Signs of Diabetes in Children

The most common type of diabetes in children is type 1 diabetes, although, as children are becoming more and more obese, the incidence of type 2 diabetes is increasing.  Type 1 diabetes in children is considered an autoimmune disease, in which the immune system cells are acting against the insulin-producing cells of the pancreas, also known as the “beta cells”.

When the beta cells are damaged by the child’s immune system, the pancreas no longer makes insulin so that the child needs to take exogenous insulin (insulin given through injection rather than made by the pancreas).

When the insulin is no longer in the body, the blood glucose levels rise, resulting in the following signs:

• Weight loss. Rather than having the cells of the body take up insulin, the glucose is wasted and is instead excreted by the kidneys. This valuable source of calories and fuel are flushed out of the body, resulting in weight loss.
• Dehydration. When the blood glucose levels become elevated, the kidneys put out more urine.  This helps the kidneys get rid of glucose but, as water is excreted along with the glucose, the child becomes dehydrated, which can become life-threatening.
• Organ Damage. As the disease progresses, the child can develop evidence of increased blood sugar levels.  The elevated blood sugar levels cause damage to various organs of the body, including the heart, kidneys, and eyes.  When this occurs, the child suffers from an increased risk of atherosclerosis or hardening of the arteries.  Diseases like diabetic neuropathy, diabetic retinopathy, diabetic nephropathy, and heart disease begin to develop in the child’s body.
• Diabetic ketoacidosis. If the body cannot use glucose as a source of cellular fuel, the body instead breaks down fatty tissue.  One of the byproducts of fatty tissue metabolism is the formation of ketones.  The ketones build up in the bloodstream and spill out in the urine.  The child develops symptoms related to an elevation in ketone level, which includes abdominal pain, nausea and vomiting, life-threatening dehydration, and a buildup of acid in the blood—a condition known as metabolic acidosis.

The Incidence of Type 1 Diabetes in Children

Even among children, the incidence of type 1 diabetes is extremely rare.  Among all diabetics, only 5 percent have type 1 diabetes.  It seems to be more common among Caucasians as opposed to African American children.  It affects children of both genders and can happen anytime in childhood and young adulthood.

Causes of Type 1 Diabetes in Children

No one knows the exact cause of type 1 diabetes in children.  Researchers have found a genetic component to the disease and, like other autoimmune diseases, it appears to run in families.  The environment also appears to play a role.  Doctors suspect that a trigger, such as the development of a viral infection, might trigger genetically- susceptible children who then make antibodies against the beta cells of the pancreas instead of the virus particles.  Type 1 diabetic children go on to develop other autoimmune diseases later in life.

Typical Signs and Symptoms of Type 1 Diabetes in Children

When type 1 diabetic children develop the disease, the sign and symptoms usually come on quite suddenly, leading to the following symptoms of type 1 diabetes:

• Increased frequency of urination
• Abdominal pain
• Nausea and vomiting
• Dryness of the mouth
• Increased hunger, even after the child has already eaten
• Severe thirst
• Weight loss that occurs even though the child is eating normally
• A fruity smell in the breath
• Increased respiratory rate
• Tremulousness
• Increased confusion
• A higher incidence of infections, particularly of the vagina, urinary tract, and skin
• The development of slow, labored breathing, known as Kussmaul respirations
• Blurry vision
• Increased weakness
• Tiredness
• Loss of consciousness (which only develops if the blood sugar is extremely high

Sometimes, the signs and symptoms of type 1 diabetes in children are extremely subtle, making the diagnosis difficult.  Other times, the symptoms can be so severe and sudden, that doctors can easily make the diagnosis based on the symptoms above.

Diagnosing Type 1 Diabetes in Children

If type 1 diagnosis is suspected, the doctor will likely check a blood glucose level.  The blood glucose level will generally be very high in undiagnosed and untreated type 1 diabetes.  The urine is also checked for glucose by doing a urinalysis.  Other blood tests for metabolic acidosis may be checked by doing an arterial blood gas evaluation.

Treatment of Type 1 Diabetes in Children

As of now, there is no cure for type 1 diabetes in children but many can be successfully managed with insulin so that they can live a healthy life.  Few die from the disease in today’s times and most children with the disease go on to have long and relatively healthy lives.  This can only be achieved through keeping the blood sugars in good control and, for type 1 diabetics, it means giving insulin injections for the rest of the child’s life.

Insulin, as mentioned, is the only way to treat type 1 diabetes in children.  There are different types of insulin a child might use for the management of the disease, including the following:

• Rapid acting insulin. This is insulin that begins working in the child’s system in about 15 minutes.  The peak effectiveness of this type of insulin is about an hour and the insulin can be expected to work for 2-4 hours in the child’s body.
• Regular or short-acting insulin. This is insulin that begins working in the child’s system in about a half an hour.  The peak effectiveness of this type of insulin is about 2-3 hours, with an expected duration of action of 3-6 hours.
• Intermediate acting insulin. This is insulin that doesn’t enter the bloodstream until 2-4 hours have passed. The peak effectiveness of this type of insulin is 4-12 hours, with an expected duration of action of 12-18 hours.
• Long acting insulin. This is insulin that takes several hours before it begins to work and is expected to last in the child’s system for an entire day.

The type of insulin the child takes to control the symptoms of diabetes depend on the child’s eating habits and how well the blood sugars respond to the various types of insulin.

Signs and Symptoms of Untreated Diabetes in Children

If the child isn’t treated for their type 1 diabetes, complications can occur that have their own set of symptoms.  Some complications of untreated diabetes mellitus in children include:

• Blindness. This is also known as diabetic retinopathy and occurs in about 80 percent of type 1 diabetics who have had the illness for at least 15 years.  The best way to manage diabetic retinopathy is to keep the blood glucose levels in good control.
• Kidney Damage. If the diabetes is left unchecked, the kidneys can become damaged, leading to kidney failure. About 20-30 percent of children with type 1 diabetes will develop kidney damage, also known as diabetic nephropathy.
• Nerve damage. The child can develop signs and symptoms of nerve damage from high blood glucose levels.  This results in symptoms of burning pain or numbness in the feet, although it can occur in the hands as well.  Diabetic nerve damage is also referred to as diabetic neuropathy.

References:

1. Type 1 Diabetes. http://www.webmd.com/diabetes/type-1-diabetes-guide/type-1-diabetes. Accessed 5/31/16.