.
  • Polyphagia:
    • The child is very hungry and eats much more than usual.
  • Weight loss without dieting.
  • Fatigue and fatigue.

These symptoms are very typical in the patient with a diabetic debut and are due to the fact that the increase in blood glucose (blood sugar) pathologically wants to be eliminated by the kidney (this is called glycosuria: presence of sugar in the urine). In order for glucose to be eliminated in the urine it has to be dissolved in large quantities of water, which is why the body demands a greater intake of water. This is the reason for the increase in thirst and urine in the child.

In addition, since there is not enough insulin, the cells can not use glucose as fuel and the signal that the organism sends is of greater energy requirements, that is, a sign that it is “hungry”. This is the cause of increased appetite and food intake.

But, no matter how much the child eats, the cells still lack energy and they have to find a “plan B” to obtain it: extract energy from body fat. This causes unexplained weight loss, fatigue (despite eating so much) and the elimination by urine of waste substances called ketone bodies. These ketone bodies, moreover, cause a very typical fruity breath odor.

The presence of any of the symptoms described justifies a visit to your pediatrician.

The pediatrician quickly suspects the presence of type I diabetes. Usually the family consults in two or three weeks after the onset of the first symptoms. The diagnosis is simple: the blood glucose is measured (glucose in blood), and if it is higher than 200 mg / dl, we have the diagnosis.

Treatment of diabetes mellitus in children

After the diagnosis of diabetes and after starting insulin treatment, some children may have a temporary improvement. The needs to administer external insulin decrease significantly. This is due to the pancreas recovers slightly and begins to produce some insulin.

This remission phase is not presented by all children and is rare in children under three years of age. 

After the diagnosis, the specialist indicated to evaluate the child and start the blood glucose controls and the insulin treatment is the infant endocrinologist.

7 types of sugar that are hidden in the labels

To find out if a food contains sugar, we should read the list of ingredients and locate the word “sugar” in it.

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In theory it seems simple to locate if a food has sugar among its ingredients, but in practice it is somewhat more complicated. Sugar has a thousand faces and hides on labels under different names.

  1. Saccharose
  2. Fructose
  3. Dextrose
  4. Maltodextrins
  5. Corn syrup
  6. Agave syrup
  7. Polialcoholes

Seven different types of sugar that can go unnoticed


It is made up of a molecule of glucose and a molecule of fructose and is the most widely used sweetener in the world. It represents 75% of all added sugars, of which, it is estimated that 20% is added by the consumer as table sugar and 80% would be the “invisible sugar”. This “invisible sugar” is what the industry adds to products such as soft drinks, bakery products, candies, juices or dairy products. Depending on its purity, sucrose is classified into different types, such as brown sugar (85% sucrose) and white sugar (99.5% sucrose). Yes, you read correctly, 
brown sugar and white sugar , in fact, are first cousins.SACCHAROSE

FRUCTOSE

It is found naturally in honey (38%) and also in fruits, vegetables and vegetables in different proportions. It is the most soluble and sweet sugar of natural sugars and is used especially in confectionery products for its high sweetening power without crystal formation. In general, the consumption of fructose naturally in the fruits and vegetables themselves does not imply any problem. However, its excess consumption as a sweetener in processed products can lead to intestinal disorders and diarrhea. It also favors synthesis of triglycerides (ie, fats) in the liver. In the long run, this could lead to metabolic diseases such as obesity or type II diabetes.

DEXTROSE or D-GLUCOSE

It is also found naturally in honey (31%) and in fruits, vegetables and vegetables. Its sweetening power is less than that of sucrose. In food technology, it is mainly used to make beverages and bakery products and confectionery. Although glucose is found freely in the blood and used in cells as a source of energy, we have good news: it is not necessary to consume glucose directly. Under normal conditions, our organism can obtain the simple molecules of glucose from the division of complex carbohydrates. Unless we perform high intensity and long duration sports (cycling, marathons), from vegetables and cereals our body can get the glucose it needs.

