Clinical Reference Systems: Pediatric Advisor 10.0

What is diabetes?

Diabetes is a disorder where the body does not make enough of a hormone called insulin. Children with diabetes usually urinate a lot, drink a lot of fluids, and lose weight. Diabetes is also called insulin-dependent diabetes mellitus, childhood diabetes, juvenile diabetes, or type 1 diabetes.

Childhood (type 1) diabetes mellitus should not be confused with adult-onset (type 2) diabetes. People with type 2 diabetes can still produce insulin in regular amounts and are treated differently.

What cause type 1 diabetes?

Insulin is a hormone produced by an organ in your body called the pancreas. When food is digested, the body breaks down much of the food into sugar (glucose). Blood carries the sugar to the body's cells for energy. Insulin helps the sugar enter the cells and controls the level of sugar in the blood.

In type 1 diabetes destruction of cells in the pancreas causes the pancreas to produce very little insulin. When there is not enough insulin in the body, the amount of sugar in the blood reaches very high levels. Too much sugar in the body can cause many serious problems. If the problems are not treated, they can be life-threatening.

Often it is not known why cells of the pancreas are destroyed. There is a tendency for diabetes to run in families. Destruction of pancreas cells could be the result of an immune response, possibly triggered by a viral infection.

What is the treatment?

Type 1 diabetes usually develops in childhood or early adulthood and must be treated with insulin shots. With treatment, blood sugar levels can be controlled.

1. Initial test for diabetes

   If you suspect your child has diabetes, call your physician. If you want to test for diabetes before you are able to see your doctor, you can purchase a simple urine dipstick test called Keto-Diastix at a pharmacy. Keto-Diastix can be used to check the level of sugar and other chemicals in your child's urine. Call your child's physician immediately if the test of the urine is positive.

2. Education and diet

   When a child is diagnosed with diabetes, there is a lot the family must learn about the disease. This education is usually done for 2 or 3 days at a children's diabetes specialty clinic. Health care providers will teach you what diabetes is and how to give shots of the proper amounts of insulin to your child. You will learn how to test for sugar in the blood and for ketones in the urine. You will learn how to treat low blood sugar and other procedures needed to keep your child healthy.

   A dietician will teach you about food management. A child with diabetes should not eat too many carbohydrates, particularly between meals, and should eat and snack consistently from day to day.

3. Control of blood sugar levels

   Home care involves balancing diet, exercise, and stress with the correct dosage of insulin. Children with diabetes must get insulin shots. The correct dosage of insulin in the shots is not always the same. The dosage must be adjusted according to the level of sugar in the child's blood at the time of the shot. If a child gets too much insulin, low blood sugar (hypoglycemia) could result. Just as prevention of high blood sugar is important, prevention of low blood sugar is also very important.

   Most families use a home meter to measure the level of sugar (glucose) in their child's blood three or four times each day. After the age of 7 to 10 years, the child can learn how to test blood sugar. Families also learn how to give the insulin shots, and children can learn when they are 10 or 11 years old to do their own shots. Measuring blood sugar and giving insulin shots at home allows the best adjustment of insulin dosages and thus the best control of sugar in the blood.

   Blood sugar levels measured when a child has not eaten for at least 2 hours ("fasting blood sugar") should be kept in the following ranges:

   • Children under the age of 5 years: 100 to 200 mg/dL (5.5 to 11.1 mmol/L).
   • Children ages 5 to 11 years: 80 to 180 mg/dL (4.4 to 10.0 mmol/L)
   • Children over 12 years old: 70 to 150 mg/dL (3.9 to 8.3 mmol/L).

4. Follow-up visits with your child's doctor.

   Your child's doctor will measure the overall glucose control every 3 months with a test called the hemoglobin A1c (HbA1c). If the HbA1c is kept in a good range, the risk is greatly reduced for the eye, kidney, and nerve problems that diabetes can later cause.

5. Urine dipstick tests

   It is important to keep urine dipstick tests (Ketostix or Keto-Diastix) at home to measure ketones in the urine when necessary. The urine must be tested if a child with diabetes is sick (even vomiting once), or if the blood sugar is high (for example, above 240 mg/dL, or 13.3 mmol/L). Fat breaks down into ketones when not enough insulin is available. Ketones have acid properties that can make a person very sick, causing a condition called ketoacidosis.

6. Checking other family members

   Other family members have a 1 in 20 chance (5%) for also developing diabetes. A blood glucose level test is not very helpful because the test does not show high glucose levels unless the person already has diabetes. Fortunately, a test called the "islet cell antibody" test is now available that can predict diabetes as much as 10 years before a person gets diabetes. It is a free test through the Diabetes Prevention Trial (DPT-1). Call 1-800-425-8361 for more information (in Denver call 303-315-6397).

Call Your Child's Doctor Immediately If:

• A urine dipstick test is positive for sugar in a child who has not yet been diagnosed with diabetes.
• Your child frequently has low blood sugar (hypoglycemic reactions), particularly if your child loses consciousness or has seizures.
• A urine dipstick test shows that there are moderate or large amounts of ketones in your child's urine.

Call Your Child's Doctor During Office Hours If:

• Blood sugar values measured at home are constantly above the desired range for your child's age (see recommended values under "Treatment").
• Blood sugars done at home are frequently (one or two times a day) below the desired range for your child's age.
• Another illness (for example, flu) occurs, which might upset the diabetes.
• If you have other questions about diabetes.

A book is available for families who have a family member with type 1 diabetes that explains home care in detail. It is called "Understanding Insulin Dependent Diabetes." The book is available for $10.00 (this includes shipping and handling and is payable by check made out to CDF-Guild). You can get the book by writing to:

The Guild of Children's Diabetes Foundation
777 Grant Street, Suite 302
Denver, Colorado 80203