Symptoms related to diabetes to watch for in your child

Diabetes is a severe chronic disease that happens when your body is not producing enough insulin, not producing it at all, or cannot make effective use of the insulin as needed. Insulin is made by the pancreas, which controls the amount of glucose and aids it into our cells. Though thought to be that diabetes only affects older age, children can also develop the disease, according to CDC. Let's dive deeper to note the warning signs of diabetes in your children.

There are two main types of diabetes, and both can affect children: type 1 and type 2.

Type 1 diabetes is when the body produces very little to no insulin. This is an autoimmune disease where the body's defense system attacks the cells that produce the hormone insulin. Type 1 diabetes can develop at any age but is usually diagnosed in children and young adults who have diabetes for life. Patients with this type need to take insulin daily to control their blood glucose levels and thus, survive. Based on the AACE article, approximately 5% have Type 1 Diabetes, which roughly impacts about 20 million individuals worldwide.

Type 2 diabetes, on the contrary, is when the body does not use insulin well. Although it often occurred in middle-aged and older adults and was once called adult-onset diabetes, this can also affect children. This is the most common type of the disease and accounts for 424 million individuals, according to NCBI. The cornerstone of Type 2 Diabetes is primarily a healthy lifestyle such as a healthy diet and regular exercise. However, patients might also require oral drugs and insulin to control their blood glucose levels over time. 

SYMPTOMS AND WARNING SIGNS OF DIABETES TO WATCH FOR IN CHILDREN

In type 1 diabetes, signs and symptoms are mainly the same for most people, but parents and caregivers must be watchful and aware of possible warning signs. Symptoms in children include the following:

• increased thirst and urination
• blurred vision
• tiredness
• unexplained weight loss
• increased hunger

These symptoms take place over a few days to weeks. The most common and first signs include increased thirst and urination, which might happen with diabetic ketoacidosis (DKA). This is a paramount concern when the body enters a condition of ketosis due to a lack of glucose entering the cells. At this point, the body begins converting lipids into ketones, which it uses as energy.

Parents must also look for symptoms of DKA in their child as this is a medical emergency; this includes:

• nausea or vomiting
• dry or flushed skin
• fruity-smelling breath
• difficulty breathing
• stomach pain
• difficulty thinking

In type 2 diabetes, signs and symptoms are not always apparent. The disease progresses gradually and may continue for a long time before detection. This means that children occasionally may not show any. 

• frequent urination
• feeling thirsty
• frequent hunger 
• extreme fatigue
• blurred vision
• cuts and bruises that can be slow to heal
• tingling, pain, or numbness in the hands or feet

What are the causes of diabetes in children?

Type 1 diabetes, as aforementioned, is an autoimmune disorder, wherein if a person has this condition, their immune system attacks their healthy cells. What specifically triggers the immune system to attack pancreatic cells is still unknown. Yet risk factors may be increased by certain hereditary factors. For instance, those with the genes HLA-DR3-DQ2, HLA-DR4-DQ8, or both are more likely to develop type 1 diabetes. If a parent has type 1 diabetes, a kid may be at risk of developing the disease from 1 in 17 to 1 in 25.

Type 2 diabetes has two leading causes: the child's pancreas does not make an adequate amount of insulin as needed, or the body does not react appropriately to the insulin produced. It is strongly correlated with being overweight, as insulin resistance is more likely to occur with this condition. High blood sugar level results in several potentially significant health issues as the body attempts to control insulin.

How are children with type 1 and type 2 diabetes diagnosed?

A pediatrician should do blood tests to diagnose suspected type 1 diabetes. This includes:

• Random blood sugar test. This is given at any time during the day, and according to an article, this is used as the primary screening test for type 1 diabetes.
• Glycated hemoglobin A1C. This is also given at any time during the day; it measures your average blood sugar levels over the past few months.
• Test for autoantibodies. As Type 1 Diabetes is an autoimmune disease, checking for autoantibodies is crucial to differentiate this condition from Type 2 Diabetes. Ketone-checking might also be done through urine samples as the presence of ketones in the urine is unlikely to be the other type of disease.

Meanwhile, in diagnosing type 2 diabetes, your child's symptoms and lifestyle are essential to the diagnosis. Glycated hemoglobin A1C is done as well, like in Type 1. However, some tests are added. Other tests are:

• Fasting plasma glucose. This tests the blood after at least 8 hours of not eating.
• Oral glucose tolerance test. This test measures blood glucose levels 2 hours after drinking a glucose drink.

Since treatment plans for type 1 and type 2 diabetes are different, your health care provider may advise further testing to make the distinction.

How is diabetes treated and managed in children?

Upon a diabetes diagnosis in your child, the pediatrician and other health providers would start establishing a diabetes management plan with the patient and the patient's parents. The approach will be determined by the child's lifestyle, preferences, health objectives, and other health conditions.

Type 1 diabetes treatments for children are: 

• Taking insulin
• Monitoring blood sugar
• Eating healthy foods
• Exercising regularly

INSULIN

Patients who have type 1 diabetes are those who will be having the disease for life and thus needs lifelong treatment of one or more types of insulin to survive. These types of insulin are the following:

• Rapid-acting insulin. Works within 15 minutes. It lasts roughly 4 hours and has its peak effect after 60 minutes. This is often used 15 to 20 minutes before meals. Lispro (Humalog, Admelog), aspart (NovoLog, Fiasp), and glulisine (Apidra) are among the examples of this type.
• Short-acting insulin. Often known and called regular insulin, this starts working around 30 minutes after injection. It lasts between 4 and 6 hours and reaches its full effect around 90 to 120 minutes. Examples are human insulin (Humulin R, Novolin R).
• Intermediate-acting insulin. Also called NPH insulin, it works in about 1 to 3 hours. It achieves a peak effect at 6 to 8 hours and lasts about 12 to 24 hours. Examples are NPH insulin (Humulin N, Novolin N).
• Long- and ultra-long-acting insulin. The name provides the most prolonged coverage for as long as 14 to 40 hours. Glargine (Lantus, Toujeo, other), detemir (Levemir), and degludec (Tresiba) are examples of it. 

