Diabetes in childhood
diabetes; insulin; sugar; blood; hypo; hypoglycaemia; diabetes; mellitus; glucose; insulin-dependent; ketoacidosis; juvenile-onset; IDDM; mature-onset; diabetes; insipidus; urine; hypos;
Contents
Alert!
If a person who is known to have diabetes becomes confused, obviously unwell, drowsy or unconscious, that person needs urgent help. She may have very low levels of blood glucose (hypoglycaemia) or ketoacidosis (very high levels of blood glucose with dehydration and other blood chemistry problems).
Children who have been diagnosed with diabetes, and their families, need to learn many new things – how to measure blood glucose levels, give injections and how to balance food and activity – all of which they will find difficult to start with. Diabetes will have to be managed for all of the child’s life, but diabetes need not prevent a child from living a full and active life.
Note: All children and young people who have diabetes should have their own diabetes management plan worked out with their doctor and their diabetes team.
This topic has information about types of diabetes, early signs of diabetes, and problems caused by diabetes.
- In this topic, the word 'diabetes' will usually mean 'diabetes mellitus type 1'.
- Glucose is the type of carbohydrate (sugar) that is made and used in the body. The term 'blood sugar' is often used when talking about diabetes, but in this topic the correct word 'glucose' will be used.
- The topic 'Diabetes - managing diabetes in childhood' has information about day-to-day management, and living with diabetes.
What is diabetes mellitus?
Diabetes (diabetes mellitus) is a condition where the body cannot use energy from food. It is caused by having no insulin or not enough insulin.
- Insulin is a hormone made in the pancreas, which helps glucose (which is made from food) go from the blood stream into the body's cells. Most cells get their energy from glucose.
- In this way, insulin controls the level of glucose in blood.
- Without insulin, glucose builds up in the bloodstream and overflows into the urine. High glucose levels in the blood and the urine are the first signs of diabetes.
Types of diabetes
There are two main types of diabetes mellitus – type 1 and type 2.
Diabetes mellitus type 1 usually starts in childhood, adolescence or early adult life.
- It is sometimes called juvenile-onset diabetes, or insulin-dependent diabetes mellitus (IDDM)
- The insulin-making cells (ß islet-cells) in the pancreas have been destroyed and do not make insulin.
- The causes of diabetes mellitus type 1 are complex and include some genetic factors, and probably a viral infection which 'triggers' the body’s own immune system to destroy the insulin making cells (an auto-immune disease).
- Diabetes mellitus type 1 is not directly passed from a parent to a child. Most people who get diabetes do not have parents, brothers or sisters who have it.
- Diabetes mellitus type 1 can be managed with balancing insulin injections (usually needed 2 to 6 times each day), exercise and diet. However it cannot yet be cured.
Diabetes mellitus type 2 mainly affects older people, and it is sometimes called 'mature-onset diabetes'.
- The pancreas makes insulin, but the insulin does not work normally.
- Diabetes mellitus type 2 is also partly caused by genes, plus other things in the person's lifestyle, such as being overweight and inactive. It often occurs in other people in the same family.
- Younger people can get type 2 diabetes, especially if they are very overweight. With the increasing levels of childhood obesity, the numbers of younger people with type 2 diabetes is rising.
- People with diabetes mellitus type 2 usually do not need insulin. Weight loss, diet control, exercise and often other medicines are usually used to control blood glucose levels.
Gestational diabetes is diabetes mellitus which occurs during pregnancy (see the topic Diabetes in pregnancy).
Diabetes insipidus is a completely different health problem, caused by the lack of a hormone which controls how much urine is produced in the kidneys. It is not discussed in this topic.
How common is diabetes in children?
- Diabetes mellitus type 1 occurs in about 1 in 1,000 children in Australia (in adults, about 1 in 25 have diabetes mellitus type 2).
- Diabetes mellitus type 1 usually begins between 5 and 12 years of age, although it can occur in younger children.
- Most people with diabetes mellitus type 1 will have it diagnosed before the age of 30 years.
Signs of diabetes mellitus type 1
The start of diabetes may not be noticed, especially in younger children.
The first signs of diabetes usually are:
- tiredness
- increasing thirst
- passing lots of urine (wee). Some children start to wet the bed again at night.
- weight loss
- glucose in the urine (sometimes this is the only sign).
Some children become quite ill (ketoacidosis – see below) before it is recognised that they have diabetes. They may start vomiting and become drowsy, dehydrated, and possibly comatose. In extreme cases, a child could die before the reason for their illness is worked out. However, if a child who is very ill is taken to a doctor or hospital, it is easy to diagnose diabetes with a simple test of their blood glucose level. Children usually become better very quickly with emergency treatment – starting with lots of fluid through a drip (intravenous infusion).
Starting treatment
When children are diagnosed with diabetes, they will usually spend several days in hospital learning how to manage diabetes with the help of the diabetes team.
- The goals of treatment are:
- to keep the level of blood glucose as close as possible to the levels of a person who does not have diabetes
- to have a balance between insulin doses, food intake and physical activity
- to avoid blood glucose levels that are too high or too low
- to help the child grow and develop normally.
- Children and their family will need to learn how to use insulin. This includes:
- doing blood tests
- learning what the test results mean
- working out how much insulin to give
- giving the injections.
- With this specialist management, a child who has diabetes will be well, and able to do almost all of the things that other children of their age can do.
The specialist diabetes team includes a doctor (possibly an endocrinologist - a specialist doctor who treats people with disorders of the endocrine glands such as the pancreas), a nurse, a dietitian and a diabetes educator.
Is there a cure?
- As yet there is no cure for diabetes. There is a lot of research going on world-wide to find a cure, including trying to find ways of transplanting insulin-making cells.
