By: Brittany Bruggeman, MD, FAAP & Chineze Ebo, MD, FAAP
Diabetes is a condition that affects the way the body uses food for energy. There are different types of diabetes. Type 1 diabetes is one of the
most common chronic diseases affecting children and teens.
Currently, type 1 diabetes is a lifelong condition with no known cure. However, highly effective treatments are available to manage the disease. With the right care and support, people with type 1 diabetes can lead healthy, fulfilling lives.
What causes type 1 diabetes?
Type 1 diabetes happens when the body cannot make enough of the hormone insulin. Nutrients in food are changed into a form of sugar called glucose. Insulin allows glucose to move from the bloodstream into cells throughout the body to be used for energy.
Ordinarily, our bodies produce insulin in special cells called beta cells. These are found in the pancreas, an organ located in the belly. However, with type 1 diabetes, the immune system becomes confused; it mistakenly attacks and destroys these beta cells, treating them as if they were harmful germs. This ongoing attack may occur quickly or over a period of years.
What happens when the body doesn't have enough insulin?
Without insulin,
glucose is "stuck" in the bloodstream. This leads to high blood glucose levels (hyperglycemia), which can cause damage in the body.
Since the cells can't use glucose without insulin, the body breaks down fat for fuel. This process creates
ketones, which serve as an alternate energy source. However, ketones are acidic and so harm the body when their levels are too high.
Symptoms of type 1 diabetes
Symptoms of type 1 diabetes largely result from the lack of energy caused by the body not being able to use glucose. High ketone levels in the bloodstream can also cause symptoms. So can high sugar levels in the bloodstream that spill into the urine and pull water along with it, causing
dehydration (lack of fluids).
Type 1 diabetes symptoms in children can include:
Increased thirst and increased urination (peeing). This can be missed in infants who are not toilet trained, because parents may not realize that they are in need of more frequent
diaper changes. Also, "accidents" in a toddler and older children previously toilet-trained may be overlooked.
Hunger, at times extreme, associated with weight loss.
Fatigue or feeling tired.
Headache.
Irritability or unusual behavior.
Blurry vision (not a common symptom, but this can occur if the sugar is very high).
Symptoms of a diabetic emergency
If untreated, type 1 diabetes can lead to symptoms that require immediate medical care.
Diabetic emergency symptoms include nausea; vomiting; belly pain; rapid breathing; a fruity or nail polish remover-like odor to the breath, and drowsiness or loss of consciousness.
Can type 1 diabetes symptoms be mistaken for other illnesses?
Sometimes, untreated type 1 diabetes can look like the
flu. A child may feel very tired, have nausea, vomiting and belly pain. It can seem like the child is OK because they are still peeing normally, or even more than usual. Normally, frequent peeing is a sign that a child is not dehydrated, but with type 1 diabetes, a child can still be dehydrated even if they are peeing a lot. If your child has flu-like symptoms along with increased thirst and frequent peeing, get them checked by a doctor right away.
How is type 1 diabetes diagnosed?
Diabetes is diagnosed when a child has the classic symptoms of diabetes described above, along with abnormally high blood sugar levels. Diabetes can also be diagnosed by a test that shows what the average blood sugar has been in the blood over the past 3 months. This test is called
hemoglobin A1c (HbA1c). A result that is equal to or greater than 6.5% is consistent with diabetes.
Less commonly, diabetes is diagnosed with an
oral glucose tolerance test (OGTT). With this test, blood sugars are measured before and after a sugary drink is given.
Having ketones in the urine or coming into the hospital with
diabetic ketoacidosis (DKA), where ketone levels have built up to dangerously high levels, strongly suggests type 1 diabetes. However, this can sometimes happen in
type 2 diabetes, as well.
Type 1 or type 2 diabetes: how to tell the difference?
The best clues to whether a child has type 1 or
type 2 diabetes is a combination of factors doctors consider. This includes the child's age and other factors like the presence of proteins called
islet autoantibodies in the bloodstream. This is a sign there is an immune attack happening against the beta cells. For a child diagnosed with diabetes, islet autoantibodies indicate type 1 diabetes.