Subcutaneous insulin injection is the most common route of insulin administration. The attending physician may deliver insulin administered to children with type 1 diabetes in the following options:

• Fine needle and syringe. This comes with a small syringe and a very thin and short needle.
• Insulin pen with a fine needle. This device resembles an ink pen, except the cartridge is filled with insulin and has a needle for injection.
• Insulin Pump. This small device, which is programmed to supply a certain amount of insulin throughout the day and at mealtimes, was worn by the patient outside their body. A catheter is implanted beneath the skin of the patient's abdomen and is connected to an insulin reservoir by a tube.

MONITORING BLOOD SUGAR

The blood sugar of a diabetic child must be checked and recorded at least four times every day. Before each meal, at bedtime, and occasionally in the middle of the night, the parent or child tests their blood sugar. The more frequent blood sugar testing, the better, ensuring that the child's glucose level remains within the reference range. 

HAVING HEALTHY DIET

The child's diet substantially influences the diabetes treatment and management plan. The dietary plan does not have to be a restrictive eating regimen. Just like what we are taught in health lessons at school and at home, nutritious foods low in calories and fats, such as vegetables, fruits, lean protein, and whole grains, should regularly be included in the diet. 

A dietitian working with the physician attending this management can develop a suitable meal plan that suits your child's preferences and health objectives.

REGULAR EXERCISE

Everyone, especially those with type 1 diabetes, should engage in regular exercise.

Any physical activity may impact blood sugar levels by causing them to stay at a certain level for hours or even overnight. It's important to check blood sugar levels more frequently if your child starts a new activity. Additionally, when new activities are created, the child's diet plan or insulin doses for increased exercise must be changed. Ensure that this physical activity will be part of your child's everyday routine. Lastly, encouraging them to engage in physical activities might also mean you do it with them for at least 60 minutes daily.

Type 2 diabetes treatment is lifelong and can include:

• Healthy diet
• Regular physical activity
• Insulin or other medications
• Blood sugar monitoring
• Weight-loss surgery, in some cases

HAVING HEALTHY DIET

What your child eats substantially influences the diabetes treatment and management plan. In type 2 diabetes, being overweight or obese is a risk factor, which is why your health care team may recommend weight loss to improve the blood sugar levels of your child. The same goes with type 1 diabetes, and it is highly suggested to include foods that are high in nutritional value and low in fat and calories but high in fiber, such as fruits, vegetables, nuts, whole grains, and olive oil.

The dietician can help you create a dietary plan to achieve your child's goals without compromising their food preferences or nutrition.

PHYSICAL ACTIVITY 

We all know that everyone should engage in regular exercise, especially diabetic children. 

Physically active children are better able to manage their weight, utilize the sugar produced for energy, and effectively use insulin, lowering their blood glucose levels. Again, ensuring that your child regularly engages in physical activity is vital. You can spread out at least 60 minutes of physical activity throughout the day rather than having to do it all at once. Finally, motivating them to exercise may require you to do it with them for at least 60 minutes each day.

MEDICATIONS

Several people with type 2 diabetes can control their blood sugar levels by diet and exercise. Others might require diabetes medications, insulin shots, and other treatments. The attending pediatrician may recommend one or more drugs as part of this approach.

According to Mayo Clinic, the Food and Drug Administration (FDA) has approved the use of three drugs for treating type 2 diabetes in children.

• Metformin (Glumetza, others). This helps reduce the sugar a child's liver releases into the bloodstream between meals and helps the body's cells use insulin more effectively.
• Liraglutide (Victoza). This medicine is administered intravenously. After meals, when blood sugar levels are more remarkable, it aids in the body's production of more insulin from the pancreas. The adverse effects of this drug on the digestive system could include nausea or diarrhea.
• Insulin. In some cases, insulin may be required if your child's blood sugar levels are high. Insulin lowers blood sugar levels by allowing sugar to enter cells for energy.

BLOOD SUGAR MONITORING 

You will check your child's blood sugar levels as frequently as your doctor instructs. Children taking drugs, particularly insulin, typically require more regular testing, sometimes four times per day or more.

Continuous glucose monitoring can be a possibility, depending on the treatment requirements. The more frequently blood sugar levels are checked, the more likely the child's glucose level will stay within the reference range as it is well-monitored.

WEIGHT-LOSS SURGERY

This option is not for everyone. Parents and the child may improve the management of type 2 diabetes if they undergo weight-loss surgery, particularly if the child's body mass index (BMI) is at or above 35, which is considered substantially obese.

Your healthcare team will evaluate how efficiently you control your child's diabetes at least once a year. You could need to make modifications to the management strategy, or you might need extra guidance and assistance. Your child's diabetes management plan might also alter because of a change in their health (such as a new diagnosis or complication) or their level of care (for instance, being discharged from the hospital).

Growing numbers of children and adolescents are developing diabetes. Disregarding warning signs may result in complications and, regrettably, unfortunate outcomes. Giving these diabetic kids the tools they need to manage their disease effectively as a parent, family, caregiver, or healthcare provider can increase their chances of living long, healthy lives.