An overview of Type 1 diabetes in children
Type 1 diabetes in children is a medical disorder characterised by the inability of your child’s body to no longer produce a vital hormone known as insulin. Every child needs the insulin hormone to survive, so the missing insulin will need to be replaced with injections or an insulin pump. Type 1 diabetes in children may be also be known as juvenile diabetes or insulin-dependent diabetes.
Diagnosing and managing type 1 diabetes in children can be overwhelming, particularly in the beginning. All of a sudden, you and your child, irrespective of age, will have to learn how to give injections, count carbohydrates and monitor blood sugar level.
Unfortunately, there’s no cure for type 1 diabetes in children yet. However, it can be managed, and the several advances that have been made in blood sugar monitoring and insulin delivery have helped improved blood sugar management and life quality for children with type 1 diabetes.
Understanding type 1 diabetes
It should be known that type 1 diabetes is an autoimmune disorder. It develops when the pancreas is no longer able to produce insulin as a result of attacks from the immune system on the cells that produce insulin, which leads to their destruction. Insulin is an important hormone in the body and it’s needed to let glucose (blood sugar) move from the bloodstream into the body’s cells, where it can be used for energy or stored up for later use.
In the absence of insulin, glucose cannot get into the body cells to do its work, and as a result, continues to stay in the bloodstream. This leads to high blood sugar levels, which in turn leads to diabetes.
Classification of Type 1 Diabetes in Children
Type 1 diabetes in children can be in various forms which gave rise to the various classes of the disease. The is outlined as follows
- Preclinical β-cell autoimmunity,
- The onset of clinical diabetes,
- Transient remission, and
- Established diabetes.
How juvenile diabetes is diagnosed?
To diagnosis juvenile diabetes, as type 1 diabetes in children is also known, a child must have fulfilled the general diagnostic criteria for diabetes, which require the identification of any of the following signs and symptoms of type 1 diabetes in children such as polyuria, polydipsia, and poor weight gain with a normal or minimally changed feeding pattern.
To diagnose juvenile diabetes, some of the following investigations are carried out
- A random blood sugar level analysis, which requires no fasting. The blood sample is drawn at any random time during the day and blood glucose levels are measured. If the blood glucose levels estimate a value ≥ 200 mg/dL (or 11.1 mmol/L) and the symptoms of type 1 diabetes in children are present, diabetes may be confirmed.
- A fasting blood sugar level analysis. This requires overnight fasting for a period of 8 hours. If the blood glucose levels estimate a value ≥ 126 mg/dL (or 7.0 mmol/L), and the symptoms of type 1 diabetes in children are already seen, diabetes is confirmed.
- Measurement of glycated haemoglobin (A1C) in the blood. That is, measuring the haemoglobin that has glucose attached to it. If the results show a value ≥ 6.5%, then a diagnosis of juvenile diabetes may be confirmed.
After diagnosing juvenile diabetes, it may be necessary to conduct other tests to differentiate the type of juvenile diabetes diagnosed.
- A screening for islet (insulin-producing) cells antibodies and glutamate decarboxylase antibodies may be conducted. The presence of islet autoantibodies shows the body is having an immune system response to the islet cells in the pancreas that produce insulin. While these autoantibodies are not necessarily among the causes of type 1 diabetes in children, they have been identified to be a positive marker for the condition.
- A urinalysis test for the detection of ketones which are more common in type I diabetes.
- A renal function analysis to know the health status of the kidney and rule out renal failure, and achieve a baseline state prior to the commencement of treatment.
- An oral glucose tolerance test to distinguish type I diabetes from maturity-onset diabetes of the young and hyperglycaemia.
The most vital intervention in the management and treatment of type 1 juvenile diabetes is the option of insulin therapy since there is no longer an endogenous production of insulin. These commercial insulin are of different types (rapid-acting insulin, long-acting insulin, immediate-acting insulin and regular, short-acting insulin) and they differ in how swiftly they work and how lasting their effects are. The doctor will, however, guide you on the right combination of insulin for your child.
