Symptom Awareness

Be aware of type 1 diabetes symptoms in children

Sarah Hoffman give herself her insulin injection as her mother Diane Ziegler-Hoffman looks on in their home in Pompano Beach on October 30,2013.
Sarah Hoffman give herself her insulin injection as her mother Diane Ziegler-Hoffman looks on in their home in Pompano Beach on October 30,2013.
Joe Rimkus Jr. / Miami Herald Staff

Type 1 Symptoms

at a Glance

• Being very thirsty.

• Feeling hungry.

• Feeling tired.

• Having blurry eyesight.

• Losing the feeling or feeling tingling in your feet.

• Losing weight without trying.

• Urinating more often.

Source: MedLine Plus

Special to The Miami Herald

For two weeks in early October, Sarah Hoffman, 13, of Pompano Beach was not herself. She had been thirsty, she had lost some weight and she was tired.

“I would kid her that she was turning into an old lady like me,” says Diane Ziegler-Hoffman, her ever-energetic mom. Ziegler had seen changes in her daughter and, for a while, she was able to rationalize each one.

But finally, realizing that her daughter wasn’t well, Ziegler-Hoffman made an appointment with the family pediatrician. Sarah never made it to his office.

The morning of the pending doctor’s visit, the youngster felt so drained she virtually couldn’t move.

That’s when her mother called an ambulance. By that afternoon, she had been tested and admitted to the critical-care unit at Chris Evert Children’s Hospital in Fort Lauderdale.

Her diagnosis: type 1 diabetes.

“I wish I knew then what I’ve found out in the weeks since my daughter’s diagnosis,” says Ziegler-Hoffman. “I might have been able to step in and get her help a whole lot sooner. It’s just so frightening that she could have been in a coma or worse.”

Today, type 2 diabetes that is related to obesity is getting a lot of press. But type 1 is still a life-threatening disease that accounts for 5 to 10 percent of all diagnosed cases of diabetes in children, according to the National Diabetes Education Program. And its prevalence is on the rise.

“It’s a slow rise, but it’s there. And no one is quite sure why,” says Dr. Sarah Hart-Unger, a pediatric endocrinologist at Joe DiMaggio Children’s Hospital in Hollywood.

Unlike type 2 diabetes that results from the body using insulin inefficiently and can often be controlled with diet and exercise, type 1 is brought on by an autoimmune reaction and requires insulin injections. To catch this potentially serious disease before it can do permanent damage, you need to recognize its symptoms.

“Insulin acts like a key in a door to the cells that lets the sugar come in,” says Christina Ring, an advanced registered nurse practitioner (ARNP) in pediatric endocrinology at Joe DiMaggio Children’s Hospital.

It’s produced by the beta cells of your pancreas, and when those cells are destroyed by an autoimmune reaction, children and adults alike develop type 1 diabetes.

Certain genetic markers put you at risk for this disease. Sarah’s family had distant relatives on both sides that had diabetes. But there also has to be a trigger that sets off the body’s attack on its own beta cells. It could be a virus or something in the environment.

“Despite a lot of research in the area, the specific triggers that start the autoimmune process are still largely unidentified,” says Hart-Unger.

Once about 90 percent of your beta cells are destroyed, you develop the symptoms that result in a diagnosis of type 1 diabetes. This process can take from years to months.

“It’s progressive, but it seems that younger children have a much shorter window than older ones,” says Ring.

Sarah had been for a checkup with her pediatrician at the end of June, and her blood work had been within the normal range. That’s generally considered to be a fasting blood sugar of under 100 mg/dL (milligrams of sugar per deciliter of blood).

“Everything was perfect,” says her mom, who is always careful to check. But just weeks later, when the girl arrived at the hospital, her blood glucose had risen to an unacceptable 650 mg/dL.

Sarah had had a virus that, looking back, Ziegler-Hoffman believes may have triggered the autoimmune reaction attacking her beta cells.

But no one can be sure.

One of the first symptoms a parent on the lookout for diabetes will discover is thirst. Now don’t worry if your kids want a drink after playing outdoors on a warm day. That’s normal. But what you need to note are changes in patterns, says Ring.

Perhaps your son is asking to visit the drinking fountain during school, so he’s disrupting the class. Or maybe your daughter who dislikes plain water is constantly visiting the refrigerator for a glass.

As the child drinks more liquids, urination becomes more frequent.

It’s a real sign when the child starts asking for water and to use the bathroom at night, says Hart-Unger. Or a child might start wetting the bed when they didn’t before.

“That can be a key marker,” she adds.

A child may also lose weight because fuel or glucose can’t get into the child’s cells. While the cells think they are starving, the blood is full of sugar, the doctor explains.

If your child exhibits any of these symptoms, make an appointment with the pediatrician, who will do blood and urine tests. A fasting blood glucose over 126 mg/dL or a random glucose taken on two occasions that reaches over 200 mg/dL is consistent with a diagnosis of diabetes, says Hart-Unger.

Although these symptoms also often appear in people suffering type 2 diabetes, diabetic ketoacidosis or DKA is much more commonly seen with type 1.

In the days leading up to her admission to the hospital, Sarah not only was thirsty and lost weight, but she also suffered frequent vomiting. It appears that the girl’s cells that were deprived of glucose began to produce ketones to use as fuel. High levels of ketones make the blood acidic, and this can lead to abdominal pain and vomiting.

Ketone buildup can also manifest itself in faster breathing as the body tries to expel the acid, and the child’s breath may actually have a fruity aroma from the ketones. DKA can lead to confusion as the acid affects the brain, as well as cause temporary renal failure.

Diabetic ketoacidosis is a life-threatening condition.

“It’s not the kind of thing you can sleep on for a couple of days. It needs to be handled now,” says Hart-Unger.

And when it’s discovered with a blood and/or urine test in your pediatrician’s office, the child is usually sent directly to the emergency room.

Lucky for Sarah, she was already there when it was determined she had DKA. “I didn’t know what to expect,” says her mom.

Sarah was kept in critical care for 2 ½ days while her endocrinologist got her stabilized, and she stayed in the hospital for a week.

Today, she and her family are coping with the requirements of living healthfully with type 1 diabetes. Her mom prepares healthy meals including school lunches and helps Sarah count the carbohydrates in them. She says she never stops being concerned about her daughter’s health.

“At first I felt kind of scared, but it’s getting better,” says Sarah, who has made the cheerleading squad since her diagnosis.

She now checks her own blood-glucose levels over a half dozen times a day, gives herself insulin injections during school and tries to cope with her new regimen.

“Now this is my way of life, and it’s not that hard. I’m getting used to it,” she says.

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