Type 1 (Juvenile) Diabetes in Children

Diabetes is a very common illness these days but when a child is diagnosed with Type 1 diabetes, the world around the parent seems to collapse and they seek answers to the following questions:

• What is Type 1 diabetes?
• What should I do now?
• How do I care for my baby?
• Is it curable and is it dangerous?

Diabetes Mellitus often referred to as “Diabetes”- is a medical condition characterized by increased sugar levels in the body. It is categorised as:

• Type 1 diabetes
• Type 2 diabetes

What is Type 1 Diabetes?

The sugar levels in our body are controlled by the pancreas, whose main purpose is to secrete Insulin. Insulin is a hormone that converts glucose into glycogen. Glucose generates energy for our day-to-day activities but excess glucose causes serious health problems and is termed in the extreme as diabetes.

Type 1 diabetes is a condition that occurs when there is little or no insulin produced by the pancreas. In the absence of insulin, the body is unable to break the sugars (in our food) and hence the sugars remain in the bloodstream. So, the blood sugar levels rise above the optimal level, endangering our lives.

It is often found in children, sometimes after birth. It is also categorised as an autoimmune disease because it is our own body’s defence mechanism that is destroying healthy cells. Without proper care and medical help, this can become a serious problem over a long period, damaging other organs too. This type of diabetes is also referred to as “Juvenile Diabetes in children”, “Insulin-dependent diabetes mellitus in children”, “Brittle Diabetes in children” and “Sugar Diabetes in children”.

What Are the Causes of Type 1 Diabetes?

Researchers have identified a few reasons for this condition in children. It could probably be a viral infection, which compromises the body’s immune system or a hereditary component that could explain the autoimmune aspect of this type of diabetes. However, the exact cause for this condition is still unknown.

The only known reason is the special beta cells (produced in the pancreas) that carry insulin are destroyed by the antibodies. Ideally, these cells should destroy only unhealthy/foreign cells.

What Are the Symptoms?

It is important to be alert and notice the following symptoms in children:

• Frequent urination
• Feeling very thirsty
• Eating more than usual or even noticeable weight loss
• Feeling unusually tired
• Nausea
• Feeling irritated
• Rapid breathing or falling unconscious

How is Type 1 Diabetes Diagnosed in Children?

It is important to keep a track on some red flags such as frequency of urination, increased water intake and intense urge to eat more. If you think these symptoms occur consistently for a given period, it is advisable to approach a medical practitioner.

Physicians will suggest blood tests and urine tests to confirm the diagnosis. It is recommended that you do not use glucose meter at home because it might not give a reliable reading. Also, it is good to take the HbA1c test, which indicates an average blood sugar level for the last 3 months.

Routine visits to the doctor are required to monitor the sugar levels and control it.

What Are the Risk Factors for Developing Type 1 Diabetes?

Research data shows us that the most probable risk factors of Type 1 diabetes are:

1. Genetic Predisposition

If you have a gene marker linked to Type1 diabetes, the chances of you developing Type 1 diabetes is higher. The Chromosome 6 is the marker that is linked to Type 1 diabetes. HLA (Human Leukocyte Antigen) complexes are found to be connected to this type of diabetes and if there are multiple makers of these complexes, you have an increased risk of Type 1 diabetes.

2. Viral Infection

Viruses such as German Measles, Coxsackie and Mumps have found to trigger Type 1 diabetes. These viruses attack the body’s immune system and cause the body to fight against its own self, creating an autoimmune problem.

3. Heredity Factor

The family history plays a very important role. If both parents have Type 1 diabetes, then their child is more susceptible to developing the same. Furthermore, it is observed that the father having Type1 diabetes increases the risk as compared to the mother or other siblings having Type 1 diabetes.

4. Geographical locations

The environment in which we live affects our body. People living in warm countries have a lesser risk of developing Type 1 diabetes because the chances of viral infections are less. Cold countries have shown more cases of Type 1 diabetes rather than warm countries.

5. Other autoimmune diseases

Some autoimmune disease like Graves’ diseases and multiple sclerosis have an increased risk of developing Type 1 diabetes as a co-existing condition because they have the same gene marker HLA, which is affected.

Complications of Type 1 Diabetes in Kids

Type1 diabetes is a serious illness. It needs close monitoring and proper care. If not managed properly, it could give rise to a lot of complications, sometimes short-term and sometimes long-term.

