Type 1 diabetes mellitus is a lifelong disease, occurring due to the lack of insulin in the body. It is also called insulin-dependent diabetes or juvenile diabetes (in children). Insulin plays a crucial role in energy production by moving blood glucose (a type of sugar) to the cells. So children with type 1 diabetes will have higher blood glucose levels.
Approximately 1 in 400 children and adolescents under 20 years of age are affected by type 1 diabetes (1). Although there is no permanent cure for it, type 1 diabetes can be effectively managed with regular insulin administration.
Read this post to know more about the causes, risk factors, symptoms, complications, diagnosis, treatment, and prevention of type 1 diabetes in children and to know how to help your child with diabetes.
Causes Of Type 1 Diabetes In Children
The exact reasons for type 1 diabetes in children are yet to be identified (2). However, environmental and genetic factors may have a role in the development of juvenile diabetes.
It can be caused by autoimmune destruction of beta cells (insulin-producing cells) in the islets of Langerhans, which is the region in the pancreas containing hormone-producing (endocrine) cells (2).
Attack of the body’s immune system to insulin-producing cells may result in a lack or insufficient production of the insulin hormone. This could cause high levels of glucose in the blood that often leads to life-threatening complications.
Symptoms Of Type 1 Diabetes In Children
Children may have rapid development of the signs and symptoms of type 1 diabetes when there is a lack of insulin. Diabetes signs and symptoms in children may include (3):
- Excessive thirst
- Frequent urination or bedwetting
- Increased hunger
- Weight loss
- Behavioral changes
- Fruity odor in the breath
Seek medical care if your child has these signs and symptoms of type 1 diabetes. Consulting a pediatrician at the earliest could help in diagnosis and treatment before the development of complications.
Risks For Type 1 Diabetes In Children
The following risk factors could increase the likelihood of developing type 1 diabetes in children (4).
- Genetic factors could increase the risk for diabetes in children. This can be due to the expression of specific genes. Positive family history could increase the risk, especially if parents or siblings have the disease due to inherited factors.
- Exposure to certain viruses may trigger an autoimmune attack of endocrine cells of the pancreas. Viral infections by enteroviruses, coxsackievirus B, rotavirus, mumps virus, rubella, and cytomegalovirus play a role in the destruction of pancreatic endocrine cells (5).
Complications Of Diabetes Type 1 In Children
- Hypoglycemia is a blood glucose level lower than the required levels. Increased physical activity, skipping meals, or a high dose of insulin are significant causes of hypoglycemia in children with diabetes. Hunger, sweating, shakiness, loss of consciousness, etc. are symptoms of low blood glucose l Taking a fast-acting carbohydrate such as a fruit juice, glucose tablets, candies, or sweet soda (not diet soda) can be helpful. Unconscious children may require an emergency injection of glucagon hormone to raise blood sugar levels.
- Hyperglycemia is blood sugar levels above the optimal range. Low doses of insulin, eating more than the limit, illness, or not doing recommended exercises can be reasons for increased glucose levels. Nausea, dry mouth, increased urination, blurred vision, etc. are symptoms of hyperglycemia. If you notice higher blood sugar levels through tests, seek doctors’ advice.
- Diabetic ketoacidosis (DKA) is a condition when the body begins to use fat for energy since there is no insulin to breakdown glucose. Dry mouth, thirst, confusion, fruity breath, etc. are symptoms of ketone build-up in the body. Excess ketones in the blood can be life-threatening, and it is advised to seek emergency medical care if you spot the symptoms.
Note: Consuming sweets with fat content, such as ice cream or chocolates, may not have quick effects during hypoglycemia since fats slow down sugar absorption. Do not make your child exercise if they have high blood sugar levels or ketones on urine tests.
- Cardiovascular diseases. The risk of heart and blood vessel diseases, such as hypertension (high blood pressure), stroke, and narrowing of blood vessels, is increased in later life.
- Neuropathy is nerve damage due to injury of capillaries (tiny blood vessels) supplying the nerves. Burning pain, numbness, and tingling are symptoms of nerve damage.
- Nephropathy (kidney damage) may occur in diabetes due to the injury of capillaries from sugar.
