Exploring Pediatric Diabetes

Approximately 90-95% of the over 37 million Americans with diabetes have Type 2 diabetes.

Unfortunately, the diagnosis of children with diabetes — including Type 2 — has been on the rise.

As of 2019, the American Diabetes Association estimates that around 283,000 Americans under age 20 have been diagnosed with diabetes, accounting for about 0.35% of that demographic.

While factors such as genetics, family history, physical inactivity and belly fat play a role, the exact causes of Type 2 diabetes are unknown. What we do know is that Type 2 diabetes affects nearly every major organ in a child’s body, including the blood vessels, nerves, eyes, and kidneys. The disease’s long-term complications, such as high blood pressure, high cholesterol, heart, and blood vessel disease, stroke, blindness, and kidney disease, can be disabling and even life-threatening.

Related: Correcting Blood Sugar Dysregulation

Important distinctions

Pediatric diabetes generally refers to Type 1 diabetes, and is the most common form of diabetes in children and adolescents, says Fran Cogen, MD, CDE, director of the childhood and adolescent diabetes program at Children’s National Hospital in Washington, D.C.

Type 1 diabetes is caused by the autoimmune destruction of the islet cells in the pancreas that are responsible for insulin production.

"Due to the loss of these cells, children with Type 1 diabetes are unable to produce their own insulin, resulting in high blood sugar levels," says Cogen, noting that adults may also develop Type 1 diabetes later in life.

However, an increasing number of children and adolescents are developing Type 2 diabetes, in which the child (or adult) is still able to produce their own insulin, but their body is resistant or unable to use insulin effectively, she says.

"Because of these differences, people with Type 1 diabetes are usually insulin-dependent, whereas those with Type 2 diabetes are treated with oral agents and may also need to eventually be treated with insulin."

Diabetes and obesity

While we usually associate children with Type 1 diabetes, more kids are developing Type 2 diabetes as childhood obesity continues to increase, says Jill Brodsky, MD, MBA, FAAP, associate medical director and chair of pediatrics, pediatric gastroenterology, pediatric endocrinology, and pediatric neurology at CareMount Medical in Poughkeepsie, N.Y. "Sadly, as children have grown heavier, more are developing Type 2."

"Type 2 diabetes starts as a disorder of excess insulin. An obese body must make extra insulin because the extra weight causes insulin resistance," says Brodsky, adding that patients with Type 2 diabetes initially over-produce insulin.

"Over time, their pancreas cannot keep up with that demand. They develop insulin insufficiency. Patients with Type 2 diabetes can treat the disease with a variety of oral therapies that improve insulin sensitivity and non-insulin injectable therapies, for several years, before they become reliant on insulin therapy."

Critical warning signs

Some common signs in children who develop new-onset diabetes include increased thirst, urination, changes in energy level, and weight loss, with younger children possibly developing diaper rashes as well.

Healthcare providers can identify these symptoms when interviewing patients at annual exams, and completing a review of systems, says Cogen.

"Children with new-onset diabetes may also initially present to the emergency department with diabetic ketoacidosis (DKA), due to elevated blood glucose, resulting in the development of ketones and high acid levels in the blood. The symptoms of DKA include abdominal pain, nausea, vomiting, dehydration, and fatigue," says Cogen. "Healthcare professionals should pay attention to those symptoms and also monitor for increased heart rate and respiratory rate, changes in blood pressure."

Patients with DKA might even present in an altered mental status. This constitutes an emergency and requires immediate treatment and hospitalization.

"In summary, a child who presents with any of these symptoms and an elevated blood glucose level or glucose in the urine should immediately make clinicians suspect pediatric diabetes."

Pediatric diabetes patients might also experience new-onset nocturia, adds Brodsky.

"Many elementary-aged kids will start having bedwetting accidents when they were previously dry at night. This is usually an alarming symptom for parents that prompts them to bring their child to the doctor," she says. She adds that the late stages of the presentation will likely also include lethargy, listlessness, and an inability to wake up the child.

"This is a catastrophic warning sign that diabetes can be present."

Ensuring effective diabetes treatment

Insulin therapy is the mainstay of treatment for Type 1 diabetes in children and adolescents.

This is the key that enables glucose to enter the cells in the body to provide energy, says Cogen.

"The amount of insulin administered is dependent on blood glucose levels. Children with diabetes are required to closely monitor their blood sugars by a glucose meter or a continuous glucose sensor," she says. She also notes that diabetes education is essential for the child and family, in order to teach the necessary skills to manage diabetes.

"Most diabetes teams include healthcare providers, certified diabetes educators, and dieticians, as well as a psychosocial team, in order to provide multidisciplinary care to families. Maintaining appropriate blood glucose control has long-term benefits, too. It can help prevent the vascular complications of diabetes, including kidney damage, retinopathy, and cardiovascular disease," says Cogen. She adds that yearly lab work and eye exams are conducted to monitor and/or prevent any developing complications.

Monitoring for the development of associated autoimmune diseases such as thyroid, celiac, and juvenile rheumatoid arthritis is part of routine care for Type 1 diabetic patients, says Cogen. Cogen also recommends that children receive immunizations such as the flu and pneumococcal vaccine if appropriate.

Related: Nutrition: Understanding Macronutrients for Weight Loss

Tools and technologies

There are other technologies available to help them monitor their blood glucose levels, says Brodsky.

Traditionally, patients monitored this through finger stick glucose levels. Patients would prick their fingers six to eight times a day to understand their blood sugar levels.

"Now, we have technologies available called continuous glucose monitoring systems (CGM). These allow us to have minute-to-minute data on the current blood glucose number. They also show trends: where their number has been and where it is headed," she says. "This allows the patient to make better treatment-related decisions. It also helps prevent extreme highs and lows in blood sugar levels.

Patients can take insulin by injection or through an insulin pump. The dose is based on current blood sugar levels, food composition, and any anticipated physical activity. Brodsky also stresses the importance of having an adult oversee the process for children and adolescents.

"It is a fairly complex decision-making process. Most children need an adult to co-manage to be as successful as possible."

This article was adapted from our sister site, Elite Learning.