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World Diabetes Day: the alarm bells that signal the onset of the disease in children

The November 14 is World Diabetes Day, a chronic disease that can present in different forms and at different ages.

While the type 2 diabeteswhich is the most common form, usually occurs after the age of 30-40, associated with several risk factors, the type 1 diabetes generally occurs in childhood or adolescence. It’s about a disease defined as autoimmune because of the underlying mechanism, namely a destruction process by autoantibodies of the cells in the pancreas that produce insulina hormone that plays a fundamental role in maintaining normal blood sugar concentration.

«As a mother I can say that dealing with this diagnosis involves a radical change of life. For me, who knew little about this pathology, it was like stepping into a blender. The fact that it is one chronic irreversible disease puts you in front of the evidence that will not pass and as a parent it is not easy to accept it“.

So he tells Ileniamother of a girl who has been living with type 1 diabetes since the age of 5, as well as founder of Diabetica.ita blog and an Instagram account (@ diabetica.it) in which she tells, with courage and irony, her experience as a mother struggling with the management, not always easy, of a disease that is in some ways still little known.

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Type 1 diabetes: what is the incidence

“L’incidence of the disease is variablebased on age but also on geographical areas – he explains Livio LuziFull Professor of Endocrinology at the University of Milan and Director of the Department of Endocrinology, Nutrition and Metabolic Diseases of the MultiMedica Group – In our country, for example, for reasons that have not yet been scientifically clarified, Sardinia has a very high incidence of type 1 diabetes, 3 to 4 times higher than in other parts of Italy. An incidence similar to that found in the countries of Northern Europe “.

And about the mean age of onset? “L’maximum incidence is observed around 14 yearsthat is in adolescence – explains Professor Luzi – however the disease can also manifest itself in moles children. Indeed, although it represents a rarer possibility, there is also the so-called neonatal diabetes which concerns those children who show the pathology from the first days of extrauterine life “.

Type 1 diabetes: what are the causes?

As the case of Sardinia testifies, the causes of the disease are not yet fully known. Even if today they know who they are the main risk factors.

«The causes are in genetic part – explains Professor Luzi – today we know that the presence of polymorphisms of some genes predisposes to type 1 diabetes. To this genetic predisposition then there are environmental factors which can present themselves as triggering events. Among them, the best known it is a viral infection, like a trivial flu. In fact, when talking to parents it is common to hear that, 4 or 8 weeks before the clinical onset of diabetes in the child, there was a febrile episode of viral infection. This is clearly an environmental factor that can only act in a subject already predisposed, affecting the immune system which begins to produce autoantibodies against pancreatic cells“.

Diabetes in children: the alarm bells to watch out for

If the presence of one or both parents with type 1 diabetes should be a wake-up call in itself, there are of the signs that experts recommend to pay attention to.

«The typical course of the disease is rapid or galloping – explains Professor Luzi – with more easily recognizable symptoms. Autoantibodies that damage and destroy the insulin-producing beta cells of the pancreas can act within a few weeks, giving rise to symptoms caused by increased blood sugar. The first is definitely there polyuriaor the increased amount of urine and frequency of urination. If the blood glucose exceeds a certain threshold, the glucose is eliminated in the urine by a physiological mechanism and as the glucose captures water, its quantity increases. Whether the child or the boy begins to wake up two or three times at night to go to the bathroomand a urinary tract infection has been ruled out, this can be considered a spy ».

Another characteristic symptom is what is termed polydipsiaor the excessive thirst with increased fluid intake.

“By urinating more and losing more fluids, the child, like the adult, gets to drink more and be more thirsty – specifies the expert – a mistake not to make, especially if there is a clinical doubt, is to give to the child sugary drinks that can worsen hyperglycemia ‘.

Then there is a third signal associated with type 1 diabetes, namely the polyphagia, increased hunger.

“It may be the consequence of another typical signal that occurs especially when the course of the disease is slower: that is body weight loss – explains Professor Luzi – Un strange weight loss in a guy who eats a lot and that he is more hungry can be considered a wake-up call. The lack of insulin, in fact, determines a condition of loss of muscle mass which in turn activates a physiological mechanism of hunger ».

In the most serious cases, then, type 1 diabetes it can give rise to confusional states, alteration of some mental functions and ketoacidosic coma.

