Diabetes has become a scourge of epidemic proportion in recent decades. Most pediatric health experts agree that the primary culprit is the rise in childhood obesity. Not only does this condition doom the child to a lifetime of constant blood tests and medications, it wreaks havoc on the body, taking a toll that causes it to deteriorate and ultimately leads to an early grave.
Regardless of the type, diabetes is a condition in which the body loses its natural ability to regulate and utilize blood sugar. As a result, blood-sugar levels fluctuate wildly in children with diabetes. The bloodstream gets inundated with sugar right after a meal, and this abnormally high level of sugar causes chemical changes in the blood vessels. These chemical alterations do not cause symptoms early on, but the cumulative effects of these changes are devastating in the long run.
Insulin is the hormone that triggers blood sugar in the bloodstream to be transported to the body's cells so the sugar can be utilized as an energy source for the body's functions. In diabetics, there is either a deficiency of insulin or the cells in the body stop responding to the signal conveyed by existing insulin.
Type 1 Diabetes
Type 1 diabetes used to be called juvenile type diabetes, but that has become a misnomer now that more children are diagnosed with type 2 diabetes than type 1. Before the dramatic increase in childhood obesity, children rarely got type 2 diabetes. The rampant overweight problem in children quickly changed all that.
Type 1 diabetes is hypothesized to originate from an immunologic attack within one's own body on the organ that produces insulin. Without an adequate amount of insulin, the body cannot transport the sugar from the bloodstream into the cells. Therefore, the sugar in the blood remains abnormally high, while the cells in the body starve.
Symptoms start relatively quickly when children first come down with type 1 diabetes. These include increased thirst, urination, and weight loss, despite a ravenous appetite. If undiagnosed, the weight loss can be quite drastic. Lack of energy and vomiting are warning signs that the diabetes is far out of control. Unless these children seek medical help urgently, they may drift into a coma.
Type 2 Diabetes
Type 2 diabetes is primarily the result of being overweight. As obesity sets in, the body's natural hormone-control mechanism fails, and the cells stop responding to the signals from insulin. Consequently, the insulin level in type 2 diabetics is initially elevated to compensate for the lack of response. Eventually, the body's insulin production shuts down after working excessively for an extended period of time.
Symptoms associated with type 2 diabetes generally occur more insidiously than with type 1 diabetes. The body initially tries to compensate for the insulin insensitivity, but after working overtime for so long, it ultimately fails. Symptoms are similar to those associated with type 1 diabetes except that they are less acute and less pronounced. Frequent yeast infections and slow wound-healing can be early signs of the illness. Children with type 2 diabetes are less likely to develop coma from the onset of diabetes because the symptoms tend to appear gradually.
Type 1.5 Diabetes
Some children with diabetes have elements of both type 1 and type 2 diabetes. Pediatric endocrinologists (specialists who take care of children with diabetes) have termed this condition “type 1.5 diabetes.”
The initial symptoms for these children consist of a hybrid between type 1 and type 2 diabetes. In particular, these children tend to be more overweight than children with type 1 diabetes.
Establishing the Diagnosis
Early signs of type 2 diabetes include rapid weight gain and the appearance of dark pigmentation around the neck and the armpits. These are ominous findings, but they do not always precede type 2 diabetes. Clinicians usually order screening tests for diabetes if these physical findings are present in a patient.
Laboratory evaluation typically involves a blood sugar level, a urine test for excessive sugar leaking into the urine, other hormone levels (including thyroid hormone), and a cholesterol level. Fortunately, confirming the diagnosis for diabetes is relatively straightforward. It's what comes after the diagnosis that is complicated.
Complications of Diabetes
There are too many potential complications from diabetes to be listed here. The most devastating include blindness, amputation of the feet, heart attacks, and strokes.
All of the horrific conditions listed above result from damage within the blood vessels due to an elevated blood sugar level. Diabetes is the leading cause of blindness in the United States, and it is also the leading cause of amputation. It also contributes to the high death rate from cardiovascular diseases, such as heart attacks and strokes.
The damage to these organs starts immediately when diabetes first sets in, regardless of the age of the child. The sooner the blood sugar is brought under control, the more you can minimize the long-term disability caused by diabetes. Frequent evaluation by an eye doctor is absolutely essential for children with diabetes.
Once diabetes strikes, there is no cure for it. Consequently, it's paramount to regulate blood sugar to minimize the damage that diabetes can do to the body. Most children rely on insulin injections to control their blood sugar, but a very small minority can be managed with oral medications. Regardless of the insulin regimen, healthy nutrition and a regular exercise program are the most important components of any diabetic management plan. A lifestyle change is often necessary for these patients, especially for those with type 2 diabetes.
Insulin can be a particularly dangerous medication. If it is given inappropriately (at the wrong time or in the wrong dosage), it can quickly kill a child. Even if the correct dose is given at the right time, if the child already has low blood sugar for whatever reason (such as a missed dinner or sleeping in), the usual dose of insulin can lower the blood sugar to a life-threatening level.
It's a tricky business getting children to stick to their insulin regimen, which requires them to measure their blood sugar levels meticulously and consistently. For a child who is not yet mature enough to manage her own insulin injections, the parents or caregiver must step in to supervise her care.
At the same time, studies show that a very aggressive insulin regimen — one that lowers blood sugar more than the traditional approach — can prevent or delay long-term complications from diabetes. So a regimen that is too lax is less risky in the here and now, but the regimented child suffers permanent organ damage in the long run.
A more strict insulin regimen has higher risk of causing dangerously low blood sugars, but it protects the patient from permanent disability. It's a fine line between balancing the risk of management and long-term disability.