Friday, August 24, 2012

Philippines - Diabetes: The new childhood epidemic

IF you think diabetes happens among adults only, think again.  When he was still in kindergarten, Michael used to drink soft drink for breakfast. 

During lunchtime, he ate his favorite pork adobo with four plates of rice and gulped orange juice loaded with sugar. “I gorged myself with so much food, but I never felt full,” he recalled.

Michael’s parents never took notice of his eating behavior; they thought it was normal.  Unknowingly, the weight of their son steadily climbed.  By the time he turned 10, Michael weighed 90 kilograms. He was overweight for his age.

In the Philippines 1.8 percent of boys and 0.8 percent of girls between the ages of six and 10 are obese.

At one time, when Michael got sick, he was brought to the hospital. His parents were surprised to know that their son was suffering from a debilitating disease called diabetes. “But he is too young to have such kind of disease,” the mother insisted.

Michael’s case won’t surprise Dr. Lorna Abad, president of the Philippine Society of Pediatric Metabolism and Endocrinology.  She estimated that around 8 percent of the country’s children could be diabetic.  To think of, the approximation was 2 to 3 percent a decade earlier.

“Diabetes is one of the most common chronic diseases among children,” reports the Brussels-based International Diabetes Foundation (IDF).  “It can strike children of any age, including infants and toddlers. Yet diabetes in children is often diagnosed late, when the child has very high, potentially life-threatening, blood-glucose levels. Sometimes, it can be mistaken for something else, such as flu.”

Currently, there are almost 250 million people with diabetes worldwide.  “Within 20 years, this number is expected to grow to 380 million,” IDF predicts.  “Diabetes is certain to be one of the most challenging health problems in the 21st century,” comments Dr. Daniel J. McCarty of the International Diabetes Institute based in Melbourne, Australia.

A disorder of the body’s power-supply system, diabetes is a slow-moving calamity that profoundly disturbs every cell in the body. At the core, it’s the failure of cells to absorb glucose—the sugar molecules that fuel muscles, nerves and the brain.

When sugar cannot enter the cells, it builds up in the blood, leading over time to devastating complications: heart attack, stroke, kidney failure, nerve damage, even limb amputation and blindness.

Not too many know that diabetes is not a single disease.  In his book The Best Treatment, Dr. Isadore Rosenfeld explains: “Although all diabetes has abnormally high blood sugar, the mechanisms responsible for it are not necessarily one and the same. For example, diabetes appearing in childhood or adolescence requires insulin, is often difficult to regulate, and has a significant impact on the quality and duration of life. By contrast, the adult-onset type usually does not need insulin, sugar levels are generally stable, and the risk to life is much smaller.”

The pancreas, which lies deep in the belly behind the stomach, virtually on our backbone, makes the insulin, which regulates sugar metabolism.

In insulin-dependent diabetes mellitus (or type 1 diabetes), which affects mostly children, there is very little insulin around because the special cells that produce it within the pancreas have been destroyed by the body.

The most common form is the non-insulin-dependent diabetes mellitus (type 2 diabetes), which involves insulin resistance.  A person may be making insulin, but his body is not using it properly. This type comes on gradually, making it difficult to detect.

At one time, type 2 diabetes was called adult-onset diabetes; nearly all its victims were over 30.  But now, type 2 affects children as young as four. Michael, for instance, is suffering from this type, which could become the most widespread, and potentially devastating, disease to attack children since polio.

A third type of diabetes may develop during pregnancy. Other rarer types of diabetes also exist.  Some children diagnosed with diabetes may have elements of both type 1 and type 2 diabetes. This phenomenon is often referred to as “hybrid,” “mixed,” or “double” diabetes.

Maturity-onset diabetes of the young is a rare form of diabetes in children that is caused by a single gene that results to the faulty secretion of insulin. This form of diabetes is thought to account for up to 5 percent of all cases of diabetes in children. It often goes unrecognized.

There are five common symptoms of diabetes: increased urination, increased thirst, increased appetite, weight loss and fatigue. Among adults, people with diabetes experience blurred vision, frequent skin and vaginal infections, and poor healing of wounds.

“Type 1 diabetes is growing by 3 percent per year in children and adolescents, and at an alarming 5 percent per year among preschool children,” IDF discloses.  Around the world, 70,000 children under 15 develop type 1 diabetes each year, or almost 200 children a day.

Untreated or poorly controlled type 1 diabetes results to diabetic ketoacidosis (DKA).   This life-threatening consequence occurs because there is low or no insulin available in the body to help the organs and tissues take up glucose for energy. “DKA is the leading cause of death and disability in children with type 1 diabetes around the world,” IDF informs.   “If left untreated, it has a 100 percent death rate.” (Between 60 and 90 percent of all DKA-related deaths are consequences of cerebral edema, or swelling of the brain.)

On the other hand, the global incidence of type 2 diabetes in children “looks likely” to increase by up to 50 percent over the next 15 years, according to IDF.   In the United States, some doctors see maybe one or two kids a year with type 2.  Today, in children’s hospitals and pediatric clinics, up to 46 percent of all new diabetes cases are type 2.

There’s no invading virus or sinister bacteria to blame for this epidemic, no vaccine to ward it off or quick-fix pill to cure it.  Type 2 diabetes is a lifestyle disease—a body-fat disease—caused by too much television and playing computer games and too little activity.

The International Life Sciences Institute of Southeast Asia studied 1,208 Filipino urban children aged eight to 10 found that on average they spent 106 minutes a day watching television, but only 30 to 37 minutes playing outdoor games.

Studies have shown that most children diagnosed of having diabetes eat too much high-calorie junk food.  “Across the globe, more people are consuming high-fat foods that are heavily processed and low in fiber,” IDF notes.  “Increasingly, families are eating food prepared outside the home.”

In fact, the majority of children (some 85 percent) with type 2 diabetes are overweight or obese at the time of diagnosis.

The figure is quite alarming as only 3 percent of children were considered obese back in 1998, according to Dr. Yolanda Olivares of the Department of Health.  Five years later, the figure rose alarmingly as 2.6 percent of children under five years were found overweight, while 5 percent of children from six to 12 years old were also found overweight.  This means that these obese children are at increased risk of diabetes.

According to IDF, type 2 diabetes usually develops slowly in children.  “It is frequently reported around puberty, when insulin sensitivity may be reduced by as much as 30 percent because of changes in the body,” it explains.

Many children with diabetes have no warning signs, or they have symptoms so mild that they’re missed.  If your child is overweight, schedule a doctor’s appointment if you see any of these type 2 clues: frequent urination, excessive thirst, extreme hunger, unexplained weight loss, increased fatigue, irritability and blurry vision.

“Children with diabetes are at high risk of developing complications at a young age,” IDF warns. Despite modern treatment, over 50 percent of children with diabetes develop complications 12 years after diagnosis. Intensive diabetes therapy can control diabetes and allow children to live full and healthy lives. However, it can also result to an increased incidence of low blood-sugar levels, which when frequent, may slow down brain development and function in young children.

“At the time of diagnosis, it is not uncommon for young people to have developed multiple risk factors for early cardiovascular disease, including high blood pressure and abnormal blood fat,” IDF points out.


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