MALTODEXTRINAS

They are obtained by hydrolysis (breaking) of the starch. Although its flavor is less sweet than that of the previous sweeteners, they are widely used by the industry for its interesting technological properties. They have dispersing, moisturizing, thickener and texturizing capacity. They are used in sausages, sauces, butters, margarines, cakes, infant formulas or products for athletes, among others.

CORN SYRUP WITH HIGH FRUCTOSE CONTENT

In North America it is replacing sucrose as a sweetener. It is a syrup with high concentrations of fructose (up to 90%) with a sweetening power greater than sucrose. It is used in the production of soft drinks, bakery, fruit preserves, dairy products and confectionery. Its use is controversial because different studies refer to the increase in the prevalence of obesity in relation to the increase in consumption of these syrups.

SYRUP OR NECTAR OF AGAVE

It is a type of sugar that is obtained from the Agave tequilana plant with a sweetening power 1,5 superior to sucrose. Although it has a lower glycemic index, its fructose content is high (70%) and therefore, in no case is it a healthy alternative to sugar, as it is sometimes tried to show.

POLYALCOHOLES: sorbitol, maltitol, xylitol, mannitol, erythritol

They are also known as polyols or “sugar alcohols.” Although some are naturally present in different fruits, it is usual to add them to foods as sweeteners since they have characteristics appreciated by the industry and the consumer, for example:

  • They do not cause cavities.
  • They cause a certain sensation of freshness in the mouth.
  • The glycemic response is lower, so they would be well tolerated by diabetics.
  • Although its energy value is similar to sugars, its absorption is lower and the average caloric value is 2.4 kcal / g instead of 4 kcal / g.

Polyalcohols are used as additives in products such as chewing gum, candy, ice cream, desserts, pastry products or confectionery. Dietary guidelines for people with diabetes are especially appreciated.

Despite these possible advantages, polyalcohols present some drawbacks such as the laxative effect if consumed in excess. On the other hand, like any other sweetener, they favor the preference for sweet taste which can induce to consume other sugary products. You can learn more about what happens when consuming sugar in this video:

Conclusions

As we have seen, sugar in excess is not healthy … but neither are your cousins! The best way to avoid both sugar and its substitutes is to consume fresh products in their natural form: fruits, vegetables, legumes, cereals, dairy products, meats, fish, etc.

When we go to the supermarket and an ultra-processed product falls into our hands, take out the magnifying glass! We should not obsess, since all these types of sugar are safe and are admitted in the legislation, but knowing how to identify them in order to reduce their consumption should be our goal.

Why should I take care of my glucose?

Not taking care of glucose can have consequences. Learn tricks that you can follow to control your levels and the effects of not doing it.

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We must take care of glucose values ​​because precisely the abnormal increase in blood levels (hyperglycemia) characterizes diabetes mellitus. This metabolic alteration may be due to a defect in the secretion of insulin by the pancreas, to an irregularity in the action of the same or to both phenomena at the same time. We can talk about two types of diabetes:

Diabetes mellitus type 1: it is characterized by an absolute lack of the hormone insulin that normally makes the pancreas at adequate levels and, therefore, who suffers it should receive treatment with insulin several times a day. It used to be known as “insulin-dependent” diabetes. It can occur at any age, but it is more frequent to occur, abruptly, in children and under 30 years (it is known as “juvenile diabetes”).

Diabetes mellitus type 2: corresponds to approximately 85-90% of all cases of diabetes. Its main characteristic is the resistance of the tissues of the organism to the action of insulin (the beta cells of the pancreas are capable of producing insulin, but the problem is that it can not fulfill its function correctly). The treatment therefore, at least at the beginning, will not be the administration of insulin but will be based on adequate nutrition and exercise. Before it was known as “non-insulin-dependent diabetes” and there is still someone who refers to it as “adult’s diabetes” because it usually occurs after age 40 and older.

Glucose care

To take care of glucose levels and, therefore, reduce the risk of developing diabetes, we must avoid risk factors such as sedentary lifestyle, unhealthy diet, overweight. That’s why changes in lifestyle are the first step in reducing the likelihood of suffering from diabetes. Caring for glucose levels goes through:

Follow a healthy diet

Follow a balanced diet , low in fats and simple sugars (sweets, pastries, precooked …) and abundant in fruits and vegetables.

