More and more children are developing type 1 diabetes
Keyla is nine years old. She wet the bed that night. Even though she has long been dry. Keyla has had to pee constantly for five days. Her urine volume has increased and she is always thirsty. Yesterday she drank almost four litres, her mother notes. The next day, her father returns from a week-long business trip and notices that Keyla has lost a lot of weight. Her cheeks are sunken, she looks tired and ill. They go to the paediatrician - the diagnosis is a shock: Keyla has diabetes, the most common metabolic disease in children. She has to go to hospital. Nothing seems to be the same for the family. Diabetes is a chronic disease that can be treated but cannot be cured.
Act quickly
«Diabetes has three main symptoms,» explains Prof. Dr Urs Zumsteg, paediatric diabetologist at the University Children's Hospital Basel: «Those affected excrete more urine, drink litres and lose weight.» As the sugar can no longer be utilised in the body, it is excreted via the urine, where it binds a lot of water. «In technical jargon, we speak of osmotic diuresis,» says Zumsteg. The children compensate for the loss of water by drinking more, but this only works for a short time. According to Zumsteg, diabetes 1 develops very quickly, so that without treatment there is a risk of death within two weeks. As with Keyla, the diagnosis is usually made by the paediatrician or family doctor, who refers the children to a diabetologist. Many have to be hospitalised first to treat the loss of fluids with infusions and to adjust the insulin therapy. At this point, Vreni Ritschard, a diabetes consultant at the University Children's Hospital Basel, gets to know the children.
Type 1 diabetes can be fatal within two weeks without treatment.
She explains how to use insulin, how to measure blood sugar, the connection with food and what to do in the event of hyperglycaemia or hypoglycaemia. Type 1 diabetes mellitus is an autoimmune disease in which the body's defence cells specifically destroy the insulin-producing beta cells of the pancreas. It is not entirely clear why this happens. Experts assume that a combination of a genetic risk constellation and stress on the immune system following an infection is the trigger. According to the specialist journal «The Lancet», childhood diabetes is on the rise virtually everywhere in the western world. A study by the University of Belfast showed that the number of new cases of diabetes 1 in Europe is increasing by almost 4 per cent every year. In children under the age of five, the figure is even 5.4 per cent.
Is it due to hygiene?
Experts are puzzling over the reasons. Theories revolve around the connection between hygiene standards and autoimmune diseases. It has been observed, for example, that the number of immune diseases has risen with the improvement of hygienic conditions in everyday life. Various studies indicate that our defence system is increasingly overwhelmed by the artificial substances it comes into contact with on a daily basis. As a result, it is increasingly reacting against natural substances, even against its own cells. Similar theories also exist for allergic diseases such as hay fever or asthma, the frequency of which is also increasing. But there are also other study theories. One states that the less worm infections occur in children, the more frequently autoimmune diseases are diagnosed. This could also have something to do with the maturation of the immune system. «The answer to the question of why type 1 diabetes is increasing in children is worthy of a Nobel Prize,» says Thomas Danne, Chairman of the Board of Deutsche Diabeteshilfe, in an interview with Die Welt.
Genes and obesity
«In type 2 diabetes mellitus, also known as adult-onset diabetes, genetic predisposition plays a much greater role than in type 1 diabetes,» says Zumsteg. For example, the probability of both identical twins developing type 1 diabetes is around 30 per cent, whereas for type 2 diabetes it is almost 100 per cent. The risk gene constellation for type 2 is also more common in people of African, Hispanic or Asian descent. Central Europeans have this risk constellation much less frequently.
It is more expensive, but those affected have a normal quality of life and life expectancy.
Obesity is also partly responsible for the disease. Although Swiss children have also gained weight in recent years, there is no diabetes 2 epidemic among children and adolescents in this country, says Zumsteg. This is also evident in his outpatient clinic: «I look after 300 children and adolescents with type 1 diabetes, but only 3 with type 2 diabetes, none of whom are Central European.» According to Zumsteg, type 2 diabetes is already an issue among children and adolescents in America due to the different races. But not in Switzerland. According to the latest health promotion monitoring programme, obesity in children is on the decline again.
Avoid late damage
The treatment of type 1 diabetes aims to replace insulin in the body as naturally as possible. «Today, we treat with five doses per day: two basal injections in the morning and evening and three injections with each main meal,» explains Vreni Ritschard. As insulin is a protein hormone, it has to be injected, because in tablet form it would be broken down in the gastrointestinal tract by the digestive enzymes, explains Zumsteg. Administration forms are injections or pumps. In addition, nutritional counselling is provided so that the child learns how to deal well with carbohydrates in the diet and insulin therapy. The better the sugar balance is adjusted, the less consequential damage diabetes causes. Phases of life such as puberty, when hormones are on a rollercoaster and blood sugar levels are often on a rollercoaster too, can be a challenge. Vreni Ritschard says that a diabetes diagnosis affects the whole family. The Basel team emphasises that the aim is to enable everyone involved to lead an almost normal life. «It takes more effort in everyday life, but those affected now have a normal quality of life and life expectancy,» says Zumsteg. «A child with diabetes can and should do everything!»
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Insulin
Insulin is needed to break down carbohydrates and utilise them as energy. The hormone is produced in the beta cells of the islets of Langerhans in the pancreas. If the production or mode of action of insulin is impaired, this is referred to as diabetes with the two main types diabetes 1 and diabetes 2. Experts like to use the keyhole mechanism to explain this: in diabetes 1, insulin, the key, is missing and must be replaced. In diabetes 2, the lock is jammed and the insulin no longer works properly. Without treatment, the blood sugar level fluctuates, which can be life-threatening.
The forms of diabetes in brief
Diabetes mellitus type 1 Insulin deficiency (autoimmune disease):
- Eigene Abwehrzellen zerstören die insulinproduzierenden Betazellen.
- Tritt akut vor allem bei Kindern und Jugendlichen auf.
- In der Schweiz gibt es etwa 15 000 Betroffene, 1 von 1200 Kindern hat heute diesen Diabetes.
- Eine lebenslange Insulintherapie sowie Unterstützung durch spezialisierte Ärzte, Diabetesfachpflege und Ernährungsberatung sind nötig.
Diabetes mellitus Typ 2 Insulinresistenz:
- Die Ursachen sind eine genetische Veranlagung, verbunden mit einem ungesunden Lebensstil mit mangelnder Bewegung und Übergewicht.
- Tritt gehäuft in zunehmendem Alter auf.
- In der Schweiz gibt es etwa 250 000 Betroffene, laut Experten besteht eine hohe Dunkelziffer. Therapie mit einer Kombination von Medikamenten und gesunder Ernährung, regelmässiger körperlicher Aktivität und Gewichtsreduktion.