«Today on the pathology there is more information so we can say that, fortunately, now the diagnosis occurs in most cases in the outpatient clinic – specifies the expert – and no more in the emergency room as it happened 30 years agowhen patients arrived in emergency conditions with very high glycemic levels ».

Not only. Although the diagnosis of diabetes is not easy to accept, especially for a parent, it is good to consider that today the quality of life of patients has also improved.

“The well-treated type 1 diabetes allows any patient, adult or child, to lead a normal life – specifies the expert – The proof is that there are many Olympic athletes suffering from this disease which, if treated, does not involve problems from a physical point of view. In addition to the relationship between patient and diabetologist, which is fundamental, it is necessary work on acceptance of the disease. Make a child or young person understand that diabetes is one potentially very serious disease but only if not adequately treated. In addition to using insulin, it is important to teach respect a correct lifestylewhich can be good, among other things, for the whole family: eat at regular times, avoid foods rich in simple sugars or saturated fats, such as exercising ».

Type 1 diabetes in children: the new technologies available

To date, to control type 1 diabetes, there are no other therapies besides insulin. Insulin has to be given to children several times a day by means of a subcutaneous injection usually done with pen injectors. However, these devices are also being replaced new systems designed to make life easier for patients and disease management.

In fact, there is today another way of administering insulin, the insulin pumpa continuous infusion pump, which infuses insulin into the subcutaneous tissue 24 hours a dayaccording to defined settings and with different automation levels.

“The new technologies available today they reduce the effort for families and improve the quality of life – explains in fact Stefano TuminiHead of the Regional Center for Pediatric Diabetology and Prevention of Cardio-metabolic Diseases of the “SS Annunziata” Hospital Chieti – The possibility of deliver insulin continuously through the pumpreceiving and processing real-time information of the blood glucose trend on the mobile phone, and to use the information for modulate insulin deliveryalso under the remote control of a caregiver, it allows in fact to keep the situation under control constantly, with simplicity and discretion ».

Just last September, it was presented in Italy mylife Loopthe first system interoperable e completely smartphone-basedapproved for automated and adaptive insulin delivery.

«At the base of this system there is an algorithm that receives data on blood glucose values ​​from the sensor – explains Dr. Tumini – and is able to predictively determine the amount of insulin that will be delivered. We can say that Artificial Intelligence intervenes above all in two crucial moments: when your blood sugar is droppingso that the system reduces or stops delivering insulin, or when on the contrary it tends to riseand in this case the system is able to automatically increase the delivery, thus managing to keep blood glucose values ​​within a desirable range“.

The benefits for parents appear to be many.

“These systems allow easy access to data – concludes Dr. Tumini – parents can indeed monitor your child’s blood glucose trend on your phone, but not only. It’s about a technology that makes the disease less invasive in everyday life: if the child is, for example, celebrating his birthday, the parent can monitor your blood glucose trend or deliver insulin for the meal directly from the smartphone, without interrupting the activity of the little one for glycemic control or for delivery of the bolus. In addition, thanks to artificial intelligence, i parents are better equipped to support secondary caregiverssuch as the babysitter or teachers ».

Diabetes and school

“Technology has made enormous progress and has helped us a lot – Ilenia also confirms – we came out of the hospital, 5 years ago, when the traditional blood glucose meter, the one who pricked his finger. Pump and sensor that communicate with each other represent one great opportunity“.

But if technology has made huge strides, there are aspects that still need to be worked on. As the management by the school of children with type 1 diabetes.

“In this sense we are still standing – underlines Ilenia, who is also involved in providing support to families in the delicate moment of the onset of the disease – many parents are forced to spend the mornings at school because the children are small, they cannot self-manage and cannot count on other support. There is a protocol for the management of diabetes but still, in many schools, it is not implemented. Some schools unfortunately, they are not yet ready to assist a child with type 1 diabetes and this entails enormous difficulties for children and parents ”.

And it is precisely to the parents who are facing the diagnosis of type 1 diabetes together with their children that Ilenia addresses an encouraging thought: «I would like to tell them that they can do it. Which, even if it all seems too much at first, it can be done: extraordinary strength comes from children which, most of the time, they prove to accept everything with a surprising normality ».

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Ilaria, 25 years old: “I have Jarcho Levin syndrome, a very rare disease, and I dream of being a writer to destroy certain taboos”

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Source: Vanity Fair

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