Diabetes in children
and Martina Feichter, medical editor and biologistDr. med. Julia Schwarz is a freelance writer in the medical department.
More about the expertsMartina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.
More about the experts All content is checked by medical journalists.
Diabetes in children is usually type 1 diabetes. It must be treated with regular insulin injections for the rest of its life. Sometimes children also have type 2 diabetes, which is otherwise mostly found in older adults. Other forms of diabetes are very rare. Read everything you need to know about diabetes in children here!
Diabetes in children: description
By far the most common form of diabetes in infants, children and adolescents is type 1 diabetes. Experts estimate that around 30,000 to 32,000 minors are currently suffering from it in Germany. Around 2,300 new cases are added each year. These numbers are forecast to increase over the next few years. Type 1 diabetics have to supply the blood sugar-lowering hormone insulin to their bodies for their entire life, as the immune system destroys the insulin-producing cells in them.
Type 2 diabetes is becoming more and more common (in addition to type 1 diabetes) in children and adolescents. This usually occurs after the age of 40. However, many offspring today show the typical risk profile of this disease: lack of exercise, obesity and a diet that is very high in sugar and fat. This is why an estimated 200 children between the ages of 12 and 19 develop type 2 diabetes every year - and the trend is rising.
Some children and adolescents develop rare forms of diabetes. This includes, for example, MODY (Maturity-Onset Diabetes in the Young). There is little reliable data on the frequency of such rare forms of diabetes in children, adolescents and adults.
Diabetes in children: symptoms
Type 1 diabetes in children often only shows symptoms when more than 80 percent of the insulin-producing beta cells in the pancreas have been destroyed. Before that, the remaining amount of insulin is sufficient to prevent a complete derailment of the sugar metabolism.
The symptoms of type 1 diabetes in children can develop within a few weeks. This includes:
- large amounts of urine, urinating or wetting at night
- extreme thirst and drinking quantities of several liters per day
- Dullness and poor performance
- Weight loss with constant cravings (children with type 1 diabetes are usually slim)
- severe abdominal pain
- In the advanced stage, a typical acetone odor (like “nail polish remover”) in the exhaled air
The symptoms of the much rarer type 2 diabetes in children, on the other hand, develop slowly. They are similar to type 1 diabetes. However, these diabetic children are usually significantly overweight (obesity = obesity).
Diabetes in children: causes and risk factors
The causes of diabetes in children (and adults) depend on the type of diabetes.
Type 1 diabetes in children
Type 1 diabetes is an autoimmune disease. Antibodies attack the insulin-producing beta cells in the pancreas and destroy them. As a result, the body can no longer produce enough insulin (absolute insulin deficiency).
Various such autoantibodies that occur in type 1 diabetes are now known. These include, for example, autoantibodies against cytoplasmic islet cell components (ICA) and against insulin (IAA).
It is unclear why the patient's immune system acts against their own tissue. Genetic factors seem to play a role because type 1 diabetes sometimes affects several members of the same family. Researchers have now identified several genetic changes that appear to be associated with type 1 diabetes.
In addition, other factors are also suspected to be involved in the development of the autoimmune form of diabetes. These include, for example, infections such as mumps, measles and rubella. Scientists are also discussing the possible influence of too short a period of breastfeeding after childbirth or of giving children cow's milk and foods containing gluten too early. These suspected connections are still being researched.
By the way: Type 1 diabetes often occurs together with other autoimmune diseases, such as celiac disease or Addison's disease.
Type 2 diabetes in children
Type 2 diabetes develops over years: the body cells are increasingly insensitive to the blood sugar lowering hormone insulin. This insulin resistance leads to a relative insulin deficiency: the patient's body usually still produces sufficient insulin, but its effectiveness on the cells does not decrease. To compensate for this, the pancreas increases the production of insulin. At some point, however, she exhausts due to the overload. Then insulin production decreases. In advanced stages of the disease, an absolute insulin deficiency can occur.
