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Diabetes in children
Reviewed by Dr Stephen Greene, consultant paediatrician,
Professor Ian Campbell, consultant physician and Dr Soon
Song, consultant physician
The last 30 years has seen a rise in childhood diabetes.
 Type
1 diabetes is the most common form of diabetes in
children: 90-95 per cent of under 16s with diabetes have this
type.
It is caused by the inability of the pancreas to produce
insulin.
Type 1 diabetes is classified as an autoimmune
disease, meaning a condition in which the body's immune
system 'attacks' one of the body's own tissues or organs. In
Type 1 diabetes it's the insulin-producing cells in the
pancreas that are destroyed.
How common is it?
Childhood diabetes isn't common, but there are marked
variations around the world: in England and Wales 17 children
per 100,000 develop diabetes each year in Scotland the figure
is 25 per 100,000 in Finland it's 43 per 100,000 in Japan
it's 3 per 100,000.
The last 30 years has seen a threefold increase in the number
of cases of childhood diabetes.
In Europe and America, Type 2 diabetes has been seen for the
first time in young people. This is probably in part caused
by the increasing trend towards obesity in our society.
 But
obesity doesn't explain the increase in the numbers of Type 1
diabetes in children - who make up the majority of new cases.
What causes childhood diabetes?
As with adults, the cause of childhood diabetes is not
understood. It probably involves a combination of genes and
environmental triggers.
The majority of children who develop Type 1 don't have a
family history of diabetes.
What are the symptoms?
The main symptoms are the same as in adults. They tend to
come on over a few weeks:
1. thirst
2. weight loss
3. tiredness
4. frequent urination.
Symptoms that are more typical for children include:
1. tummy pains
2. headaches
3. behaviour problems.
Sometimes diabetic acidosis occurs before diabetes is
diagnosed, although this happens less often in the UK due to
better awareness of the symptoms to look out for.
Doctors should consider the possibility of diabetes in any
child who has an otherwise unexplained history of illness or
tummy pains for a few weeks.
If diabetes is diagnosed, your child should be referred to
the regional specialist in childhood diabetes.
How is diabetes treated in children?
The specialised nature of managing childhood diabetes means
that most children are cared for by the hospital rather than
by their GP.
Most children with diabetes need insulin treatment. If this
is the case, your child will need an individual insulin
routine, which will be planned with the diabetes team.
Most now use frequent daily dosage regimes of fast-acting
insulin during the day and slow-acting insulin at night.
Very small children normally don't need an injection at
night, but will need one as they grow older.
Increasing numbers of older children use continuous insulin
pumps.
Often in the first year after diagnosis, your child may need
only a small dose of insulin. This is referred to as 'the
honeymoon period'.
As well as insulin treatment, good glucose control and
avoidance of ‘hypos’ (low blood glucose attacks) is
important. This is because many of the complications of
diabetes increase with the length of time diabetes has been
present.
What can parents do?
Your child and diabetes
Children bring their own problems in relation to:
diet restrictions
activity levels
compliance with instructions.
Your family and your child's medical team can help you
through difficult times.
Living with diabetes can put families under considerable
strain, so access to backup support is crucial. This may be
from your GP, the hospital team or social services.
Understanding all the different aspects of diabetes and its
treatment requires patience, but will benefit your child and
family life.
The diabetes team at the hospital can help you with the list
below.
Learn how to administer insulin injections. Insulin is
usually injected into the skin over the abdomen or the
thighs.
Know the symptoms of low blood glucose and diabetic acidosis
and what to do about them.
Make sure glucose is always available.
Measure blood glucose levels and teach your child how to do
this as soon as they are old enough.
Teach your child how to self-administer insulin injections as
soon as they are old enough - around the age of nine is
typical.
See the doctor on a regular basis, and particularly if your
child becomes ill for any reason - treatment is likely to
need adjusting.
Inform the school and friends about the symptoms of low blood
glucose and what to do about them.
Contact your local diabetes association for help and support.
Diet
Diet guidelines
1. Current recommendations for children with diabetes:
2. three main meals
3. two to three snacks
4. the whole family eats the same meals.
A trained dietician is usually one of the members of the
hospital diabetes team.
It's important to give your child a healthy balanced diet
that is high in fibre and carbohydrates.
A healthy diet is the same for everyone, whether or not they
have diabetes.
How much your child should eat depends on age and weight. The
dietician and parents should determine this together.
Sweets are no longer off limits because the 'diabetic diet'
is now a relic of the past.
Once your child gets to know how her body responds to eating
and taking insulin, sweets in moderation are possible -
accompanied by the appropriate dose of insulin.
Physical activity
Physical activity is important for children with diabetes,
who should try to exercise every day.
Physical activity lowers the blood sugar level, so if your
child takes insulin, she may need to reduce the dose.
This is because a combination of too much insulin and
exercise can lower the blood sugar level and lead to hypos.
To counter this, your child should always carry sugar.
Physical activity also affects how much your child can eat.
Before your child exercises or plays sport, give extra bread,
juice or other carbohydrates.
In the long term
A child who develops diabetes will live with the condition
longer than someone who develops diabetes in adulthood.
The longer diabetes is present, the higher the risk of
long-term complications such as those affecting the eyes and
kidneys.
These can start after puberty, but are usually a concern only
in later life.
Regular checkups for late-stage complications begin around
the age of nine. From then on, this checkup is done every
year.
Based on a text by Dr Jan E. Henriksen, consultant and Bendt
B Jacobsen
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