Dr Oluwakemi Ashubu, a pediatrician at the University College Hospital (UCH), Ibadan, in this interview withSADE OGUNTOLA, states that children can develop type 1 diabetes, and they should not be viewed as cursed or subjected to stigma since the cause remains unknown but is associated with a combination of genetic and environmental influences.
What role does excessive nutrition play in the occurrence of diabetes among children in Nigeria?
Excessive nutrition is associated with a high consumption of refined carbohydrates, sweet snacks, and drinks, along with a lack of physical activity, all of which contribute to increased glucose levels. Extra glucose is stored as fat in the body; excessive fat, particularly around the organs, in children can lead to insulin resistance — where the body's cells become less responsive to insulin, necessitating higher insulin production. Over time, this may result in β-cell fatigue and the onset of type 2 diabetes (T2D). It is crucial for children to maintain a balanced diet that includes carbohydrates, proteins, fats, and oils, alongside sufficient amounts of fruits and vegetables. Many children skip healthy breakfasts before heading to school, and some rely on fast food when home-cooked meals are not available. Often, their daily routines revolve around school, after-school activities, homework, and bedtime, leaving little time for physical exercise. These factors represent significant risk elements for diabetes development.
Have you encountered instances of children suffering from diabetes in your clinic because of an improper diet or insufficient physical activity?
Yes, I have a group of overweight patients whose medical tests showed they were approaching prediabetes and hypertension because of poor dietary choices and insufficient physical activity. They started on lifestyle changes, during which dietitians provided guidance on proper nutrition in terms of quality, amount, and timing. Additionally, they were advised on enjoyable activities that could help them stay active. Exercises like dancing, walking for short errands, walking a pet if they own one, jumping rope, and playing football, among others. Their situation improved when they followed the lifestyle changes, and now they lead healthier lives.
Several studies have indicated that genetically modified foods (GMOs) may be contributing to diabetes, particularly among children and adolescents. What is your opinion on this?
Genetically modified foods do not directly lead to or contribute to diabetes in young children and teenagers. There is no scientific agreement or substantial evidence to back this assertion. Generally, leading science and health organizations concur that genetically modified foods available today are equally safe and nutritious compared to non-GMO options.
How many children are residing with diabetes in Nigeria? What forms of diabetes do they suffer from?
The database maintained by the Society for Paediatrics and Adolescent Endocrinology in Nigeria (SPAEN) includes 2,139 children and teenagers who have Type 1 diabetes in Nigeria.
The most prevalent form of diabetes among children is type 1 diabetes. Other forms include type 2 diabetes, neonatal diabetes, and various additional types.
What about type 2 diabetes in kids? Do you have any data on this?
Type 2 diabetes accounts for approximately 3 percent of childhood diabetes cases. However, the rate is rising because of the global increase in overeating. At present, our clinic treats 2 children who have Type 2 diabetes.
Could it be that in some rare instances, childhood diabetes might have a genetic cause?
In Type 1 diabetes, specific genes have been associated with its onset, yet these genes by themselves are not sufficient to trigger the condition. Factors in the environment, including contact with viral infections, certain protein types, stress, and frequent illnesses, are believed to be required to initiate the autoimmune reaction that damages insulin-producing cells. Additionally, a child's risk is somewhat increased if a parent or sibling has Type 1 diabetes.
In Type 2 diabetes, there is a significant genetic influence, which is why it can be common in certain families. The genetic predisposition is further heightened by lifestyle decisions, as children might become overweight, have unhealthy eating habits, and lack physical activity if they inherit these tendencies from their parents.
What are the indicators and manifestations of type 1 diabetes in kids? How do these appear?
Without insulin, the glucose from consumed food stays in the bloodstream, causing elevated blood sugar levels. The body's cells are deprived of energy, resulting in hunger and weight loss even with large amounts of food intake. Since the cells aren't receiving sufficient nourishment, the person feels fatigued. Extra glucose in the blood is excreted through urine. Due to frequent urination, the child experiences intense thirst and consumes more water. These symptoms are commonly referred to as the four Ts of diabetes – Thirst, Toilet, Thinner, and Tiredness.
What is the age of the youngest patient in your clinic who has diabetes? Is it possible for children to be born with diabetes?
