The First Private Teaching Hospital in South Africa, Johannesburg

Diabetes in Children

Children with diabetes should be referred to a paediatric diabetes specialist centre that has a team that specializes in the treatment of children with diabetes because care is very different from adults with diabetes. Here at the Wits Donald Gordon Medical Centre we are fortunate to have one of the most comprehensive paediatric diabetes centres in the country. Our team is led by paediatric endocrinologist, Dr David Segal, and includes a team of diabetes educators, dieticians and a paediatric psychologist.

Dr Segal completed his undergraduate training at Wits University before leaving our shores to specialize in Paediatrics at the world renowned Cleveland Clinic. He super specialized in Paediatric endocrinology at Riley Children’s Hospital in Indiana before returning to South Africa in 2003.

Children are presenting with diabetes at an ever increasing rate and at younger and younger ages. Type 1 diabetes (juvenile onset diabetes, insulin dependent diabetes) is the most commonly encountered form of diabetes presenting in children, but type 2 diabetes (adult onset, non-insulin dependent) is now presenting in adolescence and childhood associated with the obesity epidemic and is prevalent in certain ethnic groups.

People with type 1 diabetes require the use of injected insulin from the time of diagnosis, but people with type 2 diabetes may initially be managed by weight loss, exercise and a tablet called metformin. Failing this other tablets may be required (sulphonylureas) or even insulin by injection.

The treatment goals in diabetes are to keep blood glucose levels as close to normal to prevent the devastating short and long-term complications of diabetes.

Typical diabetes symptoms that should prompt further investigation include: increased frequency of urination, urinating at night or new onset bedwetting, excessive thirst, weight loss, blurred vision and tiredness. If early symptoms are missed, diabetic ketoacidosis may develop and has symptoms of rapid breathing, tummy pain, nausea and vomiting and even coma. The index of suspicion needs to remain high when any of the previous symptoms are present.

Diabetes is an incredibly complex condition that affects every aspect of a child’s life and our goal is to coach children and parents on how to fit diabetes into their lives and succeed.

Most children use a regimen of multiple daily injections (MDI) with a combination of background or long acting insulin, intermediate acting insulin and short acting or meal time insulin. The typical MDI regimen consists of 5 injections per day. Injections are now given with pen devices using very short fine 4mm needles that are virtually painless. Other options include continuous subcutaneous insulin infusion pumps- or insulin pumps. Insulin pumps are a valuable part of the diabetes armamentarium and help motivated well educated patients to achieve and maintain optimal blood glucose control. Insulin pumps need to be managed by specialist diabetes teams at centres accredited and experienced in insulin pump therapy.

Our centre is heavily involved in research and delivers world class care allowing our patients to access the latest and most advanced diabetes technologies in the world. Our philosophy: “Give a man a fish and he will not go hungry that day, teach him how to fish and he will never go hungry.” Chinese proverb