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Type 1 diabetes in children, also known as insulin-dependent diabetes, occurs when the pancreas stops producing insulin, a hormone essential for regulating blood glucose levels and delivering glucose to cells for energy. Without insulin, glucose builds up in the blood, causing blood sugar levels to rise dangerously high. While type 1 diabetes can develop at any age, it is most common in children and typically develops rapidly after onset. Early diagnosis is crucial as the condition worsens over time and can lead to severe health problems, including kidney failure, coma, and even death.
Steps
Recognizing early and current symptoms
Observe for excessive thirst. All symptoms of type 1 diabetes stem from high blood sugar, meaning there is too much glucose in the body, and the body is trying to balance it. Excessive thirst (polydipsia) is one of the most common symptoms. Intense thirst indicates that the body is trying to eliminate glucose from the bloodstream, which cannot be used because there is no insulin to transport it to cells. A child may constantly feel thirsty or drink an unusually large amount of liquids, far exceeding their normal daily intake.
- Standard guidelines suggest children should drink between 5 and 8 cups of fluids per day. Younger children (ages 5-8) may drink less (around 5 cups), and older children can drink more (up to 8 cups).
- However, this is just a general guideline, and only you know how much your child usually drinks each day. Therefore, assessing increased thirst depends on how much your child typically consumes. If your child usually drinks three cups of water and one cup of milk at dinner but now constantly asks for more water and consumes far more than the usual 3-4 cups daily, this may be a sign to be concerned about.
- The child may become so thirsty that no matter how much they drink, the thirst remains unquenched, and they may even show signs of dehydration.
Watch for signs of increased urination. Frequent urination, known as polyuria, occurs when the body tries to filter glucose through urine. Of course, this can also result from drinking more fluids. When a child drinks more water, their body produces more urine, leading to more frequent trips to the bathroom.
- Pay close attention to nighttime and check if your child is urinating more than usual during the night.
- There is no universal average for daily urination. This depends on what the child eats and how much they drink, so the typical frequency for one child may not be the same for another. However, you can compare their current urination frequency with their usual habits. If your child used to go to the bathroom 7 times a day and now goes 12 times, this could be concerning. Nighttime is a good time to observe. If your child never used to wake up to use the bathroom and now wakes up 3-4 times a night, you should take them to the doctor for a check-up.
- Watch for signs of dehydration, such as sunken eyes, dry mouth, and skin losing its elasticity (gently pinch your child’s hand and lift it up. If the skin doesn't snap back immediately, it's a sign of dehydration).
- Also, keep an eye out if your child starts wetting the bed again. This is particularly important if they have been potty trained for a while.
Notice unexplained weight loss. Type 1 diabetes often leads to significant weight loss due to metabolic disturbances caused by high blood sugar levels. Typically, weight loss happens quickly, though it can sometimes be slower.
- Your child may lose weight and even appear frail and weak due to type 1 diabetes. Note that this condition often results in a reduction of muscle mass alongside weight loss.
- As a general rule, unintentional weight loss always warrants a consultation with a doctor.
Watch for sudden increases in hunger. The breakdown of fat and muscle, combined with a reduction in calories due to type 1 diabetes, leads to greater energy depletion, resulting in increased hunger. This can seem paradoxical – a child may lose weight even though they are eating heartily.
- Polyphagia, or excessive hunger, occurs when the body tries to take in glucose that cells require but cannot absorb due to a lack of insulin. The body demands more food to gather glucose for energy, but it never reaches the cells. No matter how much the child eats, the glucose remains in the bloodstream.
- Understand that there is no scientific standard for assessing a child’s hunger. Some children naturally eat more than others. Don't forget that children often eat more during growth spurts. The best way to assess is by comparing their current eating habits with past ones. For instance, if your child used to be picky and eat little but has recently been eating everything on their plate and asking for more, this is a warning sign for diabetes. Moreover, if your child is also thirsty and urinating more, it might not just be due to a growth spurt.
Be alert if your child suddenly feels very fatigued. The loss of calories and glucose for energy, combined with the breakdown of fat and muscle, often leads to tiredness and a lack of interest in normal games and activities they once enjoyed.
- Sometimes children also become irritable and moody due to fatigue.
- Along with the symptoms described above, observe any changes in your child’s sleep patterns. If your child used to sleep 7 hours a night and is now sleeping up to 10 hours but still complains of tiredness or appears sluggish, lethargic, or drowsy even after a long night’s sleep, this could indicate that the child isn’t just going through a growth phase or temporary fatigue, but might be dealing with diabetes.
Notice if your child complains of blurry vision. High blood sugar levels can alter the water composition in the lens, causing it to swell, which leads to blurry or distorted vision. If your child mentions having blurry vision and eye exams don’t yield any results, you should consult a doctor to rule out type 1 diabetes.
- Blurry vision can be improved by stabilizing blood sugar levels.
Monitor for late-stage or co-occurring symptoms.
Observe for recurrent fungal infections. People with diabetes often have high levels of sugar and glucose in their blood and vaginal secretions, creating an ideal environment for yeast cells to grow and cause infections. As a result, your child may experience skin fungal infections that return frequently.
