Increasing Prevalence of Diabetes in Children
November 14th is observed in India as children’s day. Celebrated on the birth anniversary of India’s first prime minister Jawaharlal Nehru as a tribute, children’s day highlights the rights, care and education of children.
November 14th is also world diabetes day, observed internationally to create more awareness on diabetes mellitus.
Coincidence may be, but one which persuades us to be more aware of the growing incidence of diabetes in children and act upon it, to ensure the right of children for a healthy and wholesome life.
The number of children who are diagnosed with diabetes is increasing worldwide. Some studies say that the prevalence is such that one in every 350 children under 18 is affected by diabetes. (1) The incidence of both types of diabetes is increasing, with more children under 5 years being diagnosed with type 1 diabetes and more youth between 15 and 19 being diagnosed with type 2 diabetes. Around one lakh new cases of diabetes in children under 15 were reported in 2019. (2)
What is Diabetes?
Diabetes is the condition when there is too much-unused glucose in the blood. It is caused either when there is a shortage of insulin in the body or when the body is not able to use insulin properly to metabolize glucose. Insulin is the hormone that regulates blood sugar by enabling cells to take up glucose and facilitating the storage of glucose in the liver. Insulin is produced by specialized cells in the pancreas.
There are two types of diabetes, namely type 1 and type 2:
Type 1 diabetes:
This condition is caused by the inability of the pancreas to produce enough insulin, usually because the insulin-producing cells are destroyed by the body’s own immune system. This is the most common type of diabetes in children and is called juvenile diabetes or insulin-dependent diabetes. Although this type of diabetes can occur at any age, it mostly manifests between 4-6 years of age. 10% of all individuals having diabetes have type 1 diabetes.
What causes type 1 diabetes?
Juvenile diabetes has a strong genetic link and environmental factors increase the risk.
Close relatives are at increased risk of diabetes (about 15 times the risk of the general population), with an overall incidence of 4 to 8% (30 to 50% in monozygotic twins). This is due to the involvement of multiple genes. Children at risk should be monitored for symptoms and risk factors should be avoided.
What are the symptoms of type 1 diabetes?
The most common symptoms of type 1 diabetes include:
- Abnormal thirst and dry mouth
- Sudden weight loss
- Frequent urination
- Lack of energy, tiredness
- Constant hunger
- Blurred vision
Confirmation is done by analyzing blood glucose levels.
Which factors increase the risk of Type 1 diabetes?
Some studies suggest that certain viral infections trigger the autoimmune reaction leading to juvenile diabetes in high-risk children. Another risk factor is obesity and an unhealthy diet which can cause both triggers and worsen type one diabetes.
Can Type 1 diabetes be treated?
There are no treatments to cure insulin-dependent diabetes. However, we can manage it by supplementing with an adequate amount of insulin and following an appropriate diet plan and exercise regimen.
Proper care and support should be given for such children to administer insulin at the correct time and more importantly for avoiding junk food and to follow a healthy diet plan.
Can Type 1 diabetes be prevented?
There is no conclusive evidence that insulin-dependent diabetes can be prevented. However, there is some evidence that overweight and a high growth rate in children are weak risk factors, indicating that a healthy lifestyle can be beneficial. That includes avoiding both over-eating and a sedentary lifestyle in children who are at high risk due to family history. Also adhering to a healthy diet with low sugars and high fiber, and leading active life is helpful.
Type 2 diabetes:
Formerly called non-insulin-dependent diabetes is caused when the body cells are unable to use the inulin, despite insulin being produced sufficiently. This type of diabetes is largely the result of excess body weight and physical inactivity. According to recent WHO reports, until recently, type 2 diabetes was seen only in adults but it is now also occurring increasingly in children, adolescents, so much so that in some parts of the world type 2 diabetes has become the main type of diabetes in children. The global rise of childhood obesity and physical inactivity is widely believed to play a crucial role.
What are the symptoms of type 2 diabetes?
Symptoms may be similar to those of type 1 diabetes but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen. Especially in children, the symptoms of type 2 diabetes are mild or nearly absent, leading to nondetection in the early stages.
Can Type 2 diabetes be treated?
Although the condition cannot be completely cured, Type two diabetes can be managed comparatively easier than type one diabetes with medicines, diet, and lifestyle modifications. Ayurvedic medicines are also proven to be very effective in treating type two diabetes.
Can Type 2 diabetes be prevented?
Type 2 diabetes is preventable by following a healthy diet, active lifestyle, and exercise.
How does Ayurveda views diabetes?
