To ease their transition to such a regime, Professor Thomas Danne, Director of the Department of General Paediatrics and Endocrinology/Diabetology at the auf der Bult children’s hospital in Hannover, Germany, and President of the International Society for Paediatric and Adolescent Diabetes (ISPAD) as well as the German Diabetes Association, accompanies young diabetics and their families. The professor is also director of the Sweet project (www.sweet-project.eu), which aims to establish qualified reference centres for adult and paediatric diabetes in the EU Member States. During a discussion with Karoline Laarmann (European Hospital), Professor Danne explained the specific requirements of paediatric diabetics and technical advances in insulin therapy from which children in particular can benefit.
‘When a child has type 1 diabetes, the family and the immediate social environment are very much involved. Diabetes affects many different activities in a child’s life and, during childhood, these activities are coordinated by the parents to a large extent. Thus, providing adequate training for family members is a major challenge since we want the child to be able to lead as normal a life as possible, despite the chronic disease.
‘Obviously the training programme for children is different from that for the parents. For example, you would not talk to an eight-year-old about possible diabetes sequelae, such as loss of eyesight since you would only frighten him or her. Therefore it is highly recommended that children be treated in specialised paediatric diabetes centres, where physicians are not only available to provide medical care but where psychologists and educators offer a full service. In addition, for paediatric patients the insulin dose changes frequently, due to physical development or changing daily schedules, for example. Consequently, the doses must be adjusted about every six weeks.’
Improving the lives of young diabetics
‘As recently as ten years ago we thought we had to spare the children as many insulin injections as possible. However, this meant that the metabolism had to be maintained at a constant level – something you can achieve only by adhering to a very strict diet, which is not a sensible approach with children. Moreover, the kids handle frequent injections and blood glucose measurements amazingly well. For them it is much more important to lead a normal integrated life amongst their peers. As far as continuous subcutaneous insulin infusion (CSII) is concerned there is one exciting innovation that allows pain free and above all continuous blood glucose monitoring. In addition to the insulin pump, a small sensor is inserted in the fatty tissue, which measures blood glucose. The good news is that these sensors can remain in the body for much longer – up to seven days.’
Insulin pump therapy is gaining ground in the treatment of adult diabetics. Asked whether this is also the case for children, Prof Danne was affirmative: ‘This therapy option is particularly well suited for children because it doesn’t impact on the child’s daily routine as much as injections do. Only fast-acting insulin is used for insulin pump therapy; its absorption by the body can be predicted more accurately. This means the patient can eat or exercise whenever he feels like it. In our children’s hospital half of our 600 paediatric patients already use the insulin pump.
‘Two major innovations now make insulin pump handling easier: First, there are so-called patch pumps, which stick on the skin and no longer require an insulin catheter. Second, there is the combination of insulin pump and blood glucose sensors, which continually monitor blood glucose levels. The values can immediately be read out on the display of the device. This facilitates programming insulin release, particularly before meals.
‘Unfortunately, there is one thing the systems cannot yet do: automatic self-regulation of blood glucose measurements and insulin release. The devices don’t yet react quickly enough to a sudden blood glucose increase. A pump with such a feedback loop, which works without human intervention, would be great – particularly for children.’