Diabetes Mellitus in Children

Overview

Diabetes Mellitus, commonly referred to as diabetes, is a condition that affects how the body processes blood sugar (glucose). Glucose is a vital source of energy for the body’s cells, but for it to be used effectively, the body needs insulin, a hormone produced by the pancreas. In children with diabetes, either the body doesn’t make enough insulin or can’t use it properly, leading to high blood sugar levels.

There are two main types of diabetes in children: Type 1 and Type 2.

Type 1 Diabetes

This is the most common type in children. It’s an autoimmune condition where the body’s immune system mistakenly attacks the insulin-producing cells in the pancreas. As a result, the body produces little to no insulin, requiring lifelong management.

Type 2 Diabetes

This type is less common in children but has been increasing due to rising obesity rates. In Type 2 diabetes, the body still produces insulin, but it doesn’t use it effectively, a condition known as insulin resistance.

Symptoms

Recognizing the symptoms of diabetes early is crucial for prompt diagnosis and treatment. Here are common symptoms to watch out for:

  • Increased Thirst and Urination
  • Unexplained Weight Loss
  • Extreme Hunger
  • Fatigue
  • Blurred Vision
  • Slow-Healing Sores or Frequent Infections

Identifying whether a child has Type 1 or Type 2 diabetes at the time of diagnosis is crucial because the treatments and management approaches differ.

Typical Characteristics of Type 2 Diabetes:

  • The symptoms of Type 2 diabetes usually develop slowly over time, making it harder to notice initially.
  • Common in Overweight or Obese Children
  • There is often a strong family history of Type 2 diabetes. 
    • This may be linked to shared lifestyle habits that lead to obesity, as well as a family history of heart disease or metabolic issues.
  • Acanthosis Nigricans: 
    • This is a skin condition where dark, thickened patches of skin appear, often around the neck or under the arms, which is a sign of insulin resistance.
  • Polycystic Ovary Syndrome (PCOS): 
    • In girls, PCOS, which affects the ovaries and hormone levels, is sometimes associated with Type 2 diabetes.
  • High Blood Pressure (Hypertension): 
    • Children with Type 2 diabetes may also have high blood pressure.
  • Eye Issues (Retinopathy): 
    • Although more common in adults, some children with Type 2 diabetes may show early signs of eye problems due to high blood sugar levels.

Causes

The exact cause of diabetes in children is not fully understood, but several factors may contribute to its development:

Causes and Risk Factors of Type 1 Diabetes in Children

Main Cause: Environmental and Genetic Factors

GENETIC FACTORS

  • Genetic Susceptibility: 
    • Most cases (about 95%) of Type 1 diabetes occur when environmental factors interact with a person who is genetically prone to the disease. 
    • This interaction triggers an autoimmune response that attacks the insulin-producing cells in the pancreas, gradually destroying them. 
  • Genetic Factors
    • Family History: 
      • If a child has a family history of diabetes, especially in close relatives like parents or siblings, their risk of developing Type 1 diabetes is higher.
    • Twin Studies: 
      • Identical twins have a 60% chance of both developing Type 1 diabetes, but this risk drops to 8% for fraternal twins, which is similar to the risk among other siblings.
    • Parental Influence: 
      • If the mother has Type 1 diabetes, the risk for her child is 2-3%. 
      • This increases to 5-6% if the father has diabetes. 
      • If both parents have diabetes, the risk for their child rises to nearly 30%.
    • Neonatal Diabetes: 
      • If diabetes is diagnosed in infants younger than 6 months, it may be due to a genetic defect in a specific potassium channel in the pancreas. 

ENVIRONMENTAL FACTORS

  • Influence of Environment
    • Viral Infections: 
      • Certain viral infections may trigger or worsen the autoimmune process that leads to Type 1 diabetes. 
      • For example, there’s evidence that a mother’s enteroviral infection during pregnancy could increase the risk of her child developing diabetes.
  • COVID-19 and Diabetes: 
    • Recent studies suggest that children who had COVID-19 are more likely to be diagnosed with diabetes afterward. 
    • The exact link between COVID-19 and diabetes is still being studied
  • Dietary Factors
    • Breastfeeding: 
      • Breastfed infants have a lower risk of developing Type 1 diabetes compared to those who are not breastfed.
    • Cow’s Milk: 
      • Some studies suggest a link between early exposure to cow’s milk and an increased risk of diabetes
    • Chemicals in Food: 
      • Chemicals like nitrosamines, found in smoked foods and some water supplies, have been shown to cause diabetes in animals, but the link in humans is not yet confirmed.
  • Geographical Influence
    • Distance from the Equator: 
      • The risk of developing Type 1 diabetes increases the farther you are from the equator. 
      • This might be due to reduced sunlight exposure, leading to lower vitamin D levels, which are linked to a higher risk of diabetes.
  • Chemical Causes
    • Exposure to Certain Chemicals
      • Streptozotocin and RH-787: These chemicals, used as a rat poison, specifically damage insulin-producing cells and can cause Type 1 diabetes.

