Healthy Seed (19/02/21) (in Chinese)

Cultivate good living habits to prevent type 2 diabetes in children

Original Link：Cultivate good living habits to prevent type 2 diabetes in children

In the past, diabetes was a common chronic disease among the elderly, but in recent years, the number of children suffering from type 2 diabetes has been on the rise, which is a cause for concern. The main cause of type 2 diabetes is closely related to daily eating habits. Being overweight in children is a high-risk factor for type 2 diabetes. If blood sugar levels cannot be controlled, there is a greater chance of causing acute and chronic complications with serious consequences. Children can help prevent type 2 diabetes by maintaining a balanced diet, exercising more, and controlling their weight. The following is the correct information about type 1 and type 2 diabetes, broken down by Dr. Yau Ho-chung, medical consultant of the Children’s Diabetes Association and president of the Hong Kong Society of Paediatric Endocrinology, so that parents can have a deeper understanding of the true face of diabetes.

Type 2 diabetes among children in Hong Kong is on the rise

Diabetes is a chronic disease, most of which are type 1 or type 2 diabetes.

According to statistics from the Hong Kong Childhood Diabetes Register, from 1997 to 2007, the number of children with type 1 diabetes was an average of 2.2 new cases per 1 million people per year; from 2008 to 2017, the number was an average of 4.3 new cases per 1 million people per year. There was a easing trend from 2015 to 2017, and the figures are also lower than those in other Nordic countries such as Finland.

On the other hand, the number of children with type 2 diabetes was 1.27 new cases per 1 million population per year from 1997 to 2007; and 3.42 new cases per 1 million population per year from 2008 to 2017, indicating that the number of children with type 2 diabetes has increased more than that of children with type 1 diabetes.

In terms of age of onset, children with type 1 diabetes develop the disease at an average age of 10.5, while children with type 2 diabetes develop the disease at an average age of 14.7. In terms of the ratio of male to female patients, 56.5% of girls suffer from type 1 diabetes, while 51.9% of boys suffer from type 2 diabetes.

Two major types of diabetes

The cause of type 1 diabetes is a problem with the patient’s immune system, which leads to a decline in pancreatic function and insufficient secretion of insulin to control blood sugar stability, resulting in high blood sugar levels. Type 1 diabetes is caused by genetic and environmental factors. In terms of genetic factors, the incidence of type 1 diabetes in children in Hong Kong is lower than that in Nordic countries, indicating that Hong Kong children carry fewer pathogenic genes; in terms of environmental factors, studies have shown that when children are infected with enterovirus, there is a chance that their immune system will have problems and induce diabetes.

Patients with type 2 diabetes are not sensitive enough to insulin, so their pancreas needs to produce more insulin to effectively control blood sugar levels. Type 2 diabetes is caused by the patient’s daily living habits and obesity.

Early detection of typical symptoms

In terms of symptoms, sugar in patients with type 1 and type 2 diabetes accumulates in the blood and has to be excreted through urine, causing patients to urinate frequently and become thirsty.

Due to insufficient insulin secretion, the body cannot effectively convert sugar into energy and needs to break down fat and protein in the body to produce energy, causing the patient to lose weight abnormally.

Patients with type 1 diabetes and a small number of type 2 diabetes may also experience symptoms of ketoacidosis. Ketones are produced when the body breaks down fat. When excessive ketones accumulate in the body, ketoacidosis may occur, causing the patient to experience symptoms such as fatigue, shortness of breath, abdominal pain, nausea, vomiting, etc., and in severe cases, it may even lead to coma.

When parents notice that their children have typical diabetes symptoms such as frequent urination, thirst and weight loss, they should see a doctor as soon as possible for a blood test.

Type 1 diabetes: Four major treatment principles

In terms of treatment, there are four basic principles for controlling blood sugar in children with type 1 diabetes. Most children with type 1 diabetes control their blood sugar by injecting insulin before breakfast, lunch, dinner and bedtime every day; or by injecting insulin through an insulin pump to help children control their blood sugar.

The second principle is to monitor blood sugar. Children are advised to check their blood sugar levels by “sticking their fingertips” before breakfast, lunch, dinner and bedtime, or by using a 24-hour blood sugar monitoring device.

The third principle is to start with diet. Children with type 1 diabetes and their parents can make an appointment with a dietitian to learn and master the concept of carbohydrate exchange and learn to read the nutrition labels of packaged foods to choose suitable foods. Parents can also learn to use sugar substitutes to make desserts and other dishes suitable for diabetics, so as to establish balanced and healthy eating habits for children.

The fourth principle is to exercise. It is recommended that children do 30 minutes or more of exercise that they are interested in and of moderate intensity (i.e. sweating, rapid breathing and increased heart rate after exercise) every day, such as running, ball games and cycling.

In addition, patients may experience hypoglycemia after injecting insulin, so children and parents should also be aware of the symptoms of hypoglycemia and the correct way to deal with it.

Type 2 diabetes: oral medications for treatment

Children with type 2 diabetes can first control their blood sugar by exercising and adjusting their diet. If the above methods fail to control blood sugar, they will need to take biguanide hypoglycemic drugs. If the effect is still not satisfactory, they should consider injecting insulin or GLP-1 receptor agonists to control blood sugar.

Acute and chronic complications

If children cannot control their blood sugar well, it may lead to acute and chronic complications. For example, if children with type 1 diabetes do not receive enough insulin, they may develop the acute complication of ketoacidosis. If blood sugar remains high for a long time, it will cause chronic complications and affect the large and small blood vessels in the body. For example, affecting the blood vessels of the eyes will cause retinal disease, affecting the blood vessels of the kidneys will cause diabetic nephropathy, and affecting the large blood vessels of the lower limbs will cause peripheral vascular disease.

Prevention methods

Since type 2 diabetes is mainly caused by daily living habits and obesity, children should start with their daily living habits to prevent type 2 diabetes. It is recommended to exercise for 30 minutes or more every day and maintain a balanced diet to control weight and blood sugar.

Data provided by: Children’s Diabetes Association, Dr. You Kecong (Medical Advisor of Children’s Diabetes Association and President of Hong Kong Society of Paediatric Endocrinology)