Neonatal Diabetes Mellitus - What Every Parent Should Know
Wouldn't you feel overwhelmed to know that your newborn child has a disease you hardly know about, such as neonatal diabetes mellitus? It becomes even worse to know that the condition is beyond your ability to help your baby out of it.
"Can newborns be diabetic," you may wonder! Yes, diabetes is a common disease that can affect anyone regardless of age.
Infants are not spared either from diabetes. Neonatal diabetes mellitus is the diabetes prevalent in newborn babies. It is essential to empower yourself with the knowledge of the disease. You can then make the right choices concerning your baby's health.
Follow the conversation to learn what Neonatal diabetes is, causes of neonatal diabetes, signs of the disease, and other vital information you would not want to miss.
What is Neonatal Diabetes Mellitus?
Neonatal diabetes mellitus (NDM), which you can also call congenital diabetes mellitus, is a condition in the infant's age, affecting insulin production. It is a monogenic type of diabetes in infancy, resulting from a single gene mutation or changes.
NDM usually occurs during the initial six months of an infant's life. It is a rare type of diabetes that inhibits insulin production causing glucose buildup in the blood.
Neonatal Diabetes Mellitus Overview
Diabetic statistics show that in 2016, about 1.6 million patients globally die from diabetes. The staggering figure is nothing compared to the 425 million diabetes patients, including neonatal diabetes cases worldwide.
Since neonatal diabetes mellitus is about hyperglycemia or high blood glucose, your pediatrician can easily misdiagnose it. It is a condition that can easily pass as an infection, after-birth physiological stress, or other conditions.
Whatever the reason, your baby's doctor can come up with the wrong prognosis concerning the cause of hyperglycemia. However, it would help if you were alert and full information to see that such a mix up does not happen during the treatment.
According to one reliable publication of 2018, 1 in 90,000 infants are likely to have neonatal diabetes. The statistics may mean that the NDM is a rare condition, making it difficult to diagnose, especially when surrounded by various neonatal hyperglycemia causes.
After-birth hyperglycemia should not exceed one week. If it does, then you should suspect and question the condition, whether it is neonatal diabetes. You have a right to point out your suspicion to your pediatrician.
Specific genes are responsible for the function of the pancreas, beta-cell apoptosis (formation and eliminating old and unhealthy cells), and insulin production. Gene mutation can interfere with such critical roles to develop high blood glucose in infancy.
Neonatal diabetes mellitus is early-onset diabetes that mostly occurs within the first week to a month of an infant born with hyperglycemia.
At birth, a preterm or low-weight infant has a high chance of neonatal hyperglycemia in the first few days of life and up to 10 days, but eventually clears within the period. It might pose a challenge to diagnose it during that time since it can appear to be a temporal hyperglycemia case or NDM.
The unborn baby with a gene mutation that causes neonatal diabetes mellitus can have intrauterine growth restriction (IUGR). Such an infant is at a high risk of retardation or weak growth than others that match the age or sex. But, with the right treatment and nutrition, growth and development can normalize.
TNDM vs. PNDM - What are the Different Types of Neonatal Diabetes Mellitus?
A neonatal diabetes mellitus (NDM) case can either be transient neonatal diabetes mellitus (TNDM) or permanent neonatal diabetes mellitus (PNDM).
Transient Neonatal Diabetes Mellitus (TNDM)
TNDM is one type of neonatal diabetes mellitus. It occurs in the first few days of an infant's life that primarily features high blood glucose and intrauterine growth retardation (IUGR). IUGR occurs due to the pancreatic cells trying to cope with the high demand of insulin against hyperglycemia in the fetal last gestational trimester.
Insulin inadequacy continues in the affected infant a month or so after birth, which would then require outside or exogenous insulin administration.
A diagnostic examination might rule out Type 1 diabetes due to the negative results of autoimmune islet antibodies. The test would reveal some cell maturation defect through gene mutation.
Transient neonatal diabetes mellitus goes into remission a few months after the birth of the affected newborn. The condition would later recur in adolescence or even in adulthood.
The recurring TNDM can manifest as non-autoimmune diabetes type 1 or type 2 diabetes due to high insulin resistance. For a young mother, it can manifest as gestational diabetes.
Due to diabetes recurrence in TNDM cases, a close follow up even through the remission period is inevitable to avoid chronic diabetes complications.
Permanent Neonatal Diabetes Mellitus (PNDM)
PNDM is the other half of neonatal diabetes mellitus, although not as common as TNDM. As the name suggests, it is a permanent type of neonatal diabetes mellitus.
Permanent neonatal diabetes mellitus can appear during the first six months of a newborn child and continue throughout its life.
An unborn child with the condition has high blood sugar and slow gestational growth referred to as intrauterine growth retardation. After birth, the infant may continue with a slow growth rate or fail to thrive and gain weight.
The primary role of insulin is to balance blood sugar by sending it into the body cells. Another function of insulin in unborn children is promoting growth in early development. Insufficient insulin can contribute to intrauterine growth retardation.
