Disease: Type 1 diabetes in children

Controlling Your Diabetes

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Type 1 diabetes in children is a condition in which your child's pancreas no longer produces the insulin your child needs to survive, and you'll need to replace the missing insulin. Type 1 diabetes in children used to be known as juvenile diabetes or insulin-dependent diabetes.

The diagnosis of type 1 diabetes in children can be overwhelming at first. Suddenly you and your child — depending on his or her age — must learn how to give injections, count carbohydrates and monitor blood sugar.

Although type 1 diabetes in children requires consistent care, advances in blood sugar monitoring and insulin delivery have improved the daily management of type 1 diabetes in children.

Source: http://www.mayoclinic.com

Controlling Your Diabetes

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The signs and symptoms of type 1 diabetes in children usually develop quickly, over a period of weeks. Look for:

  • Increased thirst and frequent urination. As excess sugar builds up in your child's bloodstream, fluid is pulled from the tissues. This may leave your child thirsty. As a result, your child may drink — and urinate — more than usual.
  • Extreme hunger. Without enough insulin to move sugar into your child's cells, your child's muscles and organs become energy-depleted. This triggers intense hunger.
  • Weight loss. Despite eating more than usual to relieve hunger, your child may lose weight — sometimes rapidly. Without the energy sugar supplies, muscle tissues and fat stores simply shrink. Unexplained weight loss is often the first sign to be noticed.
  • Fatigue. If your child's cells are deprived of sugar, he or she may become tired and lethargic.
  • Irritability or unusual behavior. Children with undiagnosed type 1 diabetes may suddenly seem moody or irritable.
  • Blurred vision. If your child's blood sugar is too high, fluid may be pulled from the lenses of your child's eyes. This may affect your child's ability to focus clearly.
  • Yeast infection. Girls with type 1 diabetes may have a genital yeast infection, and babies can develop diaper rash caused by yeast.

When to see a doctor

Talk to your child's doctor if you notice any of the signs or symptoms of type 1 diabetes — increased thirst and frequent urination, extreme hunger, weight loss, blurred vision, or fatigue.

Source: http://www.mayoclinic.com

Controlling Your Diabetes

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The exact cause of type 1 diabetes is unknown. Scientists do know that in most people with type 1 diabetes the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas. Genetics may play a role in this process, and exposure to certain viruses may trigger the disease.

Insulin key to sugar entering cells

Whatever the cause, once the islet cells are destroyed, your child will produce little or no insulin. Normally the hormone insulin helps glucose enter your child's cells to provide energy to the muscles and tissues. Insulin comes from the pancreas, a gland located just behind the stomach.

When everything is working properly, once you eat, the pancreas secretes more insulin into the bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter the body's cells. Insulin lowers the amount of sugar in the bloodstream, and as the blood sugar level drops, so does the secretion of insulin from the pancreas.

The liver acts as a glucose storage and manufacturing center. When insulin levels are low — when you haven't eaten in a while, for example — the liver releases stored glycogen, which is then converted to glucose to keep your blood glucose level within a normal range.

Dangerous sugar level in bloodstream

In type 1 diabetes, none of this occurs because there's no or very little insulin to let glucose into the cells. So instead of being transported into your child's cells, sugar builds up in your child's bloodstream, where it can cause life-threatening complications.

The cause of type 1 diabetes is different from the more common type 2 diabetes. In type 2, the islet cells are still functioning, but the body becomes resistant to insulin or the pancreas doesn't produce enough insulin.

Source: http://www.mayoclinic.com

Controlling Your Diabetes

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If your child's doctor suspects diabetes, he or she will recommend a screening test. The primary test used to diagnose type 1 diabetes in children is the:

  • Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when your child last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes.

If your child's random blood sugar test results don't suggest diabetes, but your doctor still suspects it because of your child's symptoms, your doctor may do a:

  • Glycated hemoglobin (A1C) test. This blood test indicates an average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells.

    The higher the blood sugar levels, the more hemoglobin that has sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates diabetes.

Glycated hemoglobin (A1C) test. This blood test indicates an average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells.

The higher the blood sugar levels, the more hemoglobin that has sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates diabetes.

Another test your doctor might use is a fasting blood sugar test. A blood sample will be taken after an overnight fast.

A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7.0 mmol/L) or higher on two separate tests, your child will be diagnosed with diabetes.

If your child is diagnosed with diabetes, your doctor will also run blood tests to check for autoantibodies that are common in type 1 diabetes and help doctors distinguish between type 1 and type 2 diabetes. The presence of ketones — byproducts from the breakdown of fat — in your child's urine also suggests type 1 diabetes rather than type 2.

After the diagnosis

Once your child has been diagnosed with type 1 diabetes, he or she will regularly visit his or her doctor to ensure good diabetes management.

