Juvenile Diabetes

Abstract
Juvenile Diabetes is a disease that more and more children are getting each day and it affects about 0.1 percent of children that are school age. There are two types of diabetes that are common in children. The first one is type-one diabetes and the second one is type-two diabetes out of all the cases diagnosed, type-one makes u p 5-10 percent of them. There are major health problems associated with type-one including troubles physically , a multidisciplinary approach by physician, nurse, and dietitian is needed to treat juvenile diabetes. In patients with new-onset type 1 diabetes, lifelong insulin therapy must be started. As a chronic disease, DM requires long-term medical attention both to limit the development of its devastating physical and psychological complications and to manage them when they do occur. As per ADA (American Diabetes Association) DM is a disproportionately expensive disease; in 2002, the per-capita cost of health care was $13,243 for people with diabetes, while it was $2560 for those without diabetes (ADA, 2007). As of now there is no cure for juvenile diabetes but there is ongoing research to test medications and new products to find a cure for Juvenile Diabetes. There are however many coping methods, support groups, counseling, insulin injections and pumps that children with juvenile diabetes make a part of their everyday lives.

Juvenile Diabetes

Juvenile diabetes is a big disease for little kids, which affects all aspects of their lives. Juvenile diabetes (which is known as Type 1 Diabetes Mellitus) is a chronic disease of carbohydrate, fat, and protein metabolism caused by the lack of insulin, which results from the marked and progressive inability of the pancreas to secrete insulin because of autoimmune destruction of the beta cells which leads to high blood sugar and if it is not treated properly can cause a lot of problem to the kids and affect their body and soul. In this paper I will answer these questions
1. What is juvenile diabetes?
2. What cause juvenile diabetes?
3. How dose juvenile diabetes affect children ‘lives?
4. How do we treat juvenile diabetes?
5. What are the latest researches finding for juvenile diabetes?

What is Diabetes?
Diabetes is defined as inappropriate fasting and postprandial hyperglycemia, is not homogenous entity but a syndrome characterized by disturbed metabolism of carbohydrates, fat and lipids. There are two types of diabetes that are common in children. The first one is type-one diabetes and the second one is type-two diabetes. Type-one diabetes is referred to as juvenile diabetes mellitus. It is one of the most common chronic diseases that affect children.

Figure 1

Since islets cells produce insulin, they define the different types of Diabetes http://www.juvenilediabetic.com/diabetes.html It is a disorder of the endocrine system and affects about 0.1 percent of children that are school age. Type-one comes about when the pancreas ceases to produce insulin the body needs to break down glucose in the blood ( Figure 1). These diabetics take injections of insulin to keep their glucose level in their blood down. Children being overweight or obese cause type-two diabetes. Up until about a decade ago, this type was rarely heard of in children. This sudden increase of type-two diabetes in children is caused by kids eating too much junk food and their lack of physical exercise. Type-two occurs when the body has a glucose level in the blood that is too high and it consumes the insulin produced by the pancreas.

What causes juvenile diabetes?
Type 1 DM has a strong genetic component and extra genetic factors also may contribute. Potential triggers for immunologically mediated destruction of the beta cells include viruses (e.g., mumps, rubella, coxsackievirus B4), toxic chemicals, and exposure to cow’s milk in infancy, and cytotoxins. As beta-cell mass declines with ongoing immunologic destruction, insulin secretion decreases until the available insulin no longer is adequate to maintain normal blood glucose levels (Figure 2). After 80-90% of the beta cells are destroyed, hyperglycemia develops and diabetes may be diagnosed. (Khardori, 2012)
Figure 2 http://www.juvenilediabetic.com/diabetes.html
A meta-analysis suggests a significant association between enterovirus infection and autoimmune/type 1 DM. (yeung, 2011)
Effects of juvenile Diabetes: Symptoms of having Type-one diabetes are being extremely thirsty, frequent urination, increase in appetite, drowsiness, dry and warm skin, sweet or fruity odor on the breath, and deep breathing. Type-one is a lifelong disease where your body cannot metabolize glucose because of a lack of insulin produced by the body. In maintaining normal blood concentration, the kidneys pull out sugar and mass amounts of water from the body. This results in frequent urination, which results in dehydration and then causes the child to become very thirsty and drink large quantities of liquid. Because the cells due to the lack of insulin do not use the sugar going into the body, the child feels hungry and eats mass amounts of food, loses weight, and becomes tired and weak. While insulin allows a person with type 1diabetes to stay alive, it does not cure the disease, nor does it prevent the development of serious complications, which can be many and varied. High blood sugar levels eventually damage blood vessels, nerves, and organ systems in the body. Managing diabetes is a full-time job with no holidays and no time off. That may sound bleak, but a lifetime of maintaining normal blood sugar is infinitely preferable to dealing with the devastating complications that can result from uncontrolled diabetes. (Meinhardt, 2009) Dr. Sperling summarized the effect of diabetes on the kids in the chapter of diabetes mellitus in Sperling Pediatrics Endocrinology:
The increasingly prolonged survival of diabetic child is associated with an increasingly prevalence of complications that affect the microcirculation of the eye (retinopathy), the kidney(nephropathy) and nerves (neuropathy)as well as the large vessels(arthrosclerosis) and the lens (cataracts).(p.351)
Sometimes, living with diabetes can seem like a full-time job -- trying to keep up with everything you need to do for proper diabetes care. "Diabetes is a very time-consuming disease to manage well," says Karmeen Kulkarni, MS, RD, CDE, and former president of health care and education for the American Diabetes Association. "The medication, the food, the physical activity -- you add life in general to that whole picture and it ends up being quite challenging".(Kam, 2008) Having diabetes represents a crisis for the children and to the parents may lead to psychological reactions to living with the disease if the family doses not go through the five stages of grief (Frank, 2005). Some kids refuse to accept the illness or adhere to treatment by refusing insulin also the deep involvement of parents in the care of child treatment of diabetes leads to dependency for children with diabetes. Having diabetes requires lots of attention because of the involved medical treatments and restricts the child’s activities. Some kids might blame others of having diabetes by being arrogant and acting up or go to the other end by withdrawing from social activities and get depressed or emotional, having diabetes as a child can be very stressful. Marcia R Frank summarized the solution for overcoming these issues “coping skills training has shown to improve adolescents ‘metabolic control and quality of life”(Frank, 2005).
Treatment of diabetes
Unfortunately juvenile diabetes is lifelong disease and as of now no cure and the mainstay of treatment is to control blood sugar by giving multiple insulin shots daily and adherence to the diet and exercise advised by the diabetes team Dr. Robert Richard (2011) outlined the treatment of juvenile diabetes by
Insulin, T1DM is treated with long-acting insulin, such as NPH, glaring (Lantus) and detemir (Livamir) to cover the fasting and pre-meal states, and short-acting insulin to cover meals. …Type 1 can also be treated with a continuous, subcutaneous insulin infusion done with a small pump that provide a continuous basal rate all day, with programmed increase prior to meals. (P.34)

