Brief overview
- Symptoms: Strong thirst, increased urge to urinate, ravenous appetite, weight loss, fatigue, poor performance, lack of concentration, abdominal pain, possibly acetone odor of exhaled air
- Treatment: In type 1 diabetes, insulin therapy; in type 2 diabetes, lifestyle changes (balanced diet, more exercise), oral diabetes medication if necessary, insulin therapy if necessary, diabetes education
- Course and prognosis: Only partially curable, symptoms can be significantly alleviated with successful therapy; if left untreated, complications such as hypoglycemia or diabetic ketoacidosis are possible, and life expectancy is reduced
- Examinations and diagnosis: doctor’s consultation, physical examination, determination of fasting and long-term blood glucose (HbA1c), oral glucose tolerance test if necessary, antibody test, blood and urine tests
- Causes and risk factors: In type 1 diabetes, not clear, probably autoimmune response, genetic factors or infections, possibly short breastfeeding; in type 2 diabetes or MODY, unhealthy lifestyle and lack of exercise and genetic factors, rarely substances such as drugs or chemicals
- Prevention: Type 1 diabetes usually not preventable; in type 2 diabetes, often a healthy lifestyle and adequate exercise reduces risk of disease
How does diabetes manifest itself in children?
However, doctors are increasingly diagnosing type 2 diabetes in children and adolescents (in addition to type 1 diabetes). This usually occurs after the age of 40. However, many of today’s offspring have the typical risk profile of this disease: Lack of exercise, overweight and a diet high in sugar and fat. As a result, an estimated 200 children between the ages of 12 and 19 develop type 2 diabetes each year – and the number is rising.
Some children and young people develop rare forms of diabetes. These include MODY (“maturity onset diabetes in the young”). There are few reliable data on the frequency of such rare forms of diabetes in children, adolescents and adults.
What symptoms indicate diabetes in children?
Type 1 diabetes in children often only shows symptoms when more than 80 percent of the insulin-producing beta cells in the pancreas have already been destroyed. Before that, the remaining insulin is sufficient to prevent a complete derailment of the sugar metabolism.
However, the symptoms of type 1 diabetes in children sometimes develop within a few weeks. These include:
- Large amounts of urine, urinating at night or wetting oneself
- Extreme feeling of thirst and drinking quantities of several liters per day
- Dullness and poor performance
- Severe abdominal pain
- A typical exhaled air acetone odor in the advanced stage (like “nail polish remover”)
In contrast, the symptoms of the much rarer type 2 diabetes in children develop slowly. They are similar to those of type 1 diabetes. However, affected children are usually significantly overweight (obesity = adiposity).
Treating diabetes in children
Immediately after diabetes is diagnosed, children and their parents receive special diabetes training. They learn more about the disease, how it develops, how it progresses and what treatment options are available.
Among other things, they learn how much carbohydrate is contained in various foods and how much insulin the body needs for which foods at what time of day. The training also teaches the correct way to deal with possible complications of diabetes (such as hyperglycemia and hypoglycemia).
Treatment of type 1 diabetes
Type 1 diabetes requires lifelong injections of insulin (usually with an insulin pen), as the pancreas no longer produces insulin itself. As a rule, those affected receive insulin as part of an intensified insulin therapy. However, doctors also use an insulin pump for many children and adolescents, which can be controlled flexibly and quickly.
The type of diabetes therapy and the therapy targets (such as blood glucose level and HbA1c value) are determined individually. For HbA1c, for example, values below 7.5 percent are the goal.
Intensified insulin therapy (basic bolus principle)
Patients inject long-acting insulin once or twice a day to meet their basic insulin requirements (baseline). Before each meal, the diabetic children measure their current blood glucose level and then inject themselves with another normal-acting 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 their quality of life despite diabetes. The doctor implants a fine needle in the abdominal fat, which is connected to the insulin pump via a small tube. This is a small, programmable, battery-powered device with an insulin reservoir. The pump can be attached to a belt or carried in a small pouch that patients hang around their neck with a strap and tuck under their shirt. In this way, it is not visible from the outside.
The insulin pump gives those affected a great deal of freedom. It also significantly relieves the burden on children with diabetes, because the daily painful insulin injections are no longer necessary. The insulin pump remains on the body at all times, even during sports or play. However, if necessary – for example for swimming – the pump can be disconnected for a short time.
The insulin pump is adjusted individually in a specialized diabetes practice or clinic. It is necessary to replace or refill the insulin reservoir (cartridge) regularly.
