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Diabetes is a disorder of the metabolism described as high levels of blood glucose caused by a imperfection in creating insulin,
failure to respond to insulin’s effects (insulin resistance), or both. Low blood sugar occurs from occasionally in many people
with diabetes. It results from taking too much diabetes medication or insulin (sometimes called insulin reaction), missing a meal,
doing more exercise than usual, or taking certain medications for other conditions. Insulin is a hormone that is necessary to
convert glucose and other food into energy. Insufficient insulin causes a high accumulation of glucose that builds up in the
blood and leaks into the urine, causing a necessary urinary discharge of glucose. As a result, the body loses its main source of
fuel. Diabetes can lead to serious conditions and premature death, but people living with diabetes can make progress by
managing the disorder in turn lowering the risk of complications.

Childhood Diabetes Statistics

Diabetes is one of the most common lifelong ailments in children. In the United States, about 176,500 persons under 20 years
of age have diabetes. About 1 in every 400 to 600 children has type 1 diabetes. Each year, more than 13,000 children are
diagnosed with type 1 diabetes. The incidence of type 1 is about 7 per 100,000 per year in children ages 4 and under; 15 per
100,000 per year in children 5 to 9 years, and about 22 per 100,000 per year in those 10 to 14 years of age. About 75 percent
of all newly diagnosed cases of type 1 diabetes occur in individuals younger than 18 years of age. The majority of these
children attends school, preschool and/or daycare and need a knowledgeable staff to provide a safe school environment. Both
parents and the health care providers must work together to make certain that schools and day care providers have the
information and training they need to allow children with diabetes to participate fully and safely while attending school.

Presently, since 10 to 15 percent of children and teens are overweight the number of young people have type 2 diabetes has
doubled since the last decade. In several clinic-based studies, the percentage of children with newly diagnosed diabetes
classified as type 2 has increased from less than 5 percent in 1993 to 30 to 50 percent in the years following. According to the
Centers for Disease Control and Prevention (CDC), “at risk for overweight” is defined as being in the 85 to 94 percentile and
“overweight” is defined as at or above the 95th percentile on the CDC’s Body Mass Index (BMI)-for-age growth charts. You
may visit the CDC’s website for the Body Mass Index.

Identifying Children with Diabetes

Insulin dependent diabetes mellitus (type 1 diabetes) results from the destruction of b cells as a consequence of an autoimmune
process in the pancreas. The rate of beta cell destruction in type 1 diabetes is fairly rapid in infants and children. Children and
adolescents may present with ketoacidosis (key-toe-ass-i-DOE-sis) a serious condition that can lead to diabetic coma (passing
out for a long time) or even death. Ketocidosis means dangerously high levels of ketones. Ketones are acids that build up in the
blood. They appear in the urine when the body doesn't have enough insulin. Ketones can poison the body. They are a warning
sign that diabetes is out of control.

Most children and adolescents diagnosed with type 2 diabetes are overweight or obese, insulin resistant, and have a family
history of type 2 diabetes. They also may have physical signs of insulin resistance such as acanthosis nigricans (a skin disorder
characterized by dark, thick, velvety skin in body folds and creases). Undiagnosed type 2 diabetes in children and adolescents
may place these young people at early risk for cardiovascular disease; however, no data are available to define the extent of this
problem. As a result, it is important for health care providers to consider testing for diabetes in high risk or susceptible children.

Type 1 Diabetes in Children

Developing type 1 diabetes often has no family history of diabetes. Although type 1 diabetes can develop at any age, it typically
appears during childhood or adolescence. Type 1 diabetes is an autoimmune disease in which the immune system destroys the
insulin producing beta cells of the pancreas that regulate blood glucose. Type 1 diabetes has an intense onset, with children and
adolescents usually able to identify when symptoms began. Since the pancreas can no longer produce insulin, people with type
1 diabetes require daily injections of insulin for life. Children with type 1 diabetes are at risk for long-term complications
(damage to cardiovascular system, kidneys, eyes, nerves, blood vessels, gums, and teeth).

