Diabetes in Children

Diabetes is a chronic condition that can appear at any age, even in the first year of a child’s life. Read on to find out more about the symptoms and warning signs of diabetes, in toddlers and older children, how diabetes is diagnosed, what diabetes treatment is available and what you can do, day-to-day, to manage diabetes in your little one.

What Is Diabetes?

Diabetes is a metabolic disorder that affects the levels of blood sugar (also known as blood glucose, or just glucose) in a person’s body.

Blood sugar is a source of energy the cells in the body need. When we eat, the carbohydrates in the food we consume are broken down into glucose, which becomes fuel for the body.

When someone has diabetes, the body can’t turn the glucose into energy. This is the job of a hormone called insulin, which transports the glucose in the blood to the cells. Insulin is produced by the pancreas, an organ located behind the stomach.

With diabetes, either the body doesn’t produce enough insulin, or the insulin that it produces doesn’t work the way it should. Because sugar stays in the blood, this leads to high blood sugar levels. When the blood sugar levels are high for long periods of time, this can cause health problems.

Although diabetes can’t be cured, it can be managed. If your toddler is diagnosed with this condition, there are steps you can take to manage it so your child can lead a full, happy and above all healthy life.

What Types of Diabetes Are There?

There are two main types of diabetes that could affect your child: type 1 diabetes and type 2. A third type – gestational diabetes – only affects mums-to-be during pregnancy, but this could also affect your newborn baby’s health and wellbeing if it goes untreated.

So what is the difference between the different types of diabetes?

Type 1 Diabetes

People with type 1 diabetes don’t produce insulin. When someone with type 1 diabetes eats, the carbohydrates in the food are broken down into sugar, but without insulin this sugar can’t enter the cells to make energy.

This leads to a build-up of glucose in the blood, which is sometimes called hyperglycaemia.

If your toddler is diagnosed with diabetes, it’s most likely to be type 1 diabetes.

Type 2 Diabetes

With type 2 diabetes, either the pancreas can’t make enough insulin and/or the pancreas is able to produce insulin, but the body doesn’t respond to it as it should. In the latter case, the glucose in the blood is unable to enter the cells and can’t supply the energy the cells need – this is also known as insulin resistance – so sugar builds up in the bloodstream.

This type of diabetes is more common in adults, but some children and adolescents can also develop type 2 diabetes, often associated with obesity.

You may have also heard the term pre-diabetes, which refers to having blood sugar levels that are higher than normal, but not high enough to qualify as type 2 diabetes.

Pre-diabetes can develop into type 2 diabetes. However, the good news is that changes to diet and activity levels, along with reaching and maintaining a healthy weight, can help a child with pre-diabetes avoid getting type 2 diabetes. Positive lifestyle changes may even bring children’s blood sugar levels back to normal.

Gestational Diabetes

As the name suggests, this type of diabetes only affects mums-to-be during pregnancy, most often in the second or third trimester. Most mums-to-be who have gestational diabetes go on to deliver happy, healthy babies.

However, if it goes untreated gestational diabetes can be harmful or even dangerous to you and your foetus or newborn baby. This is why it’s important to diagnose and treat this kind of diabetes too.

If you are at a higher risk of developing gestational diabetes, your doctor or midwife may recommend you take a series of blood tests to screen for the condition.

Risk factors for gestational diabetes include:

• Being overweight with a body mass index of over 30

• Having previously had a baby weighing over 4.5 kilogrammes at birth

• Having gestational diabetes in an earlier pregnancy

• If one of your parents or siblings has diabetes

• Being of South Asian, Black, African-Caribbean or Middle Eastern ethnicity.

Ask your midwife about the gestational diabetes screening if any of these risk factors apply to you or if you experience possible diabetes symptoms – such as increased thirst, more frequent urination, a dry mouth or tiredness – during your pregnancy.

The treatment for gestational diabetes could include lifestyle and dietary changes and/or medication.

Babies born to mothers with diabetes may have temporarily low blood sugar, so if you have gestational diabetes you may be encouraged to express and store colostrum (your first breast milk) in the last few weeks before giving birth. The extra colostrum can help stabilise your newborn baby’s blood sugar level more quickly after birth.

What Causes Diabetes in Toddlers?

The cause or causes of diabetes in children and toddlers is unknown. However, experts have formed some theories and have identified risk factors for both types of diabetes:

• Type 1 diabetes. This type of diabetes usually occurs in people whose immune system – which usually fights viruses and harmful bacteria – destroys the insulin-producing cells in the pancreas. Although why this happens is not well understood, we do know that it’s not caused by your or your child’s diet or lifestyle. Experts believe that genetics or environmental factors, like exposure to viruses that trigger this autoimmune response, could be responsible.

• Type 2 diabetes. This form of diabetes is more common in adults, but rarely it can appear in children, too. Type 2 diabetes may also be linked to family history and genetics, but a sedentary lifestyle and excess fat, especially in the belly area, can also play a role.

What Are the Warning Signs of Diabetes in Toddlers?

Some of the symptoms of diabetes are similar to things that can happen in everyday life – like increased thirst on a hot day. However, if you notice any of these diabetes warning signs in your toddler it's always safest to tell your child’s doctor, who can either rule out or diagnose diabetes.

The symptoms of type 1 diabetes (the kind that most often affects babies or young children) can develop quickly – within a few days or weeks.

Type 2 diabetes symptoms develop more slowly, which is why it can sometimes go unnoticed for a long time – maybe even for several years.

