Dr Tariq Jagnarine
Family Medicine, Endocrinology and Diabetes

Each year, World Diabetes Day is commemorated on the 14th November, to raise awareness about the disease, the impact on people’s health and wellbeing and the effective strategies that can be used to prevent and control it. This year is a unique one with the COVID-19 pandemic, which has caused many challenges, including for people living with diabetes and for their health care providers. The World Diabetes Day 2020 theme is “Diabetes: Nurses make the difference” to highlight the crucial role that nurses play in supporting people living with diabetes

The main symptoms of type 2 diabetes include:
• Urinating more often, especially at night
• Increased thirst
• Tiredness
• Unexplained weight loss
• Itching around the genitals, possibly with a yeast infection
• Slow healing of cuts or wounds
• Blurred vision as a result of eye dryness
• Development of dark, velvety patches of skin, called acanthosis nigricans and a sign of insulin resistance.
• Polycystic ovary syndrome is another condition frequently associated with insulin resistance, though it is not a sign of diabetes but 50% of the cases develop diabetes eventually.

One of the most serious consequences of undiagnosed type 1 diabetes is Diabetic ketoacidosis (DKA).
When a child does not receive treatment for type 1 diabetes, they may develop DKA. Type 2 diabetes can also lead to DKA, but this is rare. DKA is a severe and life threatening condition that requires immediate treatment. If insulin levels are very low, the body cannot use glucose for energy. Instead, it begins to break down fat for energy. This leads to the production of chemicals called ketones, which can be toxic at high levels. A build-up of these chemicals causes DKA, wherein the body becomes acidic.
Early diagnosis and effective management of diabetes can prevent DKA, but this is not always possible. DKA is more common among children with an incorrect, and therefore delayed, diagnosis of type 1 diabetes.
Without treatment, type 2 diabetes appears to progress faster in young people than in adults.
Younger people also seem to have a higher risk of complications, such as
• Kidney Failure
• Eye disease – Diabetic retinopathy
• High blood pressure
• High cholesterol levels,
• Heart Problems
Type 2 diabetes in children often occurs with obesity, which may contribute to these risks been higher. Obesity affects the body’s ability to use insulin, leading to abnormal blood sugar levels. Because of this, early detection of type 2 diabetes and attention to managing overweight and obesity in younger people are crucial. This may include encouraging children to follow a healthful diet and get plenty of exercise.

Any child with signs or symptoms of diabetes should see a doctor for screening. This may consist of a urine test to look for sugar in the urine or a finger-prick blood test to check the child’s glucose levels.
The National Institute for Health Care and Excellence recommend testing children for diabetes if they:
• Have a strong family history of type 2 diabetes
• Have obesity
• Are of Black or Asian family origin
• Show evidence of insulin resistance, such as acanthosis nigricans
The outcomes for children with type 1 or type 2 diabetes improve greatly with early detection.
It is not currently possible to prevent type 1 diabetes, but type 2 diabetes is largely preventable.
The following steps can help prevent type 2 diabetes in childhood:
• Maintain a moderate weight: Overweight increases the risk of developing type 2 diabetes, as it increases the chance of insulin resistance.
• Stay active: Keeping physically active reduces insulin resistance and helps manage blood pressure.
• Limit sugary foods and beverages: Consuming lots of foods that are high in sugar can lead to weight gain and problems with insulin function. Eating a balanced, nutrient-rich diet — with plenty of vitamins, fibre, and lean proteins — will lower the risk of type 2 diabetes.
Diabetes rates in childhood and adolescence are rising. Type 1 diabetes is much more common in young people than type 2 diabetes, but the rates of both types are increasing worldwide. In most cases, people can manage the symptoms of both type 1 and type 2 diabetes with a healthful diet, regular exercise, and medications. When they control the condition well, people with diabetes can live full and healthy lives.