A diabetes management plan for young people includes insulin therapy, self-monitoring of blood glucose, healthy eating, and
physical activity. The plan is designed to ensure proper growth and prevention of hypoglycemia (abnormally low level of
glucose in the blood). New management strategies are helping children with type 1 diabetes live long and healthy lives. There is
no single way to treat type 1 diabetes. Each child’s daily incidents differ and experienced diabetes providers are essential to set
up individualized treatment plans. For treatment plans to be successful, an insulin treatment will be adjusted to the needs of the
child, as will a meal plan and recommendations for physical activity.

Children with diabetes must be allowed to participate fully in all school activities. They need the cooperation and support of
school staff members to help them with their treatment plan. Blood sugar monitoring is vital to assist in evaluating whether the
treatment plan is useful. Most children can administer blood sugar checks by themselves but may need a personal area to do so.
Some children may need supervision to oversee that the procedure is done properly and results are recorded accurately.

Type 2 Diabetes in Children

Type 2 diabetes is the most common form of the diabetes, a substantial 90-95% of all people with diabetes suffer from this
type. It was formerly identified as beginning during adulthood or not having to rely on insulin because this type of diabetes most
often occurs after age 40. However, a recent development has emerged in which type 2 diabetes is being diagnosed in children,
adolescents and young adults. Currently, studies are in progress to better recognize the populations at highest risk for this form
of diabetes. A doctor may test your child for diabetes if he or she is overweight, gets little physical activity, or has other risk
factors for the disease. A risk factor is anything that increases your chances of having a disease. Some children are diagnosed
with type 2 diabetes when they have a blood or urine test for some other reason.

Family history is closely linked with type 2 diabetes; such as a first degree or second degree relative. One of the greatest risk
factors for type 2 diabetes is excess weight. The same is likely true for children with diabetes. As an individual gains weight,
the extra weight causes the cells of the body to become resistant to the effects of insulin. The pancreas responds by producing
more and more insulin, which eventually begins to build up in the blood. High levels of insulin in the blood, a condition called
insulin resistance, may cause problems such as high blood pressure and harmful changes in the levels of different fats
(cholesterol) in the blood.

Insulin resistance is the first step on the path to type 2 diabetes. The second step to type 2 diabetes is a condition called
impaired glucose tolerance. Impaired glucose tolerance occurs when the pancreas becomes exhausted and can no longer
produce enough insulin to move glucose out of the bloodstream into cells. Glucose begins to build up in the blood. If it is not
diagnosed and not treated, this gradual rise in glucose often leads to type 2 diabetes, high blood pressure, and heart disease, in
any order and in any combination. While all these harmful activities are going on inside the body, the affected individual may
feel perfectly fine.

Type 2 diabetes is more common in certain racial and ethnic groups such as African Americans, American Indians,
Hispanic/Latino Americans, and Asian and Pacific Islander Americans. The increased incidence of type 2 diabetes on children is
the result of the obesity epidemic among young people, a significant and growing public health problem. Overweight children
are at increased risk for developing type 2 diabetes during childhood, adolescence, and later in life. Type 2 diabetes is
considered a silent disease because it causes damage over many years without giving any noticeable symptoms. That’s why 1/3
of the people who have type 2 diabetes don’t know it.

Signs of Diabetes in Children

Frequent urination and extreme thirst are usually the first apparent signs of diabetes.

