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Aug31
JUVENILE DIABETES MELLITUS
Juvenile diabetes is one of the most common chronic conditions to affect children all over the world and each day, over 200 children are diagnosed with type 1 diabetes. Although Diabetes is a metabolic disorder, it can have psychosocial effect, if not handled in the right manner. As a long term condition that affects day-to-day living, diabetes can be particularly stressful on the child and parents. Newly detected Diabetes impacts all aspects of a child's life and its management requires the parents to tackle challenges at multiple levels physical, psychological, social and educational. If not effectively addressed, a spectrum of psychological issues ranging from lack of confidence to severe depression may result. However with proper training, learning about diabetes and making small changes in life style as a family, you can live a fairly normal life.As Diabetes affect all most organs of our Body ,it is decribed as Diabetes=flow or excess urine,(diuresis or called as POLYURIA),Mellitus= sweet as urine becomes sweet as sugar is excreted in it once our Blood Sugar level cross 180 mg% our kidney cannot absorb all sugar passing through it as sugar is lost person becomes weak(disabled) and need more food or hungry(POLYPHAGIA) and as with sugar more water or urine is also passed so person becomes more thirsty(POLYPEPSIA),these symptoms are very much seen in Juvenile Diabetes or young children then in Maturity Onset diabetes Mellitus (MODS) which affects mostly above 40 yrs of aged persons and mainly present with Metabolic Syndrome.Diabetes thickened intima of our Arteries because of Atherosclerosis as a result micro vessels or Arterioles becomes thickened and Hypertension develops which causes Kidney changes and chronic Renal Failure,Angina,Ischaemic Heart Disease,heart failure,Blocks etc,cerebro Vascular Accident, Ischaemia in Limbs,Ulcers and infections because of excess sugar in blood as well as inert and less responsive protective pain Nerve Fibres.Pain, Parasthesia,Numbness,Paresis due to radiculopathy are common in Diabetic patient,Ulcers and ischaemia of toes and fingers are serious because of single end arteries .patient also notice Sexual Dysfunction often not asked by doctor to patient and all these leads to depression and many psycho neurotic changes in patient and family members and parent leading to total social unjustment and belief in life leading to suicidal tendency due to despairness and loss of hope in life.

In this article, we examine the need for counseling and the various counseling options that a parent has to help a child and themselves deal with such issues.Becuase we belif that Diabetes is harmful but not invinsible,we can easily control it with modern medicines and change in life style with regular precautions and these children will live a normal life rather a better intelligent life ,only love,assurance and encouragement and help from parents and society is needed.
Counseling the diabetic child
A child diagnosed with diabetes is suddenly thrust into the unenviable position of dealing ith a chronic condition. Starting from dietary restrictions to insulin injections, the child has to come to terms with the all-pervasive impact of this condition. As a result, the child ay suffer from stress. Resentment, fear of being mocked at by peers, a fear of being branded as a 'sick' or 'ill' person, and anger at parental control on diet and activities are ome of the feelings that a child may experience. If allowed to build up, such feelings can have a debilitating effect on the child's mental and physiological health.
Parents can do a lot towards helping the child cope with diabetes. In fact, the attitude of parents plays a great role in forming the child's response to the condition. Paying enough attention to the psychological needs of the child can be as important as providing medication. By following these simple do's and don'ts, parents can empower the child as he/she work on responding to the condition.
Do not be over-protective. Many parents confuse precaution with apprehension and cross the fine line between being protective and over-protective. Understand that diabetes need not stop your child from leading a healthy, active life. Do not deter the child from participating in active sports and games in the mistaken belief that your child has to be protected.
2. Do listen and watch out for cues to your child's state of mind. Loss of appetite, sudden loss of interest in studies, reluctance to go to school, a listless attitude are some signs that your child needs help in coping with the condition.
3. Do not refer to the condition as a disease.It only helps to firm up an opinion that diabetes is to be feared and dreaded.
4. Do discuss the condition, its causes, treatment and precautions to be followed. An understanding about the physiological conditions and changes associated with diabetes will alleviate your child's fears about this condition and will equip him/her with the requisite knowledge to tackle it.
5. Do not express worries about the child's future, especially within earshot of the child.
6. Do not treat the child differently from his/ her siblings. This will only make your child more conscious about his/her condition.
7. Do take every opportunity to stress that diabetes is treatable.
8. Do focus on success stories of fellow diabetics from your child's area of interest - for example, successful cricketers, or athletes who are diabetics. Your child will profit from such role models.
9. Letting some one know about the fact that your child is diabetic should occur as naturally as divulging any other personal fact about yourself. If someone were to notice your child taking a shot and wondered what it was or why it was so, that would be a reason to explain! Don't express being diabetic as a negative thing or something that defines a person. Let it come naturally but definitely don't hide it. Be short, precise and positive while telling about it.
10. Be realistic in the goals set of your child.
11. Do set a personal example. Follow a healthy regimen of diet and exercise yourself to make it easy for your child to adhere to his.
12. Be understanding during the instance that your child deviates from the prescribed routine – your child is still a child and there may be occasions when he she feels the need to bypass the routine.

