I. Juvenile - Onset Diabetes
Juvenile - Insulin Dependent Diabetes Mellitus (JIDDM)
Type 1 Diabetes Mellitus (IDDM)
Age of onset usually from 1 year up
to 15 years, occasionally up to 18 - 20 years. Occurs in less than 1%
of all cases of diabetes in India. In South India it is less than 0.5%
II. Early Onset Diabetes (EOD)
Maturity - Onset Diabetes in the Young (MODY)
Age of onset is usually above 15 years
and up to 25 years (MODY) and 30 years (EOD). Some cases from these two
groups could be having insulin requiring Diabetes Mellitus. These are
grouped under the term LADA (Latent Autoimmune Diabetes in Adults) as
they exhibit significant levels of antibodies to the insulin producing
beta cells of the pancreas gland. Occurrence is about 3 to 5% of all cases
of Diabetes seen in India.
III. Genetic Syndromes Associated
of onset: At Birth
Occurs very rarely but in our centre,
up to 0.5% of all cases of Diabetes.
Type 1 Diabetes Mellitus or
When Diabetes Mellitus strikes young
children it is usually explosive, with classical symptoms of
- Excess Thirst
- Excess Urination
- Excess Hunger
- Excess Tiredness / Listlessness
- Unexplained Loss of Weight
- Occasionally with gradual drowsiness -dehydration,
chest pain, breathing difficulty and slipping into coma.
When the urine is examined, it shows
high sugar (4+) and frequently ketone bodies (1+ to 3+). Fasting, random
and postprandial blood sugars are all very high - usually over 300 mgm/dl
(over 16 mmol/L). A Glucose Tolerance Test (GTT) is usually NOT NECESSARY,
for diagnosis of this condition.
If the child is ambulant and
active, the child should be referred to a Diabetic center equipped with
integrated special care facilities for the management of juvenile Diabetes.
In any child or adolescent coming to a hospital
or an emergency service with acute, rapid, shallow breathing, complaints
of chest pain, with sweet odour of the breath, vomiting and abdominal
pain and dehydration - Diabetic Ketoacidosis (DKA) should be suspected
and spot check of capillary blood sugar and urine sugar / acetone done.
If these are high, emergency investigations and treatment should be instituted.
Insulin therapy in children
Dr.H.B.Chandalia and Dr.P.S.Lamba
have presented their point of view in a succint manner and with clarity
in their paper in . For a detailed analysis of the various
aspects of insulin therapy in children view .
Early Onset Diabetes
The genetic 'Phenomenon of Anticipation'
is usually seen when the younger generation precedes their older generation
(son and father) in getting a hereditary disorder.
This is sometimes classically
seen in Diabetes when a 25 or 30 year old person is detected to have Type
2 Diabetes, but at that point of time his parents may not have the disorder
- it may manifest in them at a later date - say a year or two later. So
when a young person (below 30 years of age) comes with any problem, without
classical symptoms of Diabetes, and routine blood / urine sugar examination
shows high or border line - high values, a GTT test (75 g) should be ordered
for making a definitive diagnosis.
EOD cases vary in severity, usually
give a positive family history of Diabetes, are generally overweight and
very often the condition is discovered when they consult their doctors
for 'minor' symptoms or undergo routine medical check - up, prior to job
placement or for Life Insurance purposes. Diagnosis is confirmed by a
As per type 2 Diabetes protocol,
diet, exercise, drugs - oral hypoglycemic agents ± insulin.
There is a small
sub group in this category of young Diabetics who may progress (march)
on to type 1 Diabetes or IDDM. They are termed as Latent
Autoimmune Diabetes of Adults or LADA and current research identifies
this subgroup on the basis of antibody titres against the insulin producing
beta cells of the Islets of langerhans. (PICA, IAA, GADA etc.)
These persons are better treated
with insulin injections than oral medication for their Diabetes. There
are no controlled studies on this subject in clinical Diabetology, and
the final opinion on this subject is yet to emerge.
This type of Diabetes usually
occurs in young people (15 to 25 years) who have a strong three generation,
family history of Diabetes viz. grand father, father, son / daughter.
It is thought to be genetically transmitted by an autosomal dominant trait.
There are several genetic sub types described in MODY patients.
(Ref. Ewan R. Pearson,
and Andrew T. Hattersley; J.R. Coll. Physicians, London. 2000, 34, 332
Again, the type of presentation
is similar to the one described above under EOD. These young persons are
usually overweight, have very few symptoms and are managed initially with
diet, exercise, weight reduction and if required oral drugs. As a matter
of fact, the definition of MODY requires 2 years of management of this
type of diabetes without insulin. Insulin is used only in situations like
infection, surgery or pre- pregnant state (i.e. married and planning to
conceive) and during pregnancy.
Again, a small percentage of
these cases of MODY may turn to be cases of LADA on follow-up. Hence close
surveillance and monitoring is essential for all cases of Diabetes in