The exact causes of type 2 diabetes are unknown. However - both in children and adults - an unhealthy lifestyle with a high-energy diet, lack of exercise and obesity can promote the development of insulin resistance. There are also genetic factors that play a role in the development of the disease.
Special forms of diabetes in children
The term MODY (Maturity Onset Diabetes of the Young) encompasses various forms of adult diabetes that occur even in minors. They are all based on genetic defects in the insulin-producing cells in the pancreas. MODY is also known as type 3a diabetes.
There are also other rare forms of diabetes with different causes (chemicals, drugs, viruses, etc.).
Diabetes in children: examinations and diagnosis
The right contact person for suspected diabetes in children is a specialist in pediatrics or a specialist in internal medicine and endocrinology. He or she may ask you the following questions in the first interview:
- Has your child been noticeably tired lately?
- Does it have to urinate frequently or does it wet at night?
- Has it been drinking more recently or is it often complaining of thirst?
- Does it complain of stomach ache?
- Have you noticed a fruity smell (like “nail polish remover”) on your breath?
- Does another family member have diabetes?
Physical exam and fasting blood sugar
The doctor will then examine the child and usually make another appointment for a (morning) blood sample. For this, the child must be sober, i.e. have not eaten anything for at least eight hours and not consumed any sugary drinks. This is the only way to reliably determine the fasting blood sugar level. However, a single measurement is not sufficient for the diagnosis of “diabetes in children”. To rule out measurement errors and fluctuations, repeated measurements of the fasting blood sugar are necessary (at least twice). If the result is more than 126 mg / dl several times, this speaks for diabetes.
Long-term blood sugar level (HbA1c)
The HbA1c value indicates how high the blood sugar level was on average in the last two to three months: If the blood sugar values are repeatedly or persistently too high, sugar molecules circulating in the blood attach to the red blood pigment (hemoglobin) - the result is " "sugared" (glycosylated) hemoglobin. Its share in total hemoglobin can be determined in the laboratory and given as an HbA1c value in percent. If it is more than 6.5 percent, there is a high probability that diabetes is present.
If type 1 diabetes is suspected in children and adolescents, the HbA1c determination is usually only carried out in cases of doubt.
By the way: The HbA1c value is also important if you already have diabetes. It is measured regularly to check the success of the diabetes treatment.
Antibody screening test
If diabetes in children cannot be clearly assigned to type 1, the antibody addiction test brings clarity. A blood sample from the patient is examined for autoantibodies, which are typical in type 1 diabetes. No such autoantibodies can be detected in type 2 diabetes.
An antibody screening test allows a very early diagnosis of type 1 diabetes in children and adolescents. The autoantibodies can be found in the blood years before the onset of the disease. Type 1 diabetes only becomes noticeable with symptoms when around 80 percent of the beta cells have been destroyed.
Oral glucose tolerance test (oGTT)
The oral glucose tolerance test (oGTT) is also called the sugar stress test. It checks how well the body can utilize sugar. To do this, the fasting blood sugar is first determined. Then the patient drinks a defined sugar solution (75 grams of dissolved sugar). The blood sugar level is measured again after one and two hours. If the fasting blood sugar and the two blood sugar values exceed certain limit values one and two hours after drinking the sugar solution, this indicates diabetes.
To diagnose type 1 diabetes in children, the oGTT is usually only carried out in cases of doubt. If type 2 diabetes is suspected, however, it is part of routine diagnostics. It is usually carried out twice to ensure a reliable result.
Urinalysis
To clarify diabetes in children, a urine test for sugar (glucose) is also useful. Normally, certain cells in the kidney medulla transport the sugar that was in the urine preliminary stage (primary urine) back into the blood. So no / hardly any sugar can be detected in healthy urine. However, if the blood sugar rises significantly above normal values, the kidneys can no longer perform this reabsorption. Then the body excretes more sugar with the urine (glucosuria) - an indication of impaired glucose tolerance or manifest diabetes.
For many years there have been special test strips for home and simple practice use that can be used to detect glucosuria. It only takes a few minutes.
