Neurological complications due to type 1 diabetes significantly affect children and adolescents as they alter the nervous system during its development. Dr. Suruchi Goyal Agarwal, Consultant – Paediatrician & Paediatric Endocrionology, Manipal Hospitals Varthur Road, discusses the types of neurological issues and how to manage them in children with type 1 diabetes.
There are several mechanisms through which type 1 diabetes patients experience neurological complications. High blood sugar level causes microvascular and metabolic changes. Microvascular changes result in reduced blood perfusion in nerves resulting in structural and functional changes in the nervous system. Metabolic alteration results in increased oxidative stress, inflammation, and mitochondrial dysfunction. These events further affect the health of nerves.
Inability to attain target glycaemic control goals are associated with an increased risk of long-term neurological complications including
● Peripheral neuropathy: Although rare in children with type 1 Diabetes, high blood sugar damages the tiny blood vessels supplying the peripheral nerves outside the brain causing numbness, tingling sensation, weakness and pain, usually in the hands and the legs. Nerve damage in the GI tract can lead to diarrhoea, nausea, indigestion, etc while damage to the autonomic nerves can cause a drop in blood pressure, sweating, increased heart rate, bladder problems, etc.
● Learning and memory: Evidence suggests children and adolescents with poor control of blood sugar in type 1 diabetes experience cognitive alterations as compared to their healthy counterparts. The younger the child, the larger the effect. Multiple studies have confirmed an alteration in concentration and psychomotor skills, visual learning and memory skills.
● Brain structure and connectivity changes: Evidence suggests an alteration in the brain structure including chances in grey matter and white matter volumes, changes in brain activity and alteration in connectivity which may have a significant influence on adulthood resulting in reduced memory and attention.
● Sleep alterations: Diabetes can be associated with poor sleep quality due to frequent urination, pain or discomfort and restless leg syndrome. Fluctuations in glucose can also cause sudden awakenings from sleep among adolescents with type 1 diabetes.
● Depression and Behavioural alterations: Inability to cope with the condition can lead to reduced quality of life, depression, mood fluctuations and increased health risky behaviour such as overeating, sedentary lifestyleand social isolation. These can further result in poor glycaemic control and increase the risk of diabetic complications. Disturbed eating behaviour is common among adolescents with type 1 diabetes.
PREVENTION AND MANAGEMENT
Diabetic neuropathy is a rare occurrence in children and adolescents due to nature of the pathology which takes years to manifest. In children with type 1 Diabetes the aim should be to maintain blood sugars in a good range , avoiding large fluctuations and aim to prevent the onset of neuropathy. At present, there is no cure for diabetic neuropathy and the goals of management should include slowing down disease progression, relieving symptoms and pain and managing complications.
There are several measures to prevent and manage neurological issues in children with type 1 diabetes, including
● Maintenance of blood sugar level within the targeted level – insulin, blood sugar checks and exercise
● Following all medications and lifestyle changes recommended by the doctor
● Never skipping on follow-up visits with regular physical exams and blood tests
● Early psychological intervention in children who need it.
(The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)