George Rogu M.D. 
Article Title
Diabetes in an internationally adopted child 
Posted Date

Diabetes mellitus is not a problem isolated to children from international adoption. It is a problem here in the United States . There are two types of Diabetes:  

Type I (previously called Juvenile diabetes or insulin dependent diabetes). This is the most common form occurring in persons less than 40 years of age. It results from damage to the insulin producing cells in the pancreas. Damage occurs gradually over many months to years, and symptoms do not occur until about 90 % of the pancreatic islet cells have been destroyed. There is a genetic predisposition to this illness and it is also believed that some environmental factors such as (viral infections, or chemicals in the diet) can cause this illness.

Type II: (non-insulin dependent) more common in older people and is associated with being overweight, and not being sensitive to insulin. Unfortunately, type II diabetes is occurring more frequently in over weight teenagers.   Diagnosis is usually made by the classic symptoms of drinking a lot, urinating a lot and weight loss. Other times the diagnosis is made at a routine physical examination when glucose in found in the urine. In the past many of these children were diagnosed when in coma, but now most are diagnosed before these severe symptoms occur.

Management and treatment: There are five major treatment variables in Type I Diabetes.

(1) Insulin injections: Insulin functions to allow glucose to pass into the cell and to decrease the physiological production of glucose, particularly by the liver and muscle. Most children receive at least two injections of insulin daily, usually a combination of short acting and long acting insulin. The actual dosages are determined by a sliding scale according the blood glucose level.

There are newer types of therapy like insulin pumps that provide a continuous infusion of insulin and with intermittent bolus to the child. In order to use  this innovative treatment successfully, patients and families must have sufficient knowledge and skills and appropriate attitudes to manage the technology. Children must have the developmental capability to learn how to program the pump and deliver insulin by both of these means. The technical skills a child must have to use the pump independently while at school and away from parental supervision include being able to insert and protect the pump, deliver a dosage of insulin to correct an abnormal blood glucose level and "cover" a meal, and suspend or alter the delivery of basal insulin. These skills usually develop between 8 and 10 years of age.

(2) Diet control :

    a: well balanced diet
    b: keep day to day intake consistent
    c: eat meals and snacks at the same time of day
    d: use snacks to prevent insulin reactions
    e: manage carbohydrate intake carefully
    f: reduce cholesterol, total fat and saturated fat intake carefully
    g: avoid becoming over weight
    h: increase fiber in diet
    i: avoid salty foods
    j: avoid excessive protein intake

(3) Exercise: Regular aerobic exercises at least 25 min per day for children. Exercise helps to increase insulin sensitivity, foster a sense of well being and helps to maintain a proper blood pressure and blood fat levels.

(4) Stress management: is very important because on a short term basis, stress hormones increase the level of glucose in the body. Chronic emotional stress can lead to missed insulin injections and compliance issues. In circumstances like this, family and individual counseling is important

(5) Blood glucose and urine ketone monitoring: All family members should be able to monitor blood glucose levels three to four times a day. This may need to be performed more frequently in small infants or during times of intercurrent illness. These blood glucose levels need to be recorded in order to look at patterns and make changes to the insulin therapy. In addition to home monitoring of blood and urine ketone levels, a test called the glycosylated hemoglobin should be measured every three months.

This test reflects the frequency of elevated glucose during the previous three months. As you can see that a child that suffers from diabetes will have a severe lifestyle change. This illness can be managed quite easily in the proper environment. With caring parents and close contact with medical professionals this illness can be controlled and future complications of this illness can be kept at a minimum with stable glucose levels. If this child is left to develop in an orphanage setting without monitoring or therapy, the complications of diabetes will set in at a very young age and they may even end up in a diabetic coma.

Note: The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it -- only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made.

References is an innovative International Adoption Private Practice dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. We are the GO TO place for your Adoption related medical questions. All medical interactions are performed via e-mail, express mail, telephone and fax. There is no need to make a live appointment or travel outside of you hometown. 
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