Type 1 diabetes is a lifelong condition that affects the way your body processes food for energy. There are different types of diabetes, but type 1 is one of the most common chronic illnesses that affects children and teens. There is currently no cure for type 1 diabetes, but there are highly effective treatments out there that manage the disease’s effects and help the person live a long, healthy life!
Causes
When you eat, nutrients from food change into a type of sugar called glucose. Your pancreas (an organ in your belly) makes a hormone called insulin that allows the glucose to move from the bloodstream into your body’s cells to be used for energy. Type 1 diabetes happens when your body can’t make enough insulin and the glucose gets “stuck” in the bloodstream, causing high blood glucose levels called hyperglycemia. When this happens, the body breaks down fat for fuel instead of glucose, creating ketones. These ketones are acidic and can cause harm to the body when levels are too high.
Symptoms
Type 1 diabetes symptoms mainly come from the lack of energy caused by the body not processing glucose correctly. High ketone levels also cause symptoms. High sugar levels in the bloodstream can spill into the urine and pull water along with it causing dehydration.
Symptoms in children can include:
- Increased thirst and urination (peeing). This is harder to spot in younger children who are not potty trained yet, because parents may not realize they’re needing more frequent diaper changes. Accidents may also be overlooked in toddlers or even older children who were previously toilet-trained.
- Hunger, sometimes extreme, along with weight loss.
- Fatigue (feeling tired)
- Headaches
- Irritability or unusual behavior
- Blurry vision. This symptom is uncommon but can happen if the sugar level is very high.
Symptoms of a diabetic emergency: untreated type 1 diabetes can cause symptoms that require immediate medical attention. These symptoms include nausea, vomiting, belly pain, rapid breathing, fruity or nail polish remover like smell in the breath, drowsiness, or loss of consciousness.
Misdiagnosis
Untreated type 1 diabetes can sometimes mimic flu symptoms including tiredness, nausea, vomiting, and belly pain. The child may seem alright because they’re peeing normally, or even a little more than usual. Frequent urination is not typically a sign of dehydration, but with type 1 diabetes a child can still be dehydrated when they’re peeing a lot. If your child has flu-like symptoms plus increased thirst and urination, get them checked by their doctor immediately.
Diagnosis
Diabetes diagnosis begins with a child exhibiting the classic symptoms listed above, along with an abnormally high blood sugar level. It can also be diagnosed using a test that shows the child’s average blood sugar levels over the past 3 months. This test is called hemoglobin A1c (HbA1c). If the result is 6.5% or greater, that is a sign that the child has diabetes.
An oral glucose tolerance test (OGTT) is a less common way to diagnose diabetes. This test measures blood sugar levels before and after a sugary drink is given.
The presence of ketones in the urine, or coming to the hospital with dangerously high levels of ketones (diabetic ketoacidosis – DKA), also strongly suggests type 1 diabetes. However, this can sometimes happen with type 2 diabetes too.
Type 1 vs. Type 2 Diabetes
Your doctor will consider a combination of factors to determine whether your child has type 1 or type 2 diabetes. This includes age and other factors like the presence of islet autoantibodies- a protein in the bloodstream that signals an immune attack happening against beta cells. This is typically and indication that a child has type 1 diabetes.
Stages of Type 1 Diabetes
Type 1 diabetes has a pre-symptomatic stage where a child may have symptoms of an autoimmune attack but not have symptoms of diabetes yet.
- Stage 1 – people will have 2 or more islet autoantibodies present repeatedly in their blood, but have normal blood sugar levels. This means it is extremely likely that they will develop type 1 diabetes in their lifetime, but it may not happen for years.
- Stage 2 – two or more islet autoantibodies are repeatedly present AND the blood sugar levels are within a “pre-diabetes” range.
- Stage 3 – this is the classic stage where most people receive a diagnosis. Children will typically have the classic symptoms listed above and have blood sugar levels within the “diabetes” range.
Treatment
Diabetes is treated by giving back the insulin that is missing. Insulin injections may be given several times daily through a pen or a syringe with a very thin, short needle. These are typically given in the upper part of the arm, front of the thigh, or in the fatty skin of the belly.
Insulin can also be given through a small wearable device typically called an insulin “pump”. This pump delivers insulin through a tiny tube under the skin.
A healthy diet and physical activity are also very important in managing type 1 diabetes. Insulin dosing must be matched with the amount of sugar (carbohydrates) taken in through food and often needs to be reduced during times of physical activity.
Blood sugar monitoring
Treating type 1 diabetes means normalizing blood sugar levels, but this is not an easy task. Blood sugars must be frequently monitored. This is done using a blood glucose meter, a portable device that tests a drop of blood placed on a test strip and inserted into the meter.
Monitoring can also be done using a continuous glucose monitor, which uses a small sensor to continuously measure the glucose level in the space under the skin.
Another option is an automated insulin delivery system, or AID, (also called an artificial pancreas) in which an insulin pump and continuous glucose monitor communicate with each other to help regulate blood sugar.
What to do if you think your child has type 1 diabetes:
Take your child to their pediatrician right away. The doctor can easily check your child’s blood sugar levels and check for sugar in their urine. It may be tempting to find a blood glucose meter yourself and test at home, but we advise against doing this. You may not do it correctly or the meter may not be working properly, resulting in an incorrect reading.
Higher Risk Children
Screening for type 1 diabetes has advanced greatly and has made it possible to assess a patient’s risk of developing type 1 diabetes long before symptoms appear. People with a family history of type 1 diabetes, and others at higher risk may be eligible for screening through a research study. Other options may be available for those who do not have a family history.
Prevention or Delay
Currently, type 1 diabetes cannot be prevented, but newer medications can help delay the onset in certain high-risk patients.
For high-risk patients in stage 2 type 1 diabetes, there is an FDA-approved medication available that can delay progression to stage 3 type 1 diabetes by an average of 2 years! It targets specific immune cells responsible for attacking the cells in the pancreas that produce insulin.
Remember
Management and prognosis of type 1 diabetes improves rapidly with early detection, timely treatment, and support of primary care providers and pediatric endocrinologists. This helps families navigate the disease effectively and look forward to a healthy future.
More Information
- Diabetes in Children
- Type 1 Diabetes Resources & Support (BreakthroughT1D.org)