OTHER CONDITIONS

  • Other Factors Leading to Type 1 Diabetes
    • Congenital Conditions: Some children are born without a pancreas or with defective islet cells, leading to diabetes.
    • Pancreatic Damage: Conditions like cystic fibrosis, chronic pancreatitis, or physical injury to the pancreas can damage the insulin-producing cells and result in diabetes.
    • Genetic Syndromes: Certain genetic disorders, like Down syndrome, Turner syndrome, Klinefelter syndrome, and Prader-Willi syndrome, slightly increase the risk of developing Type 1 diabetes.

Risk Factors of Type 2 Diabetes in Children

The major risk factors for type 2 diabetes in young persons are as follows: 

  • Obesity and Inactivity: 
    • Being overweight and not getting enough physical activity are major contributors to the body’s resistance to insulin, increasing the risk of Type 2 diabetes.
  • Ethnicity: 
    • Children of Native American, Black, Hispanic, Asian, or Pacific Islander descent have a higher risk of developing Type 2 diabetes.
  • Family History: 
    • Having close family members (like parents or grandparents) with Type 2 diabetes increases the likelihood of developing the condition.
  • Age: 
    • The risk is higher for children between 12-16 years old. This age group is more likely to develop insulin resistance due to changes in the body during puberty.
  • Birth Weight: 
    • Both low birth weight and high birth weight can increase the risk of Type 2 diabetes later in life.
  • Mother’s Health During Pregnancy: 
    • If the mother had gestational diabetes or Type 2 diabetes during pregnancy, her child is at a higher risk of developing Type 2 diabetes.
  • Infant Feeding: 
    • Not being breastfed during infancy may increase the risk of developing Type 2 diabetes.

Diagnosis

General Considerations

  • The type and extent of tests needed depend on the child’s overall health.
  • For most children, a urine test for glucose and a blood glucose measurement are enough to diagnose diabetes.
  • Some other conditions linked with diabetes may require additional tests at diagnosis and during follow-up visits.

Key Tests for Diabetes Diagnosis

  • Urine Glucose
    • A positive urine glucose test may indicate diabetes but isn’t enough for a diagnosis. High blood glucose levels are needed to confirm diabetes.
  • Urine Ketones
    • Ketones in the urine can confirm that the body is breaking down fat for energy (lipolysis) and making new glucose (gluconeogenesis).
    • When blood sugar is high and there’s a lot of sugar in the urine, ketones indicate a lack of insulin and potential risk for diabetic ketoacidosis (DKA).
  • Thyroid Function Tests and Antithyroid Antibodies
    • Children with Type 1 diabetes may also have thyroid issues, which can affect diabetes management.
  • Antigliadin Antibodies
    • Some children with Type 1 diabetes may also have celiac disease.
    • Positive antibody tests may require a small intestine biopsy to confirm celiac disease. If confirmed, the child should follow a gluten-free diet for life.
  • Lipid Profile
    • Lipid (fat) levels are often abnormal at diabetes diagnosis due to high triglycerides from the body’s glucose production.
    • High lipid levels usually normalize as blood sugar control improves.
  • Urinary Albumin
    • Starting at age 12, an annual urine test checks for microalbuminuria, which indicates early kidney damage (diabetic nephropathy).
  • Kidney Function Tests
  • Blood Glucose Levels
    • A random blood glucose level over 200 mg/dL (11 mmol/L) indicates diabetes, as does a fasting blood glucose over 120 mg/dL (7 mmol/L).
  • Most children diagnosed with diabetes due to symptoms have blood glucose levels of at least 250 mg/dL (14 mmol/L).
  • Blood glucose is usually monitored daily using capillary blood samples, test strips, and blood glucose meters.
  • Glycated Hemoglobin (HbA1c)
    • HbA1c measures average blood glucose over the past 8-10 weeks.
    • An HbA1c level of 6.5% or higher suggests diabetes. 
    • This test is useful for tracking long-term blood sugar control and doesn’t require fasting.
    • The ideal HbA1c level is around 7% to minimize long-term complications while avoiding the risk of low blood sugar.