Exercise

In general, an aerobic-anaerobic exercise of mild-moderate intensity is advised for 30-60 minutes, three to five days a week. The aerobic (walking, cycling, swimming …) is the one that brings greater benefits, since it favors weight loss   and prevents obesity and reduces the onset of cardiovascular diseases (lowers blood pressure, cholesterol and triglycerides, and increases HDL).

Give up smoking

Tobacco alters the metabolism of glucose and lipids, implies a greater difficulty to control glucose levels. Quitting smoking reduces the risk of death in diabetics.

Obesity and sedentary lifestyle are the external factors that most influence the development of type 2 diabetes. Regarding type 1 diabetes, there are no methods to prevent the presentation of this form of diabetes. The best diagnostic test is the amount of fasting blood sugar (basal glycaemia).

Other ways of taking care of glucose values ​​have to do with controlling yourself

People without the risk factors mentioned above should have an analysis starting at age 45, and if basal glycaemia is normal to repeat at 3-year intervals. In the case of obesity (central), history of gestational diabetes, or any of the risk factors, a blood test is recommended and, if it is normal, an annual blood test is done.

One of the most frequent complications of diabetes is hypoglycaemia , which is due to a decrease in blood glucose levels below normal. Also, uncorrected severe hyperglycaemia could lead to diabetic ketoacidosis (in type 1 diabetes) or hyperosmolar non-ketotic coma (in type 2 diabetes), severe acute situations.

Glucose: What is it?

Know what glucose is and what it means for the organism. Learn how to measure it and the levels that are optimal for each person.

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Glucose is the main source of energy necessary to ensure the proper functioning of the body’s cells. These need energy to be active, maintain vital functions (heartbeat, digestive movements, breathing …), body temperature and muscle movements. Somehow, you could say that glucose is for the human body like gasoline for a car, because it provides enough energy to develop normal daily activity .

  1. What is it?
  2. How is it regulated?

What is glucose?

From the nutritional point of view, it is a sugar of simple composition ( monosaccharide) that enters the body through food. During the process of digestion, a chain of chemical transformations is launched, along the digestive tract, which converts food into smaller substances, nutrients, and these in turn are broken down into even smaller elements. For example, foods rich in carbohydrates are transformed into glucose, which is its simplest component. Well, when it reaches the small intestine, it passes to the blood and from the bloodstream to the cells.

More precisely, the blood is responsible for transporting it to the liver , brain and other cells of the body. Now, to enter the cells and be able to be used as fuel, you need the mediation of insulin. This hormone is like the key that, fitted in the lock, opens the door of the cells. The cells of the nervous system and the brain are the only ones in the whole body that receive glucose directly from the bloodstream, without the mediation of insulin. In addition, for these cells it is the exclusive source of energy.

How is the amount of blood glucose regulated?

After the ingestion and subsequent digestion of a meal increases the level of glucose in the blood and, consequently, the pancreas begins to produce insulin. This hormone is responsible for increasing the uptake of glucose by cells in all tissues, so that they burn and use it as fuel. But insulin not only fulfills this function, but also activates the cellular mechanisms necessary for part of the glucose to be transformed into glycogen. This compound is stored in the liver and muscles and serves as an energy reserve, in the short term, which can be used when you need energy to make an extra effort or in periods of fasting.

When the cells are well supplied and can no longer use more glucose, insulin intervenes again. But now, its mission is to give the order to convert the surplus sugar into fat that, subsequently, will be stored in the adipose tissue cells, also as reserve material.

When the amount decreases (during periods of fasting, after physical exercise …), insulin levels also decrease, because otherwise there would be a risk that the glucose would fall too low and not enough to feed the cells of the brain. When the blood glucose falls below normal, another pancreatic hormone comes into play: glucagon. This hormone has antagonistic functions to those of insulin, since it activates the mobilization of reserves stored in the body to obtain energy.

Blood glucose levels

Controls glucose levels. They are important to avoid diseases. Diet and exercise will help you.

