FUNMILAYO AREMU examines the risk factors, symptoms and preventive measures of paediatric diabetes.
Kemi (not real name) put her 18-month-old child down on the playmat near her six-year-old son who was engrossed in the game he was playing.
Propping up the phone stand, she played her daughter’s favourite cartoon, Cocomelon and gave her a sippy cup filled with a high-sugar content drink.
“Take care of your sister,” she said to her son who had not once taken his eyes and hands off the tablet, except to take from his share of the drink or shove some cookies into his mouth.
The children would continue to play like this for hours and would be supplied with more snacks and drinks whenever they requested for them. This is their daily routine after school hours, a habit through which these children may later become predisposed to diabetes.
This is an example of how many children consume refined carbohydrates, sugary junk and live a sedentary lifestyle which, according to the World Health Organisation (WHO), plays a crucial role in the increase of diabetes in children.
Many Nigerians seem to believe that children need junk and high sugar content foods to be active and grow and that diabetes is a disease that usually affects adults. However, according to the WHO, “The frequency of diabetes is rising around the world and studies are showing that children are at increased risk of developing the disease.”
A global health care company, Novo Nordisk, also revealed that Nigeria has 3.6 million adults and 4,400 children and adolescents living with diabetes, with a projected increase of 134 per cent by 2045.
Similarly, the International Diabetes Federation (IDF) said that “the number of children and adolescents living with diabetes is increasing every year” and that there are currently an estimated 1.1 million children and adolescents living with Type 1 diabetes around the world.
Risk factors of diabetes in children
But apart from subjecting children to living on junks, what other factors cause diabetes in children, the symptoms to look out for and the preventive measures to take?
Dr Jibir Kefas Gurama, a consultant paediatrician with the Federal Medical Centre, Abuja, while speaking with Sunday Tribune, explained that though diabetes in children is not as common as in adults, there are still some other cases.
According to him: “Diabetes in children is not as common as in adults and that in children, we have basically two types, but there are few other types that are not very common.
“The major one is Type 1, which is called insulin-dependent diabetes which constitutes about 80 per cent of diabetes in children while the remaining 20 per cent is of Type 2 and others like the Maturity-Onset Diabetes of the Young which is summarily known as MODY, congenital diabetes, among others.”
He added that diabetes can occur at any age in childhood, but “the common age bracket that the diagnosis is made most of the time is four to six years and also between the ages of 10 and 14. We have also seen cases where it can be diagnosed in an infant. That is why doctors have to be very vigilant. If you suspect some signs, you still have to do your investigation and possibly make your diagnosis because missing it can cause more harm.”
When asked how common the disease is, he said Nigeria does not have the statistics and although it varies from community to community, rural to urban areas, “the international statistics are about 1 to 40 children in 100,000 population.”
He also disclosed that the causes or risk factors of diabetes can be categorised into two; “genetic predisposition, which is when there is a family history of diabetes and the environmental factors which are basically exercise and diet.”
Another consultant paediatrician from the University College Hospital (UCH), Ibadan, Oyo State, Dr OluwakemiAshubu, spoke on the dietary aspect of the risk factor of paediatric diabetes.
“Diabetes is a result of a high level of glucose in the blood and looking at a diet for children, many of the food a child will take from you will be sweet things. For those who take a lot of high-calorie diets, sugary drinks and sugary food, you will agree with me that the types of snacks we have these days have a lot of sugar.
“Imagine a doughnut that is sprinkled with sugar, the flour itself that is used for these pastries is sweetened so that the children will come back to buy more. Food laced with sugar, and more than enough honey, is what is on the market now. When a child takes more than necessary, it may actually predispose him or her to diabetes, especially in a child who has underlying factors of developing diabetes,” she said.
She added that “about 15 per cent of children with Type 1 diabetes have a family history while for the Type 2 diabetes, they have more family history of being diabetic.”
She also disclosed that if a child with a family history of diabetes indulges in some habits, it could predispose him or her to have the disease earlier.
Dr Gurama and Dr Ashubu also stated that another risk factor is infections.
According to Dr Ashubu: “When a child between the ages of four and six moves away from home and starts to go to school, they are exposed to all kinds of infections. Some other children will bring whatever they have from their houses and they also mix with adults. Some children may have infections that may predispose them, and we have noticed that some viral infections can predispose children to diabetes.
“For those in the 10 to 14 age group, which is the time of puberty, and at that time, a lot of hormones come into play, by then, they begin to have different body changes and when these hormones perform their work, they have been noted to increase blood glucose.
“So, if a child for whom the pancreas is just managing to produce insulin to cover what the child is eating now gets all these exposures to puberty and infections, the glucose in the blood will be too much and that insulin will not be able to take care of it. And when this happens, we will start seeing all these signs and symptoms of diabetes.”
Dr Gurama stated that another environmental factor is less activity. He said that these days, children are not as active as they should be because they have a lot of things that can preoccupy them like gadgets, video games and living a sedentary lifestyle in general.
The Centers for Disease Control (CDC) similarly lists family history of Type 2 diabetes, being born to a mother with gestational diabetes (diabetes while pregnant), being African, having one or more conditions related to insulin resistance, obesity, reduced activities as risk factors for Type 2 diabetes in children.
Signs of paediatric diabetes
With all these, many may fear for the health condition of their children given that the majority of Nigerian parents give these high-calorie foods and drinks to their children and many children spend so much time on tablets and phones given to them by their parents in order to keep them busy.