Possible warning signs of diabetes in your toddler or young child include:

• Increased thirst or dehydration. The excess glucose in the bloodstream pulls fluid from tissues, and this can cause increased thirst or dehydration. Although your toddler asking for more water could have many natural causes, like hot weather or playing energetically, increased thirst can sometimes be a sign of diabetes, especially if the thirst is prolonged or is combined with other symptoms.

• Frequent or increased urination. You may find that you're changing a lot more nappies than usual, or if your toddler is toilet trained you may see more frequent bedwetting or notice that your child needs to pee more often.

• Weight loss. It might be that your toddler shows an increased appetite and eats more but still loses weight, or there could be a persistent loss of appetite resulting in weight loss. Either way, let your midwife or doctor know.

• Tiredness or fatigue you cannot explain. You may notice your toddler is unusually tired all the time without any obvious reason.

• Blurred vision. Let your doctor know if your child complains about not being able to see properly, as it could be a warning sign of diabetes.

• Cuts and scratches taking longer to heal than usual. You might also notice frequent fungal infections like oral thrush.

How Is Diabetes in Toddlers Diagnosed?

If there’s reason to suspect your toddler has diabetes, your child’s doctor will do a urine test and may also take a blood sample for a glucose (sugar) test.

If these tests show that your toddler might have diabetes, your child will be offered more tests and a thorough assessment in a hospital. This might involve one of the following blood tests for diabetes:

• Fasting blood sugar test. For this test, a blood sample is taken after an overnight fast, ideally first thing in the morning before breakfast.

• Oral glucose tolerance test. If your doctor suspects type 2 diabetes, an oral glucose tolerance test may be recommended. The first blood test is taken on an empty stomach like in the fasting blood sugar test. Then your child will be given a sugary solution to drink and blood sugar levels will be rechecked after a set number of hours have passed.

What Is the Treatment for Diabetes in Toddlers?

If the diagnosis comes back positive for diabetes, treatment can begin immediately.

Your child will be assigned a diabetes care team, who will be available for you and your child until around the age of 18. At first, you’ll meet the care team every week or two. Later, once you’re better accustomed to the new situation, an appointment every three months is usually enough.

Your care team will help you learn how to manage your toddler’s diabetes, such as injecting insulin, testing blood sugar levels and keeping to a diabetes-friendly diet. They can also give advice on attending nursery or primary school and talk to your child’s teachers and any other carers.

Although there is no cure for diabetes, with treatment and consistent care your child can go on to have a normal, full and happy life. Treatment depends on whether your toddler has type 1 or type 2 diabetes, but the treatment plan may include:

• Blood sugar monitoring. You will need to check your toddler’s blood sugar regularly. Testing helps you make sure your child’s blood sugar levels are within the target range.

• Administering insulin. If your toddler has type 1 diabetes, then life-long treatment with insulin will be necessary. Some cases of type 2 diabetes also require insulin, but it’s not usually needed by young children. Insulin is often given as an injection but is sometimes administered through a pump. Your toddler’s diabetes care team will show you how to give injections or use the pump and later teach your child to self-administer insulin when he or she is old enough.

• A healthy diet. Eating well is a big part of any diabetes treatment plan, and your diabetes care team will help you work out a healthy, balanced diet plan to follow.

• Regular exercise. Encourage your little one to be physically active. Exercise has plenty of benefits, especially when it comes to managing diabetes. Besides helping to keep your child fit and at a healthy weight, staying active can also help the body to use insulin more efficiently. You can get involved and even make it a part of your family routine – there are so many ways to do this. Go outside and play ball together, take the family on a hike, play tag, or bounce around on a trampoline.

• Counting carbohydrates. If your toddler has type 1 diabetes, your child’s diabetes care team will explain how to count carbohydrates in foods so the dose of insulin can be calculated accurately.

• Medical screening. Your child will be given a glycated haemoglobin blood test (also known as HbA1c) four times a year. This is used to measure your child’s average blood sugar levels over the previous few weeks and months. Knowing the HbA1c level is important for assessing the risk of complications and taking steps to avoid them in good time. Besides the HbA1c test, your child will be regularly weighed and measured, and screened for other conditions that are sometimes associated with diabetes.

• Medication. In addition to lifestyle changes, children with type 2 diabetes may be prescribed medicines like metformin, which reduces the amount of blood sugar the liver releases into the bloodstream.

Can Diabetes Be Prevented?

As yet, there is no known prevention strategy for type 1 diabetes; but type 2 can sometimes be prevented with healthy lifestyle choices.

If you have a family history of type 1 diabetes, if you notice symptoms of diabetes in your toddler or if your child has been diagnosed with type 1 diabetes, you can prevent complications by:

• Helping your little one maintain good blood sugar levels as much as possible

• Helping your toddler follow a healthy diet

• Encouraging your toddler to get active

• Scheduling regular visits with your child’s diabetes care team.

Type 2 diabetes can be prevented by making appropriate lifestyle choices, so encourage healthy habits in your toddler from an early age by:

• Providing healthy meals and snacks. Make sure your child eats a healthy, balanced diet, focusing on fruit, vegetables, lean sources of protein and dairy and whole grains, and avoiding giving sugary sweets and drinks, high calorie treats and food high in fat.

• Keeping your toddler physically active. Try to make sure your little gets at least 60 minutes of exercise a day – make it fun and maybe even do it together. Staying fit and active together can have great health benefits for you too!

The Bottom Line

Although diabetes is a lifelong condition that requires consistent care and management, it's a condition that can be treated and there is support out there to help your child be happy and healthy throughout life.

Sooner or later the extra steps involved in managing your child’s diabetes will become second nature, and you’ll be back to focusing on watching and helping your child grow and experience all the same ups and downs, milestones and magic moments as other children of the same age.