Treatment of type 2 diabetes
As with type 1 diabetes, the therapy plan and therapy goals are determined individually.
The basis of treatment is regular physical activity and sport, as well as a change in diet (varied, balanced diet with plenty of fiber, fruit and vegetables). This helps patients get rid of excess kilos and lower elevated blood sugar levels. It also reduces risk factors for concomitant and secondary diseases (cardiovascular disease, high blood pressure, etc.). In diabetes education, children and young people with diabetes receive tips and help with their exercise program and individual nutritional advice.
If the blood sugar cannot be lowered sufficiently with a change in lifestyle, or if the young patient cannot be motivated to do more exercise and eat a healthier diet, the doctor prescribes additional diabetes medications (antidiabetics). First, he tries an oral antidiabetic (usually metformin tablets). If these do not bring the desired success after three to six months, the patient is given insulin.
An important part of the therapy is also the treatment of already existing concomitant and secondary diseases.
Life expectancy in children with diabetes
The course of the disease and the possible life expectancy vary greatly among affected children and adolescents. Both depend essentially on the type of diabetes and how well it is treated. In addition, the general condition of the patient influences the prognosis. A cure is basically not possible, since diabetes mellitus – with the exception of gestational diabetes – is a chronic disease. However, the symptoms can be well controlled.
Type 1 diabetes in children, adolescents and adults is generally more complex to treat, but here too the symptoms can be well controlled. Regular refresher training and medical monitoring are essential here. The main goal is to achieve blood glucose levels that are as constant as possible by means of insulin therapy in order to avoid secondary diseases. As a general rule, the younger the patient at the onset of the disease, the higher the risk of secondary complications in the course of life.
Acute complications that occur with varying frequency in type 1 and type 2 diabetes are hypoglycemia and hyperglycemia. In severe cases, the latter may lead to diabetic ketoacidosis (especially in type 1 diabetes). Often, it is secondary diseases that ultimately reduce life expectancy.
Acute complications
Hypoglycemia
Hypoglycemia is one of the most common and also most dangerous acute complications that occur in diabetes in children on insulin therapy. It often results from the patient inadvertently injecting too much insulin. Unusually strong physical exertion or too much sport also leads more frequently to hypoglycemia if the insulin dose remains the same.
Possible symptoms of hypoglycemia include sweating, dizziness, trembling hands, palpitations and a pronounced feeling of weakness. In severe cases, there are also concentration and visual disturbances, cramps, and impaired consciousness or even unconsciousness.
Doctors advise diabetics who are particularly dependent on insulin to always carry some glucose with them so that their blood sugar can be raised quickly in the event of mild hypoglycemia. More severe cases, on the other hand, usually require medical treatment.
Diabetic ketoacidosis
The absolute lack of insulin in type 1 diabetes children causes the cells to stop absorbing sugar (glucose) from the blood. When the body receives too little or no insulin from the outside, blood sugar continues to rise.
Such hyperglycemia often occurs in insulin-dependent diabetics during an acute infection such as pneumonia or a urinary tract infection. The body then needs more insulin than normal, even though the patient may eat little. The normal insulin dose is then insufficient, and the blood glucose subsequently rises excessively.
Typical symptoms are the fruity acetone smell of the exhaled air and very deep breathing (kissing mouth breathing). The body tries to reduce the excessively high blood sugar level by excreting sugar together with a lot of fluid. This leads to increased urine output and subsequently to dehydration. Patients are tired and weak and in extreme cases fall into a comatose state (ketoacidotic coma). This coma means danger to life! The emergency physician must be alerted immediately.
In a mild form, diabetic ketoacidosis sometimes also occurs in type 2 diabetes.
Consequential diseases
The most common secondary diseases of diabetes mellitus (regardless of type) include kidney disease (diabetic nephropathy), retinal disease (diabetic retinopathy) and nerve damage (diabetic polyneuropathy). The nerve damage, together with vascular damage, which is also a consequence of high blood sugar, triggers the so-called diabetic foot syndrome.
Heart attacks and strokes are also possible late effects of poorly controlled or untreated diabetes in children, adolescents and adults.
You can read more about possible complications and consequential damage in the article Diabetes mellitus.
Identifying diabetes in children
- Has your child often been noticeably tired lately?
- Does he need to urinate frequently or wet himself at night?
- Has he been drinking more lately or complaining of thirst often?
- Does he complain of abdominal pain?
- Have you noticed a fruity odor (like “nail polish remover”) to the breath?
