Professor Abdoulaye Leye, diabetologist: “Ketoacidosis is today the leading cause of death from childhood diabetes in our region” (2/2)
Behind signs that we often mistake for simple malaria or gastro, undiagnosed diabetes is sometimes hidden. Professor Abdoulaye Lèye, diabetologist at the Pikine National Hospital, explains how to recognize it in time and why so many children still arrive at the emergency room too late. A delay which, he says, is sometimes paid at a high price.
What is type 1 diabetes and how does it manifest in children?
The sugar we eat passes into the bloodstream as glucose. To enter cells and serve as fuel, this glucose needs a key: insulin, a hormone made by the pancreas. Diabetes is blood too high in sugar because this key is missing or malfunctioning. In children, in the vast majority of cases, the key is completely missing. The body’s defense system, which is supposed to fight microbes, mistargets and destroys the cells of the pancreas that produce insulin. This is type 1 diabetes. It is not caused by what the child ate. He can’t make up for it with a diet. It is treated with insulin every day from diagnosis.
What are the first signs that should alert parents?
The first signs are always the same. The child drinks a lot, day and night. He urinates a lot. A clean child starts wetting the bed again. He loses weight even though he eats, sometimes more than usual. He is tired, without enthusiasm. These four signs, combined in a child, should have blood sugar measured the same day. If no one reacts, the body, deprived of fuel, burns its fats and produces acetone. The child vomits, complains about his stomach, breathes quickly and heavily, his breath smells like overripe apples, he becomes drowsy. It’s ketoacidosis, a life-threatening emergency.
Can these symptoms be confused with other common childhood illnesses?
Yes, and this is the primary cause of delay. The signs of decompensated diabetes resemble the most common childhood illnesses. Vomiting and a painful stomach suggest gastroenteritis, appendicitis or malaria. Rapid breathing suggests pneumonia or an asthma attack. Drowsiness suggests meningitis or serious malaria. Weight loss and fatigue suggest malnutrition or tuberculosis. The child receives treatment for these illnesses, sometimes a glucose serum infusion, and his condition worsens.
What is the simple rule that should make it possible to avoid missing the diagnosis?
The rule that avoids these tragedies can be summed up in one sentence: any child who is vomiting, breathing quickly or is drowsy must have blood sugar measured before any other examination. It applies to the health post as well as to the large hospital.
What happens when the diagnosis is made late?
Symptoms usually set in within two to four weeks. In countries where parents and doctors are aware of the disease, the diagnosis falls within this time, before ketoacidosis, in the majority of children. With us, the delay is longer and above all, a large proportion of children already arrive in ketoacidosis.
Why is this situation particularly worrying?
When the delay is too long, the child arrives in intensive care. Ketoacidosis kills by dehydration, by heart rhythm disturbance, by brain edema. Those who survive sometimes have neurological after-effects. And a child who came close to death at diagnosis begins his journey with a traumatized family; which weighs on years of follow-up.
Once diagnosed, what does type 1 diabetes change in the life of the child and their family?
In children under 10 years old, diabetes is almost always type 1. Insulin is essential from day one and for life. No tablet replaces it. The support also differs on three points. First, the child grows: his insulin needs change with height, weight, puberty, an infection, a day of play. The doses are constantly readjusted. Then, a small child does not know how to recognize or say that he has hypoglycemia, that is to say that his sugar has dropped too low. It is the parents who must spot it. Finally, the whole family carries out the treatment: injections, sugar measurements, meals, school. An adult takes care of themselves, a child is cared for by their parents for years.
How do children gradually learn to manage their illness themselves?
Bad at first, then better and better if the adults hold on. A little child doesn’t understand why those who love him hurt him several times a day. He cries, he struggles, he hides at injection time. Parents feel guilty and sometimes give in by skipping a dose. This is the hardest period. It lasts a few weeks to a few months.
When does the child begin to gain independence?
