What Children Go Through With Type 1 Diabetes

Diagnostic Treatment and Interventions for Diabetes in Children

"Diabetes can affect many parts of the body with serious complications ... heart disease, stroke, blindness, kidney failure, and lower-limb amputations ... " (CDC).

According to the American Diabetes Association (ADA) approximately 1.25 million American children and adults have diabetes type 1. As for children, the Centers for Disease Control and Prevention (CDC) reported in 2014 that 22 out of every 100,000 children under the age of 10 in the U.S. have type 1 diabetes. And a 2014 report in USA Today quotes a study in the Journal of the American Medical Association that shows that "... nearly 167,000 children and teens younger than 20 have type 1 diabetes" (Szabo, 2014). That data conflicts with the ADA data that reports 208,000 Americans under 20 have type 1 diabetes. No matter the conflicting data, it is clear that the rate of diabetes in children has risen by 21% between 2000 and 2009, according to the U.S.A. Today article. This paper presents evidence-based peer-reviewed articles that present interventions and/or diagnostic tools used in treatment of children with diabetes.

Treating hypoglycemia in children with diabetes ... with skittles?

Notwithstanding improved insulin preparations, high-tech insulin pumps and other devices, the majority of children and teenagers with type 1 diabetes (T1D) " ... achieve A1c (glucose) levels at or above the recommended targets" (Daneman, 2010). And at the same time children with diabetes may be hit with hypoglycemia, and sometimes the episode can be severe, according to Professor Daneman, Department of Pediatrics at the University of Toronto. It is vitally important that children with diabetes avoid hypoglycemic events, however, the goal of avoiding hypoglycemia is "elusive," and "virtually all youngsters with T1D" go through experiences where blood glucose levels are "below normal" (Daneman, 149).

That having been said, statistics show the most "anxiety-provoking" situation as regards hypoglycemia is that "... about 50%" of children with T1D go though " ... prolonged, asymptomatic hypoglycemia during nighttime hours" (Daneman, 149). How is it that hypoglycemia hits children so severely sometimes? Daneman claims that it could result from snacks or meals that were not consumed, or "extraordinary amounts of exercise" that use up "available substrate without the physiological suppression of insulin secretion" (149). The additional concern about the frequency of a child enduring hypoglycemia is that studies show hypoglycemia can be linked to "impaired intellect and memory," and other cognitive functions, Daneman explains on page 150.

What is the suggested intervention to this problem? Daneman writes that children (with parental supervision) having a "mild" hypoglycemia event should: a) check blood sugar (and if low, take 10-15 grams of carbohydrate); b) if symptoms "persist after 15 minutes," take glucose measurement again and if still low, ingest another 10-15 grams of carbohydrate (150). And if the next meal is an hour or more away, Daneman suggests taking glucose tablets and Skittles (an effective source of sucrose). Skittles is that popular chewy fruit-flavored sweet which contains sugar and hydrogenated vegetable oil, plus citric acid; importantly, Original Skittles has 46 grams of carbohydrate per package. To get the child to ingest 15 grams of carbohydrate, he or she should eat between 11.5 and 13.2 pieces of Skittles, and that shouldn't be a problem since kids love candy, and they love Skittles. Hence children with diabetes hoping to avoid or abort a hypoglycemic episode can either take 2-3 glucose tables, "or a dozen Skittles" (Daneman, 150.

Continuous glucose monitoring system

A peer-reviewed article in Vojnosanitetski Pregled (VSP), a leading medical journal by doctors in the Serbian Army, reports on a study using 80 pediatric patients that were given the technologies (CGMS) to continuously monitor their blood glucose (SMBG) levels and hemoglobin. The results of this intervention were measured at three and six months, and the group that was involved in the research showed that the CGMAS "can be considered a valuable took in treating pediatric T1DM patients" (Bukara-Radujkovic, et al., 2011). The author, a physician at Children's Hospital (Department for Endocrinology) in Bosnia and Herzegovina, writes that using " ... four daily blood glucose measurements" is not sufficient to "provide and predict all relevant glycaemic fluctuations."

The continuous measurement of SMBG " ... seems to address the issue" in terms of maintaining near-normal glycemia, normalize hemoglobin, Alc, control postprandial glycaemic excursion and decrease the number of hypoglycemic events" (Bukara-Radujkovic, 651). The patients in this research were on "intensive insulin therapy (using multiple injections per day -- MDI)," Bukara-Radujkovic explains (651). The bottom line was a "statistically significant decrease in the number of hyperflycemic events" each day by the 80 patients in this research (Bukara-Radujkovic, 653).