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Type 1 Diabetes in Children

Definition :
Type 1 diabetes in children presents special challenges for parents and children alike.

Type 1 diabetes — once known as juvenile diabetes — is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to convert sugar (glucose) into energy. Although type 1 diabetes can develop at any age, it typically appears during childhood or adolescence.

Type 2 diabetes is a similar condition in which a child's body becomes resistant to the effects of insulin or when a child's body produces some, but not enough, insulin to maintain a normal blood sugar level.

Various factors may contribute to type 1 diabetes in children, including genetics and exposure to certain viruses. Although type 1 diabetes requires consistent care, advances in blood sugar monitoring and insulin delivery have simplified the daily routine of managing type 1 diabetes in children. With proper treatment, children who have type 1 diabetes can expect to live long, healthy lives.

Causes :
To understand type 1 diabetes in children, first you must understand how glucose is normally processed in the body.

Glucose is a main source of energy for the cells that make up muscles and other tissues. Glucose comes from two major sources: the food your child eats and your child's liver. During digestion, sugar is absorbed into the bloodstream. Normally, sugar then enters cells with the help of insulin.

The hormone insulin comes from the pancreas, a gland located just behind the stomach. When your child eats, the pancreas secretes insulin into the bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter your child's cells. Insulin lowers the amount of sugar in your child's bloodstream. As your child's blood sugar level drops, so does the secretion of insulin from the pancreas.

The liver acts as a glucose storage and manufacturing center. When your child's insulin levels are low — when your child hasn't eaten in a while, for example — the liver releases the stored glucose to keep your child's glucose level within a normal range.

In type 1 diabetes, your child's immune system — which normally fights harmful bacteria or viruses — attacks and destroys the insulin-producing cells in the pancreas. This leaves your child with little or no insulin. Instead of being transported into your child's cells, sugar builds up in your child's bloodstream.

The exact cause of type 1 diabetes in children is unknown. Genetics may play a role. Exposure to certain viruses may serve as a trigger as well.

Risk Factor :
A child who has a parent or sibling with type 1 diabetes has a slightly increased risk of developing the condition. In some cases — usually through a clinical trial — genetic testing can be done to determine if a child who has a family history of type 1 diabetes is at increased risk of developing the condition.

When to seek medical advice :
Consult your child's doctor if you're concerned about diabetes or if you notice any of the signs or symptoms of type 1 diabetes — increased thirst and frequent urination, extreme hunger, weight loss, blurred vision or fatigue.

If your child is diagnosed with type 1 diabetes, he or she will need close medical follow-up. At first, your child may need emergency treatment or daily visits until his or her blood sugar level stabilizes. Once your child's blood sugar is under control, the doctor may recommend checkups every few months. A thorough yearly exam and regular eye exams also are important.

Symptoms :
The signs and symptoms of type 1 diabetes in children usually develop quickly, over a period of weeks. Look for :

  • Increased thirst and frequent urination. As excess sugar builds up in your child's bloodstream, fluid is pulled from the tissues. This may leave your child thirsty. As a result, your child may drink — and urinate — more than usual.
  • Extreme hunger. Without enough insulin to move sugar into your child's cells, your child's muscles and organs become depleted for energy. This triggers intense hunger.
  • Weight loss. Despite eating more than usual to relieve hunger, your child may lose weight — sometimes rapidly. Without the energy sugar supplies, muscle tissues and fat stores simply shrink.
  • Fatigue. If your child's cells are deprived of sugar, he or she may become tired and irritable.
  • Blurred vision. If your child's blood sugar is too high, fluid may be pulled from the lenses of your child's eyes. This may affect your child's ability to focus clearly.

In babies and young children, the first indication of type 1 diabetes may be a yeast infection that causes a severe diaper rash.

Diagnosis :
If your child's doctor suspects diabetes, he or she will recommend a screening test. Various blood tests can be used to screen for diabetes, including :

  • Random blood sugar test. A blood sample will be taken at a random time. Regardless of when your child last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL) or higher suggests diabetes.
  • Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL is normal. A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes, which indicates a high risk of developing diabetes. If it's 126 mg/dL or higher on two separate tests, your child will be diagnosed with diabetes.

