Neonatal diabetes is a rare disorder affecting 1 in 2,60,000 children. It is more prevalent in communities practising consanguineous or blood-related marriages. Helping a child live with neonatal diabetes can be challenging but not impossible, thanks to modern medical technology. Read on to learn more about neonatal diabetes treatment, including causes, types, and treatment.
What is Neonatal Diabetes?
Neonatal Diabetes Mellitus is a rare genetic disorder in which patients experience severe hyperglycemia due to insufficient or no circulating insulin. NDM is detected in children before six months or between 6 months to 1 year. Depending on the diagnosis, children diagnosed with NDM need transient insulin or permanent insulin treatment. Neonatal Diabetes Mellitus is diagnosed by genetic testing. Some of the common signs of neonatal diabetes include frequent urination, rapid breathing, and dehydration.
Neonatal Diabetes Causes
Neonatal Diabetes must not be confused with Type 1 diabetes, although children diagnosed with the latest must also test for NDM. While Type 1 is an autoimmune disease, NDM is caused by a gene mutation that affects insulin production, thereby significantly increasing blood glucose levels in the body.
There are over 20 known genetic causes for neonatal diabetes mellitus, with typical reasons for the condition including increased parenteral glucose administration, sepsis, and increased counter-regulatory hormones produced due to stress and steroid medications. In over 30% of patients, neonatal diabetes causes can be traced to mutations in the KCNJ11 gene, while some 20% have mutations in the ABCC8 gene. Some patients develop NDM due to an underdeveloped pancreas in such cases, patients may also experience fatty stools because of the body’s inability to absorb fat-soluble vitamins.
Neonatal Diabetes Types
There are two types of neonatal diabetes transient NDM and permanent NDM. In patients with transient Neonatal Diabetes Mellitus, the problem is generally resolved between 13 to 18 weeks; however, it could recur during adolescence or adulthood. In contrast, permanent neonatal DM, once diagnosed, stays for the rest of the patient’s life. Patients with permanent DM also have developmental delays, recurrent seizures, and muscle weakness.
Neonatal Diabetes Treatment
Neonatal diabetes treatment depends on the diagnosis, i.e., whether it is permanent or transient diabetes mellitus. Treating transient neonatal diabetes mellitus is complex because of an absence of subcutaneous fat, especially in children with low birth weight. Also, they need minute insulin doses and have a different sensibility to exogenous insulin. These patients are also at risk of hypoglycaemia with potential for neuronal damage. Patients are treated with high doses of sulfonylurea medications to improve neurological function and glycemic control. It also helps the pancreas release more insulin. If sulfonylurea medications aren’t enough, the doctor may prescribe insulin. The medicines also help manage developmental delays.
As earlier said, different genetic mutations could be responsible for neonatal diabetes. Therefore, the treatment also depends on the gene responsible for the condition. Patients are suggested oral sulfonylurea tablets when the disease is caused by mutations in the KCNJ11 or ABCC8 genes. In our experience with hundreds of neonatal diabetes treatments, most patients have either the KCNJ11 or ABCC8 mutations. In fact, these patients respond better to oral sulfonylurea tablets than insulin injections.
In addition, patients with permanent neonatal diabetes mellitus are suggested a high-calorie diet to ensure appropriate weight gain. Doctors may also suggest pancreatic enzyme replacement therapy in patients with exocrine pancreatic insufficiency. To avoid secondary complications, the doctor may recommend constantly monitoring blood glucose to prevent diabetic ketoacidosis and hypoglycaemia.
Living with Permanent Neonatal Diabetes
Patients undergoing permanent neonatal diabetes treatment will need lifelong surveillance of blood glucose concentrations at least four times a day. Once the patient reaches ten years of age, they will need annual screening for complications like microalbuminuria and retinopathy. In addition, doctors may form a treatment plan that includes a healthy diet and physical activities to manage diabetes based on the result of the genetic testing.
Choosing The Best Diabetic Doctor in Nagercoil
If the paediatrician suspects your child may have neonatal diabetes, they may refer you to a genetic counsellor, a neonatal/pediatric endocrinologist, or other physicians specialised in this area. They will determine if genetic testing is necessary, suggest the type of genetic tests that must performed, and make recommendations based on the results. At Calwin Hospital, we have the most skilled professionals using the latest clinical and paraclinical studies to offer personalised neonatal diabetes treatment.