- Pay attention if your child shows signs of itching in the genital area. In girls, you may notice frequent yeast infections with symptoms like itching and discomfort in the genital area, vaginal discharge that is white or slightly yellow with a foul smell.
- Another form of fungal infection that may result from immune system suppression in type 1 diabetes is athlete’s foot, causing discoloration and peeling skin between the toes and on the soles of the feet.
- Boys, especially those who are not circumcised, can also develop yeast infections around the head of the penis.
Monitor for recurrent skin fungal infections. Diabetes impairs the body's ability to respond to infections, disrupting immune function. Additionally, elevated glucose levels in the blood provide a breeding ground for harmful bacteria, leading to frequent skin infections such as boils, abscesses, carbuncles, and ulcers.
- Another feature of recurring skin infections is slow healing of wounds. Even minor cuts, scratches, or small injuries can take an unusually long time to heal. You should pay attention to any wounds that don’t heal as expected.
Watch for signs of skin depigmentation (vitiligo). Vitiligo is an autoimmune disorder that causes a reduction in melanin pigment in the skin. Melanin is the pigment responsible for color in the skin, hair, and eyes. In type 1 diabetes, the body develops autoimmune antibodies that destroy melanin, resulting in white patches on the skin.
- Although it typically occurs in the later stages of type 1 diabetes and is not very common, you should consider diabetes if your child develops white patches on the skin.
Be alert for vomiting or labored breathing. These symptoms may occur as diabetes progresses. If you notice your child vomiting or breathing deeply, this is a serious sign, and you should immediately take them to the hospital for treatment.
- These symptoms could indicate diabetic ketoacidosis (DKA), a condition that can lead to coma and even death. Symptoms can develop quickly, sometimes within 24 hours. If left untreated, diabetic ketoacidosis can be fatal.
Visit a doctor for a medical check-up.
Know when to consult a doctor. In many cases, type 1 diabetes is first diagnosed in the emergency room when the child is found to be in a diabetic coma or experiencing DKA. While it can be treated with fluids and insulin, it’s best to avoid this situation by consulting a doctor if you suspect your child has diabetes. Don’t wait until your child falls into a diabetic coma due to DKA to confirm your concerns. Take your child for a check-up!
- Symptoms that require urgent medical attention include: loss of appetite, nausea or vomiting, high fever, stomach pain, fruity-smelling breath (you can smell it, but your child won’t be able to detect it).
Take your child to the doctor for testing. If you suspect your child has type 1 diabetes, it’s important to get them checked as soon as possible. To diagnose diabetes, the doctor will perform a blood test to evaluate the blood sugar levels. Two common tests include the hemoglobin test and the random or fasting blood glucose test.
- Glycated hemoglobin (A1C) test — This blood test provides information about your child’s blood sugar levels over the past two to three months by measuring the percentage of glucose bound to hemoglobin. Hemoglobin is a protein responsible for carrying oxygen in red blood cells. The higher the blood sugar, the more glucose binds to hemoglobin. A blood sugar level of 6.5% or higher on two separate tests indicates diabetes. This is the standard test used to assess, control, and research diabetes.
- Blood glucose test — With this test, the doctor will take a random blood sample. Regardless of whether your child has eaten, a random blood sugar level of 200 milligrams per deciliter (mg/dL) could indicate diabetes, especially if accompanied by other symptoms. The doctor may also recommend a fasting blood test, where a blood sugar level between 100 to 125 mg/dL suggests prediabetes, and a level of 126 mg/dL (7 mmol/L) or higher on two separate tests indicates diabetes.
- The doctor may also request a urine test to confirm type 1 diabetes. The presence of ketones (from the breakdown of body fat) in the urine is a sign of type 1 diabetes, unlike type 2 diabetes. Glucose in the urine also signals diabetes.
Receive the diagnosis and treatment plan. After completing the tests, the doctor will diagnose based on the test results and the standards set by the American Diabetes Association (ADA). Once diagnosed with diabetes, your child will begin treatment to stabilize blood sugar levels. The doctor will determine the correct insulin type and dosage for your child. You may need to consult an endocrinologist, a specialist in hormone disorders, to assist in managing your child’s diabetes treatment.
- Once your child’s basic treatment plan with insulin is established, you’ll need to bring them for regular follow-up visits and repeat some of the tests to ensure their blood sugar levels remain within an appropriate range.
- Your child will also need regular eye and foot examinations, as complications from poorly controlled diabetes often manifest in these areas first.
- Although there is no cure for diabetes, with advancements in technology and treatment methods, most children with type 1 diabetes can live a happy and healthy life by managing their condition effectively.
Advice
- Remember that type 1 diabetes, previously known as juvenile diabetes, is not related to diet or body weight.
- If a direct family member (such as a sibling, parent, or grandparent) has diabetes, it is important for the child to have a check-up at least once a year between the ages of 5-10 to ensure they are not developing diabetes.
Warning
- Many symptoms of type 1 diabetes (such as fatigue, thirst, and hunger) are subtle and can easily be overlooked. If you suspect your child has any of these symptoms or if they are experiencing a combination of symptoms, it is essential to get them checked as soon as possible.
- Early diagnosis, treatment, and management of type 1 diabetes are critical in reducing the risk of serious complications, including heart disease, nerve damage, blindness, kidney failure, and even death.