If your child is diagnosed with diabetes, the doctor may do other tests to distinguish between type 1 and type 2 diabetes — which may require different treatment strategies. Type 1 diabetes is characterized by the need for insulin treatment. It often develops at a younger age than does type 2 diabetes. Type 1 diabetes might also be suspected if your child has antibodies to insulin-producing cells in his or her blood or ketones — toxic acids produced by the breakdown of fat — in his or her urine. Type 2 diabetes, on the other hand, is more common in children who are obese. Sometimes type 2 diabetes can be managed without insulin treatment.

Complications :
Type 1 diabetes can affect nearly every major organ in your child's body, including the heart, blood vessels, nerves, eyes and kidneys. Keeping your child's blood sugar level close to normal most of the time can dramatically reduce the risk of these complications.

Short-term complications
Short-term complications of type 1 diabetes require immediate care. Left untreated, these conditions can cause seizures and loss of consciousness (coma).

  • Low blood sugar (hypoglycemia). If your child's blood sugar level drops below his or her target range, it's known as low blood sugar. Your child's blood sugar level can drop for many reasons, including skipping a meal, getting more physical activity than normal or injecting too much insulin. Watch for early signs and symptoms of low blood sugar, including sweating, shakiness, weakness, hunger, dizziness and nausea. Later signs and symptoms include slurred speech, drowsiness and confusion.

    If your child develops hypoglycemia during the night, he or she might wake with sweat-soaked pajamas or a headache. Thanks to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning.

    If your child has signs or symptoms of low blood sugar, give him or her fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. If your child loses consciousness, he or she may need an emergency injection of glucagon — a hormone that stimulates the release of sugar into the blood.

  • High blood sugar (hyperglycemia). Likewise, your child's blood sugar can rise for many reasons, including eating too much, not taking enough insulin or illness. Watch for frequent urination, increased thirst, dry mouth, blurred vision, fatigue and nausea. If you suspect hyperglycemia, check your child's blood sugar. You might need to adjust your child's meal plan or medications. If your child's blood sugar is dangerously high, call your child's doctor right away or seek emergency care.
  • Increased ketones in your child's urine (diabetic ketoacidosis). If your child's cells are starved for energy, your child's body may begin to break down fat — producing toxic acids known as ketones. Watch for loss of appetite, nausea, vomiting, fever, stomach pain and a sweet, fruity smell on your child's breath. If you suspect ketoacidosis, check your child's urine for excess ketones with an over-the-counter ketones test kit. If your child has excess ketones in his or her urine, call your child's doctor right away or seek emergency care.

Long-term complications
Long-term complications of type 1 diabetes develop gradually. The earlier your child develops diabetes — and the less controlled your child's blood sugar — the higher the risk of complications. Eventually, diabetes complications may be disabling or even life-threatening.

  • Heart and blood vessel disease. Diabetes dramatically increases your child's risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure.
  • Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your child's nerves, especially in the legs. This can cause tingling, numbness, burning or pain that usually begins at the tips of the toes or fingers and over a period of months or years gradually spreads upward. Left untreated, your child could lose all sense of feeling in the affected limbs.
  • Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your child's blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.
  • Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy). Diabetes can also lead to cataracts and a greater risk of glaucoma. By adulthood, diabetes is a leading cause of blindness.
  • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections.
  • Skin conditions. Diabetes may leave your child more susceptible to skin problems, including bacterial infections, fungal infections and itching.
  • Osteoporosis. Diabetes may lead to lower than normal bone mineral density, increasing your child's risk of osteoporosis as an adult.

Treatment for type 1 diabetes is a lifelong commitment of blood sugar monitoring, insulin, healthy eating and regular exercise — even for kids. And as your child grows and changes, so will his or her diabetes treatment plan. Over the years, your child may need different doses or types of insulin, a new meal plan or other treatment changes.

If managing your child's diabetes seems overwhelming, take it one day at a time. And remember that you're not in it alone. You'll work closely with your child's diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your child's blood sugar level as close to normal as possible.

Blood sugar monitoring
Depending on what type of insulin therapy your child needs, you may need to check and record your child's blood sugar four or more times a day. This requires frequent finger sticks. But it's the only way to make sure that your child's blood sugar level remains within his or her target range — which may change as your child grows and changes.

