With more than a third of diabetes cases in the United States occurring in people over the age of 65, diabetes is often referred to as an age-related condition. But around 208,000 children and adolescents are estimated to have diabetes, and this number is increasing.
Type 1 diabetes is the most common form of the condition among children and adolescents.
A 2009 report from the Centers for Disease Control and Prevention (CDC) revealed that type 1 diabetes prevalence stands at 1.93 in every 1,000 children and adolescents, while type 2 diabetes affects 0.24 in every 1,000.
The study found that incidence of type 1 diabetes in children aged up to 9 years increased by 21 percent between 2001 and 2009, while incidence of type 2 diabetes among youths aged 10-19 years rose by 30.5 percent.
The researchers note: "The increases in prevalence reported herein are important because such youth with diabetes will enter adulthood with several years of disease duration, difficulty in treatment, an increased risk of early complications and increased frequency of diabetes during reproductive years, which may further increase diabetes in the next generation."
Contents of this article:
Here are some key points about diabetes in children. More detail and supporting information is in the main article.
- Type 1 and 2 diabetes are both increasing in the youth of America
- Often, the symptoms of type 1 diabetes in children develop over just a few weeks
- If type 1 diabetes is not spotted, the child can develop diabetic ketoacidosis (DKA)
What is diabetes in children?
A study found that incidence of type 1 diabetes in children aged up to 9 years increased by 21% between 2001 and 2009.
Type 1 diabetes in children, previously called juvenile diabetes, occurs when the pancreas is unable to produce insulin.
Since insulin is not present, sugar cannot travel from the blood into the cells, and high blood sugar levels can result unless they are treated.
Children with the condition require lifelong insulin injections and blood sugar monitoring, with diet and exercise management to help keep blood sugar levels within their target range.
Type 2 diabetes, although less common in young children, can occur when insulin is not working properly, which then leads to a reduced production of insulin. As a result, glucose can accumulate in the bloodstream.
The condition can often be managed through a change in diet, increasing exercise, and maintaining a healthy weight, although some patients may require diabetes medication - such as metformin.
Symptoms of diabetes in children
The most common symptoms of both type 1 and type 2 diabetes among children and adolescents include increased thirst, urination, and fatigue. Some children may also experience an increase in hunger and blurred vision, while girls might develop a yeast infection.
For those with type 1 diabetes, weight loss is often a common symptom before diagnosis. For those with type 2 diabetes, signs of insulin resistance, such as dark velvety patches of skin, called acanthosis nigricans, and polycystic ovarian syndrome, may be present.
Symptoms of type 1 diabetes in children tend to develop rapidly over a period of a few weeks, while type 2 diabetes symptoms develop more slowly and may go undiagnosed for months or years.
Parents should take their child to the doctor if they notice any of the above symptoms. But despite an increase in diabetes prevalence among children and adolescents, it seems there is a lack of awareness when it comes to identifying symptoms of the condition.
The importance of early detection
According to a 2012 survey from Diabetes U.K., only 9 percent of parents were able to identify the four main symptoms of type 1 diabetes. A more recent survey by the charity found that this percentage had increased to 14 percent.
Barbara Young, chief executive of Diabetes U.K., believes that this is far from good enough:
"In too many cases, children with type 1 diabetes are not diagnosed until they are seriously ill, and in a few tragic cases, this delay in diagnosis can even be fatal."
Children with a delayed diagnosis of type 1 diabetes - and very rarely, a delayed diagnosis of type 2 diabetes - can develop diabetic ketoacidosis (DKA). It is the leading cause of mortality in children with type 1 diabetes. If the body experiences a serious lack of insulin, it is unable to use glucose for energy. As a result, the body begins to break down fat for energy; this leads to the production of chemicals called ketones, which can be toxic at high levels. A build-up of these chemicals causes DKA, where the body becomes acidic.
If diabetes is diagnosed early and managed effectively, DKA is highly preventable. Unfortunately, however, this does not happen often enough.
For younger people with type 2 diabetes, the progression is much faster than adults, and they seem to be at higher risk for complications, such as kidney and eye disease than children with type 1 diabetes.
They also have higher chances of high blood pressure and high cholesterol levels, which raise their risk for vessel disease. Because of this, early detection of type 2 diabetes in younger people is crucial.
