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Insulin-Dependent Diabetes

"We thought he had the flu."

"She was thirsty and kept running to the bathroom. The school nurse thought she might have a bladder infection."

"He felt tired and was losing weight. We blamed it on exams."

Diabetes is a great pretender, and its first symptoms are often mistaken for those of more common childhood problems - it may be the last illness that parents suspect when they bring their child to see a doctor. Yet 210,000 people under the age of 20 already have the condition.

The parents of a child who's diagnosed with diabetes have a big adjustment ahead: They must understand the condition and help their child control it and cope with it. But with care, encouragement, and some good practical knowledge about diabetes, parents can become their child's most important allies in learning to live with the condition.

What Is Diabetes?
Diabetes is a condition that affects how the body handles glucose, a simple sugar that's the major energy source for the body and is derived from the foods we eat. Blood levels of glucose are controlled primarily by a hormone called insulin - a chemical produced by beta cells in the pancreas (a gland located near the stomach).

Normally, soon after we eat, beta cells in the pancreas secrete insulin into the bloodstream to help our bodies handle glucose absorbed into the blood from digested food. Insulin allows glucose to enter individual body cells for use as fuel. It also directs the way glucose is stored in fat cells (as fat) and in the liver (as glycogen).

When children develop diabetes, it's usually because the pancreas stops producing enough insulin. From the beginning of their illness, they must depend on insulin injections to control their blood glucose levels (currently, insulin can't be taken by mouth because it's destroyed by the body's digestive juices). This type of diabetes is known as insulin-dependent diabetes mellitus (IDDM), but it can also be called type 1 diabetes or juvenile diabetes.

When insulin-dependent diabetes mellitus affects a child, the child's own immune system attacks and destroys the beta cells in the pancreas that produce insulin. Although children with insulin-dependent diabetes mellitus probably inherit a genetic tendency for developing this type of diabetes, their immune systems still need some sort of trigger to set off beta cell destruction. Although exact trigger or triggers aren't known for certain, researchers suspect that viruses may be involved in some cases.

Insulin-dependent diabetes mellitus is different from non-insulin-dependent diabetes mellitus (NIDDM) (also called adult-onset or type 2 diabetes), the most common form of the disease when all age groups are considered. Although type 2 diabetes is more common in adults, the disorder is being seen more often in children and teens in recent years. Higher rates of children who are overweight or obese are probably contributing to this trend.

This form of diabetes doesn't result from destruction of the cells that make insulin (as in type 1 diabetes) - instead, it stems from the body's "resistance" to the effects of insulin, often associated with obesity. Adults and children with non-insulin-dependent diabetes mellitus may control their diabetes with diet, exercise, and sometimes medicines taken by mouth. But in some cases of non-insulin-dependent diabetes mellitus, these treatments alone may not control the condition adequately and the patient must use insulin.

How Does Diabetes Affect the Body?
Once insulin-producing beta cells are destroyed, the child's pancreas can't replace them. As beta cells die, insulin levels in the blood drop, and glucose can no longer enter the body's cells to be used as an energy source. Without insulin, body cells are starved for glucose fuel, even as glucose levels rise higher and higher in the blood. The body interprets messages from these "hungry" cells and the low blood insulin levels as signals that the child is starving from lack of food, so the brain's appetite centers push the child to eat more (in other words, his or her appetite increases). The body also activates other anti-starvation hormone systems to begin breaking down muscle and stored fat to produce more glucose and alternative fuels (so the child loses weight).

As the kidneys flush out excess glucose from the blood via urine, the child needs to urinate more frequently and in larger volumes (a symptom called polyuria). In response to this large loss of body water through increased urination, the child becomes very thirsty. He or she drinks unusually large amounts of water or other liquids (polydipsia) in an attempt to keep the levels of body water normal.

As the child's body breaks down fats, by-products called fatty acids and ketones build up in the blood. Rising levels of ketones can trigger episodes of rapid, deep breathing (called Kussmaul respirations) and give the child's breath a fruity smell. As the child's blood fills with abnormally high levels of acid and other body chemicals, abdominal pain, nausea, and vomiting occur. High levels of acid in the body also affect the brain, which causes the child to become very sleepy or even lose consciousness. This condition is known as diabetic ketoacidosis.

