Diabetes Mellitus, or diabetes, is one of the most common chronic diseases in childhood, and its prevalence has been increasing in recent years. The most common type during this period is Type 1 Diabetes, which occurs due to a deficiency of insulin hormone produced in the pancreas. Although the exact cause is not known, genetic and various environmental factors play a role in the development of the disease.
Due to the increasing prevalence of obesity in recent years, Type 2 Diabetes, which is commonly seen in adults, has also started to be observed with increasing frequency in childhood. In this type of diabetes, there is resistance to insulin hormone, although the mechanisms may be different, the metabolic outcome is the same in both types. Glucose in the blood cannot enter the cells to be used in energy production, leading to elevated blood glucose levels.
Patients typically present with symptoms such as dry mouth, feeling of thirst, frequent and excessive urination, fatigue, weakness, frequent hunger, unintentional weight loss, blurred vision, and especially numbness, tingling, and prickling sensations in the feet – sometimes in the hands. Symptoms progress so rapidly that some patients report having no significant complaints before the diagnosis of diabetes is made. Some patients may only seek medical attention when symptoms of “diabetic ketoacidosis,” such as deep and rapid breathing, dry skin and mouth, facial redness, bad breath, nausea, vomiting, frequent urination, stomach or abdominal pain, mental confusion, and loss of consciousness, develop as a result of very high blood sugar.
In a child with suspected symptoms of diabetes, a blood glucose level measured at any time of the day, which is 200 mg/dL or higher, fasting blood sugar of 126 mg/dL or higher, and an HbA1c level of 6.5% or higher lead to a diagnosis of diabetes.
Children diagnosed with diabetes should be monitored by a team, including a pediatric endocrinologist, experienced diabetes nurse, a registered dietitian, and preferably a social worker. Individuals with Type 1 diabetes, where insulin hormone is produced very little or not at all, must take insulin from an external source (via injection) throughout their lives. Additionally, a proper diet and exercise program should be established as part of lifestyle management.
Uncontrolled high blood sugar levels (hyperglycemia) for an extended period in poorly treated patients can lead to diabetes-related issues. Hyperglycemia can damage the heart and blood vessels, leading to eye, nerve, and kidney damage, as well as heart attacks and strokes. Therefore, keeping blood sugar levels as close to normal as possible reduces the risk of encountering these complications.
**DIABETIC NEPHROPATHY (KIDNEY DAMAGE)**
The kidneys, which contain millions of tiny capillary clusters, can be damaged over time in individuals with diabetes. Diabetic nephropathy develops in approximately 15-20% of patients with diabetes around 15-25 years after the diagnosis. About 15-20% of these patients may progress to advanced kidney damage requiring dialysis or kidney transplantation within 10 years.
The first sign of diabetic nephropathy is an increase in the amount of albumin excreted in urine. Albumin increase in urine can be detected through the “microalbuminuria” test. Microalbuminuria can be reliably assessed through the examination of urine collected over 24 hours. Microalbuminuria is defined as the excretion of at least 30-300 mg/day in urine collected at least 2 or 3 times. Additionally, a spot urine test showing an albumin/creatinine ratio of 30-300 mg/g at any time is considered microalbuminemia.
When diabetes is diagnosed, one-third to one-half of patients may have slightly enlarged kidneys that filter a large amount of urine. During this period, temporary microalbuminuria may be observed, but if blood sugar is well controlled, kidney changes may reverse or at least slow down.
During a silent period of 2-5 years following the diagnosis of diabetes, some permanent changes in the kidneys gradually begin, and 7-10 years later, approximately one-third of patients develop microalbuminuria. In about 15-20% of patients, obvious nephropathy develops approximately 15-25 years after the diagnosis, and protein excretion in urine rapidly increases. Kidney function deteriorates, and blood pressure may rise. Other complications such as retinopathy may also be observed during this period. Without adequate preventive measures, patients progress to end-stage renal failure within 5-10 years and lose their chances of survival without dialysis or renal transplantation.
Several risk factors affect the development and progression of diabetic nephropathy. The most important ones include blood sugar control level, duration of diabetes, puberty, age at the onset of the disease, high blood pressure, hyperlipidemia, a family history of diabetes complications, and genetic factors. Some of these risk factors cannot be eliminated. However, maintaining good blood sugar control and regulating blood pressure are the most important preventive measures. Additionally, early detection of diabetic nephropathy is necessary for successful preventive treatment. Therefore, all patients with Type 1 diabetes lasting more than 5 years should be screened annually for microalbuminuria, as it may be the earliest sign of apparent diabetic nephropathy.
In conclusion, diabetes has become increasingly prevalent in recent years and has become a significant problem in childhood. It can lead to severe complications that threaten life and disrupt the quality of life if not treated early and appropriately. Therefore, it is crucial for families to be well aware of the symptoms of diabetes, and in cases of suspicion, necessary tests should be conducted to initiate early treatment. Children diagnosed with diabetes should be closely monitored by an experienced team, with efforts to maintain blood sugar levels and blood pressure within normal limits and lifestyle modification through a proper diet and exercise program. With these measures and regular examinations, end-stage renal failure caused by diabetic nephropathy can be prevented.