Latest research findings of juvenile diabetes
Although there is no cure for Juvenile Diabetes at present, there seems to be a great deal of buzz in the media and in research circles lately about a cure. Several promising breakthroughs have been reported recently, ranging from alternative drug therapy to beta-producing stimulants to various forms of transplantation. A study published in "Endocrine Practice," a peer-reviewed journal, revealed that scientists at CureDM isolated a peptide that repeatedly stimulated new islet production in several preclinical trials. The Human ProIslet Peptide (HIP) is responsible for regenerating pancreatic islets and has been isolated using the human genome. Studies on diabetic animals confirmed that this peptide indeed stimulated new beta cell islet production and clinical trials are soon to follow. (Levetan, 2008)

Conclusion about Juvenile Diabetes
Juvenile diabetes is a disease that affects many children in the world and it is continually growing each day. It is a disease that puts stress on everyone that is affected by the child, like family, friends, school, and doctors. If people that deal with children like this on a regular basis does not obtain knowledge of the disease, the child may suffer severely from it.
List of References
American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. Jan 2007; 30 Suppl 1:S42-7. [Medline].
Frank, Marcia (2005,januray) Psychological issues in the care of children and adolescents with type 1 diabetes, Paediatr child Health .2005 January: 10(1): 18-20
George T Griffing (2012) Type 1 Diabetes Mellitus Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: MD emedicine.medscape.com/article/117739-overview 2012
Juvenilediabetic.com/diabetes.html
Katherine Kam, (2008) Diabetes Care: Managing Your Time When You Have Diabetes, webmd.com.
Levetan, CS Discovery of a human peptide sequence signaling islet neogenesis. Endocr Pract. 2008 Dec; 14(9): 1075-83.
Meinhardt, Edmund (2009,November) Common-Complications-of-Diabetes- Nov. 25, 2009 lvrj /health/73762212.htm
Robert Richard, med study (2012,Augest) diabetes mellitus p .34
Sperling, Mark (2002) Diabetes Mellitus page 351 last paragraph, Sperling pediatrics endocrinology, second edition.
Yeung WC, Rawlinson WD, Craig ME. Enterovirus infection and type 1 diabetes mellitus: systematic review and meta-analysis of observational molecular studies. BMJ. Feb 3 2011; 342:d35. [Medline]. [Full Text].

References: American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. Jan 2007; 30 Suppl 1:S42-7. [Medline]. Frank, Marcia (2005,januray) Psychological issues in the care of children and adolescents with type 1 diabetes, Paediatr child Health .2005 January: 10(1): 18-20 George T Griffing (2012) Type 1 Diabetes Mellitus Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: MD emedicine.medscape.com/article/117739-overview 2012 Juvenilediabetic.com/diabetes.html Katherine Kam, (2008) Diabetes Care: Managing Your Time When You Have Diabetes, webmd.com. Levetan, CS Discovery of a human peptide sequence signaling islet neogenesis. Endocr Pract. 2008 Dec; 14(9): 1075-83. Meinhardt, Edmund (2009,November) Common-Complications-of-Diabetes- Nov. 25, 2009 lvrj /health/73762212.htm Robert Richard, med study (2012,Augest) diabetes mellitus p .34 Sperling, Mark (2002) Diabetes Mellitus page 351 last paragraph, Sperling pediatrics endocrinology, second edition. Yeung WC, Rawlinson WD, Craig ME. Enterovirus infection and type 1 diabetes mellitus: systematic review and meta-analysis of observational molecular studies. BMJ. Feb 3 2011; 342:d35. [Medline]. [Full Text].