Complications
by Dr. Denis Daneman, MB BCh FRCPC, Chief of the Division of Endocrinology and Associate Director of the Research Institute for the Hospital for Sick Children and Professor of Pediatrics at the University of Toronto.
Children with diabetes are at risk for developing acute or short-term complications of their disorder. These include hypoglycaemia or low blood sugar reactions, and diabetic ketoacidosis (DKA).
Hypoglycaemia
Hypoglycaemia - also called low blood sugar; hypoglycemic reactions; hypos; insulin reaction or just reactions - occurs when the blood sugar falls below the normal range.
This may happen because:
- There is too much insulin given without enough food
- If the child misses or delays a meal or a snack for too long
- If the child does a lot of physical activity which uses up the available sugar
Early warning symptoms of low blood sugar include:
- Shakiness
- Sweating
- Hunger
- Tiredness
- Fear
The child will look pale. If not treated, symptoms may become more severe with the development of confusion, a seizure (convulsion) or unconsciousness (coma).
When symptoms are mild, it is easiest to treat hypoglycaemia by drinking about half a cup of juice or other sugary drink, like pop.
If it becomes more severe, a medication called glucagon may need to be injected.
Make sure that both you and your child are aware of the causes of hypoglycaemia and its symptoms so that hypoglycaemia can be avoided wherever possible.
Treat a hypoglycemic reaction as soon as the symptoms begin. Do not wait until it gets severe!
Discuss appropriate treatment of hypoglycaemia with your diabetes health care team.
Diabetic ketoacidosis (DKA)
Diabetic ketoacidosis, or DKA, develops when the amount of insulin available is not enough to keep the sugar in balance and prevent fat stores from being broken down. This may happen when diabetes is first diagnosed or later if either insulin doses are missed or if there is a severe infection that stresses the body.
DKA starts with increased thirst and urination and proceeds to vomiting, drowsiness and dehydration.
Treatment of DKA involves hospitalization and intravenous (into the vein) administration of water, insulin and salts to replace what the body is missing.
This situation can be life-threatening.
Most episodes of DKA and hypoglycaemia can be avoided by carefully following your diabetes routines: regular blood glucose checks, appropriate food intake and correct adjustments of insulin doses to maintain the balance.
Treatment of DKA should be discussed with your diabetes health care team.
Long-term complications
The full-blown chronic or long-term complications of diabetes (such as blindness and kidney failure) rarely, if ever, develop during childhood. However, it is during childhood that the risk of complications starts.
The most important way to prevent or delay the onset or progression of these complications is to keep in good health by:
- Controlling blood sugars well
- Leading an active lifestyle
- Not smoking
During the teen years it starts to be important to do certain tests to see if the earliest signs of these long-term complications may be developing, such as regular eye check-ups, blood pressure measurements and urine tests.
Screening for complications
A child with type 1 diabetes is at risk of developing complications from living with diabetes. Throughout childhood it is recommended to conduct regular assessment of growth, puberty and blood pressure.
Some of these complications due to diabetes include increased risk of:
- Heart disease
- High blood pressure
- Nerve damage
- Kidney disease
- Blindness
- Severe leg and foot problems
Minimizing blood glucose fluctuations and maintaining good diabetes control are the best ways to help avoid long-term complications in diabetes.
Eye Care
Diabetes is a leading cause of blindness
Diabetic retinopathy (eye damage) is rare in children with type 1 diabetes who are under 10 years of age. It is important to start to screen for eye damage by an ophthalmologist (eye specialist) annually five years after the onset of type 1 diabetes in children over 15 years of age.
Kidney Function Test
The kidneys can be damaged after living with diabetes for a number of years.
Fortunately, with good blood sugar control and normal blood pressure, there is a reduced risk of developing diabetes related kidney disease (diabetic nephropathy).
If the kidneys are affected, small amounts of albumin (a protein) are secreted in the urine. This is called "microalbuminuria".
Screening annually for microalbuminuria is recommended for people over 15 years of age with a five-year history of type 1 diabetes.
Foot Care
Foot problems are the most common complication of diabetes. Foot care education and regular examination of the feet are important elements of diabetes treatment, even in childhood.
When diabetes is first diagnosed, a diabetes nurse educator and a podiatrist can provide advice about foot care, foot hygiene and the correct footwear for the child.
Good blood sugar control is important in avoiding nerve damage and serious infections in the feet.
