Everyone has heard of diabetes and knows it has something to do with sugar, but do you understand the different types and potential signs to look for in your child? This past week at work, I diagnosed diabetes in two kids. One child was type 1 and one was type 2. I’m going to feature articles this week on both. Today I’m going to look at Type 1 diabetes.
Type 1 diabetes overview
The complete name for diabetes is diabetes mellitus. It is a metabolic problem where the body does not make enough insulin. Insulin is a hormone that allows the body to take sugar (or glucose) from the blood and put it into the cells of the body to be used. So if you have type 1 diabetes, your blood sugars will be high and the way to fix it is to take insulin. However, it’s easier said than done.
Why does one get diabetes?
There are lots of theories on why Type 1 diabetes happens. It is believed to be a combination of genetic and environmental factors. Having family members with diabetes increases your risk, but does not guarantee the condition. Interesting aside, in studies of affected identical twins, both twins are only affected 30-50% of the time (despite having the same genes). The environmental component is poorly understood as well. In some parts of Europe there is a 10-fold difference in rates in Caucasians depending on where they live.
In type 1 diabetes, there is also an autoimmune (meaning the body attacks itself) component to the condition. The pancreas (the organ in the left upper part of the abdomen) has cells called beta cells that make insulin. In type 1 diabetes, the body destroys those beta cells, so there isn’t insulin produced. It has been theorized that certain viruses may trigger this autoimmune response, but the science isn’t completely definitive on it. We do know that certain chemicals (e.g., pyrinuron used to kill rodents and streptozotocin use to treat cancers) are toxic to the beta cells of the pancreas. So it is a complicated picture.
What are diabetes symptoms?
Once people understand that in Type 1 diabetes, the blood sugars are really high and can’t get sugar into the cells, all the symptoms make sense. It’s the science principle we all learned in elementary school, water follows where the most solutes are to try and balance (this is why you get wrinkly swimming in the ocean).
- Increased thirst, aka, polydipsia (the body is driving the child to drink more water to dilute the sugars)
- Increased urination, aka, polyuria (if you drink a lot, you’re bound to pee a lot)
- Increased appetite, aka, polyphagia (the sugar can’t get into the cells, so the body is starving)
- Weight loss (the body can’t absorb those sugars). The typical picture of a type 1 diabetic is a thin kid.
- Fatigue (again, no fuel to the body)
Unfortunately, many times families miss these early signs and kids present with diabetic ketoacidosis (DKA). Diabetic ketoacidosis is serious progression/complication where there is:
- Rapid breathing
- Dry skin
- Abdominal Pain
DKA is life threatening and is usually treated in an intensive care unit at the hospital. Rush to the emergency department if these are your child’s symptoms.
How it Type 1 diabetes diagnosed?
Blood tests are the gold standard for diagnosing type 1 diabetes. There is a specific test called a hemoglobin A1c (hg A1c) that tests your average blood sugar for 3 months. For a hemoglobin A1c, it doesn’t matter whether the child is fasting when the blood is drawn. If the value is greater than 6.5%, you usually have problems. Another helpful test is a fasting blood sugar. Generally, a fasting blood sugar shouldn’t be more than 126 mg/dl. In addition, there are follow up blood tests that are often done to test antibodies in the blood, which helps a doctor determine risk and type of diabetes. Sometimes, a doctor will have a patient give a urine sample to see if sugar and/or ketones are spilling into the urine (not normal).
How is Type 1 diabetes treated?
As I mentioned previously, Type 1 diabetes is treated with insulin replacement. This can be done in one of 2 ways: a separate injection (with a needle) or a pump (which has a catheter that stays under the skin). Typically, a newly diagnosed diabetic learns to treat elevated sugars with injections before moving to a pump. The difficulty in treating diabetes is finding the perfect dose of insulin. If too much insulin is given, the child will have low sugars. If not enough is given, then the sugars are high. Both lows and highs have medical problems. So in the end, the child ends up getting a lot of sugar checks (finger pokes) to make sure the levels are ok).
For clarification, Type 1 diabetes cannot be treated with oral medications (that is type 2 diabetes).
If you worry that your child may be exhibiting any signs or symptoms of diabetes, I encourage you to take your child in to the doctor. This is definitely not a diagnosis that you should “wait and watch.”