Biology assignment essay help: Diabetes in Children

Diabetes mellitus is a disorder which is characterized by increased level of blood glucose. This arises due to deficiency in insulin production and deficient action of insulin. Diabetes is also associated with premature death and serious complications, however timely treatment and diagnosis due or delay complications such as(NDEP, 2011; Brighttots, 2013) damage occurring in the kidneys, nerves, vessels, gums, skin and teeth.

The assignment discusses the statistical trends of children affected with various types of diabetes. Then the health promotion strategies in children affectedwith diabetes is explored. Moreover,the theoretical perspective linking the health of the child is discussed followed by conclusion.

Diabetes is one of the common disorders which can occur in children. Research studies conducted by National Diabetes Centre about 215,000 young children and adolescents who are less than 20 years have diabetes in 2010.Moreover, about 15,600 youth are diagnosed with type-1 diabetes and about 3,600 youth are diagnosed with type-2 diabetes (NDEP, 2011,p.3). Studies indicate that type-2 diabetes are increasingly rare in children aged less than 10 years whereas the children aged between 10-19 years are more prone to type-2 diabetes especially minority community such as American Indians, Hispanics ,Asians ,African Americans and pacific islanders.

Different forms of Diabetes and the management in children:

• Type-1 Diabetes:

Type-1 Diabetes is an autoimmune disease where the immune system destroys the beta cells present in the pancreas producing insulin, thereby altering the blood glucose level regulation. Usually type-1 diabetes occurs in children who are less than 10 years of age. The onset for type-1 diabetes usually occurs at any age and present symptoms such as ketoacidosis which is the first indication for type-1 diabetes. Other symptom includes hyperglycemia, increased thirst and hunger, frequent urination, blurred vision, weight-loss and tiredness. Insulin deficiency can bring about formation of ketoacids which are the by-products of fat breakdown, build-up in the blood and then excreted in the urine (childrenwithdiabetesuk.org n.d). Furthermore, formation of ketoacids causes abdominal pain, dehydration, vomiting, acidosis, shortness of breath, confusion, flu-like symptoms, candidiasis, nocturnal enuresis etc. If diabetes is left untreated or left undiagnosed, the affected patients can lapse into coma and other life-threatening conditions.

The management for type-1 diabetes includes administration of insulin by insulin pump or injection, management of nutrition, blood glucose testing, doing frequent physical exercises and avoidance of prolonged and severe hyperglycemia (Carol, N, 2008,p. 1326). Algorithms exist and are used for dosing of insulin based on food intake and blood glucose level. Children affected with diabetes needs to avoid liquid carb diet such as consumption of juices, soda and use of syrups. This can raise the level of blood glucose level rapidly and provide no nutrition to the affected patients. Additionally, children receive insulin analogue which are long-lasting through insulin pump (nice.org.uk, 2004). This is required for raising the blood glucose level and provides nutrition.  Further, children receiving intermediate and rapid acting fixed-dose insulin needs to be given food during the peak action of insulin whereas children receiving rapid and long-acting insulin dose before meals ,then food with appropriate carb amount  is taken for treating hyperglycemia. Usually carb counting is done for appropriate intake of carbohydrates for optimal intake (NDEP,2011,p.3). Secondly, doing frequent physical activity is one of the effective ways for effective management of insulin. Maintaining weight and cardiovascular fitness can lower the level of blood glucose.

Table indicating the level of optimal maintenance of blood glucose level and A1C goals for type-1 diabetic patients:

A1C(%)

Rationale for the study

Before MealsOvernight  Toddlers and preschool

(0- 6yrs)100-180110-200Less than 8.5Vulnerability to hypoglycaemia

Sensitivity to insulin

Unpredictability in physical activity and dietary intake

Lower goal of less than 8.0%  is achieved  without any excessive hypoglycaemiaSchool age

(6-12yrs)90-180100-180Less than 8Being vulnerability to hypoglycaemia

Lower goal of less than 7.5% is achieved without any excessive hypoglycaemiaAdolescent and young adults

(13-19years)90-13090-150Less than 7.5

A lower goal of les than 7.0% is achieved without any excessive hypoglycaemia

(Source:NDEP, 2011,p.7)

• Type-2 Diabetes:

Type-2 Diabetes usually occurs in obese patients including young children aged 10 years and older patients. The children diagnosed with type-2 diabetes are usually resistant to insulin and have a family history of type-2 diabetes. Research studies indicate that patients affected with type-2 diabetes are usually African Americans, American Indians, Pacific Islander Americans, Hispanic and Latino Americans.

