Childhood diabetes: what is life like for children diagnosed with the disease

“My son will never be able to eat candy again, go to parties, he will not have a normal life!” For the vast majority of parents, it is a shock to receive the diagnosis that their little one has type 1 diabetes. First, because the disease has no cure and, as it is chronic, requires care forever. But, more than that, because many fear that the child will be discriminated against, that he will be isolated, that he will not have the same life as his peers. “Unfortunately, several myths and misinformation still surround diabetes, but it is slowly changing,” says Luiz Eduardo Calliari, an endocrinologist at the Brazilian Society of Pediatrics and professor at Santa Casa de São Paulo.

Type 1 diabetes is one of the most prevalent chronic diseases among children and adolescents (see “Disease progression remains a mystery”). “Usually, it is diagnosed between the ages of 7 and 15, but in recent years we have been seeing cases in children under 6”, says endocrinologist Denise Franco, director of the Juvenile Diabetes Association (ADJ Diabetes Brasil). Control is done by replacing insulin – a hormone that the body stops producing, requiring daily and frequent applications through a small syringe – and measuring blood sugar levels. The test, performed with the collection of a drop of blood taken from the tip of the finger, is one of the most important guidelines for treatment, since, if done several times a day, it allows the necessary measures to be taken quickly, whether applying insulin to lower blood glucose , whether giving sugar to the little one, if she is low. Both one measure and the other aim to keep sugar levels more balanced, avoiding oscillations that can put the child’s life at risk and that, in the long term, can bring complications.

era of advances

Although care needs to be long-lasting and requires injections and finger pricks, advances in treatment have been immense. “Each year, we see more improvements, due to several factors. Today there is a huge number of diet foods, which allow the child to eat the same as peers. And being like the others is something that counts a lot for the little ones and for the teenagers”, says doctor Walter Minicucci, president of the Brazilian Society of Diabetes (SBD). He adds: “The bans are also much lighter due to new types of insulin and treatment strategies, syringes for insulin application are currently equipped with very short needles, which do not hurt, as well as the devices can monitor blood glucose with just a small drop of blood, which means a practically painless sting. Thus, something that was painful is no longer. According to Calliari, every effort was made so that diabetics could gain quality of life and not feel restricted or isolated. “The limitations are getting smaller and smaller, and they can eat whatever delicious food they want and do pretty much anything.”

And the school?

The lives of children with diabetes have improved a lot, but the same cannot be said about their daily lives at school. The lack of knowledge about the disease – either on the part of management and teachers, or on the part of colleagues – and the fear of taking a wrong step are still the biggest thorns in the shoe. “The children spend most of their time there. For the parents, it’s a struggle, as they need to be assured that she will be taken care of, which doesn’t always happen”, says Denise.

Lisandra Paes, pedagogical coordinator of the municipal school Prof. Derville Allegretti, in the Santana district of São Paulo, admits that the vast majority of professionals do not know what diabetes is. “Far less know how to recognize the symptoms of low blood sugar, which requires immediate action. In the case of public schools, this is even worse, as no action – be it treating hypoglycemia, or giving insulin, because the glycemia is high – can be done within the premises. It is necessary to resort to a Basic Health Unit (UBS), and, almost always, the child is advised not to return to the classroom that day.”

It was with a view to raising awareness among teachers and students and preparing the school to deal with the disease that the IDF, together with the ADJ and the pharmaceutical company Sanofi, launched the Kids project in August. “First, it was implemented at the Prof. Derville Allegretti, which served as a pilot, and will now be taken to 14 more schools – 13 in the state of São Paulo and one in Ceará”, says Denise. The material, with a playful approach, was made for different target audiences: students of different age groups, teachers and parents. “We are not going to talk only about type 1 diabetes, but also about the importance of having a healthy life, eating well and moving around to avoid obesity and type 2 diabetes”, says the endocrinologist. “Everyone must have access to care and support and the right to be included and safely participate in school activities,” says David Chaney, senior education specialist at the IDF.

Your doubts solved

What is hypoglycemia?

Sugar (glucose) is the body’s main source of energy. Thus, if the body’s fuel is lacking, it is natural for it to suffer. Shaking hands, sweat, mental confusion, irritation and tachycardia are some of the most common symptoms, but not in children. “It’s more difficult to notice the signs in a child, because he often hasn’t learned to identify them. Generally, they are more irritable and sleepy or cry”, explains Luis Eduardo Calliari.

Low sugar rates usually happen when the child has exercised without eating or even if he has eaten very little. It is good to remember that, in the same way that the body works basically fueled by glucose, so does the brain. A severe episode of hypoglycemia can make the child faint or have a seizure.

What is hyperglycemia?

It is the opposite of hypoglycemia, i.e. high blood sugar levels. It is one of the leading causes of death among children with diabetes. Such high levels of blood glucose can happen in some situations: when the child has the disease, but has not yet been diagnosed; when control is poor; or as a result of some other illness or use of certain medications, which can cause blood glucose to rise. Symptoms include thirst, weight loss, tiredness, frequent trips to the bathroom to pee (the kidneys work harder to eliminate excess sugar from the blood) and dry mouth. If hyperglycemia is not controlled, it can lead to nausea, vomiting, confusion and even coma. But it’s pretty easy to treat. Just give enough insulin to bring the sugar levels down and give the child plenty of water.

Should I tell my son he has diabetes?

Honesty is always the best policy. By knowing the condition that he carries, it is easier to ask for help when presenting a hypoglycemia or ketoacidosis – when there is a lack of insulin and the body cannot use glucose as a source of energy, cells use other pathways to maintain their functioning. Of course, the illness must be explained in language that is easily understood. Health professionals who deal with diabetes or entities like ADJ can help you with this.

What is Carb Counting?

It is one of the strategies for planning your diet and keeping blood sugar levels as close to normal as possible. The method revolutionized the treatment of diabetes. It is enough to count the grams of carbohydrate consumed in the meal and make a simple calculation (it is the doctor who will determine which account this is) to know how much insulin should be applied to cover what was ingested. Thus, we no longer talk about diabetic food or diet. Carbohydrate counting, which accompanied the emergence of new types of insulin, allowed those with the disease to eat virtually anything they wanted.

Can my child do any sport?

You can, as long as you monitor your blood sugar beforehand and eat. If the activity is demanding and takes a long time (a football match, for example), it is important to measure the blood sugar level at halftime, for example, and, if necessary, eat before it starts again.

Can my child go blind because of diabetes?

As with any chronic disease, which needs to be monitored throughout life, complications are the result of good or bad control. But, according to Doctor Minicucci, with the arrival of more modern insulins, disease control has improved a lot. “Now, adolescence is, in fact, the most complicated phase, as young people often do not accept the procedures and end up making the treatment difficult.”

When can my child start self-monitoring?

“From the age of 8 or 9, the child can already do the finger tip alone, always with the supervision of an adult”, explains doctor Denise Franco, director of ADJ. Around age 12, she will also be able to inject insulin on her own, also with supervision. Upon reaching adolescence, young people are already able to take control of their treatment.