In the summer of 2016, little Hakaroa Vallée, 12, started vomiting as soon as he ate. He is very thirsty and urinates often. His doctor diagnosed him with gastroenteritis but his condition worsened. Transported by helicopter to the hospital, the boy learned when he woke up that he almost died “within fifteen minutes”. The diagnosis is: type 1 diabetes.
Every year in France, nearly 1,500 children discover their type 1 diabetes while they are in a critical situation which can lead to a coma, according to the association Aid to Young Diabetics (AJD). However, there are signs that allow the disease to be detected earlier.
Bedwetting, extreme thirst and fatigue
“We don’t think about diabetes in children,” regrets Doctor Marc de Kerdanet, president of the AJD. For society, diabetes is type 2 diabetes, which occurs later and more gradually. » Unlike type 2 diabetes, type 1 diabetes is not linked to an unbalanced diet and a sedentary lifestyle. This is an autoimmune disease. The number of affected children has doubled over the last fifteen years, and the average age of diagnosis of pediatric diabetes has increased from 12 years in the 1990s to 8 years today.
In children as in adults, symptoms should alert you. “A child who wets the bed again, is thirsty all the time, vomits, loses weight, has a stomach ache and is very tired must suggest diabetes,” warns Jean-François Thébaut, vice-president of the French Federation of Diabetics. “Among all these signs, there may be only one or two,” specifies Doctor Thébaut. “These symptoms are not very specific, which means that parents – or even doctors – can miss the diagnosis,” laments Doctor de Kerdanet. However, it is vital to take these warning signals into account, otherwise there is a risk that the child's condition will deteriorate significantly and quickly.
Avoiding ketoacidotic coma
“If we notice these symptoms, we must quickly send the child for a blood test and a urine analysis to measure their sugar level,” insists Fabienne Cahn Sellem, pediatrician and member of the French Association of Ambulatory Pediatrics (Afpa). If the level is not correct, the child must be sent to the emergency room immediately because there is a very rapid risk of putting his or her vital prognosis at risk. » In a short time, the child risks developing ketoacidosis, excessive blood acidity linked to a major insulin deficiency. “Unfortunately, ketoacidotic coma still happens too often,” regrets the pediatrician. In France, five to six young people die each year from diabetic ketoacidosis, according to Public Health France.
“Of the 3,000 children diagnosed each year, almost half will develop ketoacidosis, with a severe form in 17% of them,” specifies the president of the AJD. Beyond the vital risk, diagnosing diabetes as early as possible allows you not to “damage the body” and to be “taken care of in a specialized service”, underlines Doctor Cahn Sellem. If the disease is detected early enough, immunomodulatory treatments can delay the need for insulin.
A screening
A blood test will make it possible to look for the presence of autoantibodies symptomatic of the disease. But to avoid reaching a critical situation, health authorities advise people at risk to get tested. A child whose mother has type 1 diabetes has a 4% risk of developing it, a figure which rises to 8% if the father is affected. “Immunological diseases in the child or parent, such as celiac disease or inflammatory bowel disease, also increase the risk of having type 1 diabetes,” adds Dr. Thébaut.
But 90% of type 1 diabetics have no family history. “We should do screening in the general population,” says Doctor Marc de Kerdanet. “We would like the antibody test to be offered during the child's 2- or 6-year exam, with a few drops of blood, and for it to be reimbursed,” adds pediatrician Fabienne Cahn Sellem. If early access to treatment can delay - sometimes significantly - the appearance of clinical symptoms, none can currently stop the development of the disease.