- Retinopathy (eye damage) due to retinal blood vessel injury often leads to vision issues such as cataract, glaucoma, or blindness.
- Osteoporosis can happen in diabetes in adult years due to low mineral density.
- Psychological issues. Diabetes may increase the risk of anxiety, depression, and diabetes-related distress in many children, especially during their teen years. Encouragement, education, and support from parents are essential for teens to be optimistic and not experiment with alcohol, drugs, or smoking. Substance abuse or alcohol use could worsen diabetes, often making it life-threatening.
It is essential to do regular check-ups to evaluate the glucose levels and organ functioning in diabetes patients to prevent complications. If your child has nerve damage symptoms, do not ignore them, since neuropathies and circulatory issues increase the risk of infections of wounds and often lead to amputation of extremities.
Diagnosis Of Type 1 Diabetes In Children
Any of the following blood tests can be done to diagnose type I diabetes in children (8).
- Random blood sugar test can be the primary screening test in most cases, and a blood sugar level of 200 mg/dL (11.1 mmol/L) or more may be seen in diabetes.
- A1C test or glycated hemoglobin test gives an average glucose level for the past three months. HbA1C levels higher than 6.5% on two different tests are required to diagnose diabetes.
- Fasting blood glucose test is done after overnight fasting, and 126 mg/dL (7 mmol/L) or more of fasting blood glucose level suggests diabetes.
If any of the tests mentioned above give a positive diagnosis of diabetes in your child, the doctor orders a few additional tests to confirm the diagnosis. These tests can detect diabetes, and the additional tests are essential to distinguish type 1 and type 2 diabetes since both conditions require different treatment strategies.
Positive results on the following tests may suggest type 1 diabetes than type 2 diabetes (9).
- Presence of ketones in blood or urine tests
- Presence of autoantibodies in blood tests
Pediatricians plan diabetes treatment according to the type of diabetes. Type 2 diabetes and prediabetes are conditions where high blood glucose levels are present, but not high enough to diagnose diabetes. They are often treated with lifestyle modification, such as a healthy diet and exercise.
Treatment For Type 1 Diabetes In Children
Treatment for type 1 diabetes can be monitored by a diabetes team, including a pediatrician, dietician, and diabetes educator. The goal of treatments is to keep the blood glucose levels as normal as possible.
Treatments may include (10):
1. Insulin therapy
Lifelong single or combined insulin therapy is required for the survival of type 1 diabetes patients. There are various types of insulin available, depending on the duration of action (11).
- A rapid-acting insulin is a type of insulin that begins to act within 15 minutes of administration. This can be available as insulin aspart (Fiasp, Novolog), insulin lispro (Humalog, Admelog), and insulin glulisine (Apidra) on prescription.
- Short-acting insulin works within 30 minutes after the injection and available as Human insulin under brand names Humulin R and Novolin R.
- Intermediate-acting insulin works within an hour to three hours, giving effects up to 12 to 24 hours. Humulin N, Novolin, Relion, Insulin N, and Novolin N are examples of NPH insulin – insulin with intermediate action.
- Long-acting and ultra long-acting insulin is insulin that can maintain glucose levels from 14 to 40 hours. Insulin detemir (Levemir), insulin degludec (Tresiba), and insulin glargine (Toujeo, Lantus, Basaglar) are examples of long-acting insulin.
Insulin can be administered in the following ways (11).
- Insulin pen
- Syringe and fine needle
- The insulin pump is a small device that can be worn, and it delivers insulin through a pump to the abdominal skin. Tubeless pumps are also available these days.
- The sensor-augmented pump (hybrid closed loop system) is one of the insulin delivery devices with an insulin pump and continuous glucose monitor to deliver the required amount of insulin automatically.
There are many studies ongoing on insulin delivery options, such as completely automated insulin delivery devices that can be called the artificial pancreas.
1. Frequent monitoring of blood sugar
If your child has a continuous glucose monitor (CGM), you may have to monitor their blood sugar levels a minimum of four times a day. If they do not provide a continuous monitor, you may have to record it more often to ensure your child’s blood sugar level is in the required range.
