What are the other Names for this Condition? (Also known as/Synonyms)

• Juvenile-Onset Diabetes
• Type 1 Diabetes Mellitus in Children
• Type 2 Diabetes Mellitus in Children

What is Diabetes in Children? (Definition/Background Information)

• Diabetes mellitus is characterized by high glucose level in blood. The most common diabetes in children is Type 1 insulin dependent diabetes mellitus (DM) which is a multifactorial disease with an early age onset
• In type 1 DM, the pancreas produces little or no insulin, a hormone responsible for regulating sugar level in blood. Type 1 DM remains the most common form of diabetes in childhood, accounting for two-thirds of new diagnoses of diabetes in patients less than 19 years of age (in the United States)
• Type 2 diabetes mellitus is becoming more common in children due to the increasing prevalence of obesity and physical inactivity. With this disorder, the body either resists the effects of insulin or does not produce sufficient amounts to have a normal glucose blood level
• Family history is an important risk factor for both Type 1 and Type 2 Diabetes in Children
• Common signs and symptoms for Diabetes in Children are increased thirst and appetite, increased urination, and weight loss. In the long run, uncontrolled Diabetes in Children can lead to complications such as kidney failure, heart attack, stroke, complicated feet infections and various eye-related abnormalities
• Diagnosis of Diabetes in Children is more reliably made by checking blood sugar levels after an overnight fasting
• Many times, non-insulin dependent type 2 DM can be controlled by diet, reduction in body weight and exercise. Insulin is a necessary for the treatment of type 1 DM.
• The outcome for patients with diabetes varies from one individual to another and is dependent upon many factors and health issues
• There are currently no known preventive measures for Type 1 Diabetes in Children, though Type 2 Diabetes in Children can be prevented by maintaining a healthy body weight and leading an active lifestyle

Who gets Diabetes in Children? (Age and Sex Distribution)

• About 45% children affected by diabetes present signs and symptoms before the age of 10 years
• Diabetes in Children affect both genders (males and females)
• All races and ethnic groups are affected by this condition

What are the Risk Factors for Diabetes in Children? (Predisposing Factors)

Risk factors for Diabetes in Children include:

• Genetics: The incidence of certain genes indicates a higher risk for the development of type 1 DM. HLA antigen is mainly responsible for a genetic predisposition
• Family history: Having a parent or sibling with diabetes increases an individual's risk for developing this condition
• Ethnicity: All ethnic groups are affected, but the highest rate is seen in children of European ancestry, African Americans, and Hispanics
• Environmental factors: Though insulin dependent DM is an autoimmune disorder, a viral etiology is also proposed. Exposure to Epstein-Barr virus, Coxsackie virus, mumps virus, and cytomegalovirus can trigger an autoimmune destruction of cells in the pancreas
• Physical inactivity and obesity can predispose children to type II diabetes. The more fatty tissues an individual has, the more resistant their cells become to insulin

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Diabetes in Children? (Etiology)

• The exact cause of type 1 diabetes remains unknown. It is suspected to be an autoimmune disorder. A trigger, such as an infection, may cause the body to inaccurately attack pancreatic cells that produce insulin. Insulin is a hormone produced by beta cells in the pancreas to move blood sugar into cells
• With a lack of insulin, glucose has the potential to build-up in the bloodstream, instead of being redistributed to the cells. Without the body’s ability to utilize this glucose for energy, there is a build-up of glucose, which results in type 1 diabetes
• Children with type 2 DM do produce insulin; however the pancreas either does not secrete enough insulin or the individual's liver, fat, and muscle cells develop resistance to insulin. Therefore, the blood glucose does not properly get stored into these cells for later energy use
• Exposure to one or more environmental agents appears to trigger an immune response that ultimately causes destruction of the insulin-producing pancreas

What are the Signs and Symptoms of Diabetes in Children?

The signs and symptoms of Diabetes in Children include:

• Childhood diabetes can present in several different ways. It can be a classic new onset of high blood glucose, weight loss, increased urination, and increased thirst, or silent and discovered incidentally only
• Polyuria - increased urination. It may present as bedwetting or daytime incontinence. In children who are not toilet trained, parents may note an increased frequency of wet diaper usage
• Polydipsia - increased thirst from high glucose levels in the body
• Weight loss: It is due to increased catabolism. It is one of the presenting symptoms in about half the children with diabetes
• Low blood sugar can develop in individuals with diabetes who are administered insulin. These symptoms appear most often when blood sugar levels drop below 70 mg/dl and include headache, hunger, nervousness, rapid heartbeat, shaking, sweating, and weakness
• Diabetic ketoacidosis is an emergency condition characterized by fruity-smelling breath, drowsiness, and lethargy, in addition to increased glucose levels. They can also present with dry skin, dry mouth, flushing in the face, nausea or vomiting, stomach pain, stupor, or unconsciousness

How is Diabetes in Children Diagnosed?

