The overwhelming majority of adults with diabetes – 95% – have type 2 diabetes.1 In children, the statistics are reversed. Most children with diabetes have been diagnosed with type 1. While the incidence of type 2 in children is growing it remains quite rare.

Whether a child has type 1 or type 2 diabetes, treating diabetes in children has special challenges:

Because type 1 diabetes is usually diagnosed in children, teens and young adults, it used to be known as “juvenile diabetes”. In this chronic condition, the pancreas stops producing a hormone known as insulin. Insulin’s job is to break down the carbohydrates you eat and turn them into glucose, or “blood sugar”. The glucose travels through the bloodstream, providing energy and nourishment. Without insulin to let glucose into the cells, the body is literally starving for energy. Meanwhile, excess glucose can’t be broken down, so it accumulates in the bloodstream where it can cause serious damage. Because people with type 1 diabetes must take insulin injections to survive, the disease is sometimes called “insulin dependent” diabetes.  

Once the pancreas stops producing insulin, the symptoms of type 1 come on very rapidly. These include:

  • Increased thirst
  • Frequent urination
  • Bedwetting (in children who no longer wet the bed during the night)
  • Extreme hunger
  • Unintended weight loss
  • Irritability and other mood changes
  • Fatigue and weakness
  • Blurred vision

Consult your doctor right away if your child develops any of these symptoms.

Type 2 diabetes begins with a process called “insulin resistance”. Insulin is a hormone produced by the pancreas, a large organ behind the stomach. Normally, insulin breaks down the carbohydrates you eat and turns them into glucose, or “blood sugar”. The glucose then travels through the bloodstream, providing energy and nourishment. Type 2 diabetes develops when the body starts to “resist” the insulin it produces and stops carrying glucose into the body’s cells. The pancreas tries to compensate for the added demand for insulin by making more. Over time, the pancreas can no longer keep up with the body’s increased need for insulin. Excess sugar accumulates in the bloodstream and begins to cause long-term damage.

While type 2 diabetes remains very rare in children, the condition is on the rise. In the years between 2001 and 2009, SEARCH for Diabetes in Youth, a national study sponsored by the Center for Disease Control, found a 21% increase in type 2 diabetes in children and teens ages 10-19.2 Experts agree that the most important factor behind this increase is childhood obesity: children diagnosed with type 2 diabetes are invariably overweight.

Helping a child travel well through life with diabetes takes a team approach. The family will need to work with an expert care team of clinicians, diabetes educators, dietitians, and possibly counselors or psychologists. What’s more, the family itself is a care team, responsible for the day-to-day management of the young person’s blood glucose and general health. Not only is it essential to educate the family, but also teachers and caregivers.

Some of the spontaneity of family life has to be sacrificed in the interest of the child’s health. Diabetes must be explained to the child in age-appropriate way: Younger children may not understand why they have to have their blood drawn, or why they can’t have a sweet treat. A growing child’s nutritional needs are different from those of an adult. Every meal and snack requires planning. Illness or family travel pose special challenges. For all these reasons, diabetes education and care for children and their families require a special approach. The Braden Diabetes Center is now offering specialized education and care for childhood diabetes on site, thanks to our special partnership with the UCSF Madison Clinic for Childhood Diabetes.

The care regimen for a child with type 1 diabetes requires attention to detail and a constant attention to blood sugar levels and insulin administration. The daily routine may include as many as six to eight injections of insulin and eight to twelve finger sticks to check blood glucose. On days when a child is especially active, an extra nighttime blood glucose test may be required, and action taken for the reading at 2am. Parents need to count carbohydrates at all meals and snacks to determine insulin doses. For the child’s safety, parents must reach out to relatives, teachers, day care providers, friends and babysitters and educate them about what to do to prevent a medical emergency.  

Caring for Children With Type 2 Diabetes

When type 2 diabetes is diagnosed in a young person, it is almost always related to obesity. Getting the child or teen to lose weight and adopt healthier habits is essential. In general, kids with type 2 diabetes need to:

  • Eat a healthy, balanced diet that will help them lose weight and manage their blood sugar while providing the nutrients they need to grow.
  • Get regular exercise.
  • Take medication as prescribed.
  • Monitor blood glucose as recommended by their physician.

In addition, the child must be closely monitored for other conditions associated with type 2 diabetes, including obesity, high blood pressure, or abnormal blood lipid (fat) levels. 

  • Daily testing: The American Diabetes Association has specific daily testing recommendations for adults with type 1 diabetes and insulin-dependent type 2 diabetes. However, managing diabetes in children does not lend itself to specific recommendations.  Pediatric endocrinologists need to tailor the testing to each child, based on the following considerations:
    • In children, insulin doses based on body size alone are likely to be incorrect.
    • Children respond differently to hypoglycemia (Low blood glucose) than adults do.
    • Puberty impacts a child’s risks for diabetic complications .

    Once daily testing recommendations have been worked out, parents need to keep a logbook or use a sensor to track of testing results over time. Some common testing situations include:
    • Before each meal.
    • 1 or 2 hours after a meal.
    • Before a snack.
    • In the middle of the night.
    • Before exercising, to determine whether you should eat something first.
    • During and after physical activity.
    • If you think your blood sugar may be high, low, or dropping.
    • When the child is sick or under stress.
  • A1C Testing: Once a person has been diagnosed, their doctor will periodically prescribe an A1C test to determine the level of blood sugar control. This blood test provides information about a person’s average blood sugar levels over the three months preceding the test. An A1C test result is reported as a percentage.
  • Ketone Testing: Ketone are a chemical the body produces when there isn’t enough insulin in the blood and the body starts using fat for energy instead of glucose. This is more likely to occur in type 1 diabetes than in type 2. Ketones upset the chemical balance of your blood and are toxic to the body. Combined with high blood glucose, ketones in the blood are a sign of poorly managed diabetes. Ketones can be detected through a simple urine test you can buy at the pharmacy. Talk to your doctor at once if your urine results show moderate to large amounts of ketones.
    Signs of Elevated Ketone Levels
    • Blood glucose of more than 300 mg/dl
    • Nausea, vomiting and/or abdominal pain
    • Feeling tired all the time
    • Thirst and dry mouth
    • Flushed skin
    • Breathing difficulties
    • A strange, fruity breath odor
    • Feeling confused or "in a fog"

Helping a child travel well through life with diabetes takes a team approach, including clinicians, diabetes educators, dietitians, and in some cases, counselors or psychologists. Family is an integral part of that care team, responsible for the day-to-day management of the child's blood glucose and general health.

To bring specialized care to Marin children with diabetes, the Braden Diabetes Center at Marin General Hospital forged a collaboration with UCSF's renowned Madison Clinic for Pediatric Diabetes. As a result, Marin families now have access to Madison Clinic pediatric endocrinologists and to specially trained pediatric nurses and dietitians who are also certified diabetes educators.

Click here to listen, as , pediatric endocrinologist Dr. Saleh Adi discusses the importance of continuity of care and a diabetes home base for children to get consistent medical oversight as they grow.

Sources

  1. ADA: http://www.diabetes.org/diabetes-basics/type-1/
  2. GNM Healthcare: http://www.gnmhealthcare.com/pdf/03-2008/03/1534466_Prediabetesandtype2diabet.pdf