- Does another family member have diabetes?
Physical examination and fasting blood glucose
The doctor then examines the child and usually schedules another appointment to draw blood (in the morning). For this, the child must be fasting, i.e. not have eaten anything for at least eight hours and not have consumed any sugary drinks. This is the only way to reliably determine the fasting blood glucose value.
However, a single measurement is not sufficient for the diagnosis of “diabetes in children”. To rule out measurement errors and fluctuations, repeated measurements of fasting blood glucose are necessary (at least twice). If the result is above 126 mg/dl several times, this indicates diabetes.
Long-term blood glucose value (HbA1c)
When type 1 diabetes is suspected in children and adolescents, the physician usually performs the HbA1c determination only in cases of doubt.
The HbA1c value is also important if diabetes is already known. Doctors measure it regularly to check the success of diabetes treatment.
Antibody screening test
If diabetes in children cannot be clearly assigned to type 1, an antibody screening test provides clarity. In this test, the doctor examines a blood sample from the patient for autoantibodies that are typical of 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, since the autoantibodies can be found in the blood years before the onset of the disease. Type 1 diabetes otherwise only becomes noticeable with symptoms when around 80 percent of the beta cells have already been destroyed.
Oral glucose tolerance test (oGTT)
Experts also refer to the oral glucose tolerance test (oGTT) as the sugar load test. It tests how well the body utilizes sugar. To do this, the fasting blood glucose is first determined. The patient then drinks a defined sugar solution (75 grams of dissolved sugar). After one and two hours, the doctor measures the blood glucose level again.
For the diagnosis of type 1 diabetes in children, doctors usually perform the oGTT only in cases of doubt. If type 2 diabetes is suspected, on the other hand, it is part of routine diagnostics. For a confirmed result, it is usually performed twice.
Urinalysis
A urine test for sugar (glucose) is also useful for diagnosing diabetes in children. Normally, certain cells in the renal medulla transport the sugar that has entered the urinary precursor (primary urine) back into the blood. In healthy urine, therefore, no or hardly any sugar can be detected.
However, if blood sugar rises significantly above normal levels, the kidney is often unable to perform this reabsorption. The body then excretes more sugar in the urine (glucosuria) – an indication of impaired glucose tolerance or manifest diabetes.
For many years, special test strips have been available for home and simple practice use to detect glucosuria. This takes only a few minutes.
If blood glucose levels are permanently too high, the sugar molecules damage the kidney tissue over time (diabetic nephropathy). An indication of this is a certain protein in the urine, albumin. This so-called albuminuria can also be detected with a urine test strip.
Other examinations
Why do children get diabetes?
The causes of diabetes in children (and adults) depend on the form of diabetes.
Type 1 diabetes in children
Type 1 diabetes is an autoimmune disease. Here, antibodies attack the insulin-producing beta cells in the pancreas and destroy them. As a result, the body is no longer able to produce enough insulin (absolute insulin deficiency).
Experts now know of various such autoantibodies that occur in type 1 diabetes. These include, for example, autoantibodies against cytoplasmic islet cell components (ICA) and against insulin (IAA).
Why the patients’ immune system acts against their own tissue is unclear. Genetic factors seem to play a role, because type 1 diabetes sometimes occurs in several members of a family. Researchers have now identified several gene mutations that appear to be associated with type 1 diabetes.
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 a period of years: the body’s cells become 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 initially, but its effectiveness on the cells decreases over time.
To compensate, the pancreas increases insulin production. At some point, however, it becomes exhausted due to the overload. Then insulin production decreases. In advanced stages of the disease, there may be an absolute lack of insulin.
The exact causes of type 2 diabetes are unknown. However, in both children and adults, an unhealthy lifestyle with an excessively energy-rich diet, lack of exercise and obesity are the main factors promoting the development of insulin resistance. In addition, genetic factors play a role in the development of the disease.
Special forms of diabetes in children
There are also other rare forms of diabetes with different causes (chemicals, drugs, viruses, etc.).
Can diabetes in children be prevented?
If the cause is genetic, diabetes cannot be prevented. This is especially the case with type 1 diabetes. To prevent the development of type 2 diabetes, it is important to ensure a healthy lifestyle and sufficient exercise from an early age.
Rarer forms, which are due to exposure to chemicals or medications, for example, are also difficult to prevent. Diabetes usually develops unnoticed over a long period of time, which is why stopping medication, for example, no longer prevents diabetes.
However, early diagnosis and therapy can prevent possible complications and secondary diseases.
