Type 1 Diabetes Mellitus in Children

What is type 1 diabetes in children?

Diabetes is a condition in which the body can't make enough insulin or can't use insulin normally. Type 1 diabetes is an autoimmune disorder. That is, the body's immune system damages the cells in the pancreas that make insulin. Insulin is a hormone. It helps sugar (glucose) in the blood get into cells of the body where it can be used as fuel. When glucose can’t enter the cells, it builds up in the blood. This is called high blood sugar or high blood glucose levels (hyperglycemia). High blood sugar can cause problems all over the body. It can damage blood vessels and nerves. It can harm the eyes, kidneys, and heart. It can also cause symptoms, such as tiredness.

Type 1 diabetes mellitus is a long-term (chronic) condition. It may start at any age. Insulin from the pancreas must be replaced with insulin injections or an insulin pump.

There are 2 forms of type 1 diabetes:

• Immune-mediated diabetes. This is an autoimmune disorder in which the body's immune system damages the cells in the pancreas that make insulin. It's the most common kind of type 1 diabetes.

• Idiopathic type 1. This refers to rare forms of the disease with no known cause.

What causes type 1 diabetes in a child?

The cause of type 1 diabetes is unknown. Researchers think some people inherit a gene that can cause type 1 diabetes if a trigger, such as a viral infection, occurs.

Which children are at risk for type 1 diabetes?

A child is at more risk for type 1 diabetes if they have any of these risk factors:

• Has a family member with the condition.

• Is white.

• Is descended from people from Finland or Sardinia.

• Is age 4 to 6, or 10 to 14.

A new medicine was approved to help delay the onset of type 1 diabetes. This may be a choice for people ages 8 and older who are at high risk or have early signs of type 1 diabetes.

What are the symptoms of type 1 diabetes in a child?

Type 1 diabetes often appears suddenly. In children, its symptoms may seem like flu symptoms. They can be different for each child and can include:

• High levels of glucose in the blood and urine when tested.

• Abnormal thirst.

• Fluid loss (dehydration).

• Frequent urination (a baby may need more diaper changes, or a toilet-trained child may start wetting their pants or bed).

• Extreme hunger but weight loss.

• Loss of appetite in younger children.

• Blurred vision.

• Nausea and vomiting.

• Belly (abdominal) pain.

• Weakness and severe tiredness (fatigue).

• Irritability and mood changes.

• Serious diaper rash that does get better with treatment.

• Fruity breath and fast breathing.

• Yeast infection in girls.

The symptoms of type 1 diabetes can seem like other health conditions. Make sure your child sees their doctor for a diagnosis.

How is type 1 diabetes diagnosed in a child?

The doctor will ask about your child’s symptoms and health history. They may also ask about your family’s health history. They will give your child a physical exam. Your child may also have blood tests, such as:

• Fasting plasma glucose. The blood is tested after at least 8 hours of not eating.

• Random plasma glucose. The blood is tested when there are symptoms of increased thirst, urination, and hunger.

• Oral glucose tolerance test. This is a 2-hour test that checks your child's blood glucose levels before and 2 hours after drinking a sugary drink. It tells your doctor how your child's body processes glucose.

• A1C test. This test shows the average amount of glucose in the blood over the last 2 to 3 months.

• Insulin and C-peptide levels. These levels will be low or normal with type 1 diabetes, but high with type 2 diabetes.

• Antibody levels. People with newly diagnosed type 1 diabetes will usually have high levels of antibodies against certain proteins found in the pancreas.

How is type 1 diabetes treated in a child?

Children with type 1 diabetes must get daily injections of insulin to keep the blood glucose level within normal ranges. Insulin is given either by injection or insulin pump. Your child’s doctor will show you how to give your child insulin with either method.

Treatment will also include:

• Eating the right foods to manage blood glucose levels. This includes timing meals and counting carbohydrates.

• Exercise, to lower blood sugar.

• Regular blood testing to check blood-glucose levels. Your child may use a continuous glucose monitor.

• Regular urine testing to check ketone levels.

What are possible complications of type 1 diabetes in a child?

Type 1 diabetes can cause:

• Ketoacidosis. This is when blood sugar levels are very high and the body starts making ketones. This is a very serious condition that needs to be treated right away in the hospital. Sometimes treatment is done in the intensive care unit. If your child is not treated right away, they are at risk for diabetic coma. This can cause loss of consciousness because of brain swelling. The brain swells because of the very high blood sugar levels.

• Low blood sugar (hypoglycemia). This is also sometimes called an insulin reaction. This occurs when blood glucose drops too low.

Your child’s doctor will tell you how to prevent these problems.

Over time, high blood sugar levels can damage blood vessels. Balancing insulin, diet, and activity can help keep blood sugar levels in the target range and help prevent complications, such as:

• Eye problems.

• Kidney disease.

• Nerve damage.

• Tooth and gum problems.

• Skin and foot problems.

• Heart and blood vessel disease.

How can I help my child live with type 1 diabetes?

A type 1 diabetes diagnosis can be stressful for a child and their family. A younger child may not understand all the life changes, such as glucose monitoring and insulin injections. A child may feel:

• As if they are being punished.

• Guilty.

• Fearful of death.

• Angry toward the parent.

Parents can help their child by treating them as a normal child, with diabetes management as just an aspect of their daily life. Tell siblings and close family members about diabetes so they can understand and support your child. If your child is school-age, the principal and school nurse can help make a school care plan. Have your child wear a medical alert bracelet.

Many areas have diabetes camps, support groups, and other organizations for children with type 1 diabetes and their families. Talk with your child’s doctor for more information.

When should I contact my child's doctor?

Contact your child's health care team if you need help. Also call the health care team if:

• Your child has new symptoms.

• Your child often has high blood sugar.

• Your child often has low blood sugar.

• Is sick with a fever, vomiting, diarrhea, or any other illnesses. It's often harder to control your child's blood sugar when they are ill.

Key points about type 1 diabetes in children

• Type 1 diabetes mellitus is a long-term (chronic) condition in which blood glucose levels are abnormally high. It may start at any age.

• It's most often caused by an autoimmune disorder. The body's immune system destroys the cells in the pancreas that make insulin.

• Children with type 1 diabetes must have daily insulin shots to keep blood glucose levels within normal ranges.

• Without insulin, blood glucose levels continue to rise and death will occur.

• With daily insulin injections and other management activities, children with type 1 diabetes can lead active, healthy lives.

Next steps

Tips to help you get the most from a visit to your child’s doctor:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your doctor gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s doctor after office hours or on weekends. This is important if your child becomes ill and you have questions or need advice.