Type 1 Diabetes in Children: Overview
This booklet gives an overview of type 1 diabetes in children, its causes, diagnosis and treatment.
What is diabetes?
Diabetes is a condition where the cells can not utilize the sugar in the blood stream.
When we eat, the sugar (called glucose) is absorbed into the blood.
The pancreas has specialised cells that produce a hormone called insulin.
The insulin acts as a key that opens the door of the cells to allow the glucose to enter.
Inside the cell the glucose is broken to provide energy.
In type 1 diabetes the pancreas does not produce insulin.
In type 2 diabetes the pancreas may produce less insulin than it should, and the cells may not accept the insulin.
If the cells do not take the glucose, it remains high in the blood stream.
High glucose in the blood can lead to problems.
The problems can be slow to affect the organs (like the eyes and kidney) and take years to happen.
Other problems are an emergency and need to be treated right away.
What is the cause of type 1 diabetes?
Type 1 diabetes is a condition where the pancreas does not produce insulin.
The immune system normally defends the body against harmful bacteria and viruses.
In type 1 diabetes the immune system mistakenly attacks the pancreas cells.
This is thought to have a genetic origin.
Hence, it runs in families.
What are the symptoms of type 1 diabetes in children?
When the glucose levels in the blood rise the kidneys excrete them in urine.
Water follows the glucose in the urine.
Hence, the amount of urine increases.
The child pees frequently.
Due to the loss of water in urine the child feels thirsty.
As the sugar is not entering the brain cells, the satiety centre keeps sending hunger signals.
As the cells are not using the sugar in the blood stream, the energy produced is small, so the child feels tired.
As the cells are not using the sugar in the blood stream the body starts breaking body fat and body proteins for energy.
So, the child loses weight.
Thirst.
Hunger.
Passing urine frequently.
Bed wetting in toilet trained children.
Losing weight.
Feeling tired.
How is it diagnosed?
Blood tests sent to the lab are used to diagnose diabetes.
Your doctor will discuss with you the most suitable blood tests for your child.
Blood Test
Level for diagnosis mmol/l or mg/dl
Notes
Fasting plasma glucose levels
>=7 mmol/l
126 mg/dL
Based on fasting for 8 hours.
Random plasma glucose levels
>=11 mmol/l
200 mg/dL
2-hr glucose levels
>=11 mmol/l
200 mg/dL
This assesses your response to sugar after fasting for 8 hours.*
HbA1c
>=6.5 %
Not used for diagnosis in children But a useful monitoring tool
To assess your body's response to sugar, this test requires fasting overnight.
A blood draw determines your fasting glucose level.
Then, you'll drink a special sugar solution, followed by further blood draws at 1, 2, and potentially 3 hours later.
A 2-hour level below 140 mg/dL is considered normal.
Levels between 140 and 199 mg/dL may indicate prediabetes, while levels at or above 200 mg/dL suggest diabetes.
Complications of diabetes
Some complications are slow to happen and may take years to affect organs.
Organs affected include:
The eyes.
The kidneys.
The nerves.
Skin and feet.
Other complications are an emergency that can harm the child right away:
Hypoglycaemia
This is when the blood sugar falls too low in the blood.
This can be caused by:
Skipping a meal.
Taking too much insulin.
Doing more physical activity than usual.
Your child must be aware of its symptoms, including:
Pallor
Shaking
Hunger
Sweating
Difficulty concentrating
Losing consciousness
Teach your child to measure their blood sugar levels.
If low your child will need to ingest some fast-acting sugar.
Diabetic Ketoacidosis (DKA)
The body does not produce insulin.
The body uses fats for energy.
This releases a substance called ketones.
This is very dangerous for your child.
Your child must be aware of its symptoms, including:
Thirst.
Increased urination.
Dry or flushed skin.
Nausea, vomiting or abdominal pain.
A sweet, fruity smell on your child's breath.
Confusion.
If you suspect DKA, measure the ketones in your child’s urine or blood.
If they are high, seek medical help urgently.
General Management
It is important involve your child and teach them how to manage diabetes.
Important aspects of management include:
How to measure blood glucose levels?
How to take their insulin?
Be aware of warning signs of hypoglycaemia and DKA.
Lifestyle alterations.
Nutrition.
Educating and informing other adults who interact with your child like teachers in the school.
The mental wellbeing of your child.