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Diabetes Mellitus (DM) in Children and Adolescents

By The Manual's Editorial Staff, ,

What is diabetes?

Diabetes is a disease in which your blood sugar (glucose) levels are too high because your body has problems making or using insulin.

Blood sugar is the body’s main source of energy. Insulin, a hormone your body makes, controls sugar levels in your blood. Your blood sugar comes from:

  • Sugar that you eat, such as in candy, soda, and sprinkled on food and in your drinks—syrup and honey are almost all sugar

  • Food that contains carbohydrates

Carbohydrates in food are turned into sugar by your body. Lots of foods have carbohydrates:

  • Food made of wheat or corn, such as bread, pasta, snack cakes, and chips

  • Beans

  • Vegetables, particularly root vegetables such as potatoes, turnips, or beets

  • Fruits

Types of diabetes

There are 2 types of diabetes: type 1 and type 2. A related disorder is called prediabetes.

In type 1 diabetes, your body doesn’t make the hormone insulin at all.

In type 2 diabetes, your body makes insulin but doesn’t respond to insulin the way it should.

In prediabetes, blood sugar is higher than normal but not high enough to be diabetes. Prediabetes is more common among obese teens. About half of teens with prediabetes go on to develop diabetes, especially those who continue to gain weight.

  • Type 1 diabetes almost always starts in childhood

  • Type 2 diabetes happens most often in children or teens who are overweight or obese (very overweight)

  • Urinating a lot and thirst can be early signs of diabetes

  • Type 1 diabetes is treated with insulin shots

  • Type 2 diabetes in children is treated with weight loss, a medicine called metformin, and sometimes also insulin shots

  • Depression, anxiety, and eating disorders are common in children and teens with diabetes—talking to a counselor or getting to know other children with diabetes may help

What causes diabetes?

  • In type 1 diabetes, the body's immune system attacks the cells that make insulin

  • In type 2 diabetes, the body doesn’t respond to insulin the way it should (a condition called insulin resistance)

Some children with type 1 diabetes have inherited certain genes that make their immune system more likely to attack their body's own cells (autoimmune diseases). These genes also put children at risk for other autoimmune diseases, such as thyroid disease or celiac disease. Close relatives of a child with type 1 diabetes are at increased risk of developing diabetes.

Until the 1990s, nearly all children with diabetes had type 1 diabetes. Now, because more children are obese, about one third of children newly diagnosed with diabetes have type 2 diabetes. Type 2 diabetes is more common among Native Americans, blacks, Hispanics, Asian Americans, and Pacific Islanders.

What are the symptoms of diabetes?

With type 1 diabetes, symptoms start suddenly, over several days or weeks. Your child may:

  • Urinate a lot

  • Be very thirsty and drink a lot

  • Lose weight

  • Have blurry vision

If these symptoms aren’t diagnosed quickly, children can get a dangerous problem called diabetic ketoacidosis. This happens when the body starts using fat instead of blood sugar for energy. In diabetic ketoacidosis, your child may:

  • Have breath that smells like nail polish remover

  • Breathe deeply and very fast

  • Have a headache and seem confused or sleepy

  • Have belly pain and throw up

  • Feel weak and tired

Diabetic ketoacidosis needs to be treated immediately in the emergency room.

With type 2 diabetes, your child may:

  • Have no symptoms

  • Drink or urinate more than usual

Since your child may not have symptoms, sometimes doctors find type 2 diabetes only when they do blood tests for other reasons.

Children with type 2 diabetes rarely get ketoacidosis.

What are the complications of diabetes?

People who have had diabetes for many years get clogged blood vessels. Clogged blood vessels cause many complications, such as high blood pressure, stroke, heart attack, blindness, kidney failure, leg amputations, and nerve damage. These complications take a long time to develop, so children don't usually get them until after they've grown up. Good control of diabetes throughout life helps prevent complications.

How can doctors tell if my child has diabetes?