PNDM is less common compared to transient neonatal diabetes mellitus. Neurological problems, epilepsy (recurrent seizures), and developmental delay can also be present alongside PNDM. The presence of such conditions in PNDM is known as DEND syndrome.
Other PNDM rare cases can present digestive problems due to pancreas underdevelopment. The pancreas is responsible for making digestive enzymes alongside secreting insulin. Low digestive enzymes can affect digestion and hence experience digestive issues.
Causes of Neonatal Diabetes Mellitus
Neonatal diabetes mellitus has two different types, transient neonatal diabetes mellitus and permanent neonatal diabetes mellitus. The causing factors of neonatal diabetes mellitus, therefore, would vary according to the two.
Transient Neonatal Diabetes Mellitus Causes
TNDM is a rare condition in infants. It is caused by imprinted gene overexpression. Such genetic faulty means dysregulation of genes, which leads to inappropriate activation of chromosomes. Abnormal gene expression is the cause of various genetic disorders, such as TNDM.
In the case of TNDM, the imprinted PLAGL 1 and HYMAI genes are overexpressed or become overactive on the 6q24 human chromosome.
Researches are yet to prove why such gene expression relates to transient neonatal diabetes mellitus.
But, the PLAGL1 gene produces a protein that controls other proteins called PACAP1 (pituitary adenylate cyclase-activating polypeptide receptor) produced by pituitary glands. PACAP1 mediates insulin secretion in the pancreas islets by beta cells.
The overexpression of the PLAGL1 gene may impair insulin production by reducing the insulin-producing beta cells, causing insufficient insulin.
Permanent Neonatal Diabetes Mellitus Causes
PNDM, a monogenic type of diabetes, is caused by some mutations, which changes and reduces insulin-making beta cells. Gene mutation is a permanent change of gene-making DNA sequence.
Various gene mutations such as KCNJII, ABCC8, and insulin gene (INS) alterations are responsible for permanent neonatal diabetes mellitus. Also, a KATP channel gene mutation can cause PNDM. Such mutations affect insulin stimulation by closing the KATP channel.
KATP channel is the primary molecule responsible for linking the metabolism of glucose to insulin production.
Symptoms of Neonatal Diabetes Mellitus
Symptoms may vary with the different types of neonatal diabetes mellitus. However, common neonatal diabetes symptoms include:
- Frequent urination
- Intrauterine growth restrictions
Neonatal Diabetes Mellitus Complications
Once your pediatrician has diagnosed hyperglycemia in your newborn baby, it means that the baby is at a high risk of having neonatal diabetes mellitus (NDM). It is essential to monitor your child carefully in the next six months for the development of neonatal diabetes symptoms.
If you disregard the symptoms, if any, your baby may be at risk of other common complications such as:
- Slow growth
- Diabetic ketoacidosis
- Tongue enlargement (macroglossia)
- Weak muscles
- Low weight
How Can You Prevent Neonatal Diabetes?
It is not possible to prevent neonatal diabetes now. This type of diabetes is monogenic, which involves gene changes or overexpression. Such features pose challenges in preventing the disease.
Also, you cannot, by all means, prevent the inheritance of faulty genes from either parent to the child. However, you can give your baby a comfortable and happy life by managing the condition.
How to Manage Neonatal Diabetes Mellitus
You can manage neonatal diabetes by insulin administration or through a drug prescribed by your physician.
Before administering any treatment, your child's doctor may run various tests for diagnosis. Various complications occur due to misdiagnosing the disease.
Can Neonatal Diabetes be Cured?
As per the explanation above, neonatal diabetes mellitus is a genetic condition that cannot be cured. However, there is hope for a cure in the future. Researchers are trying out techniques to edit gene mutation and personalize gene therapy.
Stem cell therapy for diabetes could be the long-awaited cure. Scientists have made strides in the said therapy, which might be in use soon for the treatment of diabetes.
Neonatal diabetes mellitus has many similarities with MODY (maturity-onset diabetes of the young), especially permanent neonatal diabetes. Both are monogenic types of diabetes caused by a single gene mutation.
The only difference between NDM and MODY is the age of the disease onset. NDM occurs during the first six months of infancy while MODY in adolescence to young adulthood.
Transient neonatal diabetes may take only a few months of infancy from the time of onset to go on remission. It can then recur later in adolescence or adulthood.
Neonatal diabetes mellitus is not preventable and, so far, not curable. However, you can manage diabetes by following all the instructions laid down by your doctor. Your baby has the right to have a healthy growing life without encountering any severe complications.
Would you like to discuss more neonatal diabetes mellitus or any other health condition? Probably you would wish to be enlightened on natural alternative treatment. Our natural therapy practitioner, a Master herbalist, would love to answer all your questions and concerns.
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This article is intended for educational purposes and the information contained within is not intended to treat, diagnose or cure any disease or health problem. Please seek appropriate medical attention for any health complaints. We cannot take responsibility for your health care decisions. Our intent is only to offer health information to help you with your search for better health.