Useful to students

1. COMPLICATIONS OF DIABETES -
PAEDIATRIC AND ADOLESCENT

2. • Diabetes (diabetes mellitus) is a chronic and
potentially life-threatening condition characterised
by the body losing its ability to produce insulin or
beginning to produce or use insulin less
efficiently.
• Diabetes comes with various challenges,
especially for young people. But, with early
detection, children and teens can learn to manage
diabetes and stay as healthy as possible.
• Type 1 diabetes is much more common in young
people than type 2 diabetes. However, the rates of
both types in young people are increasing.

3. • In 2014–2015, doctors diagnosed type 1 diabetes
in around 18,291 young people aged 10–19 years
and type 2 diabetes in around 5,758 young people.
• The National Institutes of Health (NIH)Trusted
Source report that, each year, rates of type 1
diabetes are rising by 1.8% and rates of type 2
diabetes are rising by 4.8%.
• The National Diabetes Statistics Report 2020
Trusted Source states that around 2,10,000
children and teenagers under the age of 20 years
in the United States have diagnosed diabetes.

4. • Type 1 and type 2 diabetes are different conditions,
but they both affect the body’s use of insulin.
Although type 1 is more common in young people,
both types can affect children and teenagers.
• Type 1 diabetes in children, previously called
juvenile diabetes, occurs when the pancreas is unable
to produce insulin.
• Without insulin, sugar cannot travel from the blood
into the cells and high blood sugar levels can occur.
• People can develop type 1 diabetes at any age, from
early childhood to adulthood, but the average age at
diagnosis is 13 years.
• An estimated 85%Trusted Source of all type 1
diagnoses take place in people aged under 20 years.

5. • Type 2 diabetes is less common in young children,
but it can occur when insulin is not working
correctly. Without enough insulin, glucose can
accumulate in the bloodstream.
• The chance of developing type 2 diabetes
increases as people get older, but children can also
develop it.
• The rates of type 2 diabetes are increasing along
with increases in childhood obesity.
• Young people who develop diabetes have a higher
risk of health challenges throughout their life.

6. • Complications of diabetes in paediatric and adolescent can
include:
 Heart and blood vessel disease. Diabetes increases child's
risk of developing conditions such as narrowed blood
vessels, high blood pressure, heart disease and stroke later
in life. People with diabetes have an increased risk of
getting vascular disease at an early age.
 Kidney damage: Diabetes can damage the numerous tiny
blood vessel clusters in the kidneys that filter waste from
child's blood. The kidneys act as a filter for our bodies,
passing waste into the urine to be removed from the body.
Nephropathy refers to kidney damage associated with
diabetes. Most at risk are people who have consistently
high blood glucose levels or very erratic blood glucose
levels over a long period of time.

7. Eye damage Diabetes can damage the blood
vessels of the eye's retina, which may lead to
vision problems. Retinopathy occurs when there is
damage to the retina. The retina is the thin layer of
tissue at the back of the eye. It contains small
blood vessels and nerve endings for vision. Other
diabetes related eye conditions which can occur
are cataracts and blurred vision. Regular screening
will help to minimise any damage.

8. Osteoporosis: Diabetes may decrease bone
mineral density, increasing child's risk of
osteoporosis as an adult.
Nerve problems: Neuropathy refers to nerve
damage associated with diabetes. Again, most at
risk are people who have consistently high blood
glucose levels over a long period of time. Excess
sugar can injure the walls of the tiny blood vessels
that nourish child's nerves. This can cause
tingling, numbness, burning or pain. Nerve
damage usually happens gradually over a long
period of time.

9. Foot problems: Foot problems, due to decreased
blood flow or nerve problems are unlikely to
occur in children or young people. But, feet need
to be well cared to prevent problems in later life.
Podiatrists (people who treat foot disorders) can
help.
Hypertension: This increases the risk of heart
attacks and strokes. Blood pressure should be
checked at time of diagnosis and at least once a
year.
Cholesterol or lipids: Cholesterol is a fat
substance that is naturally present in blood and
cells. High cholesterol increases the risk of heart
attacks and strokes.

10.  Auto-immune conditions (thyroid disease and coeliac
disease): People with type 1 diabetes have a higher risk of
developing other auto-immune conditions. Screening blood
tests are at diagnosis then every year for the first 5 years,
then every 2 years.
 Diabetic ketoacidosis (DKA): DKA is caused by an
overload of ketones present in the blood. It is a serious
complication of diabetes that can be life-threatening. DKA
is most common among people with type 1 diabetes. People
with type 2 diabetes can also develop DKA. DKA develops
when the body doesn't have enough insulin to allow blood
sugar into the cells for use as energy. It is common among
patients with known type 1 diabetes. It develops in about 1
to 10% of patients each year, usually because they have not
taken their insulin. Clinicians can help minimize the effects
of risk factors by providing education, counseling and
support.

11. Mental health issues: Very common among
children with diabetes and their families. Up to
half of children develop depression, anxiety or
other psychologic problems. Eating disorders are
a serious problem in adolescents, who sometimes
also skip insulin doses in an effort to control
weight. Psychologic problems can also result in
poor glycemic control by affecting children's
ability to adhere to their dietary and/or drug
regimens. Social workers and mental health
professionals (as part of a multidisciplinary team)
can help identify and alleviate psychosocial
causes of poor glycemic control.

12. Skin and mouth conditions: Diabetes may leave
people more prone to skin problems, including
bacterial and fungal infections.
Hearing impairment: Hearing problems are
more common in people with diabetes.
Alzheimer's disease: Type 2 diabetes may
increase the risk of dementia, such as Alzheimer's
disease.
Depression related to diabetes: Depression
symptoms are common in people with type 1 and
type 2 diabetes.

13. Complications of gestational diabetes:
• Most women who have gestational diabetes deliver healthy
babies. However, untreated or uncontrolled blood sugar levels
can cause problems for both mother and baby.
• Complications in the baby can be caused by gestational
diabetes, including:
 Excess growth: Extra glucose can cross the placenta. Extra
glucose triggers the baby's pancreas to make extra insulin. This
can cause baby to grow too large. It can lead to a difficult birth.
 Low blood sugar: Sometimes babies of mothers with
gestational diabetes develop low blood sugar (hypoglycemia)
shortly after birth. This is because their own insulin production
is high.
 Type 2 diabetes later in life: Babies of mothers who have
gestational diabetes have a higher risk of developing obesity and
type 2 diabetes later in life.
 Death: Untreated gestational diabetes can lead to a baby's death
either before or shortly after birth.

14. Lifestyle modifications: Lifestyle modifications
that benefit all patients include:
– Eating regularly and in consistent amounts
– Limiting intake of refined carbohydrates and saturated
fats
– Increasing physical activity