Doctors do blood tests to diagnose diabetes, including:

  • Blood sugar levels

  • A1C level

Doctors may want to measure your child's blood sugar level first thing in the morning before anything has been eaten. This is called a fasting blood sugar. However, this isn't always necessary.

When there’s a lot of sugar in the body, over time the sugar attaches to a protein in blood cells and forms A1C. By measuring A1C levels, doctors can see how the body’s blood sugar levels have been over the last 2 to 3 months. Doctors will diagnose diabetes if either blood sugar or A1c levels are too high.

Sometimes doctors do a blood sugar test before and after your child drinks a very sugary drink. This is called a glucose tolerance test. But this test is done more often in adults than children.

Sometimes doctors do blood tests to tell if your child has type 1 or type 2 diabetes.

How do doctors treat diabetes?

There's no cure for diabetes. The main goal is to keep blood sugar levels close to normal. Keeping blood sugar close to normal lowers the risk of complications.

All children with diabetes need to:

  • Be active and lose weight if they’re overweight

  • Carefully control how much sugar and carbohydrates they eat

To help control how much sugar and carbohydrates they eat, children should:

  • Eat meals and snacks at about the same time each day

  • Pay attention to how many carbohydrates they’re eating at each meal and snack

  • Eat foods that break down slowly, like fruits, whole grains, and high-fiber foods

  • Eat less processed food and fewer carbohydrates that break down quickly, like those in candy, cookies, donuts, and pastries

  • Avoid sugary drinks such as soda, sweet iced tea, lemonade, fruit punch, and sports drinks

Treating type 1 diabetes

Children with type 1 diabetes don't make any insulin so they need to take insulin. Doctors will need to figure out:

  • The best type of insulin for your child

  • The best way to give your child insulin

There are many different types of insulin. Some types act quickly and last only a short time. Other insulins act slower and last longer. Sometimes doctors prescribe a mixture of insulins.

Insulin is injected under the skin. It can't be taken by mouth. Insulin can be injected using a:

  • Syringe

  • Insulin pen

  • Insulin pump

An insulin pump is a small computerized device that gives a specific dose of insulin. The pump is worn on a belt or put in a pocket. It's connected to a small, flexible tube that goes under the skin on the belly and is taped in place. Newer insulin pumps can also measure blood sugar. That helps control how much insulin to take.

To tell how much insulin is needed, your child’s blood sugar levels will need to be checked before every meal and at night. This can be done by:

  • Pricking a fingertip with a small, sharp tool called a lancet

  • Using a continuous glucose monitoring device—worn with an insulin pump to better track blood sugar levels all day long

Treating type 2 diabetes

Losing weight is important in treating type 2 diabetes. Getting your child moving more and learning how to control portion size help with this goal.

Doctors often prescribe a medicine to take by mouth called metformin. If metformin doesn’t keep blood sugar levels close to normal, your child will also need insulin shots.

Children with type 2 diabetes also need to have their blood sugar levels checked. Your doctor will help you figure out how often to do so.

Are children and teens with diabetes at risk for emotional problems?

Many children with diabetes develop depression, anxiety, or other emotional problems. Some children handle their disease well. For others, having diabetes is stressful.

  • Counseling or family support groups can help you and your child cope with diabetes

  • Special summer camps for children with diabetes can help children learn to live with the disease

  • Older children should be involved in their own treatment

  • Treating diabetes in teens can be hard due to puberty, peer pressure, busy or changing schedules, and conflicts with parents or other caregivers

  • Insulin can cause weight gain, which can lead to eating disorders in teens

  • Doctors can help teens stay focused on controlling their blood sugar levels

How can I prevent diabetes?

Type 1 diabetes isn't preventable.

You may be able to prevent or delay type 2 diabetes. Have your child:

  • Eat a healthy diet with lots of fruits, vegetables, and whole grains

  • Get exercise

  • Lose weight and maintain a healthy weight

  • Test blood sugar at puberty, and then every 3 years if they are at risk (are overweight or have a family history for type 2 diabetes)

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