India 14 November 2016:
PREVALENCE
The World Health Organization estimates that 1,11,500 children live with Type 1 Diabetes (T1DM) around the world. Worldwide, there’s a 3% rise each year. It was assumed that T1DM was rare in India, however when the first population-based study on T1DM was conducted in 1992, researchers found that insulin-dependent diabetes was not rare and was actually higher than what was seen in many other Asian countries. Children living with diabetes constitute 1-4% of the diabetes population in the country, which is alarming, because our numbers are growing rapidly.
GOALS OF TREATMENT
he diagnosis of T1DM is traumatic for the child and the family. The child may present a host of acute symptoms of T1DM and it is important that these are addressed and alleviated on an immediate basis. Prioritizing the goals of treatment in the following order is important:
1. Comfort
2. Quality of life
3. Growth
4. Control of diabetes: to prevent complications and premature death
HOW CAN THE GOALS BE ACHIEVED?
1. Lifestyle Management : Diet and exercise
2. Insulin Therapy
Children with T1DM have to be treated with insulin and can be prescribed intensive basal and bolus treatment or insulin pumps. The current consensus is that control can be achieved with both the treatment options, but intensive insulin treatment using vials and pens is preferred due to its lower cost.
TIPS ON INSULIN THERAPY
Initiate therapy gently: Needles are scary for adults, so it’s not a surprise that most children are petrified of them. Explaining to them the need of insulin in simple terms and encouraging them to be taking their first dose in the presence of the HCP may ease this fear.
Be sensitive to your child’s needs: You may need to administer insulin for a little while, depending on the age of the child. If you feel, after a point that your child can do it on his/her own, give guidance, and sit beside him/her initially. In school, talk to the teacher. The school nurse may be able to help your child.
Choose the best: Ask your doctor if you can use an insulin pen, as this is the least painful—the 4 mm needle is the shortest and the thinnest needle available. Speak to your doctor about your child’s schedule to plan the most appropriate treatment. Different treatment plans can be used on holidays and school days for the child.
Know the basics: Correct insulin technique is important to minimize the pain and avoid injuries. Choosing the site correctly with appropriate site rotation is important to avoid lipohypertrophy and lipodystrophy with long term use of insulin. Correct storage of insulin pens, priming and matching the insulin with the correct syringe is necessary to avoid dosing errors.
Pick the site: Depending on the time of day and the activity, pick a site. There are four site options: abdomen, thighs, buttocks, arms. If your child is going out to play, avoid injecting on the leg, as the insulin may act quickly and you could end up with hypoglycemia. Rotate sites depending on factors like food and play. Also, change the site within each zone, using a two-finger distance, so you don’t inject on the same site again.
Focus on technique: Children’s skin bruises easily, so get the technique right. Have repeated sessions with your HCP to ensure the technique is correct. For instance, the pen needs to be used at a 90-degree angle. Similarly, if you’re using a syringe, the skin (not the muscle) needs to be held correctly in a way that does not squeeze the medicine out again.
The most common problems of injecting insulin are lipodystrophy and lipohypertrophy which can easily be tackled by educating the child and his family on correct technique. However compliance issues related to poor affordability and lack of infrastructure and trained personnel needs to be addressed on an immediate basis by the government.
MD
Consultant Endocrinologist
Rutu Dave
PGD (Nutrition) (Diabetes)
Diabetes Educator