The first stage of type-2 diabetes development is insulin resistance where increased amount of insulin is produced by pancreas in order to control the level of blood glucose level. At the initial stage the pancreas responds by increased production of insulin but after few years the production of insulin decreases and diabetes starts to develop (Rosenbloom, A et.al 2009, p.20). Usually, the digestive system starts to break down carbohydrates into the blood sugar glucose which leads the glucose levels from blood vessels to the body cells to be used as energy source (Web MD, 2013; American Diabetes Association, 2008, p.674). In type-2 diabetes, the body of the child become resistant to glucose and insulin effects ,this is build up in the bloodstream which further reaches the toxic levels in the body of the child. After some time the body is unable to handle the glucose levels in blood vessels, thereby causing various complications in the body such as heart disease, kidney failure and blindness. Thereby in children, diabetes starts developing insidiously and slowly in case of children and adolescents (childrenwithdiabetes, 2005; Weigensberg, M, Goran, M, 2009, p.1743).

The symptoms for type-2 diabetes include increased thirst, hunger and urination. Other symptoms include blurred vision, loss of weight, frequent infection and slow wound healing. Few other patients have increased elevation of blood glucose level, coma and dehydration(NDSS,2013). Further, the physical signs of insulin resistance include acanthosisnigricans, polycystic ovarian syndrome, excess acne and hair and absent and infrequent periods in case of humans. Other co-morbidities in children with type-2diabetes include hypertension and lipid abnormalities.

The management in case of adolescents and children affected with type-2 diabetes includes having a well-balanced diet, developing a heating healthy and well-balanced diet, increased physical activity. Also the diabetes is controlled by intake of various glucose-lowering medications and insulin therapy to normalize the blood glucose. Moreover, the health care professionals need to support, encourage and support various healthy life-style changes which can reduce or delay the risk of type-2 diabetes. Seeking the help of the health care professional is vital as the need of creating a diet plan for reduction in the blood glucose level in children to normal levels(AAP.org, 2013). Education is important to make optimum food choice and in reduction of sweets and fat and increased physical activity.

• Other forms of Diabetes:

Other form of diabetes includes first, gestational diabetes. This is a form of diabetes which is diagnosed during pregnancy and this ranges from 2-10% of the overall pregnancy and is more common in obese women having a family history of diabetes.  Children who are born to pregnant have increased risk of diabetes and obesity. Second, hybrid or mixed diabetes are disorders which are present in children who are having both type-1 and type-2 diabetes. These children from mixed diabetes are insulin resistant which is associated with obesity and diabetes. Moreover, the antibodies directed and acting against pancreatic islet cells are associated with type-1 diabetes and autoimmunity. The management of children affected with both type of diabetes includes measuring antibodies and C-peptide levels. Moreover, the children require injections for insulin or oral diabetes medications which can reduce the level of insulin resistance. Healthy eating habits and reduction in physical activities can increase insulin sensitivity (NDEP, 2011).The monogenic diabetic form usually in less than 5% of children. This can occur due to defect in the gene which further results in faulty secretion of insulin .It is very crucial to correctly diagnose the monogenetic form of diabetes in order to ensure effective treatment and prevent any delay for diagnosis of family members. Secondary diabetes can occur in children along with other disease such as consumption of glucocorticoid disease or cystic fibrosis. Usually about 1-5% of diagnosed cases are detected for diabetes.

Monitoring various complications associated with Diabetes:

Various complications exist in children who are affected with diabetes. Retinopathy is the condition which occurs during the puberty onset and after five to ten years of duration of diabetes. This condition can be managed by consulting a eye-specialist who have a good understanding of paediatric counselling and retinopathy. Also annual routine follow-ups is recommended.

The second complications which exist is nephropathy. The risk of nephropathy is reduced by optimizing the blood pressure and glucose control. Children with type-1 diabetes needs to undergo annual screening for microalbuminuria and children affected with type-2 diabetes needs to undergo annual screening of random spot sample of urine where the ratio of microalbumin to creatinine is measured. Additionally education about foot care is vital for reducing the risk of neuropathy. Moreover, research studies also indicate the performing lipid profile soon after the diagnosis helps in estimating the risk of cardiovascular diseases. Increased level of low-density cholesterol of about 100 mg/dl, the affected patient or the child needs to be treated with an adequate plan of exercise and undergoing statin therapy if the level if the level of low density cholesterol is still high. Generally having the low density cholesterol level between 130-160 mg/dl indicate the risk of cardiovascular disease. Additionally, weight loss, improved glycemic control and level of exercise can bring about improvements in the lipid profile. Furthermore, careful monitoring and control of blood pressure is vital. Hypertension usually occurs in childhood and treatment of high blood pressure or hypertension includes administration of ACE inhibitors (NDEP, 2011). This has shown to have beneficial effects on slowing the progression and prevention of diabetic neuropathy.

