You might think of diabetes as an adult condition. In fact, it’s becoming increasingly common in children. Currently, it is estimated that diabetes affects one in 700 children and one study, carried out in the Oxford area, suggested that the number is rising by four per cent every year.
It’s not clear why this is happening in the case of Type 1, insulin dependent, diabetes. But there is growing evidence that the rise in childhood obesity might account for the increase in the number of children with Type 2, non-insulin dependant, diabetes. This form of the condition is more often associated with later onset, affecting adults over the age of 40.
It’s important that parents know about diabetes and are aware of the signs and symptoms to look out for. If treated early, and effectively, it’s possible to minimise the risk of complications in later life.
In diabetes, the amount of glucose in the bloodstream is too high because the body can’t use it properly. Glucose comes from the digestion of starchy foods such as pasta and potatoes, from sugar and other sweet foods and is also produced in the liver. Insulin, a hormone produced by the pancreas, helps glucose to enter the cells where it is used as fuel by the body.
There are two types of diabetes. Type 1 affects children and young people. This type of diabetes means you depend on insulin injections and diet to control the body’s blood glucose level. It appears before the age of 40 and is different from Type 2 diabetes, which is generally controlled by diet alone.
In Type 1 diabetes, the insulin producing cells in the pancreas have been destroyed by the body’s immune system, resulting in little or no production of insulin. For some reason, the body recognises these cells as ‘foreign’ and attacks them. When this happens, the level of glucose in the bloodstream rises dramatically. If untreated, diabetes can be fatal.
There are no clear answers. We do know that a child can be genetically predisposed to the condition. The inherited genetic code is complex and the genes responsible have not yet been identified. It is thought that at least six genes are involved. However, genetic factors are less strong for Type 1 diabetes than Type 2. Other events have to trigger the process. There are various theories linking viral infections or even too much milk protein to the onset of Type 1 diabetes.
Common ages of onset are around six and seven, after starting school, and again at 12 or 13, a time when the body is full of growth hormone which is antagonistic to insulin.
The first signs of diabetes are that your child is excessively thirsty, passes a lot of urine and always seems hungry but is not putting on weight.
A simple urine test carried out by your child’s GP will show glucose in the urine. A blood sample is taken to confirm the diagnosis, to assess the level of salt and potassium in the bloodstream and determine whether a child is dehydrated.
Children are referred to a specialist diabetic team. This should include a consultant paediatrician with particular expertise in diabetes, a nurse specialising in children’s diabetes, a paediatric dietitian and a paediatric clinical psychologist who will liaise closely with your family doctor.
The main aim of treatment is to achieve near normal blood glucose levels. Bringing glucose levels down is not difficult, but once treatment has started it needs to be kept in balance.
Maintaining blood glucose levels within an ideal narrow band is a delicate balancing act. It involves checking child’s blood glucose level at least four times a day with a finger prick test. It is easy to carry out using a small machine at home: a drop of blood is squeezed on to a pad and the machine measures the level of glucose present, on which the amount of insulin injected will depend.
The level of glucose varies enormously depending on what a child has eaten and the amount of exercise taken. A child’s glucose level can swing too high or too low very quickly.
A fall in glucose level (hypoglycaemia) causes symptoms such as shakiness, sweating and dizziness. Children learn to recognise these symptoms and the problem is quickly rectified by a sugary drink or snack to increase the blood glucose level. Untreated, a child would lose consciousness.
A child will need to see the team regularly in the weeks and months after diagnosis. Once the whole family feels comfortable managing the condition, clinic visits are four times a year.
No. In fact many parents are surprised to find that their child’s diet isn’t restricted very much. A child needs to eat enough to allow normal growth and development. They should steer away from saturated fat, to help avoid heart problems in the future, and be encouraged to eat complex carbohydrates such as pasta.
Sweets can be eaten before exercise when a readily available supply of refined sugar may be needed and can be quickly used up. Diabetic sweets, chocolate and cakes aren’t necessary. They have no particular benefit over ordinary products as they often contain the same amount of fat and can have a laxative effect, especially in children.
Complications are rare in children and good diabetes control greatly reduces the risk. Damage, if it occurs, will come at a later stage and can include eye problems such as cataracts and blindness, kidney problems and heart disease caused by high blood pressure and peripheral neuropathy, which means that the nerves are affected and it is difficult to feel things properly. Feet are particularly at risk.
A great deal of research is under way – much of it focusing on what might trigger diabetes, finding more effective treatments and whether in the future it might be possible to prevent it developing.
One idea being tried is to artificially produce B cells, which produce insulin in the pancreas. A pill which can be taken instead if having insulin injections is in trials. Pancreatic transplantation is now possible, although there are substantial risks associated with suppressing the body’s immune system which is necessary in transplantation.
Last reviewed by Great Ormond Street Hospital: November 2007
This information has been written by Great Ormond Street Hospital specialists and has also appeared in a different format on the website of The Times newspaper.