Symptoms of High Blood Sugar
• Frequent urination (including during the night)
• Excessive thirst
• Extreme hunger/weakness
• Unexplained weight loss
• Extreme fatigue
• Blurred vision
• Irritability
• Itchy skin
• Slow healing of cuts and bruises
• Frequent infections of skin/gums/vagina/bladder
• Tingling/numbing in legs, feet, hands

Symptoms of Type 1 Diabetes in Children

•        Symptoms: The symptoms of type 1 diabetes usually develop over a short period of time.  
They include increased thirst and urination, constant hunger, weight loss, and blurred vision. Children also may feel very tired.
If not diagnosed and treated with insulin, the individual with type 1 diabetes can lapse into a life-threatening diabetic coma,
known as diabetic ketoacidosis or DKA. Often, children will present with vomiting, a sign of DKA, and mistakenly be diagnosed
as having gastroenteritis (inflammation of the stomach and intestines).

•        
Risk Factors: A combination of genetic and environmental factors put people at increased risk for type 1 diabetes.
Researchers are working to identify these factors and to stop the autoimmune process that destroys the pancreas.

Symptoms of Type 2 Diabetes in Children

•        Symptoms: Type 2 diabetes usually develops slowly and quietly in children. Symptoms may be similar to those of type 1
diabetes. A child or teen can feel very tired, thirsty, or nauseated and have to urinate often. Other symptoms may include
weight loss, blurred vision, frequent infections, and slow healing of wounds or sores. Some children or adolescents with type 2
diabetes may show no symptoms at all when they are diagnosed, and others may present with vaginal yeast infection or burning
during urination due to yeast infection. Therefore, it is important for health care providers to identify and test children or teens
who are at high risk for the disease.

•        
Signs of Diabetes: Physical signs of insulin resistance include acanthosis nigricans, where the skin around the neck or in
the armpits appears dark, thick, and feels velvety. High blood pressure and dyslipidemia (a disruption in the amount of lipids) in
the blood also are associated with insulin resistance.

•        
Risk Factors: Being overweight, having a family member who has type 2 diabetes, being a member of a high risk ethnic
group, having signs of insulin resistance, being older than 10 years of age, and experiencing puberty are risk factors for the
disease. It is very important when managing diabetes in children with type 2 to ensure healthy eating, with portion control, and
increased physical activity.

Childhood Diabetes Treatment

Type 1 diabetes in children

The fundamentals of type 1 diabetes management are insulin administration, nutrition supervision, physical activity, blood
glucose testing, and the avoidance of abnormally low blood sugar usually resulting from excessive insulin or a poor diet.
Journals should be used for insulin dosing based on blood glucose level and food intake.

Children with diabetes need their parents' help to keep their blood sugar levels in a safe range and to exercise safely. It is
important for children to learn the symptoms of both high and low blood sugar so they can tell others when they need help.
Further adjustment of insulin or food intake may be made based on anticipation of special circumstances such as increased
exercise. Children on these treatments are expected to check their blood glucose levels routinely before meals and at bedtime.
There are many support groups and diabetes education centers to help parents and children understand about blood sugar,
exercise, diet, and medicines.

Type 2 diabetes in children

Management of type 2 diabetes involves nutrition management, increased physical activity, and blood glucose testing. The only
oral agent approved for use in children and adolescents is metformin. Metformin is the only oral medication that's approved for
children and adolescents (age 10 and older) who have type 2 diabetes. Metformin reduces the amount of sugar a child's liver
releases into the bloodstream between meals. Although the drug is effective, some brands are only for use in adults. Side effects
may include nausea, upset stomach, and diarrhea. Some children who have type 2 diabetes can control their blood sugar with
diet and exercise alone, but many also need oral medication or insulin treatment.

There is no single method to manage diabetes that is precise for all children. Blood glucose goals, frequency of blood glucose
testing, type, dose and frequency of insulin, use of insulin injections or a pump, and details of nutrition management, all may
vary among individuals. The family and diabetes care providers determine the treatment that best suits each child's individual
characteristics and circumstances.

Type 2 diabetes is different from type 1 in that the child's life is generally not in immediate danger without treatment. However,
the child's long-term health will suffer and he or she will be more likely to develop serious complications if the disease is not
treated. Treatment also will help the child feel better. Achieving healthy blood sugar levels will help your child have more
energy, which can lead to increased exercise and weight control.