Diabetes Mellitus (DM) in Children and Adolescents
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 is a hormone your body makes. It controls sugar levels in your blood. Your blood sugar comes from:
Carbohydrates in food are turned into sugar by your body. Lots of foods have carbohydrates:
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
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.
With type 1 diabetes, symptoms start suddenly, over several days or weeks. Your child may:
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:
Diabetic ketoacidosis needs to be treated immediately in the emergency room.
With type 2 diabetes, your child may:
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.
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.
Doctors do blood tests to diagnose diabetes, including:
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.
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:
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
Children with type 1 diabetes don't make any insulin so they need to take insulin. Doctors will need to figure out:
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 slow and long-acting insulins.
Insulin is injected under the skin. It can't be taken by mouth. Insulin can be injected using a:
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:
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.
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
Type 1 diabetes isn't preventable.
You may be able to prevent or delay type 2 diabetes. Have your child: