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What is diabetes mellitus? Diabetes mellitus occurs when specialized cells of the pancreas (a gland located behind the stomach) do not produce adequate amounts of the hormone insulin. Insulin permits the body to process proteins, fat, and sugars in food to make body tissues, produce energy, and store energy. Insulin In people without diabetes, insulin is produced as needed to process food. But people with diabetes have a reduced supply of insulin or none at all. Therefore, the nutrients cannot be used by the cells but remain in the blood. Without a source of energy, the cells think they are starving. In an attempt to nourish the starving cells, the liver makes sugar from the body stores of protein and fat. This leads to weight loss and weakness, because muscle is being broken down and is not getting the energy it needs. The body tries to flush out the excess sugar circulating in the blood by making more urine. This is why people who have diabetes urinate more frequently and can become very thirsty as they try to replace the fluid loss. Without insulin, fat breaks down to form certain kinds of acids known as ketones, which are also excreted in the urine. Causes At the present time, there is no way to prevent the development of diabetes. Although there is a genetic predisposition to develop this disease, most children with type 1 diabetes (previously known as insulindependent diabetes) don?t have any close relatives with the disease. The destruction of the cells that make insulin results from a process in which the body views these cells as foreign invaders and mounts an immune response against them. This autoimmune process starts years before the first symptoms of diabetes show up. The trigger for this process may be viruses or other agents in the environment. Types Type 1 diabetes is very different from type 2 diabetes, which is much more common and occurs in nine out of ten adults with diabetes. In type 2 diabetes, the body does not respond properly to insulin. Type 2 diabetes usually is associated with obesity, and is increasing in frequency as the rates of obesity grow. (Among children diagnosed with type 2 diabetes, eighty-five out of one hundred are obese.) Youngsters who are inactive, overeat, and have a family history of diabetes have the greatest risk of developing type 2 diabetes. Children in minority groups also have a higher incidence of type 2 diabetes. In recent years, many more school-age and teenage children are being diagnosed with type 2 diabetes. Symptoms Diabetes can appear at any time, even in the first year of life. The diagnosis often is delayed in infants and toddlers until the child is very sick, because the symptoms at this age are not very specific. It is important to notify your pediatrician immediately if your child displays any of the following warning signs and symptoms of diabetes:
If your child goes to the doctor with any suspicious symptoms, be sure that a urine or blood test is done to determine whether his sugar levels are too high. This simple test will provide a clue to diabetes and prevent further deterioration, which can be dangerous. Treatment When blood tests confirm the diagnosis of diabetes, treatment is begun immediately with injections of insulin. When the child does not require intravenous fluids to correct dehydration and vomiting, most specialists do not hospitalize patients with diabetes. A diabetes education team will teach the entire family how to deal with diabetes. You?ll learn how to test blood glucose levels from a drop of blood from a finger stick and how to give insulin injections, usually twice a day at the beginning. Your acceptance and ability to carry out these basic tasks will help your child adjust to the treatment with the least anxiety and fear. By the time your child reaches age seven or eight, he will be playing a part in the management of his diabetes, and by age eleven most children are giving themselves their own insulin injections and doing their own blood tests, under adult supervision. Diet Children with diabetes do not need to be on a special diet, but particular attention should be paid to good nutrition and regular eating schedules. These youngsters have the same nutritional needs for growth and development as other children, but they can?t miss meals and shouldn?t delay them. Main meals should be similar in size and content to each other, with about the same amount of carbohydrates and the same amount of protein. Because the insulin is being absorbed constantly, these children need to eat more often, with between-meal snacks and a bedtime snack. The use of the insulin pump or the long-acting insulin glargine allows for more flexibility in the timing of meals and snacks and in the amounts of food eaten. Also, children with diabetes need to increase their food intake or decrease their insulin dose if they are more physically active than usual, since this activity increases the effect of insulin and lowers blood glucose levels. A good diet for children with diabetes at all ages is the same as that recommended for everyone. This includes:
Special diabetic and dietetic foods are a waste of money, and some, such as those that replace sugar with extra fat, actually can be harmful. Snacks are important to maintain a supply of food for the insulin to work on and thus prevent hypoglycemia (low blood sugar). Good snack choices include:
These snacks also are used for treating mild symptoms of hypoglycemia (low blood sugar) after initial treatment with juice to raise blood glucose quickly. Desserts that are good for all members of the family include:
Child care and school personnel need to know about the youngster?s diabetes and snack needs and how to recognize and treat hypoglycemia. Self-care Having children participate as much as possible in their care gives them some measure of control. Children under age three can choose which finger to stick for blood sugar tests or which place to use for the insulin injection. Children four to seven years old can help with monitoring blood sugar and with injections. Parents should handle treatment with a matter-of-fact yet affectionate attitude, and the American Academy of Pediatrics suggests that all adults in the family share responsibility for shots and blood tests. Support Children are likely to think that diabetes is a punishment for something they have done. They need regular reassurance from you that the diabetes is not their fault and they are not being punished. Emotional support for the entire family is very important. You can get this?and learn more about the disease?from the Juvenile Diabetes Research Foundation. The more you understand about diabetes and deal with it matter-of-factly, the better the chance that your child will do well. The tools available for managing diabetes today make it possible to control diabetes to a degree that will reduce the risk of later complications and permit children to grow up and lead productive, fulfilling lives.
Published online:
6/07 The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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Diabetes