Diabetes in Children
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.
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