COIMBATORE: Many parents take the dark patches of skin around the neck of children as allergy caused by jewellery or adolescent changes, doctors warn that this may be an early symptom of diabetes among them.
In Coimbatore, type I diabetes is observed in 90 percent of children, but with the change in lifestyle and increasing obesity, more case of type II diabetes patients below 16 years are now seeming medical help, said Dr P Velayutham of the Endocrinology and Diabetology Department at Kovai Medical Center and Hospital. He is also member of the Research Society for the Study of Diabetes in India.
The difference between the two types of diabetes is that in type II, there is a sudden halt in the supply of insulin following a hike in sugar levels.
Dr Gokula Ramanan, member of Diabetes Association of India, said the dark patches seen in obese children is a skin pigment disorder (acanthosis nigricans) caused by insulin resistance.
Even children who are not classified as obese get type I diabetes and in 99 percent of these cases, its presence is identified while testing for other complications including urinary tract infection, long-term upper respiratory infection, frequent fever weight fluctuation.
Diabetologists suggest that if parents spot symptoms like these dark patches seek medical care, the the management of the disease would be easier.
Dr Suresh Damodharan, endocrinologist at Sri Ramakrishna Hospital, said a major challenge parents face is overcoming certain beliefs of their elders and taking children to hospital.
According to Dr M Vijayakumar, also an endocrinologist, for children, the prescribed treatment as well as physical exercise and controlled diet are absolutely essential to reduce obesity and control blood sugar.
It is important for them not to use supplementary foods and ‘defensive snacking’, bey-ond the controlled nutritious diet advised by doctors as this might nullify the effect of drugs and vary blood sugar levels, said Dr Suresh Damodharan.
Time to Replace Old With New-gen Drugs, Say Doctors
In an interesting case, a 72-year-old diabetic from Annur was admitted in a private hospital after she fainted in her home. During clinical investigations, it was found that she had developed hypoglycemia (low blood sugar) as she had taken old-generation drugs prescribed by local doctors for years.
Many such cases of the side effects of these drugs have been reported. Doctors say that with advent of new-gen drugs, it is high time to replace the old ones.
Endocrinologist Suresh Damodharan, who has been conducting studies on anti-diabetic drugs, said the old-generation drugs, mostly based on powerful sulphonylurea derivatives, were active most of the time.
The blood sugar level varies throughout the day and these drugs, irrespective of sugar content in the blood, lower the level. So, the blood sugar level can fall below normal in those taking the drugs. If left unchecked, it might result in stroke, heart attack or renal failure, said Dr P Velayutham of KMCH.
But the new-generation drugs are milder and are active only for a shorter duration and chances of blood sugar going below normal are not high, he added.
Dr Suresh said these incretin-based third-generation drugs also do not contribute to weight gain. By sending the proper signals to the satiety centre in the brain, they keep in check both blood sugar and weight.
Other recent advances in treatment include a pumping device which can provide insulin depending on the blood-sugar level and an ‘artificial pancreas’ fitted with a glucose sensor and automated devices to replace manual checking and pumping.
‘Elderly Patients Face More Complications’
According to data available with the leading diabetes diagnostic centres in Coimbatore, close to 80 percent of diabetic patients above the age of 60 years are neuropathic.
Once this problem develops, these elderly diabetic patients do not feel any pain below their knees as the nerves in this region become damaged and they lose any sensation over a period of time, said Dr B Asokan of the Coimbatore Medical College Hospital (CMCH).
Because of this, many such patients get hurt even while walking. In these cases, treating diabetes foot wounds becomes more complicated and finally, the only option left would be amputation, he added.
Dr Suresh Damodharan of the Sri Ramakrishna Hospital said that a condition known as ‘Charcot joints’ or neuropathic joints, is also becoming prevalent among elderly diabetic patients. In those with this condition, their knee joints or foot get injured while moving around their work places or homes and the bone starts to disfigure.
If the the bone arch in the foot starts to change shape, the pain gets transferred to the hip, complicating things further, he added.
Dr M Vijayakumar, an endocrinologist, said that use of specially designed footwear based on pressure points will help to bring down the intensity of pain. However, prevention of the problem through frequent medical check-ups is better than cure. Once these conditions are reported, a comprehensive multidisciplinary approach with the help of foot surgeons (podiatrists) is vital in the treatment of elderly patients, he added.