Are there different stages of type 1 diabetes?
Type 1 diabetes also has a presymptomatic phase, where children will have signs of an autoimmune attack against the beta cells but will not have symptoms of diabetes.
In
stage 1 type 1 diabetes, people will have two or more islet autoantibodies repeatedly present in the blood, but have normal blood sugars. The likelihood of developing full-blown type 1 diabetes in their lifetime is extremely high, but it may not happen for years.
In
stage 2 type 1 diabetes, two or more islet autoantibodies are repeatedly present, and blood sugars are in the pre-diabetes range.
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Stage 3 type 1 diabetes is the classic stage where most people receive their diagnosis. Children will typically have symptoms of diabetes and will have blood sugars in the diabetes range.
How is type 1 diabetes treated?
Diabetes can be treated by giving back the very hormone that is missing: insulin.
Insulin may be given as several daily injections with either
pens or syringes with very thin and short needles. Insulin injections are most commonly given in the upper part of the arms, in the front of the thighs and in the fatty skin of the belly.
Insulin can also be given through a small wearable device often referred to as an
insulin "pump." The pump delivers insulin through a tiny tube under the skin.
A
healthy diet is also very important in type 1 diabetes. Insulin dosing needs to be matched with the amount of sugar (carbohydrates) taken in. Being
physically active is also key, and insulin often needs to be reduced at times of physical activity.
How are blood sugar levels monitored?
Treatment for type 1 diabetes is aimed at normalizing blood sugar levels. However, this is not a simple task. Blood sugars need to be monitored frequently in type 1 diabetes. This can be done with a
blood glucose meter, a portable device that tests a drop of blood placed on a test strip inserted into the meter.
Monitoring can also be done with a
continuous glucose monitor (CGM). A CGM uses a small sensor to continuously measure the glucose level in the space under the skin.
An
automated insulin delivery system (AID, also called an "artificial pancreas") is another option. With an AID, an insulin pump and a CGM communicate with each other to help regulate the blood sugars.
What to do if you are worried that your child may have type 1 diabetes
Bring your child to see their pediatrician right away. The doctor can easily check for sugar in the urine. They can also take a drop of blood from the finger to check the blood sugar level with a glucose meter. It may be tempting to borrow a glucose meter from a relative or friend to check your child's blood sugar, but we advise against this. You may not do it correctly, and the home meter may not be working properly.
Are some children at higher risk for type 1 diabetes?
Advances in screening have made it possible to assess the risk of developing type 1 diabetes before symptoms appear. People at higher risk, including those with a relative with type 1 diabetes, may be eligible for screening through a
research study. And
other options may be available for those without a type 1 diabetes relative.
Can type 1 diabetes be prevented or delayed?
While type 1 diabetes cannot yet be fully prevented, newer medications can help delay its onset in certain high-risk individuals.
For those at high risk who show early signs of blood sugar abnormalities (stage 2 type 1 diabetes), an
FDA-approved medication is available that can delay the progression to full-blown (stage 3) type 1 diabetes by an average of 2 years. It works by targeting specific immune cells responsible for attacking insulin-producing cells in the pancreas, helping to slow progression of the disease.
Remember
With early detection, timely treatment and the support of primary care providers and pediatric endocrinologists, the management and prognosis of type 1 diabetes continues to improve. This means families can navigate the disease more effectively and embrace a healthier future.
More information
About Dr. Bruggeman
 Brittany S. Bruggeman, MD, FAAP is a member of the American Academy of Pediatrics (AAP) Section on Endocrinology and a pediatric endocrinologist and type 1 diabetes physician scientist at the University of Florida. Dr. Bruggeman is also on the Florida AAP Board of Directors.
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About Dr. Ebo
 Chineze Ebo, MD, FAAP, is a member of the American Academy of Pediatrics Section on Endocrinology and a Pediatric Endocrinology fellow at Cincinnati Children's Hospital Medical Center. Dr. Ebo is also a member of the Ohio AAP chapter.
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