During these visits, the doctor will also check your child's A1C levels. Your child's target A1C goal may vary depending on his or her age and various other factors.

The American Diabetes Association (ADA) generally recommends slightly higher A1C levels for children and teens than for adults because children are less likely to notice the symptoms of low blood sugar levels. For children younger than age 6, the ADA recommends an A1C of less than 8.5 percent. In children between ages 6 and 12, the recommendation is for an A1C under 8 percent, and teenagers are advised to try to keep their A1C under 7.5 percent.

Compared with repeated daily blood sugar tests, A1C testing better indicates how well your child's diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your child's insulin regimen or meal plan.

In addition to the A1C test, the doctor will also periodically check your child's cholesterol levels, thyroid function, liver function and kidney function using blood and urine samples, as well as periodically test for celiac disease. The doctor will also examine your child to assess his or her blood pressure and growth and will check the sites where your child tests his or her blood sugar and delivers insulin.

Source: http://www.mayoclinic.com

Controlling Your Diabetes

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Type 1 diabetes can affect nearly every major organ in your child's body, including the heart, blood vessels, nerves, eyes and kidneys. The good news is that keeping your child's blood sugar level close to normal most of the time can dramatically reduce the risk of these complications.

Long-term complications of type 1 diabetes develop gradually. Eventually, if blood sugar levels aren't well-controlled, diabetes complications may be disabling or even life-threatening.

  • Heart and blood vessel disease. Diabetes dramatically increases your child's risk of various cardiovascular problems — including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure — later in life.
  • Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your child's nerves, especially in the legs. This can cause tingling, numbness, burning or pain.  Nerve damage usually happens gradually over a long period of time.
  • Kidney damage (nephropathy). Diabetes can damage the numerous tiny blood vessel clusters that filter waste from your child's blood. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.
  • Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy). Diabetic retinopathy can cause blindness. Diabetes can also lead to cataracts and a greater risk of glaucoma.
  • Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections.
  • Skin conditions. Diabetes may leave your child more susceptible to skin problems, including bacterial infections, fungal infections and itching.
  • Osteoporosis. Diabetes may lead to lower than normal bone mineral density, increasing your child's risk of osteoporosis as an adult.

Source: http://www.mayoclinic.com

Controlling Your Diabetes

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There's nothing you or your child could have done to prevent type 1 diabetes; there is currently no known way to prevent type 1 diabetes.

Tests can be done in children who have a high risk of developing type 1 diabetes to see if they have any of the antibodies associated with this disorder. However, the presence of these antibodies doesn't mean that diabetes is a certainty, and there's currently no known way to prevent type 1 diabetes if the antibodies are found.

Researchers are working on preventing type 1 diabetes in people who have a high risk of developing the disease, such as those who have the type 1 antibodies, and others are working on preventing further destruction of the islet cells in people who are newly diagnosed.

Some children with type 1 diabetes may be eligible for clinical trials, but you need to carefully weigh the risks and benefits of any treatment available in a clinical trial with your doctor.

While there's nothing you could have done to prevent your child's diabetes, you can help your child prevent complications due to type 1 diabetes by helping him or her maintain good blood sugar control as much as possible.

In addition, be sure to schedule regular visits with your child's diabetes doctor and a yearly eye exam beginning no more than five years after the initial diabetes diagnosis.

And, like everyone else, people with type 1 diabetes should eat a healthy diet full of fruits, vegetables and whole grains and participate in regular physical activity to help keep their hearts healthy.

Source: http://www.mayoclinic.com

Controlling Your Diabetes

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There is no treatment that can replace insulin for anyone with type 1 diabetes. People who have type 1 diabetes must use injected insulin (exogenous insulin) every day to survive.

It's been suggested that some substances may help with blood sugar control. But none of these substances have been proved to effectively manage or prevent type 1 diabetes and they should not replace insulin.  Some of the substances that have been tested for blood sugar control in type 1 diabetes include blond psyllium, cascia cinnamon, fenugreek, guar gum and niacinamide (vitamin B-3).

Source: http://www.mayoclinic.com

Controlling Your Diabetes

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Type 1 diabetes is a serious disease. Helping your child follow his or her diabetes treatment plan takes round-the-clock commitment and will initially require some significant lifestyle changes. But your efforts are worthwhile. Careful management of type 1 diabetes can reduce your child's risk of serious — even life-threatening — complications.

As your child gets older:

  • Encourage him or her to take an increasingly active role in diabetes management
  • Stress the importance of lifelong diabetes care
  • Teach your child how to test his or her blood sugar and inject insulin
  • Help your child make wise food choices
  • Encourage your child to remain physically active
  • Foster a relationship between your child and his or her diabetes treatment team
  • Make sure your child wears a medical identification tag

Above all, stay positive. The habits you teach your child today will help him or her enjoy an active and healthy life with type 1 diabetes.

