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Pediatrics - Diabetes, Type 1
Diabetes is a disease that affects how the body uses glucose, a sugar that is a source of fuel. Normally, insulin, a hormone, helps glucose enter the body cells where it is used for energy. People with diabetes do not produce insulin, do not produce enough insulin, or the insulin does not work like it should. As a result, glucose does not get into the body cells. Too much sugar in the blood can make people ill and result in medical complications.
There are different types of diabetes. People with Type 1 Diabetes do not produce insulin. There is no cure for Type 1 Diabetes, and it cannot be prevented. It is a lifelong condition. Type 1 Diabetes must be treated with insulin.
Type 1 Diabetes usually appears before the age of 20 and was formerly called Juvenile Diabetes or Insulin Dependent Diabetes. People with diabetes need to diligently manage their disease to remain healthy and reduce the risk of medical complications. Many people with Type 1 Diabetes lead long healthy lives. Prevention, technology, and research have greatly improved the management of this condition.
Insulin is a hormone that is produced by the beta cells in your child’s pancreas. The pancreas is a gland located near the stomach that produces chemicals for food digestion. Insulin regulates the amount of glucose in your child’s blood with a continual process. When your child eats, the amount of glucose in his or her bloodstream rises. In response to the elevated blood glucose level, his or her beta cells produce insulin. The insulin moves the glucose out of the bloodstream and into your child’s cells. In turn, a lower level of glucose is left in the blood stream. To prevent the blood glucose level from getting too low, your child’s body signals him or her to eat. This starts the process again so that your child’s body cells continually receive the energy that they need.
There are different types of insulin that differ in onset, peak time, and duration. Onset refers to how long it takes the insulin to reach the bloodstream and begin lowering the blood glucose level. The peak time indicates when the insulin is at its maximum strength. Insulin duration describes the length of time that the insulin works to lower blood glucose levels. Some types of insulin may be used alone or with another type of insulin to be as effective as possible. Additionally, there are new types of medications that enhance the way that insulin works. Medications may require mixing or they may be purchased in a convenient premixed pen. Ask your doctor about which medications are right for your child.
Managing Type 1 Diabetes also includes a nutritional component. Your doctor or a registered nutritionist can help you plan what your child should eat to help regulate his or her blood glucose levels, cholesterol, and blood pressure. A balanced meal plan includes a wide variety of foods, particularly vegetables, whole grains, non-fat dairy products, beans, lean meats, poultry, and fish. Your health care professional can help you learn to read nutrition labels, measure portion sizes, and plan balanced meals.
Because the medical complications associated with diabetes can be very serious and life threatening, people with diabetes need to diligently manage their disease to remain healthy. The following are suggestions for preventing complications from diabetes. Your child should wear a MedicAlert bracelet and carry a MedicAlert card in his or her wallet. In the case of an emergency, the MedicAlert information will be helpful to the healthcare professionals treating your child.
People with diabetes should have an eye exam at least once a year. The eye examination should include screening for glaucoma, cataracts, and diabetic retinopathy.
Attend all of your child’s scheduled medical appointments. Your child’s feet should be inspected at every visit. Discuss any concerns about depression with your doctor as well.
Am I at Risk
Is My Child at Risk?
The risk factors for Type 1 diabetes are unknown. It appears to develop more frequently in Caucasians and people younger than 20 years old, although it may occur at any age.
The symptoms of Type 1 Diabetes tend to develop rapidly. A common symptom is frequent urination. This happens as the body tries to remove the excess blood sugar by passing it out of the body in urine. In turn, your child may feel extremely thirsty and his or her mouth may feel dry. Because your child’s body is not getting energy from blood sugar, it signals him or her to eat a lot. However, even though your child is eating and drinking enough, he or she may actually lose weight. This is because your child’s body starts to use fat and muscle for fuel when it cannot access the blood sugar. Your child may feel tired and weak because his or her body cells cannot use glucose for energy.
Additionally, your child may experience abdominal pain, nausea, and vomiting. Your child may get frequent skin, urinary tract, or vaginal infections. Type 1 Diabetes can also cause blurred vision and headaches. The way your child breathes may change to become heavier or labored.
Treatment for Type 1 Diabetes can prevent symptoms from happening. However, even with treatment, some problems associated with Type 1 Diabetes may occur. These conditions include ketoacidosis, hyperglycemia, and hypoglycemia.
Ketoacidosis is a serious condition—it can lead to diabetic coma or death. Ketones are acids that accumulate in the blood when the body breaks down fats. Your body releases ketones through urine. Ketones appear in urine when the body does not have enough insulin. Ketoacidosis occurs when all of the ketones cannot be released through urine and the amount of ketones remaining in the blood becomes high enough to poison the body. Ketoacidosis usually develops slowly, but when vomiting occurs, the condition can develop in just a few hours.