Short-Term Complications

Following are some short-term complications:

1. Hypoglycemia

Type 1 diabetes is an insulin-dependent diabetes. Regular insulin injections need to be taken before every meal to keep the sugar levels under control. If the dosage of insulin is given in excess then the person goes into a hypoglycemic state, which means there is very less sugar/glucose in the body. This condition is can cause the patient to become unconscious and if not treated immediately the person may go into a coma. Following are some symptoms of hypoglycemia:

• Sweating
• Numbness in hands, legs and face
• Increased heartbeat and sweating
• Feeling drowsy/sleepiness
• Confused and unclear speech
• Headache

It is important to understand that when you notice any of these symptoms, you should NOT administer insulin. It is advised to take the child to a hospital.

Hypoglycemia can occur in 3 stages: mild, moderate and severe. Mild and moderate stages can be treated easily without much damage to the other body organs. In severe hypoglycemia, some damages caused to other organs cannot be reversed.

Upper and lower limits of blood glucose vary for each person, some children might be just fine with a glucose reading of 60-70 but some children might become hypoglycemic at those levels.

It is advisable to know the glucose levels of your child and be prepared for such events. It is recommended to stock up supplies of food such as sugary drinks, glucose tablets and eatables that release instant sugar into the body. Your child’s doctor will give you tablets for instant release of sugar when needed.

Sugar levels fluctuate during the night when the child is asleep. So it is important that you give the right dosage of insulin before dinner. This condition is called Nighttime Hypoglycemia.

2. Diabetic Ketoacidosis (DKA)

When there is a shortage of insulin in the body, the body burns fat to make up for the lack of glucose in the body. When fat is broken down in the body it releases ketones. Excess of ketones in the body can make the blood acidic, leading to this complication. Signs and symptoms of DKA include:

• Fruity smell of the breath (it is an important symptom as the ketones released in the body have the fruity smell)
• Excess thirst
• Frequent urination
• Loss of weight
• Fatigue
• Feeling of confusion

There are simple tests that can be done at home to confirm whether your child has ketoacidosis. Check the child’s glucose levels using a home glucose meter. If the value is above 250mg/dl, then there is a possibility that the child might have DKA. There are ketone strips available in pharmacies; it is used to check for ketones in the child’s urine. If the strip turns deep purple, it indicates that the child has too many ketones and might have DKA. After you are sure the child has DKA, visit the doctor immediately for treatment. DKA is a serious condition and must be addressed without delay.

Long-Term Complications

If the sugar levels are not managed properly over a period of time it can lead to serious long-term complications. These complications arise if the sugar levels are not controlled for over a period of 10 years or more. In long-term complications, the blood vessels are affected. The damage of tiny blood vessels is known as Microvascular complications. Damage to large blood vessels is known as Macrovascular complications.

Microvascular Complications

Blood vessels carry blood to different parts of the body. When they are damaged, it affects other parts of the body such as the eyes, kidney and liver. Eventually, the nerves also get damaged and this condition is called ‘diabetic neuropathy’.

The most commonly heard complaints of patients with Microvascular complications are:

• Loss of vision in the eye which is due to the damage to the retina of the eye.
• Tingling sensation in the feet. Sometimes, they may experience loss of sensation in their feet after a period of time. If this is left untreated they may develop a sore in their foot which might get infected resulting in a surgery.

Macrovascular Complications

When large blood vessels get affected it results in serious heart ailments. The damage to the large blood vessels causes plaque to get deposited in the arteries of the heart resulting in a heart attack. It is also advisable that the person not only manages his glucose levels but also follows a healthy-heart diet to counter the effects of this complication.

Treatment

Treatment for Type1 diabetes is an on-going process. It is a lifetime disease and so one needs to have patience and perseverance. It might seem as if it is impossible to manage.

You need a good team of doctors, a paediatrician, a dietician and a diabetic expert to help you and your child.

1. Blood Sugar Monitoring or Continuous Glucose Monitoring (CGM)

Since some of the complications of Type1 diabetes are serious and life-threatening, you need something that can monitor the glucose continuously without having to wait for the warning signs.

CGM is done by inserting a fine needle just under the skin to monitor the sugar levels in the blood. This is just a tool to complement the regular glucose monitoring methods and might not be very accurate.

2. Insulin Therapy

Insulin administration is very important in the treatment of Type1 diabetes. The doctor might give a mix of insulin types depending on the child’s needs.

Following are the various types of insulin available:

• Rapid-acting Insulin (therapies such as lispro, aspart) – The insulin acts in 15 minutes and lasts for 4 hours.
• Short-acting Insulin (Humulin R therapy) – Insulin must be taken 15-20 minutes before food. It lasts for 4-6 hours.
• Intermediate-acting Insulin (Humulin N therapy) – Needs an hour to start working and it lasts for 12-24 hours.
• Long-acting Insulin (therapies such as insulin glargine and insulin detemir) – It lasts for 20-26 hours.