Treatment Options

Managing diabetes in children requires a comprehensive approach, combining medical treatment, lifestyle changes, and ongoing support:

  • Medication: 
    • For Type 1 diabetes
      • daily insulin injections or an insulin pump are necessary to regulate blood sugar levels. 
      • The goal is to mimic the natural insulin production of the pancreas as closely as possible.
    • For Type 2 diabetes
      • Metformin: 
        • This is usually the first medication prescribed for children and teenagers if their HbA1c level is less than 9%.
      • If metformin doesn’t work on its own, your doctor might add insulin, a sulfonylurea (another type of diabetes medication), or another drug to help lower blood sugar.
      • Cholestrol lowering medication
        • Statins: These medications help lower cholesterol. 
        • They might be needed if someone with Type 2 diabetes still has high LDL (bad cholesterol) levels after 3-6 months of trying to improve through lifestyle changes.
      • Blood pressure lowering medication
        • ACE Inhibitors: These are often the first choice for treating high blood pressure and protecting the kidneys, especially if there are signs of kidney issues
  • Healthy Diet: 
    • A balanced diet rich in fruits, vegetables, whole grains, and lean proteins is essential. Carbohydrate counting helps manage blood sugar levels.
  • Regular Exercise: 
    • Physical activity helps the body use insulin more effectively and lowers blood sugar levels. Encouraging your child to stay active is a key part of managing diabetes.
  • Blood Sugar Monitoring: 
    • Regular blood sugar checks are crucial to ensure levels stay within the target range. This can involve finger-prick tests or continuous glucose monitoring (CGM) devices.
  • Education and Support: 
    • Understanding diabetes is vital for both the child and their family. At Gertrude’s Children’s Hospital, we offer comprehensive education and support programs to empower families in managing diabetes effectively.

Patient Success Stories

At Gertrude’s Children’s Hospital, we are committed to providing the best possible care for children with Diabetes Mellitus. Here’s why families trust us:

“When our teenager was diagnosed with Waldenström's, we were shocked and scared. The team at Gertrude's Children's Hospital guided us through every step of the treatment process. Their expertise and compassionate care have given our child a chance at a healthy future.”

Davidfather of a Diabetes Mellitus patient

Living with Diabetes Mellitus in Children

Currently, there is no cure for diabetes, but it can be managed effectively with proper treatment, diet, and lifestyle adjustments. With the right care, children with diabetes can lead healthy, active lives.

This varies depending on your child’s treatment plan. Your healthcare provider will guide you on the best routine.

If your child’s blood sugar is too high (hyperglycemia), it’s important to follow their diabetes management plan, which may include adjusting insulin or increasing physical activity. If it’s too low (hypoglycemia), provide a quick source of sugar, like juice or glucose tablets, and monitor their levels. Always consult your healthcare provider for specific guidance.

Absolutely! Children with diabetes can participate in sports and other activities. In fact, regular physical activity is encouraged as part of diabetes management. It’s important to plan ahead, monitor blood sugar levels, and have snacks or glucose tablets on hand.

Emotional support is crucial. Encourage open communication about their feelings and challenges. Involve them in their care to help them feel empowered and in control. We offer support groups and counseling services to help families navigate the emotional aspects of diabetes.

It’s important to work with your child’s school to develop a diabetes management plan. This includes educating teachers and staff about your child’s needs, ensuring access to snacks and medication, and having a plan in place for emergencies.

Contact Us

If you suspect your child may have diabetes or if they have been diagnosed and you’re seeking expert care, we’re here to help. Schedule an appointment with one of our pediatric specialists today. Early intervention and proper management are key to ensuring your child’s health and well-being.

Contact us today to schedule an appointment or learn more about our Diabetes Mellitus in Children treatment program:

At Gertrude’s Children’s Hospital, we are committed to providing the highest quality care for children with diabetes. Our compassionate team is here to support your family every step of the way, ensuring your child receives the best possible care tailored to their unique needs. Let us help your child live a healthy, happy life with diabetes.

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