A Unique Child: Health - Diabetes risk rises

A sharp rise in emergency admissions of children for diabetes treatment has raised concerns that the condition is going undiagnosed or being poorly managed. According to the latest statistics from the NHS Information Centre, emergency admissions for under-18s with diabetes rose by 8 per cent to 3,300 in the year to March 2007.

Of further concern was the high number of children being admitted with diabetic keto-acidosis (DKA), a life-threatening condition occurring when a person's blood glucose levels are dangerously high, causing nausea, vomiting, stomach pains and ultimately loss of consciousness.

NHS figures showed that under-18s accounted for more than a quarter of the 12,326 hospital admissions for DKA over the same period.

Diabetes UK believes the increases stem in part from cuts to paediatric specialist services. The charity's survey into the caseloads of paediatric diabetes specialist nurses (PDSN) found that each was dealing with 150 to 300 children, compared with what was seen as a manageable 70.

Among PDSNs' broad-ranging responsibilities is their important educational role in teaching children, their families and professionals - including a child's school or nursery staff - about managing the condition.

'It is crucial that the Government is aware that cutting services can impact on so many facets of diabetes management,' says Diabetes UK care adviser Caroline Butler. 'Diabetes is a very complex condition and people need as much information and support as they require.'

With 2.3m people in the UK already diagnosed with diabetes and £5bn of annual NHS spending dedicated to treating it and its related conditions, diabetes cannot be ignored.

Cathy Moulton, care advisor at Diabetes UK, says, 'Diabetes is a serious condition that can lead to devastating complications such as heart disease, kidney disease and blindness.'

Type 1 is the most common form of diabetes in children, with 90-95 per cent of under-16s having diabetes of this kind. It develops when the pancreas cells stop making insulin, leading to a build-up of glucose in the blood, and is treated by insulin injections along with a healthy diet and regular exercise. Its cause is not fully understood, though it probably involves a combination of genes and environmental triggers.

The condition is uncommon but still affects 20,000 children under 15, marking a threefold increase in the number of cases in the last 30 years.

Children are now no longer immune from Type 2 diabetes, which is caused by insulin resistance and accounts for around 90 per cent of all cases. Strongly associated with obesity, it has now been found in children as young as seven.

'There are 1,400 known cases of Type 2 diabetes in children, all of them directly attributable to poor diet and lack of physical exercise,' says Ms Moulton.

Type 2 diabetes is treated first by a healthy diet and tablets and, in many instances, insulin injections as the disease progresses.

PARTS TO PLAY
Identification
Signs and symptoms of diabetes in a child are:
- Increased thirst
- Urinating often, especially at night
- Extreme tiredness
- Weight loss
- Blurred vision
- Slow healing of wounds.

In Type 1, signs and symptoms are usually obvious, develop quickly and may lead to DKA. In Type 2, they are less obvious or even non-existent.

Management

If a child with diabetes is in your care, read up on the condition, for although it cannot be cured, it can be treated successfully with the right support. One source of information is www.medicalconditionsatschool.org.uk, a joint initiative between several charities including Diabetes UK, Asthma UK and the Cystic Fibrosis Trust. The site, aimed at school staff but useful too for early years settings, provides advice on medical conditions and how to provide a safe environment for children with these conditions.

Cathy Moulton says, 'It is important that nursery staff work with the child's Paediatric Diabetes Specialist Nurse and with the family to put together a healthcare plan that will ensure that a child with diabetes gets the best possible care both at home and at school. The PDSN will also be able to give the necessary training to ensure that staff can help the child with blood glucose monitoring and injecting insulin if needed.'

Prevention

And with Type 2 diabetes clearly linked to unhealthy lifestyles and 100,000 new cases every year, 'when it comes to preventing Type 2 diabetes, early years practitioners have a crucial role to play,' says Ms Moulton. 'By encouraging children to eat healthily and promoting physical activity, early years practitioners lay a foundation of good habits that will help children become healthy adults.'

More information

- Diabetes UK, www.diabetes.org.uk. For enquiries to Careline, call: 0845 120 2960

- The Anaphylaxis Campaign, www.anaphylaxis.org.uk

- Medicalconditions atschool.org.uk.