However, insulin therapy is best administered in conjunction with other supportive measures to maximize the impact of the exogenous insulin with minimum doses. Such measures include:
- Diabetic Education and counselling of the parents or caregivers of the child to ensure strict adherence to insulin and to circumvent the psychological effects of any behavioural changes.
- Intake of low-fat high-fibre food and dietary modifications.
- Regular exercises to help avoid the development of insulin resistance and trigger weight loss.
Regular glucose monitoring: this helps to detect an onset of complications, which helps to make an early intervention.
The symptoms of type 1 diabetes in children usually develop quickly, and may include
- An increased thirst
- Frequent urination, and possible bed-wetting in a toilet trained child
- Extreme hunger
- Vision change from clear to blurry.
- Sudden and unexplained weight loss
- Fatigue and tiredness
- Behavioural changes such as irritability, restlessness or moody.
- A fruity smelling breath.
- Poor wound healing.
- Abdominal pain.
The actual causes of type 1 diabetes in children and in general is unknown. What is known is that it is an autoimmune disease. That is, the body's immune system, which normally protects the body against foreign bodies such as harmful bacteria and viruses, mistakenly attacks and destroys the insulin-producing cells in the pancreas. This process could be aided by genetics and environmental factors.
Once the insulin-producing cells of the pancreas are destroyed, your child’s body produces little or no insulin, which performs the crucial job of moving blood sugar from the bloodstream to the necessary body's cells. In the absence of sufficient insulin, the sugar produced builds up in your child's bloodstream and can cause life-threatening complications if left untreated.
- How to prevent type 1 diabetes in children?
There is presently nothing known about how to prevent type 1 diabetes in children.
However, while there's nothing you can do on how to prevent type 1 diabetes in your child, you can, however, prevent your child from its complications by:
- Helping him/her maintain good blood sugar control as much as possible.
- Teaching your kid the importance of eating a healthy diet and engaging in regular physical activity.
- Paying regular visits to your child's diabetes doctor, and conducting a yearly eye examination beginning after the initial diabetes diagnosis.
- What diet should children with diabetes eat?
Diet is an essential consideration for any diabetic, particularly juvenile diabetes. Children with juvenile diabetes must, therefore, eat a balanced and healthy diet, that is high in complex carbohydrates and fibre.
However, a dietician will provide you with the necessary advice on your child’s diet.
What kind of exercise should children with juvenile diabetes do?
The second major factor in controlling diabetes is exercise. It is highly recommended that children with diabetes should try to exercise every day, as this also help governs how much they can eat. However, parents or caregivers should also know that physical activity lowers blood sugar levels.
- When should I become worried about juvenile diabetes in my child?
Type 1 diabetes poses a severe danger as a result of the sudden, extreme swings it causes in blood sugar. Therefore, you must get a physical examination done as soon as possible when you notice any of the symptoms of juvenile diabetes, in other to begin treatment right away.
- What are the probable risk factors for type 1 diabetes in children?
Some of the risk factors for type 1 diabetes in children may be
- Family history: children with either or both of their parent or siblings with type 1 diabetes has a somewhat increased risk of developing juvenile diabetes.
- Genetics: possession of certain genes are risk factors for type 1 diabetes in children.
- Race: juvenile diabetes has been found to be more common among white children of non-Hispanic descent than among children of other races.
- Certain viruses: Exposure to certain viruses may trigger the autoimmune attack and subsequent destruction of the insulin-producing cells.
- What is the life expectancy of a child with juvenile diabetes?
A 30-year study carried out by the University of Pittsburgh, published in 2012, noted that children with juvenile diabetes born after 1965 had a life expectancy of 69 years.
- Are there any complications of juvenile diabetes?
Juvenile diabetes can affect the major organs in your body, and as a result, leads to certain complications.
- Heart and blood vessel disease: juvenile diabetes puts your child at risk of developing medical conditions such as high blood pressure, narrowed blood vessels, heart disease and stroke later in life.
- Kidney damage: Juvenile diabetes can lead to damage of the numerous tiny blood vessel clusters that filter waste from the blood.
- Eye damage. Diabetes can lead to the damage of the blood vessels of the retina, which is likely to lead to vision problems.