The world celebrates World Diabetes Day on November 14, which aims to raise awareness of the risks of this disease, its complications, and ways to deal with it. Type 1 diabetes is one of the most common types among children, and requires special care to avoid complications. In the following lines, "Dalili Medical" reviews the impact of diabetes on children and ways to detect and deal with it.

**What is the role of insulin?**

 

Insulin is a hormone produced in the pancreas, where the pancreas secretes insulin into the bloodstream, allowing glucose to enter the cells. Thus, insulin reduces the level of sugar in the blood and helps regulate its secretion from the pancreas.

**What is the role of glucose?**

 

Glucose or sugar is the main source of energy for the cells that make up muscles and other tissues. Glucose has two main sources: food and liver stores. Sugar is absorbed from the bloodstream and enters the cells with the help of insulin, while the liver stores excess glucose that the cells do not need in the form of glycogen. When glucose levels drop, such as when fasting for long periods, the liver breaks down stored glycogen and converts it into glucose to keep blood sugar levels within the normal range.

**Types of Diabetes in Children**

 

Children can develop either type 1 or type 2 diabetes. Type 1 diabetes was previously known as “juvenile diabetes” because it is more common in children, while type 2 diabetes was referred to as “adult diabetes” because it was not common in children. However, the incidence of type 2 diabetes in children has increased recently.

Here is an explanation of each of the two types of diabetes that children can develop:

**Juvenile Diabetes Type 1**

 

Juvenile diabetes type 1 is a disorder that results from the pancreas not being able to produce insulin, a hormone that helps the glucose absorbed from food enter the body’s cells. As a result of the lack of insulin production, glucose cannot move from the blood into the cells, leading to high blood sugar levels and the body not using glucose as a source of energy.

**Type 2 Diabetes in Children**

 

Type 2 diabetes occurs when there is a deficiency in insulin production from the pancreas or when the body does not respond to insulin properly, leading to what is known as insulin resistance, and thus the level of glucose in the blood increases.

**What is the difference between type 1 and type 2 diabetes?**

 

Although there are some commonalities between type 1 and type 2 diabetes, there are significant differences in many aspects, such as causes and treatment methods. Many may wonder which is more dangerous, type 1 or type 2, but both types pose a risk, as high blood sugar levels can lead to serious health complications.

One of the most prominent differences between type 1 and type 2 diabetes is the way insulin is secreted:

 

- In type 1 diabetes, the pancreas stops producing insulin because the body attacks and destroys the pancreatic cells.

- In type 2 diabetes, the pancreas produces insulin, but in insufficient quantities to meet the body's needs, or the cells do not respond to insulin properly. As the disease progresses, the pancreas may stop producing insulin altogether.

As for the symptoms, they are similar between the two types, but the symptoms of type 1 diabetes appear faster compared to type 2, which develops slowly. Unlike type 2 diabetes patients, type 1 patients do not usually suffer from obesity.

Regarding treatment, type 1 diabetes depends only on insulin, while type 2 can be treated with multiple drug and non-drug methods, and insulin may be required in some cases.

**Normal sugar levels after eating for children**

 

Blood sugar levels in healthy children range between 70 and 150 mg/dL. It is normal for glucose levels to vary from one child to another or at different times, but they remain within this range.

Blood sugar levels are usually higher after eating a meal, and decrease after intense exercise.

Normal sugar levels in children vary according to age as follows:

- **Children from one day to five years:**

 

- The normal rate of fasting sugar: 100 mg/dL.

- Normal blood sugar after eating: 180-200 mg/dL.

- **Children from 5 to 11 years:**

 

- Normal fasting blood sugar: 70 mg/dL.

- Normal blood sugar after eating two hours: 150 mg/dL.

**What is insulin?**

 

Insulin is a hormone produced in the pancreas that acts as a key that allows glucose from food to move from the bloodstream into the body's cells to produce energy. After carbohydrates in foods are broken down into glucose in the blood, insulin helps bring this glucose into the cells.

**Is abdominal pain a symptom of diabetes in children?**

 

Yes, abdominal pain and vomiting are digestive symptoms associated with diabetes in children, and these symptoms often appear when blood sugar levels rise significantly, leading to a condition known as diabetic ketoacidosis, which usually occurs if the disease is not diagnosed early. Abdominal pain in children with diabetes may be accompanied by other symptoms such as vomiting, bloating, nausea, and diarrhea.

**What are the symptoms of diabetes in infants?**

 

Newborn or infant diabetes, known as neonatal diabetes, is a rare condition that usually occurs within the first six months after birth. Diabetes in infants is different from type 1 diabetes, which is more common and usually appears in children older than six months.

