What is diabetes mellitus?
Diabetes mellitus occurs when specialized cells of the pancreas (a gland located behind the stomach) do not produce adequate amounts of the hormone insulin. Insulin enables the body to process the nutrients (proteins, fat, and carbohydrates) to make body tissues, promote growth, produce energy, and store energy. These nutrients are broken down into glucose, a type of sugar used by the cells of the body as a source of energy. Glucose is fuel for the body to use.
In people without diabetes, insulin transports glucose from the bloodstream into the cells maintaining blood sugar levels within a tight range. People with type 1 diabetes have a reduced supply of insulin or none at all. Therefore, especially after eating, blood glucose levels rise. The nutrients in the food cannot be used in the cells but remain in the bloodstream. Without a source of energy, the cells think they are starving. In an attempt to nourish the starving cells, the liver makes sugar from the body stores of protein and fat. This leads to weight loss and weakness, because muscle and fat are being broken down and the body is not getting the energy it needs. The nutrients are eventually metabolized to glucose or "sugar", and build up in the bloodstream. This is called hyperglycemia. The body tries to eliminate the excess sugar circulating in the blood by excreting it in the urine and increasing the amount of urine in order to get rid of the large amount of sugar. This is why people who have diabetes urinate more frequently and can become very thirsty as they try to replace the fluid loss. Without insulin, fat breaks down to form certain kinds of acids known as ketones, which are also excreted in the urine.
Currently, there is no way to prevent the type 1 diabetes. Although there is a genetic predisposition to develop this disease, only about 30 percent of children with type 1 diabetes (previously known as insulin-dependent diabetes) have any close relatives with the disease. The destruction of the cells that make insulin results from a process in which the body's immune system views these cells as foreign invaders and mounts an immune response against them. This autoimmune process starts years before the first symptoms of diabetes show up. The trigger for this process may be viruses or other agents in the environment.
Type 2 diabetes is much more common than type 1 diabetes. In Type 2 diabetes, the body does not make enough insulin and is not able to use insulin properly. This is also known as insulin resistance. Type 2 diabetes usually is associated with obesity, and is increasing in frequency as the rates of obesity grow. Among children diagnosed with Type 2 diabetes, eighty-five out of one hundred are obese. Children who are inactive, overeat, and have a family history of diabetes have the greatest risk of developing type 2 diabetes. Children in minority groups also have a higher incidence of type 2 diabetes. In recent years, many more school-age and teenage children are being diagnosed with type 2 diabetes.
Diabetes can appear at any time, even in the first year of life. However, the diagnosis often is delayed in infants and toddlers until the child is very sick, because the symptoms may be attributed to other illnesses. It is important to notify your pediatrician immediately if your child displays any of the following warning signs and symptoms of diabetes:
- Increased thirst
- Increased urination. A toilet-trained child may start wetting, or a baby in diapers will need more frequent changes
- Weight loss with either increased appetite and food intake or loss of appetite (more common in the younger child)
- Severe diaper rash that does not respond to the usual treatment
- Vomiting that is persistent, particularly if it is accompanied by weakness or drowsiness
If your child goes to the doctor with any suspicious symptoms, be sure that a urine or blood test is done to determine whether his sugar levels are too high. This simple test will provide a clue to diabetes and prevent further deterioration, which can be dangerous.
When blood tests confirm diabetes, treatment begins immediately, and insulin injections are given. When the child does not require intravenous fluids to correct dehydration and vomiting, many specialists do not hospitalize patients with diabetes, but care for them in an outpatient setting with frequent office visits.
A health care team that specializes in diabetes will teach the entire family how to manage the diabetes. Members of the team include a physician, nurse, and dietitian who all work together and specialize in diabetes. They are known as diabetes educators. You’ll learn how to test blood glucose levels from a drop of blood from a finger stick and how to give insulin injections. You will learn about food, planning meals and snacks, and about activity and exercise. Your team will help determine how many insulin injections your child may need to control his blood sugars and successfully manage his diabetes.
Even at a very young age, children with diabetes can play a part in the daily management of their diabetes. Blood glucose meters are simple to use. They come in all shapes, sizes, and colors. Insulin pens are also available, making giving insulin easy and convenient.
Pump therapy is an alternative for managing your child’s diabetes. Some parents and children with their health care team may choose an insulin pump over injections to deliver insulin. An insulin pump is a beeper-size device that can be worn on or under clothing or on a waistband/belt. It provides a steady supply of insulin through a tiny tube placed under the skin. When your child eats, additional insulin to cover the meal is provided by pushing buttons. Pumps have many advantages over injections, including providing more flexibility and eliminating the need to carry insulin pens or vials.
Your child’s insulin regimen should provide flexibility, convenience, and good blood glucose control. You will learn to match insulin to your child’s food and activity and body needs. Using a method called carbohydrate counting is the easiest way to achieve this. Though there are many healthy carbohydrate containing foods, carbohydrates raise blood sugars. A carbohydrate-toinsulin ratio provided by your health care team will enable you to use this method, providing a variety of food choices while achieving good blood sugars.
Since children with diabetes have the same nutritional needs for growth and development as other children, they do not need to be on a special diet. Your child’s meal plan is one of the most important parts of managing diabetes. It can also be one of the most challenging for children and their families. Dietitians who are diabetes educators work with children and their families to assist in making meal planning healthful and to accommodate the child’s and family’s individual food preferences and meal schedule.
A good diet for children with diabetes at all ages is the same as that recommended for everyone. This includes: plenty of complex carbohydrates, such as whole-grain breads, pastas, potatoes, beans, and peas; unprocessed foods, such as bran cereals, oatmeal, and fresh fruits and vegetables. Snacks are important since most children require frequent feedings to supply necessary calories for growth. Snacks may also be necessary in active children to avoid hypoglycemia (low blood sugar). Good snack choices include fresh fruit, dried fruit, cheese crackers, peanut butter crackers, yogurt, trail mix, vanilla wafers, grain crackers, or granola bars, if strenuous exercise is planned. These snacks also are used for treating mild symptoms of hypoglycemia (low blood sugar) after initial treatment with orange juice or glucose tablets to raise blood sugar quickly. Desserts that are good for all members of the family include fresh fruit, low-fat yogurt, pudding, and Jell- O.
Child Care and School
Child care and school personnel need to know about your child's diabetes, her insulin schedule, and her snack needs. School personnel also need to be able to recognize and treat hypoglycemia. They need to know how to test blood sugar and have guidelines for giving insulin and testing for urine ketones.
Having children participate as much as possible in their care gives them some measure of control. Children under age three can choose which finger to stick for blood sugar tests or which place to use for the insulin injection.
Parents should handle treatment with a matter-of-fact yet affectionate attitude, and the American Academy of Pediatrics suggests that all adults in the family share responsibility for insulin injections and blood tests. Children four to seven years old can help with monitoring blood sugar and with injections.
Emotional support for the entire family is very important. You can get this—and learn more about the disease—from the Juvenile Diabetes Research Foundation.
The more you understand about diabetes and deal with it matter-of-factly, the better the chance that your child will do well. The tools and resources currently available make it possible for you and your child, along with your health care team, to mange the disease. With better blood glucose control, you'll reduce your child's risk for eye, kidney, nerve, and cardiovascular complications, and allow your child to grow up and lead productive, fulfilling lives.