‘World Diabetes Day’ observed on November 14 focuses on care and support to those with diabetes. The Goan explores how juvenile diabetes affects the lifestyle of young patients who grow up with the disease that requires constant care and lifelong management
The year was 1998 in Mapusa, Rakhi Palekar’s daughter Tanvi used to be sick with high fever most of the time and started losing weight and falling ill frequently. No doctor could diagnose why. It was only when Tanvi was extremely ill and admitted as an emergency case in Goa Medical College, that the doctors checked her blood sugar and found it alarmingly high. The immediate treatment brought her out of danger but it was detected that Tanvi had high Type 1 (now juvenile) diabetes.
As a brave heart mother Rakhi did not deter or lose hope. Instead, she stood up with courage to battle with this life-threatening condition of her child and emerge a winner. She changed her profession and her own lifestyle to match with the day-to-day routine of Tanvi. It’s been over 25 years that the mother-daughter duo began compromising on their likes and dislikes regarding food, and sticking to a strict diet, maintaining the time of meals, regular checking of blood sugar and daily intake of insulin injection.
Persons with juvenile diabetes have to adhere to a daily intake of insulin dose and a regulated diet. It’s a lifelong commitment to treatment. The role of parents in supporting their children to cope with the demands of the condition and deal with a disease that has no cure, is very crucial. “Tanvi needs to avoid sugar and oil and consume healthy food. We go to our diabetologist for check-ups. Sometimes she goes to the gym to exercise, but daily visits to the gym are not possible due to our tour business,” states Rakhi, proprietor at Swapnapurti Tours.
Tanvi, who graduated in Arts from St Xavier’s College in Mapusa, is a smart young lady, successfully helping her mother manage their tour business. Naeem Jivani’s case is slightly different. Naeem was detected as a juvenile diabetic when he was eight. The Jivani family was living in the US then. As it was difficult to manage the illness in a foreign country without the support of extended family members, the Jivani family returned to India, and to their hometown Margao.
“Naeem’s sugar levels had to be checked every six to eight hours when he was a child. We had to give him insulin doses depending on the sugar level,” recalls his father, Amin Jivani. The family dealt with the illness while Naeem continued his education in Goa, completed BBA and is now settled. He still has diabetes but he has learnt to manage it.
These examples throw light on how clever management of the disease can help a patient live his life like any other person in the society. “I did not curse my fate. I did not sit and cry. I did not blame anyone. Like the Arjun from the Mahabharata who focussed only on the eye of the parrot when his Guru told him to hit it with an arrow, I concentrated on how best I can deal with my daughter’s diabetic condition and allow herself a comfort zone and live with a smile,” shares Rakhi. So did Naeem’s father Amin, who has stood strongly with his son for all these years!
No specific reason
There is no specific reason why a child gets juvenile diabetes. Juvenile diabetes is an autoimmune disease wherein the body's immune system mistakenly attacks its own healthy cells. In this case, the immune system destroys the beta cells in the pancreas that are responsible for producing insulin. The exact trigger for this autoimmune response is not fully understood by doctors or researchers.
Juvenile diabetes can appear at any age, but it appears at two noticeable peaks. The first peak occurs in children between 4-7 years old. The second is in children between 10-14 years old. It’s a lifelong condition because, for some unknown reasons, the pancreas stops producing insulin and unless there is insulin in the blood, the sugar in the food that is consumed, cannot be digested, so the dependence on insulin intake continues for life.
Daily dose of insulin must
The daily insulin injections are necessary to survive. Combination of insulin therapy, regular blood sugar monitoring, and maintaining a healthy lifestyle helps in managing juvenile diabetes
Watch the symptoms
However, strange symptoms which appear suddenly should be taken seriously. Increased thirst, frequent urination, extreme hunger, unexplained weight loss, fatigue or tiredness, blurred vision, numbness or tingling in the feet, slow-healing sores, and bedwetting in children who were previously dry can be a sign that the person is suffering from juvenile diabetes. The parents must seek medical advice if such symptoms are seen in their child. Early detection can help a lot to handle the illness better.
Risk factors
The risk factors include family history, genetics, and geography. Anyone with a parent or sibling with juvenile diabetes has a slightly higher risk of developing the condition. Having certain genes increases the risk of developing juvenile diabetes. And the number of people who have juvenile diabetes tends to be higher as you travel away from the equator. Other possible causes of juvenile diabetes include exposure to viruses and other environmental factors.
Although it usually appears during childhood or adolescence, juvenile diabetes can develop in adults, too. Even after a lot of research, juvenile diabetes has no cure. Treatment is directed toward managing the amount of sugar in the blood using insulin, diet and lifestyle to prevent complications.
Types of diabetes
Type 1 or Juvenile diabetes is the result of complete, absolute, or near total insulin deficiency. It can be immune mediated or idiopathic. It develops at a young age and leads the child towards lifelong insulin dependency.
Type 2 diabetes is a heterogeneous group of disorders characterised by variable degrees of insulin resistance, impaired insulin secretion and increased glucose production. Genetics, family history, ethnicity, body type, lifestyle, obesity and aging contribute to this type of diabetes which can be controlled by oral medication or insulin doses.
“I got call from a father of a boy of 17 years who was having fasting and post lunch blood sugars of 378 and 421mg%. His HbA1c was 14gm%!
He was advised short acting insulin 10,10,10 units in breakfast, lunch and dinner and long acting insulin 16 units at bed time.
Surprisingly he was advised costly tests to find out antibodies against insulin etc. Parents thought as a proponent of lifestyle I could help the boy.
Apparently looking at the age, the boy had type -1 diabetes. I asked them to get done his fasting serum C-Peptide and other tests to understand organ damage. Luckily fasting serum C-Peptide was slightly below normal and tests indicated no organ damage. I told him to strictly follow Dixit Lifestyle for one month as a trial. In one month his HbA1c reduced to 9.7gm%. In next three months it further reduced to 5.9gm%! In 4 months he became prediabetic. Since almost 7 years he doesn't take any medicine for diabetes!
The lesson we learn is before assuming a patient to be of type 1 diabetes on the basis of age, it is wise to investigate properly to confirm the diagnosis. The age may deceive us as in my centre at Pune I have at least three type 2 diabetics whose age is below 18 years”. Dr J V Dixit, Proponent of Dixit Lifestyle (R), Chairman, Association for Diabetes and Obesity REversal (ADORE), Pune.
Above patients findings were published as a case report in a reputed medical journal.
