Managing diabetes: Reason to smile

Dubai : Though the number of diabetics in the paediatric population is not still known, the high incidence of obesity (12.1 per cent) and low level of physical activity among youngsters are disconcerting phenomena.

Dr Salah Ahmad Al Badawi, director of the national programme for control of diabetes under the Ministry of Health, said that as part of an integrated national strategy, the ministries of health and education are targeting schoolchildren in the UAE to create awareness about the need to fight obesity, eat healthy and be physically active.

Pilot project

“A pilot project [to tackle diabetes] is being launched in two private and two public schools in Dubai and Sharjah on December 15,” he said, adding that teachers too should be alert in recognising possible symptoms among students and reporting them to the parents.

The diabetes campaign of the Ministry of Health, organised by Ex-Health, focuses on edutainment with several games stressing the importance of healthy eating and exercising. A Blue Circle game at the Ibn Battuta Mall, for instance, had children being rewarded for recalling the names of healthy foods printed on a series of footsteps along the circle.

Similarly, a snakes and ladder game had children drinking a berry drink finding their way up the ladder, while those eating a burger slid down a slippery snake. Kathy Hyde, Director of Marketing at Green Crescent Insurance, said, “The best way to educate children is to provide them an edutainment platform.”
 

Little Alia

Dubai : Alia Nabeel, 9, (pictured right) is full of life. A Dubai-based Emirati student, she was diagnosed with type 1 diabetes two years ago.

While it was an initial challenge for her and her parents to come to terms with the sudden discovery, getting injected with insulin four times a day is now part of her regular routine.

“She is fine,” her mother said, “except when she sees marshmallows in the lunch boxes of her friends and can’t have them.”

As the campaign to create awareness about diabetes draws to a close this month-end, with another World Diabetes Day (November 14) having passed us by, the fact that every day is a date with diabetes for those like Alia cannot be wished away. “People need to understand that type 1 diabetes is a genetic disorder and not something we can prevent,” said her mother.

But the key to a normal life lies in early detection, able management and, equally important, a supportive social system.

Dealing with it

While Alia is still young and cannot manage her blood sugar level by herself, children with type 1 diabetes learn to deal with their condition by themselves by the time they are a little older, doing the required gram carbohydrate counting for every meal so that they know how much insulin they need at each intake.

Fourteen-year-old Meira M. Al Hedaidi, an Emirati student of the American School of Sharjah, for instance, who was diagnosed with type 1 diabetes at the age of nine, was on insulin injections for four years but switched to the insulin pump last year. “I calculate the carb levels of whatever I am eating and pump the required ratio of insulin,” she said, adding it has become a habit now.

Similarly, Shakah Ahmad, 12, also an Emirati and student of the Rashid Al Saleh Private School in Dubai, takes 60 units of insulin every day. She plays basketball and walks for 45 minutes daily.

According to her mother, it is important for families like hers to accept the fact that their child is diabetic and work around it rather than getting bogged down. She said parents should take the time to make notes and ensure that the children learn to eat the right kind of food with sufficient exercise.

“It is critical that parents are aware of the symptoms to look for among children and bring them to the notice of the doctor in time,” said Dr Ghaida Kaddaha, Consultant Diabetologist and head of the diabetes unit at Rashid Hospital which is treating many of these children. Among the main symptoms are tiredness, increased thirst, hunger, blurred vision and frequent urination.

Able management

To tackle the issue of able management, the Juvenile Diabetes Education Centre (JDEC) in Dubai, an initiative of the Johnson & Johnson Corporate Citizenship Trust and the Emirates Diabetes Society, has specially trained educators and dieticians who provide one-on-one and group education to children with type 1 diabetes.

Wim Boogaerts, Chairman of the Johnson & Johnson Corporate Citizenship Trust, which together with the Ministry of Health has launched a healthy family initiative focusing on diabetes in the first phase, said, “JDEC is helping 60 families in the UAE to manage juvenile diabetes.”

Support groups like Sweet Kidz, under the aegis of the Dubai Health Authority (DHA), also go a long way in educating diabetic children and their parents about managing the condition.

The group was set up in 2003 by Dr Khowla Belhoul, Director of the Thalassemia Centre in Dubai. Dr Khowla, whose daughter Afra is also a type 1 diabetic, said, “Standing by and watching Afra’s struggles with unpalatable food and sugar-free diets was very difficult for me. So I used all resources available to read up more on diet and sugar control. Things started looking better as we started using exchange lists and practising gram carbohydrate counting.

“Today Afra is 13 and is a well-adjusted child who is able to manage her diabetes very successfully, without losing out on life at all,” she said.

Regular screenings

Significantly, children can have high blood glucose without any of the typical symptoms, so regular screenings are a must. When diabetes struck during childhood earlier, it was routinely assumed to be type 1 or juvenile-onset diabetes. In recent years, however, type 2 diabetes, formerly known as adult-onset diabetes, is increasingly presenting itself in children between 10 to 19 years of age.

Children who are not routinely screened for type 2 diabetes may, by the time they are diagnosed, develop high blood pressure or severe hyperglycaemia, or elevated blood sugar levels and other complications.

“Common complications due to diabetes include blindness, leg amputations, kidney disease, heart attacks and strokes,” said Dr Ghaida.

Also acting as a factor is the genetic predisposition of a child, as Dr M. Hamed Farooqi, Medical Director, Joslin Diabetes Centre, under the DHA, pointed out. He referred to the thrifty gene phenotype hypothesis which states that poor nutrition in foetal and infant life can be detrimental to the development of the beta-cells and insulin-sensitive tissues, leading to insulin resistance under the stress of obesity.

Another challenge for children is the stigma attached. But 18-year-old Maram Dalab, a Palestinian-Jordanian student at American University of Sharjah, said, “I take diabetes as a motivation rather than a disease.”

Alarming rise

The number of people falling prey to the disease is alarming. According to the National Diabetes Guidelines, the prevalence of diabetes in the UAE adult population is at 19.6 per cent, the second highest in the world. Dr Farooqi said the DHA is working on establishing a diabetic registry with resources being mobilised for a large-scale genomic analysis.