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The level of glucose in the blood is the amount of glucose (sugar) in the blood. The blood glucose level is also called serum glucose and blood glucose. It is measured in millimoles per liter (mmol / l) or in milligrams per deciliter (mg / dl). Normally, they remain within narrow limits throughout the day (72-145 mg / dl, 4-8 mmol / l). However, it rises after meals and is lower in the morning before breakfast. People with diabetes are characterized by having glucose levels higher than normal.

  1. Why do you have to control blood glucose levels?
  2. How can I measure blood glucose levels?
  3. Adequate levels
  4. How often should the blood glucose level be measured?
  5. Measurement levels at bedtime
  6. When should it be measured?
  7. What is glycated hemoglobin?

Why do you have to control blood glucose levels?

In diabetics it is very important that the glucose level stays within normal figures and this is the main objective of the treatment; it is necessary to avoid that the glucose passes of the normal limits so much to rise as to descend too much. 
If the blood glucose level stays within normal figures, the risk of developing complications of diabetes is considerably reduced. These complications can appear between 10 and 15 years after the onset of type 1 diabetes and usually before 10 years in the case of type 2 diabetes. 
These complications (among others) consist of:

  • Neuropathy (injury to the nerves of the extremities and organs)
  • Retinopathy (injury of the retina in the eyes)
  • Nephropathy (kidney injury that can lead to kidney failure)
  • Cardiovascular diseases such as hypertension and myocardial infarction or lack of blood supply to the extremities
  • Cerebrovascular diseases, such as cerebral thrombosis.

 

How can I measure blood glucose levels?

The levels of blood glucose can be measured at home very easily and quickly with a very easy way handling device itself. There are various shapes and sizes, and they all contain at least two elements: the analysis device itself and a plastic strip where a drop of blood is deposited with which the measurement is made. 
A small amount of blood is placed on the strip and inserted into the device. After a short time (usually less than a minute), the result is displayed on the meter screen. The best method to obtain a sufficient blood sample is to prick the finger with a special needle called a lancet.

Adequate levels

The optimal values ​​are:

  • 72-110 mg / dl (4 -7 mmol / l) fasting
  • Less than 180 mg / dl (10 mmol / l) if measured one and a half hours after meals.

How often should the blood glucose level be measured ?

Type 1 diabetes
People who have type 1 diabetes , or those who have type II diabetes and are being treated with insulin , should measure their blood glucose level at least once a day: in the morning before breakfast, or bedtime The first option allows you to adjust the appropriate amount of insulin based on glucose values ​​that can fluctuate from a few days to others. 
They should also make a profile of glucose levels for 24 hours twice a week. This involves measurements before each meal and before bedtime. 
Type 2
diabetes Patients suffering from type 2 diabetes treated with dietonly, or with diet and oral tablets, should measure their blood glucose level once or twice a week, before meals or 1½ hours after meals. 
Likewise, they must make a profile of 24 hours once or twice a month. In any case, they should consult with their doctor. In this way, the risk of developing late complications of diabetes is reduced.

Measurement levels at bedtime

Before going to bed, the measurement should be between 126-180 mg / dl (7 and 10 mmol / l). 
If at that time it is too low or too high repeatedly, you may need to modify the diet you are taking or the insulin dose. Do not forget to check with your doctor.

When should it be measured?

The blood glucose should always be measured not feel good , or whenever it may be excessively high or low. Also in diseases involving fever of 37.8 ° C. 
The diabetic patients whose blood glucose level is high (above 360 mg / dl; 20 mmol / l) and showing evidence of urine sugar should check that it does not have acetone. For this they can use a strip for determination of acetone in urine. 
If acetone appears in the urine, it is a warning sign that diabetic acidosis is beginning. In that case they should consult the doctor without delay.

What is glycated hemoglobin?

The analysis of glycosylated hemoglobin in blood (HbA1c) indicates the amount of hemoglobin in the blood that is bound to glucose. This means that a molecule of hemoglobin in the body has been bound to a molecule of glucose. 
It is an indicator of the time that glycemia has remained excessively high and reflects the effect of glucose levels present during the last 6-8 weeks. 
This analysis must be done with blood obtained from the patient’s arm. 
The normal percentage is between 6% and 7%. There are no identical figures on the normal values ​​of glycosylated hemoglobin in various hospitals, but in general terms, it can be stated that for a diabetic, a level of:

The content of cholesterol in the diet: should we take it into account?