The diagnosis of Diabetes in Children may include:

• A complete evaluation of medical history and a thorough physical exam

Diabetes mellitus is diagnosed based upon one of the following signs of abnormal glucose metabolism:

• Fasting plasma glucose ≥126 mg/dl on more than one occasion. Fasting is defined as ‘no caloric intake for at least 8 hours’
• Random plasma glucose ≥200 mg/dl in a patient with classic symptoms of high blood glucose.
• Oral glucose tolerance test: Plasma glucose ≥200 mg/dl measured 2 hours after a glucose load of 75 g

Hemoglobin A1C tests with values as noted below:

• Normal: Below 5.7 %
• Prediabetes: Between 5.7% and 6.4%
• Diabetes: 6.5% or above

Diabetes in Children requires regular follow-up examinations by the physician to avoid and delay the development of complications. These may include:

• Checking the skin and bones of the feet and legs; checking feet to see if they are becoming numb
• Blood pressure checks that are held at least annually, which should be 130/80 mm/Hg or below value
• Have hemoglobin A1c test (HbA1c) completed bi-yearly, if diabetes is well-controlled; otherwise every 3 months
• Have cholesterol and triglyceride levels checked annually: A desirable level for LDL cholesterol levels is below 70-100 mg/dL
• Have yearly tests to examine kidney function, which include micro-albuminuria and serum creatinine
• Have eyes checked at least annually, for signs of diabetic eye disease
• Visit a dentist bi-yearly, for a thorough dental exam and cleaning

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Diabetes in Children?

After several years, Diabetes in Children can lead to serious complications, such as:

• Diabetes makes it difficult for one to control their blood pressure and cholesterol, leading to possible heart attacks, stroke, and other complications
• When an individual has diabetes, their risk of heart attack is equivalent to an individual who has already experienced a heart attack
• Elevated blood sugar has the potential to lead to kidney damage, also known as nephropathy. It can damage the filtering system of the kidneys, leading to kidney failure or kidney disease
• Eye-related abnormalities include reduced vision (particularly at night) and sensitivity to light. Diabetic retinopathy, a condition in which blood vessels of the retina are damaged, is caused by diabetes. This condition can potentially cause blindness. Diabetes also increases the risk for other eye disorders, such as cataract and glaucoma
• Nerve damage, also known as neuropathy, is a common complication with diabetes. Excess sugar builds up in the blood vessels causing pain, tingling, and loss of feeling to the affected limbs
• Nerve damage in the feet increases the risk of certain complications. Feet and skin can acquire sores and infections, causing pain and itching. In severe cases, the foot or leg may need to be removed
• An individual may be more susceptible to bacterial and fungal infections of the skin
• Nerve damage can cause weakness or problems with urination. It may also make it more difficult for men to have an erection
• Diabetes may cause one’s bone mineral density to lower, increasing the risk for developing osteoporosis

How is Diabetes in Children Treated?

Treatment options for Diabetes in Children may include:

Type 1 diabetes mellitus:

• Due to the quick onset and possible severe symptoms of type 1 diabetes, individuals who are initially diagnosed with the condition, may need to stay in the hospital for further evaluation/treatment
• It is recommended that after diagnosis, an individual should have a check-up each week, until a steady control of blood sugar is established. Physicians routinely suggest home blood sugar monitoring and urine testing

Insulin-related:

• Insulin lowers blood sugar by permitting it to leave the bloodstream and enter the body cells. Insulin must be administered every day in diabetic patients
• Insulin shots may be necessary, between 1-4 times each day. Insulin is often injected under the skin. In other cases, a pump can deliver insulin all the time
• Various insulin types are available, which differ in how fast-acting they are, and their duration of action in the body. The types of insulin include rapid-acting insulin, long-acting insulin and intermediate-acting insulin
• The attending physician will determine the correct/best type of insulin and the time that is best suited for its administration. More than one type of insulin can be combined for the most optimal blood glucose control

Diet and exercise:

• Individuals with diabetes should eat similar foods at relativity the same time each day, which helps in maintaining proper blood sugar levels
• The American Diabetes Association and the American Dietetic Association provide information on how to plan healthy meals
• Constant and consistent exercising is recommended to control blood sugar, as well as burn extra calories and fat in order to maintain a healthy weight
• A doctor may prescribe pramlintide (Symlin), which is injected before a meal to slow the movement of food through the stomach. This helps curb the sharp upsurge in blood sugar levels following meals
• Omega-3 fatty acids may possibly offer some protection against type 1 diabetes

