What is Type 1 Diabetes in Children?
Type 1 diabetes happens when the body’s immune system destroys certain cells in the pancreas, leading to not enough insulin being produced, which causes high blood sugar levels. This condition is long-term and managing it can be tough, both for those who have it and their caregivers. The goal is to keep blood sugar levels balanced while avoiding dangerously low levels. This balance can be affected by food, how much insulin is taken, stress, exercise, and many other things. Education for the person with diabetes and their family is crucial, alongside understanding the different challenges at various life stages when living with a long-term disease. With the right care and support, kids and teenagers with type 1 diabetes can expect to lead full, healthy lives.
What Causes Type 1 Diabetes in Children?
Type 1 diabetes occurs due to a mix of genetic and environmental factors that cause the immune system to damage the beta cells in the pancreas. These cells are responsible for producing insulin, a hormone that regulates blood sugar levels. When they stop working, blood sugar rises, causing symptoms of diabetes that require lifelong insulin therapy.
It’s estimated that a person’s specific risk for type 1 diabetes could be due to around 30%-50% of genetic factors. Specifically, a certain genetic variation associated with the human leukocyte antigen helps identify an individual’s risk. More than 50 additional genes have been discovered that might contribute to the risk of developing this disease.
In addition to genetics, an environmental “trigger,” such as certain conditions in the womb, exposure to viruses, diet, and a variety of other factors, is thought to help start the entire process. This trigger sets off a chain reaction where the immune system incorrectly identifies cells in the pancreas as a threat and destroys them. This destruction leads to a reduction in insulin, causing diabetes symptoms to become noticeable.
Recent research has highlighted earlier stages of type 1 diabetes, before symptoms are typically observed. Stage 1 is characterized by the immune system affecting the beta cells but without any change to usual blood sugar levels. In stage 2, the body struggles with managing blood sugar levels, though symptoms aren’t obvious yet. Finally, stage 3 is when symptoms related to decreased insulin start to show up.
Getting from one stage to the next can take years, and while these early stages typically don’t factor into usual medical care, they might offer opportunities for interventions that could slow or prevent the onset of type 1 diabetes.
Risk Factors and Frequency for Type 1 Diabetes in Children
Type 1 diabetes can be diagnosed at almost any age but it’s most often recognized in children around ages 5 to 7 and during puberty. Remarkably, there are more diagnoses in fall and winter seasons. Unlike many other autoimmune disorders, boys and men are slightly more likely to have type 1 diabetes. Over the past decades, the number of people diagnosed with type 1 diabetes has risen, especially among young children. This trend is seen in all ages, genders, and racial/ethnic groups.
- Geographical location and ethnicity make a difference in rates of diagnosis. For example, 60 out of every 100,000 people in Finland will be diagnosed each year, compared to only 0.1 out of every 100,000 people in China.
- In the United States, 20 to 30 out of every 100,000 people will be diagnosed each year. These rates have gone up 200% to 300% over the past decades. Today, more than 1.25 million people in the United States are living with type 1 diabetes, and about 500,000 of them are children.
If a child has type 1 diabetes, there’s a 5% chance their sibling will also have it. Among fraternal twins, the chance is around 10% to 30% and it goes up to 40% to 50% for identical twins. If an adult has type 1 diabetes, their child has a roughly 5% to 8% chance of also getting it. In the general population in the United States, the risk is about 0.3%.
Signs and Symptoms of Type 1 Diabetes in Children
When children first show symptoms of Type 1 diabetes, they usually experience increased urination, intense thirst, and lose weight over a period of days to months. If a diagnosis is delayed, symptoms might escalate to vomiting, lethargy, changes in cognitive behavior, dehydration, and acidosis (excess acid in body fluids). Once the diagnosis is made and insulin therapy begins, the child’s progress is typically monitored every few months by a pediatric endocrinologist.
Some children, however, may have ketoacidosis when first diagnosed. Ketoacidosis is a serious complication involving high levels of acids (called ketones) in the body. Symptoms may include:
- Smell of ketones
- Dehydration
- Abdominal pain
- Deep, rapid breathing (Kussmaul breathing)
- Vomiting
- Coma
- Changes in mental state
During routine visits, the healthcare provider will check the child’s diabetes status and any life circumstances that might affect their diabetes management. This could include their school experiences, changes in their diet and exercise routines, their developmental stage, their active participation in managing diabetes, changes in their family and home life, and adherence to therapy. The doctor will also assess issues related to glucose monitoring, insulin delivery and will screen for symptoms of related health problems like thyroid dysfunction or celiac disease. However, since most children with Type 1 diabetes are generally healthy, the physical examinations are usually concentrated on diabetes care aspects.
Testing for Type 1 Diabetes in Children
Keeping track of blood sugar levels at home can help people with diabetes understand how different factors, such as stress, exercise and other life events, affect these levels. The patient and their family are also usually involved in adjusting the insulin dosage, as needed.