Health promotion strategies in children affected with Diabetes:

Usually the health care professionals in partnership with young children and adolescents affected with diabetes and other caregivers need to establish and develop the diabetes management plan. This will help the affected patients to follow a healthy and balanced meal plan. The affected individuals with type-1 diabetes need to get themselves registered with a dietician or physician and the meal plan needs to ensure that proper growth and nutrition in patients(Soltesz, G., 2006,S 10). The children with type-2 diabetes need to outline adequate changes and develop healthy eating habits for better g balance and prevent obesity. An adequate and balanced meal plan keeps the level of blood glucose in the target range. Consumption of portion sized meals and the right amount of calories with reduced intake of juice and soda according to the activity and age of the child is crucial. Moreover, the support of the family post following and setting of the regular meal plan is one of the ways for success especially if the child is administered with insulin (NHS, 2012). Secondly, children need to perform regular physical activity to increase the sensitivity of insulin and lower the blood glucose level especially in children and adolescents affected with diabetes. This controls the weight of the affected patients with diabetes-2 but in case of diabetes -1, the common problem faced is hypoglycaemia, thus the blood glucose levels needs to be checked.

Treatment for diabetes-1 is a long term management. Depending on the insulin therapy the blood sugar levels needs to be checked. Continuous glucose monitoring includes maintaining the normal blood sugar levels. Insulin therapy includes consumption of rapid acting insulin such as lipsro and aspart which start to work within minutes and last for about ninety minutes. Second the short acting insulin such as human insulin, novolin R, humulin R starts to work in thirty to sixty minutes after insulin injection and lasts for about 2-4 hours (Mayo Clinic, 2012). Third, the long acting insulin includes insulin determir and insulin glargine which provide a coverage of about 20-26minutes.Forth,the intermediate acting insulin includes NPH insulin  which starts to work in 1-3 hours and peaks after eight hours. The NPH insulin has similar effects as insulin which is long-lasting. These medications can lower the level of blood glucose.

Usually exercise and healthy diet are one of the key ways in controlling the blood sugar levels. The medication for type-2 diabetes includes metformin or glucophage reduces the sugar amount which is released by the liver of the affected child into the bloodstream. The side effects of this medication includes stomach upset, diarrhoea ,lactic-acid build up and frequent headaches. Also insulin therapy can also be used if the glucose level is about more than 250 mg/dl and the A1C level is about 9% or if the person is suffering from ketoacidosis. Further insulin can be administered through insulin pump and injections (NDEP, 2011; Mayo Clinic,2012). Research studies have shown that few substances have brought about improvement in sensitivity of insulin such as vitamin E, cinnamon etc.

Theoretical perspective linking the health of the child affected with Diabetes:

Diabetes can affect the emotions of the child directly and indirectly and can have elevated risk of anxiety and depression. The child needs to be supported through counselling, encouraged and helped to follow the proper treatment plan require significant changes in lifestyle. As  the child gets older ,the health care team and family needs to play a active role ineffective management of diabetes. The child needs to be educated to test the blood sugar levels and being able to enjoy a health lifestyle to keep the sugar levels in check.

Furthermore, the diabetes care team and family helps in determining the regimen that suits the characteristics and circumstance of the child. Sometimes diabetes treatment can cause hypoglycaemia. Intake of high level of insulin, strenuous exercise and improper diet can cause hypoglycaemia. The condition of hypoglycaemia can also occur where the child becomes shaky, irritable and confused. Also loss of consciousness, fall of level of blood glucose and seizures may also develop. Thus in this condition, the child needs to consume about 15 grams of sugar which is concentrated to raise the blood glucose levels. Research studies indicate that children less than five years of age are continuously at a risk of severe cognitive impairments. The condition of hyperglycemia includes forgetfulness, doing less exercise and increased consumption of food. Moreover, being sick can raise the level of blood glucose and cause damage to the nerves, kidneys, teeth and gums with neuro-cognitive complications. Management of hyperglycemia includes assessment of ketosis and proper education for effective recovery

Conclusion:

Diabetes mellitus is a disorder which is characterized by increased level of blood glucose. This arises due to insulin production deficiency and action of insulin. Various forms of diabetes include type-1 diabetes, type-2 diabetes, gestational diabetes, hybrid and mixed diabetes,monogenic diabetic form and secondary diabetes. Diabetes is also associated with premature death and serious complications, however timely treatment and diagnosis due or delay complications such as damage occurring in the kidneys, nerves, vessels, gums, skin and teeth etc and effect the quality of life in children.

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