Cholesterol in the diet does not affect blood cholesterol as much as we thought

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For years we have been concerned about cholesterol in food. However, it is not the same cholesterol that we take from food, that we have in blood. Taking foods high in cholesterol does not mean that, directly, the blood increases.

Most of the cholesterol that we take in food is not absorbed, which is why it has no direct influence on blood cholesterol. So, why are your numbers rising? Our body autonomously is also able to generate cholesterol, hence genetic factors and the rest of daily habits are more influential in the final figures than the cholesterol we eat.

Cholesterol in food and its low influence

An egg, for example, has a high cholesterol content, but this does not mean that if we eat an egg every day our numbers will automatically shoot up. If we have a bad diet, we smoke, we drink and we are sedentary, there probably our blood cholesterol data will be affected in a negative way.

Therefore, the famous figure that puts the limit at 200 milligrams of cholesterol per deciliter of blood (200 mg / dL), we must look at it with perspective. It is not the same a person with a figure of 220 that is active, have a good diet, do not smoke or drink and have normal weight, that a person who does drink, smoke, be sedentary and obese.

However, it will be our doctor who has to assess our situation. But one thing should be clear and that eating foods that contain cholesterol does not mean raising the blood cholesterol levels.

In fact, a committee of experts in the USA, in the new dietary recommendations of 2015 has just removed the restrictions of cholesterol in the diet, when evaluating the latest research and reaching the conclusion that: “there is no relationship between dietary cholesterol and Plasma cholesterol “.

That is why we should not obsess about looking at cholesterol figures in foods, because their influence will be minimal. In what we must reflect is that our diet should be balanced: fruits, vegetables, legumes, olive oil, fiber … We must analyze whether we exercise and if our habits are healthy.

The genetics and the way in which our body generates and metabolizes cholesterol is much more influential in the blood cholesterol figures than the cholesterol content of the food we eat. Making healthy life and having a balanced diet is the best we can do for our cholesterol. Therefore, do not think in figures, think habits.

That the dietary cholesterol does not influence the blood does not mean that we can stuff ourselves with those foods that we consider appropriate. Of course, we must keep in mind some tips to keep cholesterol at bay , such as not to abuse saturated fats and have an adequate intake of fiber, in addition to leading a healthy lifestyle.

Just as the dietary cholesterol levels discussed in this article do not cause rises in blood cholesterol levels in healthy people, however, reducing the cholesterol diet is very useful in people who do have high blood cholesterol. Thus, in these last people, the diet low in cholesterol allows blood levels to be reduced by 10-15%, which is not small, since it sometimes prevents medication and above all lowers its cardiovascular risk

Tips to keep cholesterol at bay

Take care of your heart and protect yourself from cholesterol

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Although part of our cholesterol levels are determined by genetics, there are things we can do to keep it at bay: take care of food and play sports.

Tips to have good cholesterol levels.

It monitors the consumption of saturated fats: a high consumption of saturated fats due to whole milk foods or of bovine origin, affects cholesterol levels. Reducing saturated fats also reduces cholesterol levels.

Increases the consumption of extra virgin olive oil and nuts : these foods improve the levels of good cholesterol or HDL. The problem of lowering LDL levels is usually that they also lower the good, but with foods such as olive oil, nuts or fish such as salmon or sardines, HDL will not suffer.

Beware of carbohydrates: If carbohydrates are imples or refined (sugars), they can cause the same damage as fats. The question is not to stop taking fats, but to take good (unsaturated) fats, like the ones we have seen in the previous paragraph.

Improved fiber intake: the fiber – rich foods also help maintain good levels. Whole grains, fruits, vegetables and vegetables should not be missing daily to ensure fiber contributions.

Daily exercise: daily exercise burns a lot of fat and improves the lipid profile. It reduces LDL levels and increases HDL levels. A physical activity program performed 3-5 times a week for more than a month will help reduce and maintain optimal cholesterol levels.

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