Hemoglobin A1c, a test that measures average blood sugar levels over the past two to three months, is usually performed at clinic visits. The American Diabetes Association suggests this level should be under 7.5%, though only about 20-25% of young patients hit this target. Some other countries have lower Hemoglobin A1c targets and their patients have been more successful in achieving them.
Continuous Glucose Monitoring (CGM) is becoming more common amongst children and teenagers with diabetes. It measures blood sugar levels continuously throughout the day, revealing patterns that can help in diabetes management. Although the results from CGM can be more beneficial than Hemoglobin A1c results, not all insurance plans cover and not all patients prefer its use.
Regular screenings for thyroid disorders and celiac disease, along with check-ups for lipid disorders, microalbuminuria (a marker of kidney disease), and retinopathy (an eye condition) are recommended, based on how long a person has had diabetes. Mental health and social factors should also be routinely assessed.
Islet cell antibodies, special proteins connected to the immune system, are typically not used to diagnose type 1 diabetes, as only about 5% of children have them and they aren’t definitive markers of the disease. Additionally, children should have a base level check of lipid levels and start kidney health assessments from the age of 12, as they are at risk of advanced kidney disease.
Treatment Options for Type 1 Diabetes in Children
A healthcare team for managing diabetes typically includes a medical provider, a nurse, a diabetes educator, a dietitian, a social worker, and a psychologist. However, not all of these specialists are always available, easily accessible, or covered by insurance. Communication between the child, family, and the medical team is often frequent, especially at first, while the treatment is being adjusted and the family is learning how to look after a child with diabetes. In terms of making daily treatment decisions, this is usually done by the patient and their family.
Insulin can be administered in two ways: either through multiple daily injections (MDI) or an insulin pump. MDIs involve giving basal insulin once or twice a day, and bolus insulin usually three or more times a day at mealtime. The amount of bolus insulin given depends on the carbohydrate content of the meal and the current blood glucose level. Insulin pumps, on the other hand, only deliver rapid-acting insulin. They provide a set or adjustable basal rate of insulin, and calculating the insulin needed at mealtime is typically based on the carbohydrate content of the meal and the current blood glucose level.
In addition to managing insulin levels, the healthcare provider will also test for related conditions like thyroid disease, celiac disease, and dyslipidemia. They also regularly check for complications that might arise from high blood sugar levels over an extended period, like issues with the eyes (retinopathy), nerves (neuropathy), and kidneys (nephropathy). Guidelines for the detailed care of diabetes are outlined in the American Diabetes Association Standards of Medical Care in Diabetes publication, which is updated every January.
Strategies should be laid out to help parents achieve the best diabetes management for their child. Behavioral intervention has been shown to be effective in encouraging medication adherence and improving outcomes. Parents should also be taught how to recognize and manage hypoglycemia, a condition where blood sugar levels drop dangerously low.
Recent research has shown that giving probiotics to infants under three with type 1 diabetes can reduce the risk of the pancreas’s immune cells attacking their own body.
Nutritional advice is a crucial part of diabetes management. The current consensus is that carbohydrates should provide 50-55% of the daily energy intake – with not more than 10% coming from simple carbohydrates like sucrose – fats should make up around 30%, and protein 10-15%.
What else can Type 1 Diabetes in Children be?
- Poisoning from Aspirin (Salicylate toxicity)
- A tumor of the adrenal glands that can cause high blood pressure (Pheochromocytoma)
- A condition where the kidneys can’t conserve water (Diabetes insipidus)
- An overactive thyroid (Hyperthyroidism)
What to expect with Type 1 Diabetes in Children
Type 1 diabetes is a serious disease, often resulting in high rates of illness and death. For many people living with this condition, their life expectancy may be shorter by 10-20 years. This illness can lead to many complications such as severe low blood sugar (hypoglycemia) and a dangerous metabolic condition known as diabetic ketoacidosis.
For kids, handling this disease can be extremely stressful and often leads to depression. Specifically, delayed diagnosis of diabetic ketoacidosis is a leading cause of death among children with type 1 diabetes.
Possible Complications When Diagnosed with Type 1 Diabetes in Children
Some of the issues that might affect people include:
- Cataracts
- Retinopathy
- Gastroparesis
- Renal failure
- Hypertension
- Premature coronary disease
- Peripheral vascular disease
- Neuropathy
- Increased susceptibility to infections
Preventing Type 1 Diabetes in Children
It’s very important to keep a long-term eye on your child’s health. This includes checking your child’s growth at every doctor’s visit. You should also pay attention to any places where your child has had an injection, and look at their feet to see if they’re feeling any abnormal sensations or pain.
Regular check-ups of blood pressure, eye health, and urine tests are also essential to monitor. This helps ensure any health issues can be spotted as early as possible.
