Childhood Diabetes in Sub-Saharan Africa: Type 1

By Chinonso Cynthia Ukah. BNSc, RN, RM, RPHN. Freelance Health Writer. Medically reviewed by A. Odutola, MBBS, PhD, FRCSEd.

 

A  cute black child with her mother. Image credit: Freepik

 

Highlights

• There are two main types of diabetes affecting children in sub-Saharan Africa; type 1 diabetes (T1D) and type 2 diabetes (T2D). Rare variants include atypical diabetes (including malnutrition-related diabetes, ketosis prone diabetes, neonatal diabetes and rarer genetics based diabetes.

• Although the exact cause is unknown, some of the key risk factors for type 1 diabetes in children include family history, genetics, age, exposure to viral infections, and possibly socioeconomic.

• Prevention and management approaches for type 1 diabetes includes a healthy diet, weight loss, regular exercise, encouraging natural physical activities and insulin medication.

• Sub-Saharan Africa faces unique challenges in the diagnosis and treatment of childhood diabetes of any type due to low health awareness of the condition, delays in seeking help, healthcare infrastructural inadequacies, misdiagnosis, low healthcare funding and skilled personnel, etc. 

• More research is needed to inform the understanding of the diverse aspects of this condition in different African populations and to inform population level control and care. 

 

Introduction 

An African child. Generated with Freepik. 

 

When childhood diabetes is mentioned, what often comes to mind is type 1 diabetes. This was previously known as juvenile and insulin-dependent diabetes.

But there are other types of diabetes that affect children under 5 and adolescents under 19. They range from type 2 diabetes (T2D),and other atypical diabetes, including malnutrition-related diabetes. [1]

Families with diabetic children in developed countries do have challenges coping with the disease, even with good access to the best treatment options and expert medical care. [1] 

Across countries in Sub-Saharan Africa, where basic resources for diabetes management are often scarce or inaccessible, childhood diabetes awareness and care are more challenging.

This article aims to raise awareness and educate you about childhood diabetes. It will explore the different types that affect children in sub-Saharan Africa, ways to recognize them, how to manage and prevent them and some of the challenges facing diabetic children in the continent.

 

What is Types 1 Diabetes?

Type 1 diabetes is an autoimmune disease in which the body's defence (immune) system attacks the special cells (insulin-producing beta cells) of the pancreas, resulting in the body producing very little or no insulin.

Insulin is one of two major hormones in the body that regulates sugar level in the body.

Type 1 diabetes is mostly seen in children, although it can occur in other age groups.

 

How Common is Type 1 Diabetes in sub-Saharan Africa?

According to a report, between 2011 and 2012, the Africa Region recorded a five-fold rise in type 1 diabetes among children and teenagers below 19 years, with cases surging from four per 1000 children to nearly 20 per 1000. [2]

In 2021, over 1.2 million children and adolescents globally were diagnosed with type 1 diabetes, with 59,500 of them in Africa. [3]

In light of the health system challenges facing sub-Saharan Africa, it is reasonable to suspect that the reported number of new diabetes cases may be higher than estimated because some cases are missed, and some children even die without type 1 diabetes being confirmed as the cause of death. [4]

 

How to Know If Your Child Has Type 1 Diabetes?

There are several ways to recognize when your child is suffering from type 1 diabetes. These include the following:

A. Signs and Symptoms:

These are some of the concerns you may have or observe:  

• Polyuria (Frequent urination and excessive bed wetting): Your child will suddenly start urinating a lot, including in bed while sleeping (enuresis). If a baby, you may be changing their diapers more often because they urinate frequently.

• Polydipsia (Excessive thirst): Your child will show evidence of thirst and be unable to quench their thirst, even while drinking a lot of water.

• Polyphagia (Extreme hunger): Due to poor regulation of blood sugar, your child’s brain may receive conflicting messages about the need for food. For this reason, your child may experience extreme hunger even after a meal.

• Unexplained weight loss: Your child may continue to lose weight despite eating more food than usual.

• Weakness/Fatigue: Your child may feel more tired than usual or have less energy than normal.

• Vision problems: Your child may complain that they do not see words in books well at different times during the day.

• Fruity breath smell: You may notice that your child's breath smells fruity.

• Medical conditions: You may notice that your child experiences nausea and vomiting, belly pain, irritability, mood changes, or a serious diaper rash.