Even if your child takes insulin and eats on a rigid schedule, the amount of sugar in his or her blood can change unpredictably. With help from your child's diabetes treatment team, you'll learn how your child's blood sugar level changes in response to :

  • Food. What and how much your child eats will affect your child's blood sugar level. Blood sugar is typically highest one to two hours after a meal.
  • Physical activity. Physical activity moves sugar from your child's blood into his or her cells. The more active your child is, the lower his or her blood sugar level. To compensate, you might need to lower your child's insulin dose before unusual physical activity.
  • Medication. Your child needs insulin to lower his or her blood sugar. But any other medications your child takes may affect his or her blood sugar level as well — sometimes requiring changes in your child's diabetes treatment plan.
  • Illness. During a cold or other illness, your child's body will produce hormones that raise his or her blood sugar level. In addition, a fever increases your child's metabolism. As a result, your child may need to take more frequent or larger doses of insulin.

In addition to daily blood sugar monitoring, your child's doctor may recommend regular glycated hemoglobin (A1C) testing. This blood test indicates your child's average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your child's blood sugar levels, the more hemoglobin he or she will have with sugar attached. Your child's target A1C goal may vary depending on his or her age and various other factors.

Compared with repeated daily blood sugar tests, A1C testing better indicates how well your child's diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your child's insulin regimen or meal plan.

Insulin and other medications
Anyone who has type 1 diabetes needs insulin treatment to survive. Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar. Often, insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin.

An insulin pump also may be an option for some children. The pump is a device about the size of a cell phone worn on the outside of the body. A tube connects the reservoir of insulin to a catheter that's inserted under the skin of the abdomen. The pump is programmed to dispense specific amounts of insulin automatically. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.

Many types of insulin are available, including rapid-acting insulin, long-acting insulin and intermediate options. Examples include regular insulin (Humulin R, Novolin R, others), NPH insulin (Humulin N, Novolin N), insulin lispro (Humalog), insulin aspart (NovoLog) and insulin glargine (Lantus). Depending on your child's needs, the doctor may prescribe a mixture of insulin types to use throughout the day and night.

Inhaled insulin (Exubera) hasn't been approved for children.

Healthy eating
Contrary to popular perception, there's no diabetes diet. Your child won't be restricted to a lifetime of boring, bland foods. Instead, your child will need plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — and fewer animal products and sweets. In fact, it's the best eating plan for the entire family. Even sugary foods are OK once in a while, as long as they're included in your child's meal plan.

Yet understanding what and how much to feed your child can be a challenge. A registered dietitian can help you create a meal plan that fits your child's health goals, food preferences and lifestyle. Once you've covered the basics, remember the importance of consistency. To keep your child's blood sugar on an even keel, encourage your child to eat the same amount of food with the same proportion of carbohydrates, proteins and fats at the same time every day.

Physical activity
Everyone needs regular aerobic exercise, and children who have type 1 diabetes are no exception. Encourage your child to get regular physical activity. Sign up for a sports team or dance lessons. Better yet, get in the act together. Play catch in the backyard. Walk — or race! — through your neighborhood. Visit an indoor climbing wall or local pool. Make physical activity part of your child's daily routine.

Remember that physical activity lowers blood sugar. If your child begins a new activity, check your child's blood sugar more often than usual for a few weeks. You might need to adjust your child's meal plan or insulin doses to compensate for the increased activity.

The only potential cure for type 1 diabetes is a pancreas transplant.

With a successful pancreas transplant, your child would no longer need insulin. But pancreas transplants aren't always successful — and the procedure poses serious risks. Your child would need a lifetime of potent immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects, including a high risk of infection and organ injury. Because the side effects can be more dangerous than the diabetes, pancreas transplants in children are unusual.

Researchers also are experimenting with islet cell transplantation, which provides new insulin-producing cells from a donor pancreas. Although this experimental procedure has met with problems in the past, new techniques and better drugs to prevent islet cell rejection may hold promise for the future.

Type 1 diabetes can't be prevented. Researchers are studying various options for prevention, however.

For example, although oral insulin can't be used to lower blood sugar, researchers are testing whether an insulin capsule taken by mouth once a day can prevent or delay type 1 diabetes in people who have antibodies to insulin in their blood. In other studies, researchers are testing ways to slow the development of type 1 diabetes and preserve insulin production in people recently diagnosed with type 1 diabetes.

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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