Doctors failing to identify diabetes in children
It is not only parents who may be blind to diabetes symptoms among children. Recently, researchers from the United Kingdom warned that many health professionals also fail to identify the signs of the condition and are putting children's lives at risk.
In a study published in the journal Archives of Disease in Childhood, researchers analyzed 261 children aged from 8 months to 16 years who had been diagnosed with type 1 diabetes. Symptoms leading up to their diagnosis were assessed.
The researchers found that by the time children under the age of 2 years were clinically diagnosed with type 1 diabetes, 80 percent of them had already developed DKA.
The study's co-author comments:
"When symptomatic children with undiagnosed type 1 diabetes had multiple contacts with health professionals, they were more likely to present with DKA, and this is very concerning, as we know early diagnosis is essential to enable treatment with insulin and avoid complications."
Dr. Kemi Lokulo-Sodipe, research fellow at Southampton Children's Hospital, U.K.
A 2008 study, published in the journal Pediatric Endocrinology, Diabetes and Metabolism, found that among 335 children under the age of 17 with new-onset type 1 diabetes, the initial diagnosis was incorrect in more than 16 percent of cases.
The study revealed that among these cases, doctors initially diagnosed 46.3 percent of children with a respiratory system infection, while others received a diagnosis of perineal candidiasis (16.6 percent), gastroenteritis (16.6 percent), urinary tract infection (11.1 percent), stomatitis (11.1 percent), or appendicitis (3.7 percent).
Furthermore, the researchers found that incidence of DKA was more frequent among children who received an incorrect - and therefore delayed - diagnosis of type 1 diabetes.
Although children and adolescents with diabetes usually experience four main symptoms, Young notes that having all four symptoms is "the exception rather than the rule," noting that many children may only have one or two. In some cases, no symptoms will be present.
As such, a child suddenly becoming more thirsty or tired may not ring diabetes alarm bells for a parent. And because diabetes is much rarer among very young children, doctors may attribute any symptoms to other, more common illnesses.
Ensuring early detection of child diabetes
So what can be done to ensure that children who have symptoms of diabetes are diagnosed early and receive adequate treatment?
"As a nation, we need to emphasize that type 1 diabetes is common, and the incidence is increasing," says Dr. Lokulo-Sodipe. "It can present in babies and young children, and it should be at the top of the list in any child with increased toileting - including heavy wet nappies and bedwetting - but also weight loss and fatigue."
In 2012, Diabetes U.K. launched the "4 Ts" campaign - aimed at increasing awareness of the symptoms of type 1 diabetes that children may experience.
Campaigns that aim to increase awareness of child diabetes symptoms have proved successful in the past. A 2012 study, published in the journal Pediatric Diabetes, revealed that during such a campaign in Australia, the rate of DKA at initial diagnosis of type 1 diabetes in children reduced by 64 percent.
The 4 Ts that Diabetes U.K. say people should be aware of in children are:
- Toilet - using the toilet frequently, heavier nappies in babies or bedwetting from a previously dry child
- Thirsty - drinking more fluids than usual but being unable to quench thirst
- Tired - feeling more tired than usual
- Thinner - weight loss
A video providing more information on the 4 Ts can be viewed below:
The organization says that if a child is showing any of the 4 Ts, parents should take them to the doctor and insist on an immediate type 1 diabetes test. This consists of a finger-prick test in which the child's blood is analyzed to determine their glucose level.
"As well as making parents and those who look after and work with children aware of the symptoms, we need to increase understanding that a child who has any of the 4 Ts needs to be tested straight away.
This is because onset can be so quick that a delay of a matter of hours can be the difference between being diagnosed at the right time and being diagnosed too late."
Barbara Young, chief executive of Diabetes U.K.
For those with type 2 diabetes, following the suggested testing guidelines as recommended by the American Diabetes Association (ADA) can help improve diagnosis.
The ADA recommends testing asymptomatic children who are overweight (over 85 percentile for body mass index or over 120 percent ideal weight for height) if they have any two of the following risk factors:
- Family history of type 2 diabetes in a first or second degree relative
- High-risk ethnicity (Native American, African American, Latino, Asian American, or Pacific Islander)
- Signs of insulin resistance
- Maternal history of diabetes or gestational diabetes during the child's gestation
The outcomes for children with type 1 and type 2 diabetes are greatly improved with early detection.