B. Behaviour Changes 

Although not specific to diabetes, there are certain behaviour changes that you may observe in older (adolescent) children with type 1 diabetes. [5] Some of these may include: 

• Sleep problems

• Depression and anxiety

• Eating disorders

• Higher absence from school

• Low grades and physical activity performance in school

• Mood changes (including increased conflictual relations and authority  issues)

If you notice any of the listed signs, symptoms and behaviour changes in your child, take them to see a doctor for accurate diagnosis immediately.

 

How is Type 1 Diabetes Diagnosed in Children?

The diagnosis of type 1 diabetes by your child’s healthcare provider involves taking a medical history, performing a physical exam, and ordering laboratory tests including, blood and urine tests. 

History

In taking a medical history, the healthcare provider will ask about:   

• Your child's symptoms and health history
• The family's health history
• Any medications the child is on, etc.

Physical examination

his will involve: 

• The healthcare provider conducting full body assessment (physical examination) on your child

Labratory Tests

Common blood tests that the healthcare provider may request include:

• Random plasma glucose: A blood sample taken at any time
• Fasting plasma glucose: A blood sample taken after at least 8 hours of not eating. Usually this test is taken early in the morning after an overnight break from food 
• Hemoglobin A1C (A1C) test: A blood test that measures average blood sugar levels over the past 2 to 3 months 
• Ketones test: A test that measures ketones in the blood or urine 

 

How is Type 1 Diabetes Treated in Children?

The treatment of type 1 diabetes in children can be tasking, and includes the following approaches: 

• Establish a feeding routine: Find a routine around your child's mealtime. You can do this by feeding the child at the same time every day. This helps to stabilise glycemic (sugar)  levels in your young child.

• Nutrition: Focus on the nutritional makeup of your child's meals carefully. Make sure the nutrients in the food are balanced as this supports stable blood glucose levels.

• Insulin dosing: Give your child smaller, more precise and prescribed doses of insulin because children are more sensitive to insulin than older people.

• Regular blood sugar checks: Regularly check the blood sugar levels in your diabetic child daily so that you can provide appropriate care as needed should the level be abnormal at any given time. 

• Urine testing: Check the urine of your child regularly for ketone levels. Ketones are substances that are formed in the body when fat, instead of sugar, is being used to form energy. Abnormal ketone levels may signal a dangerous condition known as diabetic ketoacidosis in the body and calls for prompt correction.

• Encourage physical activities: If the child is an adolescent, he or she should be encouraged to participate in physical activities such as football, running, walking, and school team sports, as this helps to maintain a healthy weight and glycemic levels.

The International Society for Pediatric and Adolescent Diabetes recommends 60 minutes of moderate-to-vigorous physical activity (MVPA) each day.8

As a parent, you should learn how to reduce the risk of hypoglycemia or low blood sugar  in your child, promote healthy eating, physical activity, and participate in their overall diabetes management.

 

How to Recognise Low Blood Sugar (Hypoglycemia) Condition in Children with Type 1 Diabetes 

Children who are diagnosed with type 1 diabetes are mostly prone to developing low blood sugar (hypoglycaemia), and this occurs more often with children on insulin injections. [6]

 

Hypoglycemia can occur in children with type 1 diabetes. Image generated with Freepik. 

 

Hypoglycemia is an abnormal condition where blood glucose levels fall too low such that it triggers stressful responses in the child. 

Some of the indicators of low blood sugar (hypoglycaemia) in children include: 

1. Palpitation: The child's heart beats faster than usual

2. Sudden and excessive sweating: Sweat appears on their forehead or palms suddenly.

3. Agitation: Their hands or body starts to shake like they're catching a cold but this is due to the low blood sugar.

4. Anxiety/Fearfulness: The child feels unusually anxious or scared, even when there's no obvious reason to be scared.

5. Sudden weight loss: The child starts to lose weight suddenly as they're not able to get nutrients into their blood cells.

6. Weakness/Fatigue: The child feels too tired to participate in their usual plays and sometimes is unable to stand due to lack of energy.

7. Mental disorientation: The child might seem disoriented, have trouble thinking clearly, or not understand what's happening around them.

8. Skin discolouration: Their skin looks unusually light or pale and loses its normal colour.

9. Sudden loss of consciousness: The child might even lose consciousness, in severe cases. [6]

 

How to Reduce the Risk of Hypoglycaemia in Children with Type 1 Diabetes

If you want to reduce the negative effects of hypoglycaemia in your child, the first thing to do is perform regular blood sugar tests, especially at night.

