More than 200,000 children and teens living in the United States suffer from diabetes. The most common form of diabetes in children is type 1. This condition results from destruction of islet cells, the insulin-producing cells in the pancreas.
Type 1 diabetes is part of a family of autoimmune conditions in which the body’s immune system produces antibodies that fight against its own body. The process is thought to be related to a combination of genetic and environmental factors. The role of environmental factors is underscored by the incidence of type 1 diabetes increasing steadily in the past 10 years, especially among children under5.
In all forms of diabetes, blood glucose cannot be used by cells to produce energy, and thus glucose levels rise. This causes high levels of glucose and water to be lost by the kidneys. The body then begins to break down fat to try to generate energy and produces ketones that can cause stomach pain, nausea, vomiting and dehydration. The condition is called diabetic ketoacidosis.
Because of increased awareness of the signs and symptoms of high blood sugar, many children with diabetes are now diagnosed in the early stages of the disease and avoid the complications of ketoacidosis. Signs your child might have diabetes include:
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▪ Frequent urination or bed-wetting
▪ Increased thirst
▪ An increase in appetite
▪ Decreased energy level
▪ Weight loss
When caring for a child with newly diagnosed type 1 diabetes, your endocrinologist will explain that diabetes is a condition that can be controlled and that the outlook for children with type 1 diabetes is better than ever. We now have the ability to maintain blood glucose at closer to normal levels, and all studies show that this is the most important factor in reduction of risk for long-term complications. Your pediatrician will also describe how a health care team of endocrinologists, diabetes educators, nutritionists, social workers and psychologists will work with your family to maintain optimal blood glucose control in your child.
Optimal blood glucose control requires matching insulin to the amount of carbohydrates consumed. To do this, patients and their families learn carbohydrate counting. Many books and smart phone apps are available to assist with calculating the amount of carbohydrate in each kind of food.
Insulin dosing is tailored to your child. Ideally, your child’s insulin treatment regimen would mimic the operation of a pancreas, where insulin is being released constantly but at higher levels after a meal. To approximate these levels, both long-acting insulin and rapid-acting insulin are used to maintain normal blood glucose.
Avoidance of low blood sugar is critical as extreme drops in blood glucose can cause seizures or life-threatening events. Your family will be taught to recognize and treat low blood sugar. Symptoms that your child has low blood sugar may include pallor, sweating, trembling, high heart rate, hunger, headache, drowsiness, mental confusion, and mood and personality change.
Exercise is important for optimal diabetes control, and carbohydrate intake may need to be modified to prevent swings in glucose during and after activity. However, even though your child has diabetes, he or she should be allowed full participation in all school activities. State law requires each school to have someone on site who can monitor blood glucose, administer insulin and help if your child becomes ill.
Numerous technological advancements have improved patient care in recent years. Many children now use an insulin pump that delivers insulin throughout the day and avoids the need for separate insulin injection. The pumps allow more precise insulin dosing but still require careful monitoring of blood glucose levels and carbohydrate intake. Another new tool is the continuous glucose monitor, which has boosted our ability to manage diabetes by providing information on blood glucose levels every five minutes via a subcutaneous site, and many important new studies are ongoing to prevent, delay or eliminate type 1 diabetes.
Today, type 1 diabetes can be successfully managed, but it is important that you contact your pediatrician immediately if you suspect your child has diabetes. You can also call upon pediatric diabetes experts at UHealth – University of Miami Health System at (305) 243-2920.
Janine Sanchez, M.D., is a pediatrician and the Director of the Pediatric Diabetes Program at UHealth – University of Miami Health System. For more information, visit UHealthSystem.com/patients/pediatrics.