Around age seven or eight, many children measure their own blood sugar levels and are proud to do so.
What promotes this autonomy?
What helps: quick and sure actions, always done in the same way, by a calm parent. Insulin pens rather than syringes, which have thinner needles. A ritual after the injection, a game, a song. Let the child choose the injection site, hold the cotton, press the button of the pen when he is older.
How can we prevent injections and checks from becoming a permanent source of tension for the child?
What damages: the injections given on the sly, the child being held by force, the threats and above all the fact of hiding the illness. A child who has to hide to inject himself learns that he is ashamed of himself. Brothers and sisters also matter: they feel neglected or are afraid of catching the disease. You have to talk to them. Parents need to be supported as much as the child. Parental burnout is real after months of waking up at night to control sugar. Family associations and education days organized by monitoring centers are there for this purpose.
What role does diet play in the management of type 1 diabetes?
For type 1 diabetes, sugar does not destroy pancreatic cells. A child who has never tasted candy can develop type 1. Telling a mother that her child is diabetic because she gave him sugary foods or juices is false. This shortcut adds guilt to the illness.
Should certain foods be banned from diabetic children?
The diabetic child remains above all a child. His needs are those of every child, because he must grow up. The hardest part is telling him no. A child will never let himself starve: if we take away his rice, he will turn to chips and sweets.
How to reconcile the constraints of illness with a normal child’s life?
What I tell parents: water rather than juice, fruit rather than biscuits, family meals rather than snacks.
What are the main risks to which a diabetic child is exposed on a daily basis?
A small child does not know how to recognize or say that he has hypoglycemia, that is to say that his sugar has dropped too low. It is the parents who must spot it.
In what situations can the vital prognosis be engaged?
At three times. At diagnosis, by ketoacidosis, when the disease was not recognized in time. It is today the leading cause of death from childhood diabetes in our region. During follow-up, by insulin breakage. A family that no longer has the means, a pharmacy that is out of stock, a trip without reservation, a decision to stop treatment to try something else. Without insulin, ketoacidosis returns within a few days. At any time due to severe untreated hypoglycemia, especially at night or during illness that prevents the child from eating. These three causes have one thing in common: none is due to the disease itself. All are due to a lack of diagnosis, insulin or vigilance.
What are the difficulties that families face in daily monitoring?
The first is insulin itself. A child who no longer has insulin dies within a few days to a few weeks. We therefore need an uninterrupted supply, a cold chain and money each month. The second difficulty is less visible: the strips for measuring sugar. A child should check their blood sugar four times a day. Over a month, the strips often cost more than insulin. Many families reduce measures to save money and the child lives with poorly regulated sugar levels. The third is follow-up. Diabetes in children requires a consultation every three months, a measurement of glycated hemoglobin, and an annual check-up.
What role should the school play in caring for a diabetic child?
A decisive role and often poorly performed. A child spends six to eight hours a day at school. During this time, he may experience hypoglycemia: sweating, paleness, tremors, hunger, confusion, then loss of consciousness if no one reacts. He may also need to drink, go to the toilet, eat a snack at a specific time, or take an injection before lunch. The school must therefore know.
What simple precautions can the establishment take?
Parents give the teacher or director a simple sheet: what diabetes is, the signs of hypoglycemia, what to do, three cubes of sugar or a glass of sugar water and who to call. A box with sugar remains in the classroom, in the child’s name. The child is never deprived of sport, water or toilets.
What complications can appear in the long term when diabetes is poorly controlled?
Poorly controlled diabetes damages small vessels and nerves. After 10 to 15 years of too high sugar levels, it affects the eyes to the point of blindness; kidneys until dialysis; the nerves of the feet until amputation; the heart and arteries. There are complications specific to the child. Poorly controlled diabetes slows growth and delays puberty. Repeated severe hypoglycemia in a child under six years old, whose brain is still developing, leaves its mark on memory and learning.
Interview conducted by Yaya Sow (Intern)
