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Type 1 diabetes in children

Type 1 diabetes in children is a condition in which your child's pancreas no longer produces the insulin your child needs to survive, and you'll need to replace the missing insulin. Type 1 diabetes in children used to be known as juvenile diabetes or insulin-dependent diabetes.

The diagnosis of type 1 diabetes in children can be overwhelming at first. Suddenly you and your child — depending on his or her age — must learn how to give injections, count carbohydrates and monitor blood sugar.

Although type 1 diabetes in children requires consistent care, advances in blood sugar monitoring and insulin delivery have improved the daily management of type 1 diabetes in children.

Symptoms Causes Risk factors Complications Prevention

The signs and symptoms of type 1 diabetes in children usually develop quickly, over a period of weeks. Look for:

  • Increased thirst and frequent urination. As excess sugar builds up in your child's bloodstream, fluid is pulled from the tissues. This may leave your child thirsty. As a result, your child may drink — and urinate — more than usual.
  • Extreme hunger. Without enough insulin to move sugar into your child's cells, your child's muscles and organs become energy-depleted. This triggers intense hunger.
  • Weight loss. Despite eating more than usual to relieve hunger, your child may lose weight — sometimes rapidly. Without the energy sugar supplies, muscle tissues and fat stores simply shrink. Unexplained weight loss is often the first sign to be noticed.
  • Fatigue. If your child's cells are deprived of sugar, he or she may become tired and lethargic.
  • Irritability or unusual behavior. Children with undiagnosed type 1 diabetes may suddenly seem moody or irritable.
  • Blurred vision. If your child's blood sugar is too high, fluid may be pulled from the lenses of your child's eyes. This may affect your child's ability to focus clearly.
  • Yeast infection. Girls with type 1 diabetes may have a genital yeast infection, and babies can develop diaper rash caused by yeast.

When to see a doctor

Talk to your child's doctor if you notice any of the signs or symptoms of type 1 diabetes — increased thirst and frequent urination, extreme hunger, weight loss, blurred vision, or fatigue.

The exact cause of type 1 diabetes is unknown. Scientists do know that in most people with type 1 diabetes the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas. Genetics may play a role in this process, and exposure to certain viruses may trigger the disease.

Insulin key to sugar entering cells

Whatever the cause, once the islet cells are destroyed, your child will produce little or no insulin. Normally the hormone insulin helps glucose enter your child's cells to provide energy to the muscles and tissues. Insulin comes from the pancreas, a gland located just behind the stomach.

When everything is working properly, once you eat, the pancreas secretes more insulin into the bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter the body's cells. Insulin lowers the amount of sugar in the bloodstream, and as the blood sugar level drops, so does the secretion of insulin from the pancreas.

The liver acts as a glucose storage and manufacturing center. When insulin levels are low — when you haven't eaten in a while, for example — the liver releases stored glycogen, which is then converted to glucose to keep your blood glucose level within a normal range.

Dangerous sugar level in bloodstream

In type 1 diabetes, none of this occurs because there's no or very little insulin to let glucose into the cells. So instead of being transported into your child's cells, sugar builds up in your child's bloodstream, where it can cause life-threatening complications.

The cause of type 1 diabetes is different from the more common type 2 diabetes. In type 2, the islet cells are still functioning, but the body becomes resistant to insulin or the pancreas doesn't produce enough insulin.

There aren't many known risk factors for type 1 diabetes, though researchers continue to find new possibilities.

Known risk factors

These include:

  • A family history. Anyone with a parent or siblings with type 1 diabetes has a slightly increased risk of developing the condition.
  • Genetic susceptibility. The presence of certain genes indicates an increased risk of developing type 1 diabetes. In some cases — usually through a clinical trial — genetic testing can be done to determine if a child who has a family history of type 1 diabetes is at increased risk of developing the condition.

Possible risk factors

Possible risk factors for type 1 diabetes include:

  • Viral exposure. Exposure to Epstein-Barr virus, coxsackie virus, rubella or cytomegalovirus may trigger the autoimmune destruction of the islet cells, or the virus may directly infect the islet cells.
  • Low vitamin D levels. Research suggests that vitamin D may protect against type 1 diabetes. However, early intake of cow's milk — a common source of vitamin D — has been linked to an increased risk of type 1 diabetes.
  • Other dietary factors. Drinking water that contains nitrates may increase the risk of type 1 diabetes. The timing of the introduction of cereal into a baby's diet also may affect a child's risk of type 1 diabetes. One clinical trial found that between ages 4 and 7 months appears to be the optimal time for introducing cereal.

Type 1 diabetes can affect nearly every major organ in your child's body, including the heart, blood vessels, nerves, eyes and kidneys. The good news is that keeping your child's blood sugar level close to normal most of the time can dramatically reduce the risk of these complications.

Long-term complications of type 1 diabetes develop gradually. Eventually, if blood sugar levels aren't well-controlled, diabetes complications may be disabling or even life-threatening.

  • Heart and blood vessel disease. Diabetes dramatically increases your child's risk of various cardiovascular problems — including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure — later in life.
  • Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your child's nerves, especially in the legs. This can cause tingling, numbness, burning or pain.  Nerve damage usually happens gradually over a long period of time.
  • Kidney damage (nephropathy). Diabetes can damage the numerous tiny blood vessel clusters that filter waste from your child's blood. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.
  • Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy). Diabetic retinopathy can cause blindness. Diabetes can also lead to cataracts and a greater risk of glaucoma.
  • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections.
  • Skin conditions. Diabetes may leave your child more susceptible to skin problems, including bacterial infections, fungal infections and itching.
  • Osteoporosis. Diabetes may lead to lower than normal bone mineral density, increasing your child's risk of osteoporosis as an adult.

There's nothing you or your child could have done to prevent type 1 diabetes; there is currently no known way to prevent type 1 diabetes.

Tests can be done in children who have a high risk of developing type 1 diabetes to see if they have any of the antibodies associated with this disorder. However, the presence of these antibodies doesn't mean that diabetes is a certainty, and there's currently no known way to prevent type 1 diabetes if the antibodies are found.

Researchers are working on preventing type 1 diabetes in people who have a high risk of developing the disease, such as those who have the type 1 antibodies, and others are working on preventing further destruction of the islet cells in people who are newly diagnosed.

Some children with type 1 diabetes may be eligible for clinical trials, but you need to carefully weigh the risks and benefits of any treatment available in a clinical trial with your doctor.

While there's nothing you could have done to prevent your child's diabetes, you can help your child prevent complications due to type 1 diabetes by helping him or her maintain good blood sugar control as much as possible.

In addition, be sure to schedule regular visits with your child's diabetes doctor and a yearly eye exam beginning no more than five years after the initial diabetes diagnosis.

And, like everyone else, people with type 1 diabetes should eat a healthy diet full of fruits, vegetables and whole grains and participate in regular physical activity to help keep their hearts healthy.

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