Counseling partners and caretakers
Juvenile diabetes impacts the entire family, not just the affected child. The parents of a diabetic child are also subject to stress, although for different reasons. In the case of parents, possible stressors are a fear of societal ridicule, apprehension about a girl child's marital prospects, worry about the child's longevity and future and sometimes guilt on not being able to protect the child from this condition. Counselling of parents and caretakers can go a long way in helping them tackle the emotional impact of this condition. While child counselling sessions help to assure the child, reinstate confidence and also infuse the belief that diabetes is a manageable condition, parental counseling seeks to allay the parents' fear regarding their child's future.

External sources of counselling
Depending on the extent of the psychological impact, counselling of the child is therefore not just desirable but even required. Although parents may be able to provide suchadvice, external help and counseling can effectively supplement the efforts of parents.

There are various counseling options available.
These are :
Family physician: The family physician is often the first line of support. The family physician will have an intimate knowledge of the child, his/her interests, and temperament. Further, the family physician enjoys the trust of the parents and the child alike. A talk with the family physician may be a timely confidence-booster.

Friends and family: Advice from friends and family, especially fellow-patients can also be very effective. A family member or friend who is successful and happy, despite such a diagnosis can be a very effective role model.

Online and offline support groups: Online support groups for both children and parents alike, provide a global network of support and also resources that the parents and child can tap into. Online support groups overcome the barriers of distance and allow parents to communicate, share and get answers to mutual concerns on bringing up a diabetic child.
Professional counseling: Where the emotional impact is deeper, professional counseling is not just desirable but required. Where thepsychological impact has resulted in mild or severe Depression,advice from a psychiatric professional is mandatory.
Tretment
Like MODS this Diabetes is too curable but here oral Medicines like Glipizide,Tolbutamide, Chlopropamide, Gliclazide,Glimperide etc.which stimulate Insulin production from Beta cell of Pnacreas does not work as Beta cells are absent in these children's pancreas,even Peripheral receptors stimulator like Metformin or Pio or Rosigliatazone or Repaglinide or Netaglinide or acrabose,Vobiglose,Majlitol,Vidagliptine or Sitagliptine does nor work.
Sole therapy is Injectable Insulin which may be porcine or Bovine Soluble insulin three times a day (used as cheap but leads to resistance and more lipidostophy ,now a days Human or recombinant tech E.Coli produced soluble Insulin three times or Protamin or Zinc insulin Suspension as Lente or UltraLente Insulin in various mixture proportion with Soluble Insulin 1-2 times used as subcutaneous injections at thigh or at belly part.Now a days prtamine fine preparation as Lispro Insulin and once used Insulin Glargin is used.Insulin Detemir or Expenta Injections are too used.Genetherapy and Stem cells are also coming with Pancreatic Beta cell transplant is also practised in developed rich countries.Insulin pump and Nasal Insulin spray is now also used in our country.

Conclusion
Dealing with diabetes is not just about taking medication, it is about dealing with its invisible and intangible effects. Counselling is one of themost potent tools that parents have to successflly manage the psychological consequences of this condition.
For stories on successful role models for children and more tips to young people on self management, coping and living with diabetes should be written and available to children sothat they never give away rather becomes more courageous to face it with change in life style,control over food and regular medicines and prevention of getting infected with infections and avoiding trauma to toes and nails with every care for any dental or any other minor sugical intervention.Such precautions will allow to lead the Child to lead a normal life with normal development ,activities,education and Social upbringing.
Dr.D.r.Nakipuria


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