By Dr Smita Koppikar
It is Diwali, but the bustling children’s Intensive Care Unit (ICU) in New Panvel, Mumbai, shows no signs of festivities. It is business as usual.
We are treating children who are so ill they need admitting to the ICU rather than the children’s ward.
In a corner lies Shreya, a two-year-old girl, all decked up as she was ready to celebrate Diwali with her family. In stark contrast to the festive look she dons are the alarms from the gadgets she is connected to, with all the drips going into her tiny body.
Her cries for the sweets she was promised for Diwali only evoke tears in her parents sitting nearby. The most difficult thing in their life is denying food to their little moppet. A posse of relatives stands anxiously outside the ICU. When I enter, the first thing the parents say to me is, “Doctor, we have been told she has diabetes, so we have discarded all the sweets that were made for her.”
A few beds away is Aniket, an 11-year-old boy whose parents have been wondering why their child landed in the ICU despite their seeking prompt medical attention several weeks ago. Aniket was eating and drinking in plenty, but kept losing weight and was getting increasingly tired. The family was assured by their local doctor that all was well, till the time he started gasping for breath, which is when they rushed him to a bigger hospital.
Six-year-old Priya’s parents heave a sigh of relief as her condition gets better and she is about to be sent home after a turbulent time in the ICU, her second time. They have had a steep learning curve. They now resolve to listen to their doctor and give Priya her injections four times a day for the rest of her life. They realize that omitting the injections, much against the advice of the paediatric endocrinologist, landed Priya in the ICU. She was pulled in time from the jaws of death, all of which was entirely avoidable.
Shreya, Aniket and Priya all have a life-long condition called Type 1 diabetes, loosely called juvenile diabetes. In stark contrast to the commonly known Type 2 form of diabetes that affects grown-ups, juvenile diabetes has no cure, but can only be controlled by four injections each day that administer a drug called insulin.
The children start with relatively innocuous symptoms, such as drinking a lot of liquids, passing lots of urine, eating much more than normal, and still losing weight. There is no pain and usually no fever. Unless promptly diagnosed with an instant blood test, they could deteriorate rapidly and end up in the ICU, like Aniket and Shreya did.
These symptoms in a child of any age, going on for more than four days, should merit a prompt visit to a paediatrician. When diagnosed quickly and treated properly, children do well, despite needing to take daily injections.
On the other hand, if not managed appropriately, it could lead to rapid sinking of the child’s condition, as in Priya’s case, and valuable lives have also been lost in the process.
The diagnosis of diabetes brings with it a common misperception about taking the child totally off sweets, rice and potatoes. Children need nutritious food to grow tall and clever, and so starving them to control their diabetes does not work.
Shreya’s parents were very relieved when I told them they could feed her just like any other child, but taught them a way to balance the insulin injections with the food she was eating, so that her diabetes would remain in control.
Developed countries, like the United Kingdom, have ways of allowing the child to eat a full and nutritious diet along with the occasional treat, and still maintain good diabetes control. They also have fewer diabetes-related children’s deaths due to greater awareness in those countries in contrast to Asian countries, including India.
All this is perfectly possible in India, too, if parents and doctors are aware of this condition and its symptoms and seek appropriate medical help early.
Dr Smita Koppikar, MBBS, DNB (Paediatrics), MRCPCH (UK), CCT (UK), is a paediatric endocrinologist, i.e a children’s doctor specializing in hormonal conditions. She worked for 12 years in Europe and is now based in Mumbai.