About half of infants diagnosed with diabetes develop a lifelong condition called diabetesNeonatal diabetes is a permanent condition that occurs in one in 260,000 babies worldwide. The other half may have a condition that goes away within three months after birth, but it can recur later, known as transient or temporary neonatal diabetes.

When blood glucose levels rise significantly, the body excretes some glucose through urine, leading to symptoms of diabetes in infants, including:

- Increased number of wet diapers.

- Increased appetite.

- Dry skin.

- Weight loss despite regular breastfeeding.

- Vomiting that may last for three or four days without a clear cause.

**When do diabetes symptoms appear in children?**

 

In most cases, diabetes symptoms appear in children after the age of five, but some children may not show any symptoms until they reach their late thirties. It is important for parents to monitor their children and not ignore any symptoms, and to quickly consult a doctor to find out the reasons for any changes in the child, which helps avoid any future complications that may result from delayed diagnosis.

**Does diabetes disappear in children?**

 

Neonatal diabetes, which appears in newborns before six months, can disappear, as we mentioned earlier. In this case, neonatal diabetes is transient or temporary, as it usually disappears during the first year, often in the first three months after birth, and may return later in the future.

As for type 1 diabetes, it is unfortunately a chronic condition for which there is no definitive cure. Treatment in this case aims to maintain sugar levels within the normal range, and prevent any complications or health risks that may result from its rise.

**Causes of type 1 diabetes in children**

 

If your child has recently been diagnosed with type 1 diabetes, you may wonder about the reasons behind it, and whether you can do anything to prevent it from happening. Genetic and environmental factors play a major role in the development of type 1 diabetes in children.

**Environmental and genetic factors**

 

These factors can contribute to accelerating or starting the process of destroying beta cells. There are known genes that increase the risk of diabetes, and others that protect against it. However, even in identical twins (who carry identical genes), the risk of the other twin developing type 1 diabetes ranges from 1-65%. Therefore, it can be concluded that type 1 diabetes in children is not caused solely by genetic factors.

The risk of developing type 1 diabetes and also the risk of developing other autoimmune diseases increases if one of the parents or siblings has diabetes or immune-related diseases. These diseases include:

- Hashimoto's disease (hypothyroidism)

- Graves' disease (hyperthyroidism)

- Celiac disease

- Rheumatoid arthritis

- Lupus

- Multiple sclerosis

- Albinism and others

**Viral infections**

 

Viral infections can contribute to the development of type 1 diabetes in children. Viruses either indirectly stimulate the immune system or directly damage beta cells.

According to the so-called acceleration theory, certain factors (such as genetics and being overweight) can cause insulin-producing beta cells to overwork, increasing the risk of diabetes.

**Hygiene and the immune system**

 

Ironically, the development of type 1 diabetes may also be linked to high levels of hygiene.

**Dietary errors**

 

Dietary errors, such as eating large amounts of processed foods, early feeding with cow's milk, gluten, and toxic substances (such as N-nitroso compounds), can be possible causes of type 1 diabetes in children.

**Vitamin D3 deficiency**

 

In addition, vitamin D3 deficiency may be another cause of type 1 diabetes in children. Epidemiological studies indicate that type 1 diabetes is much less common in countries with more sun exposure throughout the year, which means that vitamin D deficiency is less common there.

**Gestational diabetes**

 

Children whose mothers have gestational diabetes are more likely to develop type 1 diabetes.

**Stress**

 

Stress can be a contributing factor in the development of type 1 diabetes. Psychological stress can accelerate the onset of the disease.

**Type 1 diabetes and sweets**

 

It is a misconception that eating too many sweets is the cause of type 1 diabetes in children. This type of diabetes occurs when the body stops producing insulin, not as a result of excessive sugar intake. So, the saying "Don't eat sweets because you will get diabetes" is a misconception.

**Symptoms of type 1 diabetes in children**

 

Symptoms of type 1 diabetes appear when about 90% of the beta cells in the pancreas are destroyed. Common symptoms include:

- **Increased thirst and frequent urination**: If your child wakes up frequently at night to go to the bathroom and drinks large amounts of fluids, this may be a sign of type 1 diabetes.

- **Unexplained weight loss**: If your child drinks a lot, urinates frequently, and loses weight without changing his diet, this may be an indication of the disease. Parents may notice that their children are eating more and still losing weight.

- **Acetone-like breath**: If there is an abnormal odor from the child's mouth, other symptoms associated with diabetes should be checked.