Continuous glucose monitoring (CGM) is done by an implanted, or temporary sensor device placed under the skin and records glucose levels every few minutes. Some types of devices give a reading on a smartwatch or on a smartphone, whereas some may require the receiver to be placed over the sensor.
2. Healthy diet
Diabetes treatment plans always include a healthy diet since the blood sugar levels depend on the type of food we consume. Children may not have to follow a strict diabetes diet, but must follow a dietician’s directions for adequate nutrition. Low-calorie and low-fat diets with high nutritional value are best recommended for kids.
Vegetables, fruits, lean proteins, and whole grains are included in the diet. Meal plans are made according to health goals, and this may also include occasional treats. Diabetes educators may help parents learn how to count carbohydrates in foods to determine insulin doses.
3. Regular exercise plans
Children with type I diabetes require regular physical activity as recommended by the doctor. Exercise could lower blood glucose levels, and you may have to check glucose levels to adjust diet and insulin doses according to it.
You may have to check blood sugar often when your child begins a new activity to maintain the optimal glucose levels.
Note: There are no alternative supplements, home remedies, or medicines to replace insulin to manage diabetes type 1.
Follow-up care is an essential part of diabetes management to assess the glucose level and other organ functions. The follow-up care can include tests for liver function, thyroid hormones, kidney function, eye health, and cholesterol levels.
How To Support A Child With Diabetes Type I?
Diabetes type I is a lifelong disease, and your child may require emotional support to deal with the disease’s hurdles. Along with the emotional and psychological support, you may also help your child understand the physical symptoms of glucose variations in the blood and how to deal with it.
Careful management of type 1 diabetes could help reduce the risk of complications in your child. It is a lifelong condition, and it may not be possible for parents or caregivers to assist the child in a 24-hour care plan. So, involving your child in diabetes management can be beneficial for them. Here is what you may teach the child about managing the condition.
- Let your kid actively participate in diabetes management
- Teach them when and how to perform glucose measurements and insulin injections
- Tell them about healthy food choices
- Encourage regular physical activity
- Tell them to wear and show their medical identification tag since it is useful in emergencies
Let your child’s school nurse and teachers know their condition to assist in the school hours. Diabetes may cause behavioral changes and irritability in children due to fluctuating glucose variations, and the hurdles of the disease may also indirectly affect the child.
Prevention Of Type 1 Diabetes In Children
There is no way to prevent or slow down the development of type 1 diabetes, yet (12). Scientists are working on diabetes prevention in high-risk groups to slow down the islet cell destruction through drugs. Even though autoantibodies are detectable in many people months or years before developing diabetes type 1, not everyone develops it.
Although it is impossible to prevent type 1 diabetes, the following tips may help prevent diabetes complications in a child.
- Maintain blood glucose level as recommended
- Healthy eating and regular exercise
- Follow up on time
Regular examinations of eye, kidney, liver, etc. are essential to identify the organ functions and begin treatments at the earliest.
Diabetes type 1 is a lifelong disease. However, it can be managed adequately in most cases through treatment plans and follow-ups. You may seek help from a psychotherapist or a counselor to help your child during the teenage years. Examples of online support websites for parents and children with diabetes are Children with Diabetes, JDRF, and the American diabetes association (ADA). You may also ask your child’s pediatrician about local support groups.
2. Type 1 diabetes; MedlinePlus; The United States National Library of Medicine
3. Diabetes Type 1; MedlinePlus; The United States National Library of Medicine
4. Genetics of Diabetes; American Diabetes Association
5. Christophe M. Filippi and Matthias G. von Herrath; Viral Trigger for Type 1 Diabetes; The United States National Library of Medicine
6. Type 1 Diabetes Mellitus; Harvard Medical School
7. Complications of Diabetes; American Diabetes Association
8. Diabetes Tests; The Centers for Disease Control and Prevention
9.What type of diabetes is it?; Macleod Diabetes & Endocrine Centre Royal Devon & Exeter Hospital
10. Jane L. Chiang, et al.; Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association; American Diabetes Association
11. Insulin, Medicines, & Other Diabetes Treatments; The National Institute of Diabetes and Digestive and Kidney Diseases
12. Symptoms, Treatment and Prevention of Type 1 Diabetes; Children’s Hospital Los Angeles
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