Type 1 diabetes in children: "Ketoacidosis remains the leading cause of death in our region" (Prof. Abdoulaye Lèye)

Type 1 diabetes in children remains a major health challenge in sub-Saharan Africa, marked by often late diagnoses. In an exclusive interview, Professor Abdoulaye Lèye, a diabetologist at the Pikine National Hospital Center, details the challenges associated with this disease, from recognizing the first symptoms to daily management by families and schools.

The mechanism of the disease is based on an immune deficiency. Ingested sugar is transformed into glucose in the blood, requiring insulin, a hormone produced by the pancreas, to enter the cells and provide energy.

In children, the immune system mistakes its target and destroys the insulin-producing pancreatic cells. This type 1 diabetes is not caused by diet and cannot be treated with a simple diet, but requires daily insulin injections from the moment of diagnosis.

Four warning signs should immediately mobilize those around the child: intense thirst day and night, frequent urination including episodes of bedwetting in a toilet-trained child, weight loss despite sometimes increased appetite, and profound fatigue without energy.

Without prompt treatment, the body burns its fat reserves and produces acetone. The child vomits, experiences abdominal pain, has rapid and deep breathing, emits breath that smells like ripe apples, and becomes drowsy, thus entering ketoacidosis, an absolute life-threatening emergency.

Diagnosis is frequently hampered by formidable symptomatic confusion. Vomiting and abdominal pain suggest gastroenteritis, appendicitis, or malaria. Rapid breathing points to pneumonia or asthma, while drowsiness suggests meningitis or severe malaria, and weight loss raises suspicion of malnutrition or tuberculosis.

To avoid these errors, which can sometimes have fatal consequences, Professor Lèye formulates an absolute rule: "Any child who vomits, breathes rapidly, or appears drowsy must absolutely have their blood glucose measured before any other examination, whether in a health post or a large hospital."

Diagnostic delays lead to tragic situations. In regions where the disease is well-known, diagnosis occurs within weeks, before the onset of ketoacidosis. In the local context, delays are longer, and many young patients arrive directly in intensive care. Ketoacidosis kills through dehydration, cardiac arrhythmias, or cerebral edema, while survivors sometimes suffer lasting neurological damage, and families endure profound trauma.

The treatment process profoundly and permanently disrupts the daily lives of the child and their family. Insulin remains essential for life, and the requirements are constantly adjusted according to growth, weight, puberty, and activity levels. Since young children cannot express hypoglycemia, parents must remain constantly vigilant.

The burden thus falls on the entire family unit, which must coordinate injections, check-ups, and meals.

Learning to self-administer insulin is a gradual process. The beginning is often difficult, with children crying and refusing injections, which can make parents feel guilty. Around the age of 7 or 8, many children are able to measure their blood glucose independently and with pride. This process is facilitated by safe techniques, the use of insulin pens with finer needles, the establishment of reassuring routines, and the child's active participation in choosing the injection site.

The specialist also emphasizes the importance of never hiding the illness to spare the child a feeling of shame, while supporting siblings and parents in the face of exhaustion.

Regarding diet, Professor Lèye challenges common misconceptions by reminding us that a diabetic child is first and foremost a growing child with normal nutritional needs. Rather than drastically banning certain foods, which often leads to sneaky snacking, he advises favoring water over fruit juice, fruit over biscuits, and maintaining shared family meals.

The major health risks for children lie in initial ketoacidosis due to delayed diagnosis, insulin supply disruptions, and untreated severe hypoglycemia. Families face significant financial hardship, as the monthly cost of blood glucose test strips often exceeds that of insulin itself, leading some parents to ration treatments.

The school plays a crucial role in daily monitoring. Since the child spends a large part of their day there, the teaching staff must be informed of the signs of hypoglycemia and the appropriate actions to take, such as administering sugary water or three sugar cubes. Teachers must ensure that the student is never deprived of water, scheduled snacks, bathroom breaks, or physical education.

In the long term, poor glycemic control damages small blood vessels and nerves, threatening vision, kidney function, the cardiovascular system, and the lower limbs. In children, it also disrupts growth and puberty, while severe and repeated hypoglycemic episodes before the age of 6 can impair brain development and learning abilities.