In addition to short-term problems, diabetes can also cause long-term complications. Heart disease and stroke are two to four times more common in people with diabetes than in those without it. Diabetes is also the leading cause of blindness in people over age 20, and it's the leading cause of end-stage renal disease, the most severe cause of kidney damage.

People with diabetes are also at higher risk for high blood pressure; periodontal disease (severe gum disease that can lead to tooth loss); nerve problems that can cause numbness or pain in the extremities, particularly the feet; and disease of the blood vessels that supply the legs and feet that can result in gangrene and lead to amputations. However, research has shown that better control of diabetes can significantly reduce a person's risk of developing these problems.

What Are the First Symptoms?
Parents of a child with classic symptoms of diabetes may notice that their son or daughter is abnormally thirsty, needs to urinate frequently, and has been losing weight in spite of a good appetite. But this is only one possible set of symptoms. Sometimes, the first sign of diabetes is bedwetting in a child who has always been dry at night. Other times, in girls, it's a vaginal yeast infection (also called a Candida infection).

About 25% of children have already progressed to diabetic ketoacidosis by the time they first see the doctor. Because these children may vomit and complain of abdominal pain, their symptoms can be mistaken for the flu or appendicitis. If the condition isn't recognized and treatment isn't started, the other symptoms of diabetic ketoacidosis develop: rapid and deep breathing, fruity breath odor, and possible loss of consciousness.

Doctors diagnose diabetes by testing for glucose and ketones in the urine and by measuring glucose levels in the blood.

What's It Like for Kids With Insulin-Dependent Diabetes?
Children with diabetes grow up with the task of monitoring and controlling their body's glucose levels, which involves:

  • following a balanced diet to control their intake of carbohydrate (sugars and starches in food that release glucose into the blood)
  • getting regular exercise to help control their blood glucose levels and reduce their risk of long-term complications of diabetes (such as heart and blood vessel disease)
  • checking their blood glucose levels several times each day by testing a small blood sample with a glucose meter
  • giving themselves insulin injections (based on their blood glucose levels) according to a plan that's been worked out with their doctor beforehand

Living with diabetes is a challenge, no matter what a child's age, but young children and teens often have special issues to deal with. Young children may not understand why the blood samples and insulin injections are necessary and may be angry and uncooperative.

Teens may feel different from their peers and may struggle through times when they want to live a more spontaneous lifestyle than their diabetes regime allows. Even when they faithfully follow their treatment schedule, teens with diabetes may feel frustrated when the natural adolescent body changes and the surge of growth hormone - a hormone that tends to raise blood glucose - may make their diabetes somewhat harder to control.

Are There Advances in the Treatment of Diabetes?
Fortunately, new products and equipment are being developed every day to help children cope with the special problems of growing up with diabetes. Devices that may make blood sugar testing and insulin injections easier and more effective are being continuously developed. Some, such as the insulin pump, are already in use.

Researchers are also working on techniques to deliver insulin through nasal sprays, inhalers, patches, and pills. The genetically engineered human insulin now used has replaced older forms of insulin that were more likely to cause skin problems and allergic reactions. Scientists also are perfecting revolutionary new glucose monitors that would make traditional blood sampling obsolete.

The development of devices that can continuously and accurately measure a person's blood sugar are the key to producing an "artificial pancreas." With such a system, the blood sugar readings from a sensing device are fed into a computerized insulin pump, which can then dispense the precise amount of insulin the person needs. This kind of reliable and practically wearable or implantable system could enable a person with diabetes to achieve excellent blood sugar nearly effortlessly.

A potential "cure" for diabetes involving transplantation of insulin-producing pancreatic cells is now possible, too, but not perfected. Scientists are making progress in finding safe ways to protect the transplanted cells from being attacked and destroyed by the body's immune defenses.

Researchers are also testing ways to stop diabetes before it starts. Currently, the U.S. government's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is studying nondiabetic relatives of people with insulin-dependent diabetes mellitus to see if they can prevent diabetes in those who may have inherited an increased risk for the disease.

Until scientists have perfected ways to better treat and possibly even prevent diabetes, you can help your child lead a happier, healthier life by giving constant encouragement, arming yourself with diabetes information, and making sure your child eats right, exercises, and stays on top of glucose levels every day.

Reviewed by: Steven Dowshen, MD
Date reviewed: December 2004