- **Increased weakness and sleepiness**: If your child loses interest in playing or ignores his schoolwork, this could be a sign of diabetes.

- **Dry skin**: As a result of dehydration caused by the disease.

- **Leg cramps**.

- **Deterioration in visual acuity**.

- **InflammationFrequent**: such as mouth or genital infections.

- **Learning and concentration difficulties**: The child may have problems at school or appear irritable.

**Ketoacidosis**

 

If the above symptoms appear and the insulin deficiency continues for a long time, ketoacidosis may develop, which includes:

- Increased weakness and drowsiness.

- Stomach pain, nausea and vomiting.

- Rapid and deep breathing.

- Disturbances in consciousness.

- Diabetic coma.

**What are the methods for diagnosing type 1 diabetes?**

 

Type 1 diabetes can be diagnosed relatively easily through a set of the following tests:

1. **Blood glucose test:**

 

Health care providers use a blood glucose test to measure blood sugar levels. A random test (without fasting) or a fasting test (not eating or drinking for at least eight hours before the test) may be ordered. If the results show a significant increase in sugar levels, this usually indicates type 1 diabetes.

2. **HbA1c Test:**

 

If your blood glucose test results show diabetes, your provider may order an HbA1c test, which measures your average blood sugar levels over a three-month period.

3. **Antibody Test:**

 

This test is used to detect antibodies to determine whether you have type 1 or type 2 diabetes. Antibodies are proteins that mistakenly attack your body’s own tissues, and the presence of certain autoantibodies indicates type 1 diabetes, as these antibodies are not usually found in people with type 2 diabetes.

4. **Urine Analysis:**

 

A urinalysis is a test that examines the visual, chemical, and microscopic aspects of your urine. In type 1 diabetes, this test may be ordered to check for ketones, which are substances your body releases when it needs to break down fat for energy instead of using glucose.

5. **Arterial Blood Gases:**

 

Arterial blood gas (ABG) is a test that requires a sample from an artery in the body to measure the levels of oxygen and carbon dioxide in the blood.

**Can Type 1 Diabetes Be Prevented?**

 

Unfortunately, there are no effective ways to prevent type 1 diabetes. Because this type of diabetes can be hereditary, healthcare providers can test family members for autoantibodies associated with the disease. The presence of these antibodies, even in the absence of symptoms, means that a person may be at higher risk for type 1 diabetes.

**How ​​is diabetes tested in children?**

 

If you notice signs or symptoms in your child that may indicate type 1 diabetes, there are a number of tests that can be used to confirm the diagnosis, including:

**Random blood sugar test**

 

This is the first test that doctors rely on to diagnose diabetes, as a blood sample is taken at any time. If your child’s blood sugar level is above 200 mg/dL, this indicates that he or she may have diabetes.

**Fasting blood sugar test**

 

In this test, the doctor takes a blood sample after the child has fasted overnight. If the blood sugar level is higher than 126 mg/dL, it indicates the possibility of type 1 diabetes.

**Two-hour postprandial blood sugar test**

 

Also known as the fasting blood sugar test, a blood sample is taken two hours after eating a meal to assess the effect of food on the blood sugar level. If the glucose level two hours after a meal is higher than 160 mg/dL, it may be an indication that the child has diabetes.

**HbA1c test**

 

This test aims to measure the child's average blood sugar level over the past three months. If the HbA1c is higher than 6.5% in two different tests, this is an indication of diabetes.

There are additional tests that can be used to determine whether your child has type 1 or type 2 diabetes, such as:

**Urine sugar test**

 

It is used to detect the presence of ketones, which indicate type 1 diabetes.

**What are the complications of type 1 diabetes?**

 

If blood sugar levels are not controlled or symptoms and treatment are not paid attention to quickly, complications may appear that affect many vital organs in the body, the most serious of which are:

- Ketone formation, which is a serious condition that requires treatment in the pediatric intensive care unit, as it can lead to coma, loss of consciousness, and swelling of the brain due to a sharp rise in blood sugar levels.

- Damage to blood vessels.

- Peripheral neuropathy.

- Damage to the nerves of the eye.

- Kidney disease.

- Gum infections and tooth loss.

- Osteoporosis.

- Hearing disorders.

**Treatment**

 

Type 1 diabetes treatment includes several main aspects. Children with this type of diabetes are treated with insulin injections, as the required dose varies from one patient to another. The insulin dosing plan usually includes two types: rapid-acting insulin, which is used mostly during the day, and slow-acting insulin, which helps control blood sugar levels while sleeping at night.