At my clinic, the youngest patient I currently treat is three years old; she was identified as having Type 1 diabetes when she was two and a half years old. Neonatal diabetes is a rare form of diabetes that occurs in infants and is usually the result of a particular genetic mutation. Genetic testing plays a crucial role in making an accurate diagnosis and may lead to a shift in treatment, such as moving from insulin injections to oral medications.
But what should parents be aware of regarding diabetes in kids?
They ought to be aware of the initial symptoms: extreme thirst, regular urination, unexpected weight loss even with proper eating, or fatigue, commonly referred to as the four Ts of diabetes – Thirst, Toilet, Thinner, and Tiredness.
They need to realize that, with appropriate attention, kids living with diabetes can enjoy complete, energetic lives — attending school, participating in sports, having big aspirations, and achieving any goal they set for themselves in life.
They need to be involved in establishing a secure environment where the child feels encouraged and accepted, rather than judged.
They ought to promote their health by providing nutritious food and making sure they engage in regular physical activity.
Do parents hold incorrect beliefs about diabetes?
First and foremost, diabetes cannot be transmitted from one person to another; it is not infectious. Type 1 diabetes is not triggered by consuming excessive amounts of sugar or other types of food. Your child will not outgrow Type 1 diabetes. It does not transform into Type 2 diabetes as they age.
Are medical practitioners, particularly those working in primary health care facilities, sufficiently informed to detect children suffering from diabetes for timely treatment?
SPAEN (Society for Paediatrics and Adolescent Endocrinology in Nigeria) is collaborating with various organizations to ensure this message reaches the community through a specific program. Since 2023, we have been working with healthcare professionals at primary health centers, educating them on the signs and symptoms of diabetes, as well as how to conduct early screening for the condition. When a child shows symptoms such as UTI, breathing difficulties, or pneumonia, they should also consider diabetes and check their blood sugar levels upon arrival at the facility. Additionally, they are being trained to screen for diabetes in children who were previously toilet-trained but start experiencing bedwetting. They are also encouraged to pass on this training to other healthcare workers within their facilities.
What position will the organization take on making blood sugar testing for children a standard procedure in all hospitals?
Yes, it should be standard practice. At UCH, no child enters the pediatric emergency department without a blood sugar test. This is one of the first steps we take, not only to screen for diabetes. Ideally, in hospital environments, checking blood glucose is a key procedure. Testing both urine and blood sugar can help healthcare professionals identify potential issues when a child is unwell. What if you check the blood glucose and find it low in a child who arrived with seizures? You can quickly address it, which might be all that's needed for the child to regain consciousness. Therefore, checking blood sugar is an essential test.
Is the blood glucose test included in the guidelines for children's healthcare in Nigeria?
In fact, there are constructive initiatives aimed at establishing it as a policy. The initial set of guidelines on this matter was created at the federal level, and we are collaborating with other involved parties to ensure that it evolves into a policy that is enacted through a bill.
A blood sugar test is cost-effective and provides significant insights beyond just checking for diabetes. Therefore, when collecting blood samples for packed cell volume, a random blood glucose test can also be conducted. Combined with a urine test, it can offer valuable information about the child's overall health.
Are there other factors that might increase a child's risk of diabetes besides unhealthy eating habits and poor food selections?
We are unaware of the precise cause of diabetes. Could it be linked to viral infections? Could it be something some individuals refer to, such as cow's milk? There is no evidence to support these claims. However, we prefer to stick with what remains unknown. Individuals should maintain a healthy lifestyle. If they notice symptoms that may indicate diabetes, they should visit the nearest hospital and share their concerns. A healthy lifestyle helps prevent disease.
Is there any warning for parents of children with diabetes about their health?
Parents must pay attention to and adhere to medical advice regarding proper dietary habits, administering insulin shots or medicines, encouraging physical activity, and offering emotional support. Children should participate in managing their diabetes to the extent they are capable, which helps them comply with their treatment plan.
But naturally, avoid promoting harmful behaviors such as drinking alcohol or smoking. Let them know occasionally that you are there for them, that you comprehend their feelings and empathize with them. Refrain from blaming them, claiming they are cursed and that is the reason they have diabetes. They should not face discrimination. The manner in which a parent supports a child with diabetes will influence how society perceives them.