School and diabetes

Along with at-home care, you'll also need to work with your child's school nurse and teachers to make sure they know what the symptoms of high and low blood sugar levels are, and in some cases, the school nurse may need to administer insulin or check your child's blood sugar levels.

Federal law protects children with diabetes, and schools must make reasonable accommodations to ensure that all children get a proper education.

Source: http://www.mayoclinic.com

Controlling Your Diabetes

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Living with type 1 diabetes isn't easy — for you or for your child. Good diabetes management requires a lot of time and effort, especially in the beginning.

Your child's emotions

Diabetes can affect your child's emotions both directly and indirectly. Poorly controlled blood sugar can directly affect his or her emotions by causing behavior changes, such as irritability. And if that happens at a birthday party because your child forgot to take insulin before having a piece of cake, he or she could end up fighting with friends.

Another way diabetes can take a toll on your child's emotions is by making him or her feel different from other kids. Most of the time, children don't want to be different, and having to draw blood and give themselves shots definitely sets kids with diabetes apart from their peers. Getting your child together with other children who have diabetes may help make your child feel less alone.

Mental health and substance abuse

People with diabetes have an increased risk of depression and anxiety, which may be why many diabetes specialists regularly include a social worker or psychologist as part of their diabetes care team.

Teenagers, in particular, may have a particularly hard time dealing with diabetes. A child who has been very good about sticking to his or her diabetes regimen may rebel in the teen years by ignoring his or her diabetes care.

Teens may also have a harder time telling friends or boyfriends or girlfriends that they have diabetes because they want to fit in. They may also experiment with drugs or alcohol, behaviors that can be even more dangerous for someone with diabetes. Eating disorders and forgoing insulin to lose weight are other problems that can occur more often in the teen years.

Talk to your teen, or ask your teen's doctor to talk to your teen, about the effects of drugs and alcohol on someone with diabetes. If you notice that your child or adolescent is persistently sad or pessimistic, or if you notice dramatic changes in his or her sleeping habits, friends or school performance, talk to your doctor or a therapist to have your teen assessed for depression. Additionally, let your child's doctor know if you notice that your son or daughter is losing weight or doesn't seem to be eating well.

Support groups

Talking to a counselor or therapist may help your child or you to cope with the dramatic lifestyle changes that come with a type 1 diabetes diagnosis. Your child may find encouragement and understanding in a type 1 diabetes support group for children. Support groups for parents also are available.

Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences or helpful information, such as where to find carbohydrate counts for your child's favorite takeout restaurant. If you're interested, your doctor may be able to recommend a group in your area.

Or you can visit the websites of the American Diabetes Association, the Juvenile Diabetes Research Foundation (JDRF) or Children with Diabetes to find support and regional activities for people with type 1 diabetes and their families. The American Diabetes Association also offers diabetes camp programs that provide children and teens with diabetes education and support. And these groups offer online information and forums for children and teens.

Putting information in context

Because complications from poorly controlled diabetes can be so frightening, it's important to remember that many studies — and therefore, a lot of literature you may be reading — were completed before many advances in diabetes care occurred. And that means many of those scary statistics don't necessarily apply to your child. If you and your child work with your child's doctor and do your best to control blood sugar levels, your child will likely live a long and normal life.

Source: http://www.mayoclinic.com

Controlling Your Diabetes

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There aren't many known risk factors for type 1 diabetes, though researchers continue to find new possibilities.

Known risk factors

These include:

  • A family history. Anyone with a parent or siblings with type 1 diabetes has a slightly increased risk of developing the condition.
  • Genetic susceptibility. The presence of certain genes indicates an increased risk of developing type 1 diabetes. In some cases — usually through a clinical trial — genetic testing can be done to determine if a child who has a family history of type 1 diabetes is at increased risk of developing the condition.

Possible risk factors

Possible risk factors for type 1 diabetes include:

  • Viral exposure. Exposure to Epstein-Barr virus, coxsackie virus, rubella or cytomegalovirus may trigger the autoimmune destruction of the islet cells, or the virus may directly infect the islet cells.
  • Low vitamin D levels. Research suggests that vitamin D may protect against type 1 diabetes. However, early intake of cow's milk — a common source of vitamin D — has been linked to an increased risk of type 1 diabetes.
  • Other dietary factors. Drinking water that contains nitrates may increase the risk of type 1 diabetes. The timing of the introduction of cereal into a baby's diet also may affect a child's risk of type 1 diabetes. One clinical trial found that between ages 4 and 7 months appears to be the optimal time for introducing cereal.

Source: http://www.mayoclinic.com

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