Copyright Baltimore Sun
By Brittany Bruggeman, MD, FAAP and Chineze Ebo, MD, FAAP, American Academy of Pediatrics Each November, we observe National Diabetes Month and engage in discussions surrounding prevention, management and the impact of this increasingly common autoimmune disease. Diabetes, both type 1 and type 2, are conditions that affect the way the body uses food for energy. Type 1 diabetes, sometimes called juvenile diabetes, is one of the most common chronic diseases affecting children and teens and has no known cure. Type 1 diabetes happens when the body cannot make enough of the hormone insulin, which helps break down nutrients in food into a form of sugar called glucose. Insulin allows glucose to move from the bloodstream into cells throughout the body to be used for energy. Ordinarily, our bodies produce insulin in special cells called beta cells found in the pancreas. However, with type 1 diabetes, the immune system mistakenly attacks and destroys these beta cells as if they were harmful germs. Without insulin, glucose is “stuck” in the bloodstream. This leads to high blood glucose levels (hyperglycemia), which can cause damage to the body. Since cells can’t use glucose without insulin, the body breaks down stored body fat for fuel. This process creates ketones, which serve as an alternate energy source. However, ketones are acidic and harm the body when their levels are too high. Symptoms of type 1 diabetes largely result from the lack of energy caused by the body not being able to use glucose. High ketone levels in the bloodstream can also cause symptoms as can high sugar levels in the bloodstream that spill into the urine and pull water along with it, causing dehydration. Type 1 diabetes symptoms in children can include increased thirst, urination and hunger that can sometimes be extreme and is usually associated with weight loss regardless of eating habits. Other symptoms include headache, irritability and blurry vision if blood sugars are extremely high. If untreated, type 1 diabetes can lead to symptoms that require immediate medical care. Diabetic emergency symptoms include nausea, vomiting, belly pain, rapid breathing, a fruity or nail polish remover-like odor to the breath and drowsiness or loss of consciousness. Sometimes, untreated type 1 diabetes can look like the flu. It can seem like the child is OK because they are still urinating normally, or even more than usual. If your child has flu-like symptoms along with increased thirst and frequent urination, get them checked by a doctor right away. Diabetes is diagnosed when a child has classic symptoms along with abnormally high blood sugar levels. Diabetes can also be diagnosed by a test that shows what the average blood sugar has been over the past 3 months. This test is called hemoglobin A1c (HbA1c). Less commonly, diabetes is diagnosed with an oral glucose tolerance test (OGTT). With this test, blood sugars are measured before and after a sugary drink is given. Doctors can also test urine for ketones. The best clues to whether a child has type 1 or type 2 diabetes is a combination of factors doctors consider. This includes the child’s age and other factors like the presence of proteins called islet autoantibodies in the bloodstream. This is a sign that there is an immune attack happening against the beta cells, indicating type 1 diabetes. Treatment for type 1 diabetes is aimed at normalizing blood sugar levels but this is not a simple task. Blood sugars need to be monitored frequently with a blood glucose meter – a portable device that tests a drop of blood placed on a test strip inserted into the meter – or a continuous glucose monitor (CGM). A CGM uses a small sensor to continuously measure the glucose level in the space under the skin with results being sent to an insulin pump, phone app or handheld device. Diabetes can be treated by giving insulin through multiple daily injections. This can be done with either pens or syringes with very thin and short needles. Insulin injections are most commonly given in the upper part of the arms, in the front of the thighs and in the fatty skin of the belly. The insulin is absorbed into fatty tissue and typically isn’t very painful. Insulin can also be given through a small wearable device often referred to as an insulin “pump.” The pump delivers insulin through a tiny tube under the skin called a cannula. That tube can be made from plastic or even metal depending on how the wearer tolerates them. There are also multiple different kinds of insulin pumps to best fit the wearer’s lifestyle. A healthy diet is also very important in type 1 diabetes. Insulin dosing needs to be matched with the amount of carbohydrates ingested. Being physically active is also key, and insulin often needs to be reduced at times of physical activity. Several insulin pumps have settings that can drop insulin levels during exercise and sleep to minimize the chance of having a low blood sugar episode or hypoglycemia. An automated insulin delivery system (AID, also called an “artificial pancreas”) is another option. With an AID, an insulin pump and a CGM communicate with each other to help regulate the blood sugars. AID systems can drop background insulin levels if the wearer is riding low or boost insulin output if sugars are climbing. If you notice any of the symptoms of type 1 diabetes in your child, bring them to their pediatrician right away. The doctor can easily check for excess sugar in the urine or blood. It may be tempting to borrow a glucose meter from a relative or friend to check your child’s blood sugar, but we advise against this. It is always best to get an opinion from a doctor so they can swiftly begin treatment if needed. Advances in screening have made it possible to assess the risk of developing type 1 diabetes before symptoms appear. People at higher risk, including those with a relative with type 1 diabetes, may be eligible for screening through a research study. And other options may be available for those without a type 1 diabetes relative. While type 1 diabetes cannot yet be fully prevented, newer medications can help delay its onset in certain high-risk individuals. For those at high risk who show early signs of blood sugar abnormalities, an FDA-approved medication is available that can delay the progression to full-blown type 1 diabetes by an average of 2 years. It works by targeting the specific immune cells responsible for attacking insulin-producing cells in the pancreas, helping to slow progression of the disease. Chineze Ebo, MD, FAAP, is a member of the American Academy of Pediatrics Section on Endocrinology and a Pediatric Endocrinology fellow at Cincinnati Children’s Hospital Medical Center. Brittany S. Bruggeman, MD, FAAP is a member of the American Academy of Pediatrics Section on Endocrinology and a pediatric endocrinologist and type 1 diabetes physician scientist at the University of Florida. ©2025 Tribune Content Agency, LLC.
