The role of parents is decisive.But it is necessary to know how to face these problems with great lucidity.

Diabetes in children.How to recognize it and what advice can be given to parents?Il Corriere della Sera (February 21) presents, at nine points, the disease and how to behave when it occurs.

1 - What is type 1 diabetes mellitus

Type 1 diabetes mellitus is a chronic auto-inmune metabolic pathology in which the pancreas is not able to produce insulin.In Italy, around 20,000 children and adolescents live with diabetes mellitus.The incidence of this pathology is increasing throughout the world and is not surprising that today diabetes mellitus represents the most frequent endocrine disease of pediatric age (Source: Italian Society of Pediatrics).

2 - Excess glucose and urine

Unlike the most frequent type 2 diabetes in adult and secondary resistance to insulin, in the child the cause of hyperglycemia is the progressive reduction of insulin production due to the destruction of the basic auto-inmune pancreatic beta cells(The cells that within the pancreas are designated for the production of such hormones).

The progressive destruction of beta cells involves a slow but inexorable reduction in insulin production and, consequently, an excess of blood glucose (hyperglycemia) that is eliminated by the organism through urine (glucosuria).

3 - Symptoms

At the beginning of diabetes, glucosuria entails an increase in the frequency of urination and the amount of urine and the mother can be disturbed by the fact that the child wakes up more and more often at night to urinate.

In short, the characteristic symptoms of type 1 diabetes mellitus are at the beginning are:

- Intense thirst and frequent desire to urinate
- Weight loss quickly, despite the increase in appetite
- Loss of sugars in urine (glucosuria)

In the most advanced and most serious phase it is reached:

- Heavy and tiring breathing
- Acetonemic breath (with the smell of rotten or vinous apples)
- fatigue
- Sweatments, loss of consciousness

4 - Blood exam

The diagnosis of diabetes is done through simple blood tests that can be followed by a pediatrician study using a simple drop of blood or a urine sample.The presence, in fact, of hyperglycemia (values ​​greater than 125 mg/dl after an 8 -hour fast and/or greater than 200 mg/dl regardless of meals), of glucosuria and chetonuria are paradigmatic of diabetes.

5 - Hypoglycemia

Hypoglycemia (sudden fall in blood sugars with a blood glucose less than 70 mg/dl), is the most fearsome complication in young people with type 1 diabetes. It can be asymptomatic but, in the case where blood glucose descends rapidlyGive a characteristic symptomatology due to the activation of hormones against insulin regulators (glucagon and adrenaline).

Initial symptoms: paleness, sweating, tremors, hunger, palpitations, to which, if the condition persists, mental confusion, disorientation and weakness can be added.

In this phase it can still be controlled, drinking sugary liquids (a glass of a sugary drink or a fruit juice or a tablespoon of honey, which correspond to around 15 grams of sugar).

Regarding solids, it is better to have liquids because they fill their stomach more quickly, heading by “the path of water” so they reach more quickly to the first tract of the intestine, the duodenum, where they are absorbed.

6 - Hyperglycemia

Hyperglycemia is when the blood glucose level rises through a food too abundant, or having eaten "wrong" food, or by a concomitant disease (such asthe flu) or for having practiced an insufficient insulin treatment or by having skipped the treatment.

Alarm symptoms are: the need to urinate frequently, a lot of thirst, tiredness, cloud view, irritability, difficulty concentrating, headache.It is important to immediately control glycemia and perform an insulin supply, according to what the pediatric specialist advises.

If there is a presence of chetonuria or persistently high blood glucose with hyperchetonemia it is recommended to immediately notice the doctor.

7 - The treatments

The treatment of type 1 diabetes is based on the supply of insulin integrated into an individualized nutritional and physical activity program.Pediatric specialists agree on the fact that the therapeutic regime that provides three or four insulin supplies or subcutaneous micro-infuster, represent the best useful therapeutic approach to delay or prevent complications.

The four injections scheme called "Basal-Bolus", provides for the administration of basal insulin once a day, normally before going to sleep, and the administration of ultra-sword or fast human insulin bolus in the meals in calculable doses on the base on the baseof preprandial blood glucose and in the amount of carbohydrates consumed.

8 - Rules to follow

It is important that the person with diabetes follow some simple rules of life to achieve a good quality of life;Some are obvious and essential, others depend on the character and personality of each.

It is essential to regularly take medications;follow a correct diet, do physical activity;lose weight, if you are overweight, and seek not to gain weight;Maintain pressure and cholesterol levels under control, through diet, physical exercise and possibly resorting to medications prescribed by the doctor.

It is also important to perform annual controls of the organs that are the target of diabetes (eg, heart, kidneys);Perform screening of auto-inmune pathologies associated with diabetes (thyroiditis in 15% of cases, celiac disease in 6% of cases);carry out dental periodic controls;Control mouth hygiene after each meal (wash your teeth and use dental thread): diabetes, in fact, increases the risk of parodontopathy (gum infections).

We must often examine the feet, even between the fingers, after having washed with warm water and drying them, paying attention to the appearance of ampoules, small wounds, redness;Learn the greatest possible things about this condition and how to manage better.

9 - Parents

The communication of a chronic condition such as diabetes determines a destabilization in family life because, from the beginning, deep lifestyle changes are necessary for both the patient and the family, the more if they are children and/or adolescents.

The disease management is usually entrusted to one of the parents who "take care" of all the medical and "no" problems of the child himself and this inevitably involves, by the child a certain degree of dependencethat makes it difficult to become autonomous with respect to their contemporaries.

Most of the parents, at the beginning of diabetes, warns a heavy sense of "responsibility" for the child's disease, which easily leads to an unjustified feeling of guilt, anxiety and depression.In some cases the father, more frequently the mother, may believe that, by reducing social and/or work commitments, he may have more time available to control the health of his child, with the result of often assuming attitudes about protectors.

The envelope protection by the parents, in relation to the childSick, it can prevent the child from developing autonomy in the management of the disease and the progressive emotional independence of the family nucleus.