The first symptoms of ketoacidosis include thirst, dry mouth, frequent urination, high blood glucose levels, and high levels of ketones in the urine. These symptoms are followed by: dry or flushed skin; continual tiredness; nausea, abdominal pain, or vomiting; difficulty breathing; impaired attention span or confusion; and fruity smelling breath. If your child has any of the symptoms contact your doctor immediately; call emergency services, usually 911; or go to the nearest emergency room of a hospital. Treatment for ketoacidosis usually involves a hospital stay.
You can help prevent ketoacidosis by monitoring your child for warning signs and checking your child’s urine and blood regularly. Follow your doctor’s instructions if you detect high levels of ketones. If your child has high levels of ketones, he or she should not exercise. Exercise increases the levels of ketones.
Hyperglycemia, the term for high blood glucose, happens occasionally to people with diabetes. Untreated hyperglycemia can cause ketoacidosis, and overtime, lead to medical complications. Hyperglycemia can occur for many reasons. People with Type 1 Diabetes may experience it if they did not administer enough insulin, ate more than planned, exercised less than planned, or were sick or stressed.
The warning signs and symptoms of hyperglycemia include high blood glucose levels, high levels of sugar in the urine, frequent urination, and increased thirst. You should follow your doctor’s instructions for treating hyperglycemia as soon as you detect high blood sugar levels or ketones in your child’s urine—this is very important. If you fail to do so, ketoacidosis could occur. If your child has ketones in his or her urine, he or she should not exercise. Exercising will only make the situation worse.
Hypoglycemia, also called low blood sugar or insulin reaction, is not always preventable. Hypoglycemia can occur even if your child does everything that he or she can to manage his or her diabetes. Symptoms of hypoglycemia include shakiness, dizziness, sweating, hunger, headache, pale colored skin, sudden moodiness, clumsiness, seizure, poor attention span, confusion, and tingling sensations around the mouth.
Check your child’s blood if you suspect that his or her blood glucose level is low. You should treat hypoglycemia immediately. The quickest way to treat hypoglycemia is to raise your child’s blood sugar level with some form of sugar—glucose tablets, fruit juice, or hard candy. Ask your doctor for a list of appropriate foods. Once you have tested your child’s blood glucose level and treated your child’s hypoglycemia, repeat the process again until your child’s signs and symptoms have cleared.
It is important to treat hypoglycemia immediately or your child could pass out. If your child passes out, he or she needs immediate treatment. Your child should receive an injection of glucagon. Glucagon is a medication that raises blood sugar. You should tell those around your child how and when to use it. If glucagon is not available, your child needs emergency medical assistance. You should take your child to the emergency room of a hospital or call emergency medical services, usually 911. If your child passes out from hypoglycemia, you should not inject insulin or consume food or fluids.
Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a serious condition that most frequently occurs in older persons and those with Type 2 Diabetes. However, it can also occur in individuals with Type 1 Diabetes. An illness or infection usually brings on HHNS. HHNS can cause severe dehydration and lead to seizures, coma, and death.
With HHNS, dehydration occurs as your body tries to remove excess blood sugar by passing it out of the body in urine. The rate of urination may be frequent at first, but then decrease. Your child may become very thirsty. Your child’s urine will become very dark. It is important for your child to drink plenty of liquids to remain hydrated. Warning signs and symptoms of HHNS include a blood sugar level of over 600 mg/dl; a dry parched mouth; extreme thirst that may gradually disappear; warm dry skin that does not sweat; a high fever, over 101° Fahrenheit; sleepiness or confusion; vision loss; auditory or visual hallucinations, seeing or hearing things that are not there; and weakness on one side of the body. Call your doctor immediately if your child experiences any of these symptoms.
You can avoid HHNS by checking your child’s blood glucose levels regularly. You need to check your child’s blood glucose levels more often when he or she is sick or has an infection. You should work with your doctor and health care professionals to develop a monitoring plan for when your child is sick.
Nerve damage caused by diabetes is called diabetic neuropathy. Nerves carry messages between your brain and body about pain, temperature, and touch. They also control muscle movements and organ systems, such as the processes for food digestion and urination. Sensorimotor neuropathy and autonomic neuropathy are two common types of nerve damage.
Prevention, technology, and research have greatly improved the management of this diabetes. Sugar-free foods, new types of insulin, and easy-to-use insulin delivery methods have made diabetes management more convenient. The American Diabetes Association’s Resource Guide is a great resource for new products.
Pancreas transplants are an option for select people with Type 1 Diabetes. In some people, a pancreas transplant can “cure” Type 1 Diabetes. However, there are high risks involved with pancreas transplantation, some people do not survive. The transplanted pancreas is at risk for being rejected by the body. Further, people must take anti-rejection medications that have their own risks. Researchers are studying the effects of transplanting just the islet or beta cells from the pancreas, in hopes that it is more affective.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.
The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.
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