- Management of diabetes mellitus type 1 is through regular checking of blood glucose levels, and managing diet, insulin and exercise. The person with diabetes will need insulin every day for the rest of his or her life.
- Diabetes is not life-threatening if it can be well managed, so it is important to work out good patterns of management early in life.
Other health problems from diabetes
If diabetes mellitus type 1 or 2 are not well managed, the complications later in life can be severe. It is important to be aware of the potential complications, as they are usually preventable with good management.
If blood glucose levels stay high most of the time, damage to blood vessels will occur.
- Damage to small blood vessels can cause problems in the eyes, the kidneys and the nerves.
- Damage to large blood vessels can cause heart disease and circulation problems.
- In older people, this damage over a long period can result in kidney damage, loss of sight or loss of limbs.
Hyperglycaemia (high blood glucose)
Hyperglycaemia usually develops slowly, although it can happen more quickly if the child is ill.
- The symptoms of hyperglycaemia are similar to those that occur before diabetes is diagnosed.
- Increased thirst
- Frequently passing urine
- Drowsiness and tiredness
- Laboured breathing (rapid deep breathing ('Kussmaul respiration'), where the person seems to push the air out, unlike the passive exhaling that we normally do).
- If the hyperglycaemia is not recognised and treated, it can lead to ketoacidosis, which is a serious emergency.
- Each family needs to have a plan to manage hyperglycaemia for their child. This includes working out why the child has hyperglycaemia, so that the correct treatment can be given, and working out ways to avoid this happening.
Ketoacidosis develops when the body, which is starved of glucose (because it cannot get from the blood into the cells), starts to break down fats for energy.
- The products of this breakdown of fats are called ketones, and the levels of ketones in blood and urine rise.
Signs of ketoacidosis
- Confusion, drowsiness
- Breath odour, which smells 'fruity' or like acetone (nail polish remover)
- Rapid deep breathing
- Being very thirsty (polydipsia)
- Tummy pain, feeling sick (nausea) and vomiting, flushed cheeks
- Dehydration because much more urine is produced than normal (polyuria)
- Ketones in the urine (ketonuria)
- Glucose in the urine (glycosuria) because of high blood glucose levels
- Very high blood glucose (over 15mmol/l)
- Eventual loss of consciousness and death, if untreated.
Treatment of ketoacidosis
Treatment usually needs to be done in hospital.
- Emergency treatment aims first to give children a lot of fluid, usually using a saline 'drip'.
- Insulin is used to bring the blood glucose level back to normal.
- When the child recovers, it is really important to work out why the ketoacidosis occurred, so you can try to stop it happening again.
What is a hypo? (hypoglycaemia)
Hypoglycaemia is when blood glucose levels get too low (below about 4.0 mmol/L) usually as a result of:
- missed or delayed meals or snacks
- being unwell and not eating properly
- doing strenuous activity without eating extra food
- not taking the correct dose of insulin (taking too much)
- drinking too much alcohol.
Symptoms of hypoglycaemia
Symptoms will be a mixture of these:
- feeling shaky, anxious and weak
- sweating, going pale
- crying, being irritable
- being unable to concentrate, lacking co-ordination
- having slurred speech
- feeling hungry
- having a headache.
If not treated, the child may become confused or drowsy, and if severe, the child may lose consciousness.
Treatment of hypoglycaemia
If conscious, give any of these:
- glucose tablets
- sugar or honey (2 to 3 teaspoons) dissolved in water
- jelly beans or jelly baby lollies
- sugary soft drink or fruit juice (not diet drink)
Follow this with complex carbohydrate food, eg. a sandwich or a drink of milk.
If unconscious:
- do not give any drinks or food by mouth
- inject Glucagon (if it is available and if someone is trained to give it)
If Glucagon is not available, or the child does not respond to Glucagon, call for urgent help (eg. call the ambulance service 000 in Australia).
A person with type 1 diabetes should always carry a source of fast-acting sugar.
Preventing these emergencies
It is not possible to prevent all episodes of high or low blood glucose. Many things can affect control, for example it may not always be possible for a child to eat exactly on time, and it can be difficult to control blood glucose when a child is unwell with what would otherwise be a minor illness such as gastro or the flu. It is important to monitor blood glucose regularly, and to develop a plan with the child’s diabetes team for times when control is difficult.
For more information see the topic Diabetes: managing diabetes in childhood. This topic includes information about managing insulin, diet, blood glucose monitoring, exercise, school and special occasions.
Resources
South Australia
Australia
- Diabetes Australia:
http://www.diabetesaustralia.com.au
- National Diabetic Services Scheme (NDSS) is funded by the Australian Commonwealth Government and administered in South Australia by DA-SA. It provides an easy, low cost way for people with diabetes to buy essential diabetic supplies. Lifetime registration is free. You need to fill in a registration form, get it signed by your doctor and return it to DA-SA.
http://www.health.gov.au/pbs/healthpro/supply/ndss.htm
- Juvenile Diabetes Research Foundation in Australia
A non-profit organisation dedicated to finding a cure for diabetes and preventing its complications through research
- telephoonel 1300 363 126
http://www.jdrf.org.au
International
Isselbacher KJ (et al), Eds. 'Harrison’s Principles of Internal Medicine' Chapter 333 (Diabetes Mellitus) online:
http://harrisons.accessmedicine.com/ (restricted access) cited 2004-07-02.
Juvenile Diabetes Research Foundation (Australia) Diabetes Information Brochure 'Your Child has Type 1 Diabetes':
http://www.jdrf.org.au/ cited 2004-07-02.
The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).
This topic may use 'he' and 'she' in turn - please change to suit your
child's sex.