If the blood sugar level is permanently too high, the sugar molecules can damage the kidney tissue (diabetic nephropathy). An indication of this is a specific protein in the urine, albumin.This so-called albuminuria can also be detected with a urine test strip.
Other investigations
If type 2 diabetes is diagnosed in children and adolescents, further examinations are necessary. They should record any accompanying illnesses, for example high blood pressure, lipid metabolism disorders (such as high cholesterol) or diabetes-related eye diseases (diabetic retinopathy). At the time of diagnosis of type 2 diabetes, the increased blood sugar had already caused such consequential damage in many patients.
Diabetes in children: treatment
Immediately after a diagnosis of diabetes, children and their parents should receive special diabetes training. You will learn more about the disease, its development, its course and treatment options. The training also includes learning about the amount of carbohydrates in different foods and how much insulin the body needs for which foods at what time of the day. The correct handling of possible complications of diabetes (such as hypoglycaemia and hypoglycaemia) is also taught in the course.
Treatment of type 1 diabetes in children
Type 1 diabetes requires lifelong injections of insulin (usually with an insulin pen) because the pancreas itself can no longer produce insulin. As a rule, insulin is now administered as part of an intensified insulin therapy. However, many children and adolescents also use an insulin pump that can be controlled flexibly and quickly.
In school, children with type 1 diabetes learn when and how much insulin the body needs. The dose and timing are very important to prevent life-threatening low blood sugar levels (hypoglycaemia) or high blood sugar levels (hyperglycaemia). In the diabetes training course, patients are also shown how to properly administer insulin injections and what to look out for. Anyone who is to receive an insulin pump is specially trained in how to use it.
The type of diabetes therapy and the therapy goals (such as blood sugar level and HbA1c value) are determined individually. For example, values below 7.5 percent are usually aimed for with HbA1c.
Intensified insulin therapy (basic bolus principle)
Patients inject long-acting insulin once or twice a day in order to balance the basic need for insulin (base). Before each meal, the diabetic children measure the current blood sugar level and then inject a normal or short-acting insulin (bolus). The required bolus amount depends on the time of day and the composition of the planned meal.
Insulin pump
The insulin pump is particularly suitable for children to maintain quality of life despite diabetes. A fine needle is implanted into the belly fat, which is connected to the insulin pump via a small tube. It is a small, programmable, battery-operated device with an insulin reservoir. The pump can be attached to the belt or in a small pocket under the shirt around the neck and is therefore not visible from the outside.
The insulin pump delivers fixed amounts of insulin to the adipose tissue throughout the day, where it reaches the entire body via tiny blood vessels. This amount of insulin covers the basic requirement. During meals, the patient can administer additional insulin at the push of a button, which is intended to ensure that the planned meals are used.
The insulin pump gives those affected a lot of freedom. It also significantly relieves children with diabetes because the daily painful insulin injections are no longer necessary. The insulin pump can always be worn, even when exercising or playing. However, if necessary - for swimming, for example - the pump can also be disconnected for a short time.
The insulin pump is set individually in a specialized diabetes practice or clinic. The insulin reservoir (cartridge) is regularly replaced or refilled.
Treatment of type 2 diabetes in children
As with type 1 diabetes, the therapy plan and therapy goals are set individually.
The treatment is based on regular physical activity and sport as well as a change in diet (varied, balanced diet with lots of bulking agents, fruit and vegetables). This helps patients get rid of excess pounds and lower the elevated blood sugar. It also reduces risk factors for accompanying and secondary diseases (cardiovascular diseases, high blood pressure, etc.). In the diabetes training course, children and adolescents with diabetes receive tips and help with their exercise program and individual nutritional advice.
More exercise, the diabetic diet and the resulting weight loss are enough for some patients to get type 2 diabetes under control. However, you have to keep an eye on your blood sugar levels, as the tendency to diabetes persists.
