Childhood Diabetes is a metabolic disease in childhood mainly characterized by poor control of blood sugar levels. It is principally classified as type 1 diabetes mellitus, type 2 diabetes mellitus, and pediatric diabetic insipidus. Type 1 diabetes is a chronic condition where the body is unable to produce insulin due to the destruction of beta cells of the pancreas by the immune system. Beta cells entail the cells that produce insulin that helps counter-regulate high sugar levels in the blood. Most of the children with this type of diabetes depend on exogenous insulin throughout their lifetime. Type-1 diabetes may also be denoted as insulin-dependent diabetes.
Type 2 diabetes, also non-insulin dependent diabetes is most common in adults aged 40 years and above. It is, however, increasing exponentially in children, a change that is linked to increased rates of children who are overweight and obese (Zaccardi, Webb, Yates, & Davies, 2015) . Most patients with this type of diabetes have insulin resistance, and their beta cells are unable to counter the resistance. Diabetes insipidus, on the other hand, is a hereditary form of diabetes in which the kidneys pass large volumes of water through urination despite the status of the body's hydration. It is either due to deficiency of anti-diuretic hormone secreted by the pituitary gland or nephrogenic causes, that is, unresponsiveness of the renal tubular system to vasopressin which increases reabsorption of water in the collecting ducts. There are also two other uncommon types of diabetes that are known as Maturity-onset diabetes of the youth (MODY) and Neonatal diabetes (Zaccardi, Webb, Yates, & Davies, 2015).
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The classical symptoms for any kinds of diabetes are polydipsia-increased thirst and fluid intake, polyuria- increased urination and polyphagia-increased feelings of hunger. Unexplained weight loss is also an essential factor recognized by close family members or caregivers of the child. The children with diabetes also have high blood glucose- hyperglycemia, nonspecific malaise and signs of acidosis. Symptoms of acidosis include; increased respiratory rate (Kussmaul breathing) abdominal pain, vomiting, drowsiness or even comatose (Zaccardi, Webb, Yates & Davies, 2015) . Children mostly would present with preceding recurrent flu symptoms.
Early diagnosis and treatment are crucial in saving the life of any child who has diabetes. Any healthcare worker should take a good clinical history and physical examination with a high index of suspicion of diabetes since the signs and symptoms in children could be very non-specific. It is only in diabetes where a child presents with frequent urination in spite of a dry tongue. Some children may have sweet smelling breath, an indicator of ketoacidosis as a complication of diabetes since ketones are fruity smelling. For diagnosis, clinical history and exam plus laboratory investigations are used. A fasting blood sugar level of more than 11.1 mmol/ liter or a random blood sugar level of more than 16.6mmol/ liter for more than two consecutive is diagnostic for diabetes mellitus (Zaccardi, Webb, Yates & Davies, 2015). Note that children with maturity-onset diabetes of the youth (MODY) may present as having type 1 diabetes (Zaccardi, Webb, Yates & Davies, 2015) . Urinalysis indicates positive urine glucose- glycosuria and the presence of ketones in the urine- ketonuria.
As suggested earlier, most patients have type 1 diabetes. To safely treat children with diabetes, there has to be effective management of the metabolic state of the child. This, hence, means that there has to be a proper balance in insulin, diet, exercise, stress management, blood glucose monitoring and ketones. Those are the five major factors considered in the treatment of diabetes. The first step would be to educate the family and the child on diabetes. All mothers and caregivers should learn how to administer medications to the child especially insulin, the complications that may arise in non-adherence to medicines and strategies to manage the stress that may be present after initial diagnosis. This can be done by a scheduled meeting with a diabetic counselor with all the family members. Treatment may encompass the use of drugs to increase the sensitivity of the receptors to insulin in non-insulin dependent diabetes mellitus or insulin injections for patients who have insulin deficiency- type 1(insulin dependent diabetes mellitus). Insulin allows glucose to pass into the cell, decreases the production of glucose in the body and depresses ketone production, therefore, reducing the blood glucose levels.
Complications that may occur if diabetes is not managed properly are divided into acute complications and chronic complications (Zaccardi, Webb, Yates, & Davies, 2015) . Hypoglycemia is one of the acute complications of childhood diabetes. It is defined as a blood glucose level below 3.3mmol/ liter in children. The typical manifestations of hypoglycemia include increased feelings of hunger, shakiness, drenching sweats, headache, drowsiness at unusual times, and behavior change. If there are no interventions early enough to the child may fall into unconsciousness and convulsions. Ketonuria, ketonemia, and ketoacidosis are also acute complications of childhood diabetes. It is characterized by vomiting, deep breathing and excessive weakness. It may proceed to diabetic ketoacidosis which is the most critical and dangerous acute complication of diabetes. Diabetic ketoacidosis is mostly due to non-compliance with medication. Correction of diabetic ketoacidosis (DKA) is vital in saving the life of the sick child with DKA. Chronic complications of diabetes include renal failure which is found in about 30-40 percent of children with diabetes and loss of vision (Zaccardi, Webb, Yates, & Davies, 2015) .
For the prevention of diabetes, regular exercise and low-fat diet were seen to reduce diabetes mellitus type 2 by 58 percent. Stress management, weight control, changes in lifestyles such as quitting cigarette smoking and alcohol intake for the caregivers and children prevents the development of the disease. Bottom line in the prevention of type 2 diabetes would be to stay lean and to stay active. For the type 1 diabetes and other types that are inherited, there are antibody screening tests for families with a relative who has already been diagnosed with hereditary diabetes such as type 1. Intervention trials are underway on first degree relatives who are antibody positive with the aim of trying to prevent type-1 diabetes.
Reference
Zaccardi, F., Webb, D. R., Yates, T., & Davies, M. J. (2015). Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year perspective. Postgraduate medical journal , postgradmedj- 2015.
