Diabetes can be very unforgiving. Besides children and older people, it can also affect newborns. Diabetes in infants is termed as neonatal diabetes, which is diagnosed by six months of the baby’s birth. Caused by a genetic mutation, its incidence is approximately one in around 100,000 to 400,000 live births, says Dr Ksenia Tonyushkina, pediatric endocrinologist, UH Rainbow Babies and Children’s Hospital, Cleveland, USA.
What causes neonatal diabetes?
Dr Tonyushkina says neonatal diabetes refers to the early onset of diabetes or high blood and urine glucose levels within the first 12 months of life due to defect during the development of the pancreas. “It is mostly caused by an unexpected mutation in the gene affecting pancreatic beta cell development and function. And in most cases, the mother does not have blood glucose problems or diabetes,” she says.
Dr Sandeep R, consultant, neonatology and pediatrics, Rainbow Children’s Hospital, Marathahalli, Bengaluru, says although the onset of neonatal diabetes happens in the first month of life, it is diagnosed only by the end of six months.
Many babies with neonatal diabetes are born preterm. “Preterm babies are kept in the NICU [neonatal intensive care unit] for monitoring, and in such cases, the diagnosis is made sooner as we monitor their blood sugar regularly. If their sugar levels are not under control, we suspect neonatal diabetes,” says Dr Sandeep.
Signs of diabetes in newborns
A diagnosis of neonatal diabetes is made based on persistently elevated blood glucose levels (>200 mg/dl) after ruling out all other reasons for it. “The diagnosis is confirmed when genetic testing detects a causative gene mutation,” says Dr Tonyushkina.
Dr Sandeep adds that one of the usual symptoms is failure to thrive, where the baby does not gain weight despite being well-fed. These symptoms are usually observed after they are discharged from the hospital. “Around 30 to 40 per cent of the affected babies have IUGR (intrauterine growth restriction). As a result, they have a low birth weight and are malnourished at birth,” he says.
According to experts, symptoms of neonatal diabetes include:
- Diabetes ketoacidosis (buildup of acid in the blood).
- Poor growth and development
- Frequent urination and thirst
- Dehydration
Types of neonatal diabetes
Diabetes in newborns can be temporary or permanent, say experts. Based on the clinical presentations and prognosis, it is classified into four types:
♦ Transient neonatal diabetes
Around 20 per cent of neonatal diabetes cases are transient. It is not permanent, and infants have remission in 13 weeks to one and a half years. However, some can develop other forms of diabetes during adolescence or adulthood.
♦ Sulfonylurea-responsive neonatal diabetes
This is the most common form of neonatal diabetes, accounting for around 40 per cent of the cases, says Dr Tonyushkina. Babies respond well to oral medications, which help improve insulin secretion. However, they may require lifelong medication in some cases.
♦ Insulin-dependent neonatal diabetes
They comprise around 10 per cent of all cases and require permanent insulin therapy.
♦ Neonatal diabetes associated with genetic syndromes
Approximately 10 per cent of the cases present symptoms as part of other syndromes. They typically have other significant defects in multiple organs, apart from hyperglycemia.
Complications of neonatal diabetes
The complications of neonatal diabetes usually include developmental delays, learning disabilities, muscle weakness and low birth weight. “The complications are similar to those of other forms of diabetes (type 1 or type 2 diabetes mellitus), which include damage to small and large blood vessels in the retina, kidneys and legs along with an increased risk of cardiovascular complications,” adds Dr Tonyushkina.
In addition, babies with neonatal diabetes are also at higher risk of ketoacidosis, characterised by sudden blood sugar spikes, acidosis (buildup of acid in the body) and an altered state of consciousness. Insulin infusions are required to manage the symptoms.
The condition also affects the quality of life of kids and their families. The kids are also at higher risk of developing type 1 diabetes or type 2 diabetes later in life. Neonatal diabetes can initially be managed with medication or insulin, as babies are only breastfeeding. However, this can become challenging once they start on solid food and go to school, says Dr Sandeep. “We usually don’t advise parents to be very strict with their children’s diet and allow them to eat almost everything, but in moderation. But we advise them to then adjust their child’s insulin dose accordingly,” he explains.
Hence, families must constantly monitor the children, ensure regular follow-ups and give them proper doses of insulin and other medications (as advised by the doctor) to avoid any episode of hypoglycemia in the neurodevelopmental age. “Every hypoglycemia episode can affect their brain development. However, with proper parental education, the condition can be managed,” he says.
Takeaways
- Neonatal diabetes is a condition where infants have high blood sugar levels. It is usually diagnosed by six months of age.
- The symptoms include poor growth and development, ketoacidosis, frequent urination, thirst and dehydration.
- Those with neonatal diabetes are at higher risk of developing type 1 or type 2 diabetes later in life.
- Families should regularly monitor the child’s blood glucose levels and adjust the insulin dosage accordingly.