If the lifestyle change cannot lower blood sugar sufficiently or if the young patient cannot be motivated to exercise more and eat healthier, the doctor will also prescribe diabetes medication (antidiabetic drugs). An oral anti-diabetic drug (usually metformin tablets) is tried first. If these do not bring the desired result after three to six months, the patient is given insulin.
Existing concomitant and secondary diseases of diabetes must also be treated.
Diabetes in children: disease course and prognosis
In type 2 diabetes, the course of the disease depends crucially on whether the patient changes their lifestyle. With more exercise, an individually adapted diet and weight loss, type 2 diabetes can sometimes be completely eliminated in children and adolescents.
In contrast, type 1 diabetes in children, adolescents and adults has not yet been curable. Regular refresher training and medical supervision are therefore essential. The main goal is to use insulin therapy to keep blood sugar levels as constant as possible in order to avoid secondary diseases. In principle, the following applies: the younger the patient is at the onset of the disease, the higher the risk of consequential damage in the course of life.
Acute complications that can occur with type 1 and type 2 diabetes - with different frequencies - are low blood sugar (hypoglycaemia) and high blood sugar (hyperglycaemia). In severe cases, the latter can lead to diabetic ketoacidosis (especially in type 1 diabetes).
Hypoglycemia
Low blood sugar (hypoglycaemia) is one of the most common and at the same time most dangerous acute complications that diabetes can cause in children under insulin therapy. It often occurs when the patient accidentally injects too much insulin. Unusually heavy physical exertion / too much sport can also lead to hypoglycaemia if the insulin dose remains the same.
Other possible causes are, for example, an overdose of blood sugar-lowering tablets (for type 2 diabetes), skipping a planned meal while maintaining the same dose of insulin or tablets, and excessive alcohol consumption (especially in connection with sport or other physical activity).
Possible symptoms of hypoglycaemia are, for example, sweating, dizziness, trembling hands, palpitations and a pronounced feeling of weakness. In severe cases, concentration and vision disorders, convulsions and impaired consciousness up to and including unconsciousness can also occur.
Diabetics who need insulin in particular should always have some glucose with them in order to be able to raise their blood sugar quickly in the event of slight hypoglycemia. More severe cases usually require medical treatment.
Diabetic ketoacidosis
The absolute insulin deficiency in type 1 diabetes children means that sugar (glucose) can no longer be absorbed from the blood into the cells. If too little or no insulin is supplied to the body from the outside, the blood sugar continues to rise. Such an excess of sugar (hyperglycemia) often occurs in diabetics who require insulin during an acute infection such as pneumonia or urinary tract infection. The body then needs more insulin than normal, even if the patient may be eating little. The normal dose of insulin is then insufficient and the blood sugar increases excessively as a result.
While there is clearly too much glucose in the blood when there is excess sugar, there is a glucose deficiency in the cells and thus an energy deficiency. This is particularly fatal in the brain, as it needs a lot of energy and is dependent on energy production from glucose. In order to compensate for the energy deficit, the body begins to break down more fat. This creates so-called ketone bodies. They acidify the blood (diabetic ketoacidosis).
Typical symptoms are the fruity acetone odor of the exhaled air and very deep breathing (Kussmaul breathing). The body tries to break down the excessively high blood sugar level by excreting sugar together with a lot of fluids. This leads to increased urine excretion and subsequently to dehydration. Patients become tired and weak and in extreme cases can fall into a comatose state (ketoacidotic coma). This coma is life threatening! The emergency doctor (at 112) must be alerted immediately - the patient must be treated in an intensive care unit.
By the way: In mild form, diabetic ketoacidosis can also occur in type 2 diabetes.
Secondary diseases
The most common secondary diseases of diabetes mellitus (regardless of type) include, for example, kidney disease (diabetic nephropathy), retinal disease (diabetic retinopathy) and nerve damage (diabetic polyneuropathy). The nerve damage, together with vascular damage, which is also caused by high blood sugar, can trigger a diabetic foot syndrome.
Heart attacks and strokes are also possible long-term effects of poorly controlled or untreated diabetes in children, adolescents and adults.
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