| 21 July 2023
What is diabetes?
Diabetes is a chronic medical condition in which the body does not produce enough insulin, or does not use it correctly. Insulin is a hormone produced by the pancreas and its purpose is to convert sugars into energy for the body to use. When a person has diabetes, blood glucose levels become too high, leading to a host of health problems over time if the condition goes untreated.
There are two main types of diabetes:
Type 1 diabetes
Type 1 diabetes occurs when the body’s immune system mistakenly attacks and destroys cells in the pancreas that make insulin, leading to an inability to produce insulin.
Approximately 90% of young people with diabetes suffer from type 1.
Type 2 diabetes
In type 2 diabetes, the body has the ability to make insulin, but the insulin doesn’t work correctly.
Type 2 diabetes is less common in young children, however, due to increases in childhood obesity, a growing number of children are now being diagnosed with type 2 diabetes, some even as young as ten years old.
What causes type 1 diabetes in children?
The cause of type 1 diabetes is still largely unknown, but there are several theories proposed. One popular theory is that the body’s own immune system mistakenly destroys the islet cells in the pancreas, which produce insulin. This destruction of insulin-producing cells appears to be due to a combination of genetic and environmental factors. Once these cells are destroyed, little or no insulin can be produced, leading to an accumulation of sugar in the bloodstream without proper transport to energy-dependent body cells.
There is also a general speculation amongst experts that diabetes may be triggered by genetic characteristics which are inherited, combined with environmental factors like diet or exercise. However, many type 1 diabetes cases in children have no family history of the disease, making its exact cause a mystery.
Symptoms of type 1 diabetes in children
Type 1 diabetes often appears suddenly, and symptoms can occur differently in each child. The most common symptoms of type 1 diabetes in children include:
- Frequent urination. As too much sugar in the urine pulls large amounts of fluids from the body, this can overwhelm the kidneys causing a child to wake up multiple times during the night needing to relieve themselves, or wetting their bed after having been potty-trained for some time.
- Constant thirst. Excessive urination leaves can leave a child highly dehydrated so they will need to drink lots of liquids throughout the day such to replenish these lost fluids.
- Fatigue. Low blood sugars levels, due to lack of insulin production, can make a child feel weak and lethargic, as well as cause increased hunger due to difficulty converting food into energy efficiently.
- Weight loss, despite increased hunger. Because the sugar stays in the blood, the body doesn’t get the fuel it needs. As a result, it begins burning fat and muscle for energy, which can result in unexplained or sudden weight loss.
Warning signs
According to a 2012 survey from Diabetes U.K., only 9% of parents were able to identify the four main symptoms of type 1 diabetes in their children. By 2013, this figure had increased to 14%.
How are children with diabetes treated?
There is currently no cure for type 1 diabetes, so patients must have daily injections of insulin, administered either by injection or insulin pump, coupled with careful management of food intake and regular blood sugar monitoring.
Additionally, dietary habits are key to successfully managing diabetes in children. Parents must help their child make healthy food choices with focus on consuming regular meals full of nutritious foods low in sugar, and counting carbohydrates in each meal served. The combination of balanced meals, timely injections or pump use, doctor-recommended exercise programs, and monitoring will keep the child’s diabetes under control and allow them to lead an active life
What are the possible complications of type 1 diabetes in a child?
The major organs of the body can be affected in the long-term if diabetes isn’t managed properly, including:
- Heart and blood vessels. High blood sugar leads to an increased risk of narrowed arteries, high blood pressure and heart disease which can potentially lead to stroke later in life.
- Nerve damage. Diabetes may also cause nerve damage or neuropathy over time. This can result in reduced sensation in areas such as the feet or hands, causing tingling, numbness, burning or pain.
- Kidney disease. Damage to the waste-filtering blood vessels in the kidneys can result in reduced kidney function.
- Eye damage. Damage to the blood vessels of the eye’s retina can lead to vision problems.
- Osteoporosis. Diabetes can lead to a decrease in bone mineral density, which in turn increases the risk of osteoporosis in adults.
Diabetes increases in children
Researchers have reported an increase in the number of children and teenagers worldwide being diagnosed with type 1 diabetes since the Covid-19 pandemic.
A recent study published in the JAMA Network Open journal has compiled data from various countries, including the UK, on over 38,000 young people who were diagnosed during the pandemic.
Before the pandemic, the incidence rate of childhood type 1 diabetes was already increasing – by about 3% a year. But this study found that:
- there was a 14% rise in the rate during the first year of the pandemic, compared to before Covid-19
- in the second year of Covid-19, the rate was up about 27% on pre-pandemic levels
According to experts, the cause of the increase in cases is still uncertain, but there are some theories.
One theory suggests that Covid-19 can potentially induce a reaction in certain children, leading to an increased diabetes risk. However, not all studies investigating this autoimmune response, characterised by the body attacking its own healthy cells, have provided evidence to support this theory.
An alternative hypothesis suggests that childhood exposure to certain germs may offer protection against various conditions, including diabetes. Some scientists propose that the implementation of lockdowns and physical distancing during the Covid pandemic potentially resulted in insufficient germ exposure for many children, potentially limiting this additional protection.
Diabetes education for healthcare professionals
Skills for Health has partnered with HEAL.med to provide access to an eLearning course to aid healthcare professionals to treat and manage under 18-year-olds with type 1 diabetes.
The ‘Type 1 diabetes management in children and young people course’ provides an introductory framework to enable those with no prior knowledge of the disease to treat patients effectively.
By the end of the course, learners will be able to explain the diagnosis of type 1 and type 2 diabetes, how to use insulin safely, the monitoring and assessment of blood glucose control, the role of diet in the management of type 1 diabetes and how carbohydrate counting relates to the correct dose of insulin.