Blood sugar management:

• Monitoring blood sugar levels at home and keeping a record of the results is indicative of how an individual is managing type 1 diabetes. A physician will provide information on how frequently one should check their blood glucose levels
• A glucometer device can be used to read blood sugar levels. In most cases, a small droplet of blood is produced by pricking one’s finger with a small needle or lancet, which is then placed on a test strip, which is transferred to the device. Most results are recorded in 30-45 seconds
• Physicians recommend keeping a record of blood sugar levels. A target goal for blood sugar levels should be set at different times throughout the day. A plan should be set in place for what to do when blood sugar exceeds or drops below normal levels

Type 2 diabetes mellitus:

• The principal treatment for type 2 diabetes is diet and exercise
• It is recommended that after diagnosis, an individual should have a check-up each week, until a steady control of blood sugar is established. Physicians routinely suggest home blood sugar monitoring and urine testing

Medications:

• Drugs may be prescribed to lower blood sugar levels, if they are not maintained at near-normal levels. These drugs help lower blood sugar levels in different ways; therefore, physicians may prescribe more than one drug
• Some prescriptive medications may be taken orally or intravenously
• These drugs may be administered in conjunction with insulin, or insulin may be used solely on its own

Diet and exercise:

• A physician may be consulted on how much fat, protein, and carbohydrates are necessary in one’s diet
• Managing weight and eating healthy are vital for individuals with type 2 diabetes
• Constant and consistent exercising is recommended to control blood sugar, as well as burn extra calories and fat, in order to maintain a healthy weight. When the heart beats gets faster during exercise, individuals will breathe faster, further lowering the blood sugar level, without requiring the use of medication
• Exercises are advantageous to one’s health by improving the blood flow and blood pressure level. It also has the ability to increase the body’s energy levels, decrease tension, and improve stress handling abilities

Weight-loss surgery: Increasingly, weight-loss surgery has been used as a tool to manage type 2 diabetes.

• Bariatric surgery is a weight-loss surgery that has been shown to improve type 2 diabetic condition. Severely overweight patients whose diabetes is under-managed may consider bariatric (weight-loss) surgery, such as gastric bypass surgery or laparoscopic gastric banding
• The two types of surgery available are gastric banding and gastric bypass:
  • Gastric banding is a procedure in which an adjustable band is placed around the upper stomach to form a small pouch in the upper stomach. This band controls how quickly food can pass through
  • Gastric bypass restricts stomach volume and decreases calorie absorption. During this procedure, a portion of the stomach is surgically removed
• Weight loss surgery is effective in two ways: It restricts the amount of food the stomach can take in and it helps decrease the absorption of food in the intestines

How can Diabetes in Children be Prevented?

• There are currently no known preventive measures for Type 1 Diabetes in Children. There is also no screening exam for the condition, in individuals who do not exhibit any symptoms
• Once diagnosed, an individual with type 1 diabetes can manage the condition by exercising regularly and eating healthy foods. Foods should be low in fat and calories, with an emphasis on fruits, vegetables, and whole grains
• One should aim to exercise for about 30 minutes a day. In doing so, blood glucose levels can be normalized, thereby reducing the varied medical issues and complications associated with type 1 diabetes
• Type 2 Diabetes in Children can be prevented by maintaining a healthy body weight and by having an active lifestyle
• Even if an individual has a family history of diabetes, he or she can help prevent the condition by exercising regularly and eating healthy
• If an individual is overweight, losing between 5-10% of the body weight can help reduce the risk of developing diabetes

What is the Prognosis of Diabetes in Children? (Outcomes/Resolutions)

• The outcome of Diabetes in Children varies from one child to another and is dependent upon many factors and health issues
• After several years, Diabetes in Children can lead to complications that affect the eyes, kidneys, nerves, heart, blood vessels, and other body areas
• When blood sugar and blood pressure is properly maintained, one can reduce the risk of stroke, heart failure, and other problems associated with diabetes
• Some individuals with type 2 diabetes no longer need medication, if they lose weight and maintain a higher (physical) activity level. When an ideal weight is reached, the body’s own insulin and the diet consumed have the ability to maintain optimal blood sugar levels

Additional and Relevant Useful Information for Diabetes in Children:

There are voluntary organizations and support groups for diabetes that provides counselling, help, and understanding, to the affected individuals.