Neonatal Diabetes

Diabetes mellitus (DM) is a group of conditions where the body does not produce enough insulin. This metabolic disorder can be characterized by disturbed metabolism of carbohydrate, protein, and fat. This syndrome can be classified into prediabetes, Type 1, Type 2, and gestational diabetes. Prediabetes is the condition when the blood sugar is higher and it is most common among obese adolescents. Type 1 diabetes is the most common type in children, also known as juvenile-onset diabetes. In type 1 diabetes, the pancreas produces little or no insulin.  It is an autoimmune condition as the immune system attacks and destroys the cells in the pancreas (beta-cells) that make insulin. Family history, genetics, race, and certain viruses are some of the risk factors associated with it. Symptoms include-

• Increased thirst and hunger
• Bed-wetting in a toilet-trained child
• Extreme weight loss
• Fatigue
• Irritation
• Nausea
• Fruity-smelling breath

Type 2 diabetes in children is a chronic disease characterized by peripheral insulin resistance i.e., cells in the body do not respond adequately to insulin. It affects most commonly overweight or obese younger children, also known as non-insulin-dependent or adult-onset diabetes. Risk factors for children are similar to those in adults: weight, inactivity, family history, ethnicity, age, and birth-weight. Gestational diabetes occurs during pregnancy which usually goes after birth. Severe complications of diabetes in children are diabetic ketoacidosis, psychosocial, and vascular problems. Neonatal diabetes mellitus (NDM) is referred to as the onset of persistent hyperglycemia diagnosed in children under 6 months of age. It is a rare disorder affecting all races and ethnic groups. It occurs in approximately 1 in 3,00,000 live births. Transient and permanent are the two main types of NDM. Transient neonatal diabetes is generally caused by overactivity of genes in the imprinted region of chromosome 6q24 which usually disappears within the first few weeks of birth followed by hyperglycemia, dehydration, and failure to thrive in infancy. It leads to overexpression of paternally derived genes and can come back again typically during adulthood. NDM is mainly caused by the mutations in KCNJ11 and ABCC8, often resulting in permanent NDM. It can be diagnosed through Fasting plasma glucose level, random glucose level, glycosylated hemoglobin, and oral glucose tolerance testing. Metformin can be used as a first-line treatment. Further, strict control and management of blood glucose are crucial to help prevent these complications. Dietary recommendations for children with diabetes is most important to prevent short-term and long-term complications. Children should avoid foods with saturated fats, eat fruits, vegetables, whole grains, high-fiber foods, also should eat regularly, and should not skip meals.

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