At night, the blood glucose level usually may drop compared to daytime because of increased digestion and release of insulin and can lead to hypoglycemia if not carefully monitored.

There are effective ways to prevent and minimise the risk of low body sugar (hypoglycaemia) in your child. These include:

• Making sure the glucose test strips that you use for checking your child's blood glucose are unexpired.

• Knowing the symptoms of hypoglycemia and how to treat it quickly.

• Giving your child insulin shots and diabetic medications at the prescribed times.

• Making sure your child eats food that is adequate in both quantity and nutrients.

• Ensuring that your child never skips their meals, as this is an important way to keep their blood sugar at normal levels even while they're taking their diabetic medications.

• Checking your child's blood sugar levels before letting them engage in any energy-consuming activity. For example, running, playing sports, or participating in physical education.

• Giving your child healthy snacks that are rich in complex carbohydrates and healthy fats.

 

Can I Prevent Type 1 Diabetes Occurring in my Child?

There is no single established way to prevent type 1 diabetes in a child at the moment. However, diabetes researchers have been actively studying and testing various ways to prevent the onset of the disease in children who have risk factors. [7]

As type 1 diabetes mellitus is an autoimmune disease where the body mistakes its healthy tissues as foreign and attacks them, the goal of prevention is to delay this process. This starts from pregnancy if you're a mother with diabetes.

• Maintain a healthy weight throughout pregnancy
• Treat all infections during pregnancy
• Avoid gluten-containing foods during pregnancy [7]

After birth, other ways you can prevent type 1 diabetes from progressing in your child is to:

• Practice exclusive breastfeeding
• Avoid introducing gluten-containing cereals into the child's diet
• Ensure the child receives complete vaccinations, especially rotavirus vaccines
• Ensure adequate consumption of omega-3 fatty acids [7]

 

Conclusion

Type 1 diabetes in children is an autoimmune condition that requires vigilant management, which is often challenging in resource-limited regions like Sub-Saharan Africa. It can be successfully managed with regular insulin administration, careful blood sugar monitoring, proper nutrition, and appropriate physical activity. Even though it cannot be prevented, with early recognition of symptoms, consistent medical care, and strong family support, children with type 1 diabetes can lead healthy, active lives despite the challenges. Researchers are actively looking for ways to slow down the progression of the disease from its preclinical phase to the clinical and complication phases. Some of these preventive ways have been found effective in the laboratory.

 

References: 

1. Deeb A, Akle M, Alame M, Al Ozairi A, Abou-Ragheb L, Akle B. Common Issues Seen in Pediatric Diabetes Clinics, Psychological Formulations, and Related Approaches to Management. J Diabetes Res. 2018 Feb 27;2018:1684175. doi: 10.1155/2018/1684175. Available from here.

2. IAHO & WHO. Diabetes, A Silent killer in Africa. Analytical fact sheet. [Internet]. March 2023. [Cited 2024 Dec 14]. Available from here.

3. International Diabetes Federation. IDF Diabetes Atlas, 10th edition. Brussels, Belgium: International Diabetes Federation; 2021. Available from here.

4. Musoma SN, Omar A, Mutai BC, Laigong P. Outcomes of children and adolescents admitted with diabetic ketoacidosis at Kenyatta National Hospital (KNH), Kenya. Journal of Diabetes Research. 2020;2020(1):8987403. Available from here.

5. Litmanovitch E, Geva R, Rachmiel M. Short and long term neuro-behavioral alterations in type 1 diabetes mellitus pediatric population. World J Diabetes. 2015 Mar 15;6(2):259-70. doi: 10.4239/wjd.v6.i2.259. Available from here.

6. Gonder-Frederick L, Nyer M, Shepard JA, Vajda K, Clarke W. Assessing fear of hypoglycemia in children with Type 1 diabetes and their parents. Diabetes Manag (Lond). 2011;1(6):627-639. doi: 10.2217/DMT.11.60. Abstract available from here. 

7. Ingrosso DM, Quarta MT, Quarta A, Chiarelli F. Prevention of type 1 diabetes in children: A worthy challenge?. International Journal of Environmental Research and Public Health. 2023;20(11):5962.doi: 10.3390/ijerph20115962. Available from here.

 

Related: Type 1 Diabetes Mellitus: An Explainer for Africans

 

Published: February 9, 2025

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