Many would begin to wonder what symptoms to look out for in their children. Dr Ashubu lists the common symptoms of diabetes in children to include frequent urination, fatigue, if a child drinks a lot of water more than usual, suddenly starts bedwetting, always sleepy, drowsy and weight loss despite having a healthy appetite.
Dr Gurama added that some short-term and long-term complications can arise. He said “the immediate complications that we fear most is called diabetes ketoacidosis. That is when a child presents with complications like excessive weakness, they are weak because they have no weight. The child could have convulsions, can become unconscious, these are the complications that could arise.
“Then the long-term complications, most of the time, if they are from neglected communities where they may not notice it in time, it can affect the eyes of the child; the child will lose his vision, it can also cause kidney failure, it can cause high blood pressure. High blood pressure is common with Type 2 diabetes.”
Preventive measures
Dr Gurama believes that more children can be predisposed to diabetes because they live a sedentary lifestyle. “When you compare the 20th Century with the 21st Century, you will notice that there is an increase in the number of children with diabetes and more studies have shown that based on the introduction of devices, a new lifestyle is adopted which includes staying glued to the television, spending more time on gadgets and devices. All these things bring about an increase in the number of diabetic children.
He also noted that based on studies, environmental factors contribute more to the increase of diabetes in children than heredity.
On prevention, he explained that there are modifiable factors and non-modifiable factors. “The non-modifiable factor is genetics, a child cannot change the family he or she is born into, while the modifiable factor is that of the environment. This is in terms of food, drinks and activities that children engage in.
“Diabetes in children can be prevented by increasing the activities of the children whether in the house or with the collaboration of the school, reducing screen time for children. There are some policies that can help to reduce screen time, based on their age, and avoid putting televisions in their rooms and the devices we give them. So, by regulating the time and allowing them to do exercises and reducing sedentary lifestyle, we can modify it,” he said.
“Another thing is increasing awareness, if society knows that those things can cause problems for the child, they will cooperate on the policies and information. Making an early diagnosis is also important. If the diagnosis is made early, intervention can be started early.”
According to Dr Ashubu, there are many modifications to be made in order to prevent diabetes in children.
She noted that with experience over the years, it has been noticed that parents do not give their children what they don’t eat assuming that the children will not be able to eat it and many of these things are what the children actually need.
“Sometimes, some snacks are given to the children so that they can be satisfied and then the father or mother can face whatever they are doing. They have an assignment they have brought from work, and then the child needs attention from them, the next thing they say is ‘go and pick the biscuit or juice or sweet from where I kept it.’ And this becomes a daily occurrence.
“If you are packing a child’s lunch box, what should be there should be healthy food and not those snacks. We are not saying don’t take snacks at all, but when you are putting in more than what is necessary, what are you hoping to achieve?
“Unfortunately, some of our drinks these days don’t have nutritional facts. When the white man puts nutritional facts on their products, they know what they are doing. They want you to be able to be the one making the choice yourself. It now depends on whether you, as a parent, think it is healthy enough for your child. But how many of our snacks and drinks have nutritional facts?
Dr Ashubu also added that some of these high-calorie snacks are more harmful to children with a family history of diabetes.
“I once heard of a particular biscuit, which I also experimented with to confirm its content and effect. What we realised is that when children eat that particular biscuit, they become very uncontrollable in class. So, imagine a child who now has a predisposition of having diabetes taking that biscuit, what do you think will happen?”
She advised that “instead of giving your child snacks and juice, why not cut some fruits and give your child fruit salad? Why don’t you put fruits and water in your child’s lunch box?
“Recently, in November, we had World Diabetes Day and we had an awareness walk, we spoke with people around, encouraging them to replace those everyday juice boxes with bottles of water. A child that is trained with juice will never like water and that is how they will grow up to be a father or mother and will not see the need for drinking water and the children will also become that way, so it now becomes a generational issue,” she said.
Giving more advice on the issue, Dr Ashubu said: “I want parents to know that children can have diabetes, it is not only in adults. I want them to also know that when they see a child going to urinate often, more than what they usually do, even at night, a child that has been toilet trained before now starts bedwetting and it is not because of bullying because that can also be a cause of bedwetting.
“You want to be sure that the child is not emotionally disturbed that is why the child started bedwetting again and then, you also notice that this child is losing weight despite eating, some of them will even ask for more portions. The child is easily tired and it is not as if the child has a heart condition. The child’s grades are falling, the child is excessively sleepy, tired in the morning, has no willpower, and is always fatigued. When these signs and symptoms are noticed, please don’t stay at home, go to the hospital.”
She advised that parents should take extra care with their children’s diet, saying “it is not all the things that are on the supermarket shelves that are for your children. Please look at them very well. The problem we are having now is that parents are too busy. No home-cooked meals anymore, it is a big issue. When they pack their children’s lunch boxes, what they are given is biscuits and juice, there is nothing like fruit. Let the children eat good food, well-prepared meals, and don’t rely on the restaurants. Because they will make the food attractive and some of the condiments may not be good for the children.”
She also admonished parents to check the nutritional facts of the food they buy for their children. “Look out for the calorie content; the fat, is it saturated or unsaturated? look at the salt or sodium content. You could browse the internet for more information on the product and its content, browse and find out how much calorie is good enough for your child. And some of those products tell you the number of calories per 100 grams. Unfortunately, many of our Nigerian foods don’t have that calorie content thing,” she said.