In the early stages of the disease, young children may need small, frequent doses of insulin, and may not need the night dose at first, but as they get older, this dose becomes necessary. The use of insulin pumps is common among children with diabetes, as controlling blood sugar levels is vital to avoid complications. It is important to note that children's insulin needs increase as they get older, so the dosing regimen must be adjusted periodically.

**Receiving insulin**

 

-Monitoring blood sugar levels

- Eating healthy foods

- Exercising regularly

Parents will work closely with a diabetes treatment team that includes a doctor, a certified diabetes care professional, and a registered dietitian. The goal of treatment is to keep your child’s blood sugar levels within a specific range, helping them get as close to normal as possible. Your child’s doctor will determine the target range for blood sugar levels, and this range may change as your child grows and changes.

**Insulin**

 

Anyone with type 1 diabetes requires lifelong treatment with one or more types of insulin to survive. There are several types of insulin available, including:

1. **Rapid-acting insulin**: It starts working within 15 minutes, peaks within 60 minutes, and lasts for about 4 hours. It is usually given 15 to 20 minutes before meals. Examples include lispro (Humalog, Admelog), aspart (NovoLog, Fiasp), and glulisine (Apidra).

2. **Short-acting insulin**: Sometimes known as regular insulin, it starts working after about 30 minutes, peaks in 90 to 120 minutes, and lasts for 4 to 6 hours. Examples include human insulin (Humulin R, Novolin R).

3. **Intermediate-acting insulin**: Also known as insulin NPH, it starts working within 1 to 3 hours, peaks in 6 to 8 hours, and lasts for 12 to 24 hours. Examples include (Humulin N, Novolin N).

4. **Long-acting and extended-acting insulin**: Provides an effect that lasts 14 to 40 hours. Examples include glargine (Lantus, Toujeo), detemir (Levemir), and degludec (Tresiba).

**Insulin Delivery Options**

 

Insulin delivery options include:

1. **Needle and Micro-Syringe**: This option is similar to the injection used in a doctor’s office, but it uses a smaller syringe and a much shorter, thinner needle.

2. **Insulin Pen with Micro-Syringe**: This device looks like a pen, its cartridge is filled with insulin, and it is used with a needle for injection.

3. **Insulin Pump**: This is a small device worn outside the body, programmed to deliver specific amounts of insulin throughout the day and when you eat. The device connects to a reservoir of insulin through a tube that is inserted under the skin of the abdomen.

There is also a tubeless pump option, where a pouch containing insulin is worn on the body, with a small catheter that is inserted under the skin.

**Blood Sugar Monitoring**

 

You or your child will need to check and record your child’s blood sugar at least four times a day. This can usually be done before each meal and at bedtime, and sometimes in the middle of the night. However, you may need to test more frequently if your child does not have a continuous glucose monitor.

Testing frequently is the only way to ensure that your child’s blood sugar stays within the target range.

**Continuous glucose monitors (CGMs)**

 

CGMs measure blood sugar levels every few minutes using a sensor implanted under the skin. Some devices display the blood sugar reading continuously on a receiver, smartphone, or smartwatch, while others require you to check your blood sugar by holding the receiver over the sensor.

**Closed loop system**

 

A closed loop system is a device implanted in the body that connects a CGM to an insulin pump. The monitor checks blood sugar levels regularly, and the device automatically delivers the right amount of insulin based on monitoring needs.

The U.S. Food and Drug Administration has approved several hybrid closed loop systems for the treatment of type 1 diabetes. These systems are called “hybrid” because they require some input from the user, such as entering the amount of carbohydrates consumed or checking blood sugar levels occasionally.

So far, no closed loop system has emerged that does not require any user input, but several of these systems are currently undergoing clinical trials.

How can I deal with a child with diabetes?

 

Dealing with a child with diabetes is a major challenge that can cause stress and psychological pressure for both parents and the child. However, it is important to deal with this situation wisely and consciously.

By following the doctor's instructions, modifying eating habits, and controlling calorie and sugar intake, dealing with the condition can become easier and more comfortable.

It is necessary to monitor and measure blood sugar levels on a daily basis. The child's diet must be adhered to, calculating the daily calories and the percentage of carbohydrates and sugars he consumes.

The body should be avoided starving to avoid complications when taking insulin doses. It is also important to replace unhealthy foods with balanced and healthy foods, which helps reduce the risk of high blood sugar levels and protect the rest of the body's organs.

Regular exercise also enhances the efficiency of the body's systems and helps improve the body's response to insulin, in addition to reducing stress levels.