Diabetes is viewed as a metabolic disorder by modern science. This is a shift made within 20-30 years, from a previous concept that it is a ‘hormonal’ disease due to the involvement of insulin. Whereas ayurvedic texts, written around 2500 years ago, have identified diabetes as a metabolic disorder itself. In Ayurveda, diabetes comes under the broader category of ‘prameha’. ‘Prameha’ in Ayurveda covers disorders associated with ‘kapha’ dosha, causing an imbalance in fat metabolism and also in the urinary system. (5)
The causes of diabetes according to Ayurveda include overeating, especially sweet, salty and sour tastes, combined with a sedentary lifestyle. This clearly indicates the association of impaired blood sugar with fat and metabolic syndrome. The prognosis of diabetes affecting multiple organ systems is also explained, underlining the need for early intervention.
What are the treatment options for diabetes in Ayurveda?
A complete cure for diabetes mellitus may not always be possible, according to Ayurveda. Ayurvedic textbooks classify diabetes as one of the diseases which can be managed with medicines and lifestyle modification, even though a complete cure once and for all is not envisaged.
Treatment of diabetes in ayurveda involves herbal medicines, panchakarma and lifestyle modifications. While listing the treatment of diabetes, ayurveda painstakingly details the importance of diet and lifestyle modifications. Ancient options of very low carbohydrate, high fibre diet and physical exercises like walking long distance, digging wells etc are explained. (5) This goes in line with the modern research findings about the importance of exercise to reduce the insulin resistance and adhering to a low carbohydrate diet, even when medicines are used.
Importance of Ayurvedic lifestyle in present global situation:
One recommendation among the ayurvedic treatment for diabetes is the abandoning of luxury and adopting a simple lifestyle. Pertaining to the period when the texts are written, it includes leading an agrarian life, living with cows and doing manual farm labor, avoiding luxurious diets of the time like alcohol, milk, red meat etc. In modern times, a normal life involves the food and facilities which were considered luxuries in ancient times. As advanced human beings, we should enjoy all luxuries of life. But for the lifestyle to take a toll on health is not ideal and prevents us from the very idea of enjoying life. Thus, keeping a ‘mid path’ as recommended by Ayurveda while detailing tips for healthy living is the better option. Also since physical exercise from manual labor or farm life is not received, enough substitution of those with exercise regimes is important. Considering diet, in present times also, we should think about avoiding some of the luxury food items as many of those are poor in nutrition.
Why is diabetes on the raise among children?
As we saw above, overeating, a sedentary lifestyle, and obesity increase the risk for both types of diabetes. Childhood obesity is on the rise globally with about 20% of all children and adolescents being obese. (4) In 2019, an estimated 38.2 million children under the age of 5 years were overweight or obese.(3)
The abundance of food, especially those which are nutritionally poor choices are the main cause of childhood obesity. Human beings are genetically attracted to sweets, and children are more so. Other food choices younger citizens are attracted to, like burgers, fries, etc are also bad choices and can be considered junk food. Kids do not often get the information to make them aware of nutritional facts and consciously avoid junk food or reduce sweets. Promotions, advertisements, and availability make children select junk food over healthy alternatives. Time is another factor. Either because the parents are busy cooking healthy food or because the kids themselves are engaged with studies or extracurricular activities, they often settle for what is easily available and easy to consume.
Another factor is the sedentary lifestyle. The alternatives to physically engaging games, in the form of video games, virtual reality, etc are one of the hindrances. Academic projects and social media also prevent young adults from venturing out. The new normal with Covid 19 also has drastically reduced the options of games, physical activities in schools, etc.
What are the possible solutions to reduce the incidence?
Increasing health and nutrition awareness from a young age and restricting the availability of nutritionally poor food near schools and colleges is one method to prevent early-onset diabetes and obesity. Promotions of food with poor nutritional value have to be monitored. Ideally, nutritional values have to be displayed if foods are advertised.
Physical activities should be promoted in children. School curriculums have to give more importance to physical training and find ways to provide training to children suiting their physical capacity and needs. One way to do this is to group children of a class according to athletic capabilities and provide different training for each group. The present situation is that children with superior athletic skills are selected and trained for sports events. While this has to be continued, basic exercise, suiting individual requirements should be provided to all children.
There are also possibilities with using certain ayurvedic medicines to reverse insulin resistance and ensure faster recovery from childhood obesity.
Early detection of symptoms in the pre-diabetic stage can help to reverse the condition in type two diabetes and let the children be more healthy and active. Also, the trigger of Type one diabetes can possibly be delayed or prevented.
- Vagbhata, Ashtanga Hrudayam, Nidana Sthana, Premeha Nidana.