3. Options for Insulin Delivery

There are various ways to administer insulin to a person depending on the requirements:

• Insulin Pen – This is just like a pen with a cartridge filled with insulin. In this type of a device, one cannot prepare tailored mixtures of insulin.
• Needle and Syringe – The needle is very fine and almost painless. It is convenient to use in cases when multiple insulin types need to be mixed.
• Insulin Pump – This is a device which is worn externally and works along with the CGM. It has a tube that it connected to a storage device under the skin below the abdomen.

4. Other Medications

When the child is unwell, the intake of carbohydrates is less and they might need a lower dosage of insulin. The hormones during a sick period raise the blood sugar levels in the child and so it is important to closely monitor the sugar levels before administering insulin along with other medications.

5. Healthy Eating

A diabetic diet is boring and it is very difficult to make a child follow it. It takes a toll on the parent to enforce a strict diet on children but a good dietitian can make your job a lot easier by suggesting healthy and tasty meal options for your child. A child with Type 1 diabetes requires a nutritional diet, which includes fruits, vegetables, grains and high fibre. The only thing one needs to mind is the carbohydrate and fat intake. Sugar and sweets can be included in the diet occasionally, with the approval of the doctors.

6. Physical activity

Do not restrict your child from playing or doing any other form of physical exercise. The only precaution you need to take is to check the glucose levels during the activity and post-activity since exercising reduces the glucose levels in the body. You must adjust the dose of insulin accordingly. It is a good practice to include a regular exercise routine into the child’s lifestyle.

7. Emotional Health

Type1 diabetes is an ongoing illness and can take its toll on children. They feel different from other kids as they have to eat right and take insulin shots regularly. It would be good to get your child into a support group where they can meet other kids with Type 1 diabetes.

Irritability, being one of the signs of low sugar, you need to understand that when your child behaves badly, it might be his need for food/sugar.

Some children show symptoms of depression, as well. If you observe frequent mood swings and reclusive behaviour, you need to visit a good diabetic counsellor to work with the child’s mental struggle. Changing the general lifestyle at home can help the child remain positive and less depressed.

Educate children with diabetes so that they are prepared to manage their diabetes with lesser stress.

Advanced Technology and Devices to Manage Type 1 Diabetes

A lot of pharmaceutical companies have developed devices (also use technology) that can make life easier for patients. Some of the devices, which might be in their approval stages include:

• Artificial pancreas designed by Medtronic automatically monitors the glucose levels and administers the insulin as needed.
• Livongo developed a device to monitor glucose and can upgrade itself as technology improvises.
• Big Foot Company invented an artificial pancreas that can send updates to your Smartphone.
• Omnipod, is a tube-free insulin pump. It can pump insulin worth for 3 days.
• Timesulin, is a cap that can fit on any pen. It sends data about your last dose of insulin to your Smartphone too.

How to Help a Child Living with Type 1 Diabetes?

Managing Type1 diabetes can be difficult but you need to make your child independent and self-sufficient. Talking to the child and allowing them to express their anxiety can help overcome some mental obstacles.

The following pointers can help the child:

• Teach your child to monitor her own blood sugar levels
• Train them to take insulin injections by themselves
• Educate your child about the food habits that he needs to follow
• Encourage your child to be physically active and manage diabetes
• If the child is away from you, it would be good for them to wear a medical ID card

Can Type 1 Diabetes be Prevented in Kids?

There are no preventive measures for Type1 diabetes. The best way to prevent it would be to have a healthy lifestyle and test for the genetic markers linked to Type1 diabetes.

What Are the Other Types of Diabetes in Children?

There are other forms of diabetes too, such as:

Type 2 Diabetes in Children

In Type 2 diabetes, the body is unable to use the insulin that is produced in the body. This condition can be easily managed by regulating the diet and also staying active. In very rare cases, kids might need insulin injections.

Gestational Diabetes in Children

Babies born to mothers who had gestational diabetes are at a higher risk of developing gestational diabetes later on in life. It also increases the risk of obesity in children. When gestational diabetes is left untreated in the mother, it alters the metabolism process in the child, as well. They are at a higher risk of developing diabetes or obesity. It is a treatable condition and a good doctor will catch the symptoms early and treat it.

When Should You Seek Help From Your Healthcare Provider?

When in doubt, it is advisable to consult your doctor, especially if the child:

• Has lost conscious
• Is unwell and the sugar cannot be controlled.
• Has been vomiting or has had diarrhea
• Has blood sugar higher or lower than the prescribed readings
• Is sweating
• Has blurred vision

The anxiety and fear of your child having diabetes can overwhelm you. However, with the right care and knowledge, it can be managed effectively.