Introduction:

Childhood diabetes, both Type 1 and Type 2, is on the rise globally, with Type 2 diabetes showing a particularly alarming increase in recent years. However, children are more likely to be diagnosed with type 1 diabetes. Hence, prevention and early detection can effectively help in reducing complications and ensuring better long-term health outcomes.

Let’s explore what childhood diabetes is, including its causes and risk factors, how to recognize the signs, diagnostic methods, treatment options, and preventive strategies.

What is diabetes?

Diabetes mellitus is a long-term medical condition that causes issues with the body’s ability to convert food, especially carbohydrates (sugars), into fuel for the body. If left untreated, DM can damage the heart, kidneys, blood vessels, eyes, and nervous system over many years.

What is childhood diabetes?

Childhood diabetes is referred to as diabetes mellitus in children and adolescents, which is a long-term (chronic) condition where the body of the patient has difficulty in regulating blood sugar levels due to either insufficient insulin production or an inability to use insulin effectively.

Types of childhood diabetes

Below are the types of childhood diabetes that are similar to those in adults: 

• Type 1 (pancreas produces little to no insulin)
• Type 2 (body doesn’t use insulin effectively)

Type 1 diabetes

Type 1 diabetes, previously called juvenile diabetes, is an autoimmune condition where the body’s immune system attacks and destroys insulin-producing cells in the pancreas, leading to the body’s inability to produce insulin (a hormone that converts sugar into energy), increasing the levels of sugar in the blood.

Type 1 diabetes can develop at any time, even during infancy, but is usually seen in kids between the ages of 4 and 6 years or between the ages of 10 and 14 years.

Kids with T1D are at higher risk of some other disorders in which the body’s immune system attacks itself, especially certain types of thyroid disease and celiac disease.

If left untreated, T1D can lead to serious complications such as diabetic ketoacidosis (DKA), kidney disease, nerve damage, and heart disease.

Hence, early detection plays a major role in preventing complications.

Type 2 diabetes

Type 2 diabetes occurs due to the cells in the body not responding adequately to insulin (called insulin resistance). Unlike in type 1 diabetes, the pancreas can still make insulin but cannot make enough of it to overcome insulin resistance.

T2D has been on the rise in young individuals and is correlated with the increase in childhood obesity and inactivity.

Types of childhood diabetes

Below mentioned are the types of childhood diabetes which are similar to those in adults:

• Type 1 diabetes
• Type 2 diabetes

Warning signs and symptoms of childhood diabetes

The following are some of the warning signs and common symptoms of childhood diabetes, including:

• Fatigue, weakness
• Increased thirst
• Extreme hunger
• Unintentional weight loss
• Frequent urination, possibly bed-wetting in a toilet-trained child
• Fruity-smelling breath
• Irritability or behavior changes
• Slow-healing wounds and recurring infections

Silent symptoms parents often miss

• Dry skin or itching
• Craving for sweets or excessive hunger
• Acanthosis nigricans – skin darkening
• Bedwetting in older children 

Causes and Risk factors

Causes

Both type 1 and type 2 have various causes. The exact cause of type 1 is unknown; however, some researchers have believed that certain faulty immune response, genetic predisposition and potential environmental triggers can cause the type 1.

however, type 2 is often linked to combination of genetic predisposition and environmental factors with lifestyle factors such as poor diet, obesity and lack of physical activity.

Risk factors:

• Children with family history of diabetes
• Overweight or obese and sedentary children
• Children with PCOS or other hormonal imbalances
• Kids with history of low birth weight or obesity 

Causes and Risk Factors

Causes

Both type 1 and type 2 have various causes. The exact cause of type 1 is unknown; however, some researchers have believed that certain faulty immune responses, genetic predisposition, and potential environmental triggers can cause type 1.

However, type 2 is often linked to a combination of genetic predisposition and environmental factors, with lifestyle factors such as poor diet, obesity, and lack of physical activity.

Risk factors:

• Children with a family history of diabetes
• Overweight or obese and sedentary children
• Children with PCOS or other hormonal imbalances
• Kids with a history of low birth weight or obesity 

How diabetes affects growth, learning & immunity

• Missed classes, lower academic performance
• Frequent illness or poor healing
• Psychological effects and low self-esteem
• Eating disorders
• Growth issues

Diagnosis methods

• Blood tests: Childhood diabetes can be diagnosed through a variety of methods, including blood tests such as fasting and random blood sugar tests and the A1C test that measures the levels of glucose in blood.
  • Fasting plasma glucose: This test will be performed to measure the blood sugar levels after an overnight fast (at least an 8-hour fast is required). A level of 126 mg/dL (7.0 mmol/L) A level higher than this level often indicates diabetes.
  • Random plasma glucose: This is the test that can be performed at any time. During the blood test, a blood sample will be taken, regardless of when the child last ate. A level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes.
  • Glycated haemoglobin (A1C) test: A healthcare professional performs this test to check the past 2-3 months of blood sugar levels, primarily for diagnosing and monitoring the sugar, and to assess the long-term blood sugar control. A level of 6.5% or higher indicates diabetes.
  • Oral glucose tolerance test: In this test, the doctor asks the patient to fast, then asks the patient to drink a sugary liquid, and the blood sugar levels are monitored for the next 2 hours. A level of 200 mg/dL (11.1 mmol/L) or higher indicates diabetes.

Other than blood tests, some additional tests may be performed to assess the diabetes-related antibodies to confirm the diabetes diagnosis and rule out other conditions.

• Antibody testing: In some cases, where the diagnosis is unclear (particularly with type 1 diabetes), doctors may test for specific antibodies related to type 1 diabetes, including anti-insulin or anti-islet cell antibodies and anti-GAD65.

Treatment and lifestyle management

Treatment for childhood diabetes (both type 1 and type 2) involves a combination of medications, lifestyle modifications, and regular monitoring to manage blood sugar levels and prevent complications. Usually, in both adults and children, T1D (type 1 diabetes) is treated with insulin, whereas T2D (type 2 diabetes) is treated with metformin.

Type 1 treatment

• Insulin therapy: Unlike kids diagnosed with type 2, kids with type 1 need insulin treatment to survive through an insulin pump or injections. Other classes of drugs are under assessment for their safety and efficacy in pediatric patients.
• Blood glucose monitoring: Continuous monitoring of blood glucose levels with a meter can help the doctor to adjust insulin doses and manage it effectively.
• Lifestyle management: A balanced diet with appropriate intake, coupled with regular physical activity, is essential for managing blood sugar and overall health.

Type 2 treatment

• Medications: First, doctors recommend lifestyle changes; if they won’t work, medications like metformin (an oral medication) or insulin can be recommended to control blood sugar.
• Regular monitoring: Regular monitoring of glucose levels is crucial to track the effectiveness of diabetes treatment.
• Lifestyle management: Lifestyle modifications play a major role in managing diabetes. Initially, type 2 diabetes can be managed with lifestyle changes, such as increased physical activity, dietary adjustments, and weight management.

Preventive strategies

Preventing childhood diabetes involves focusing on healthy lifestyle choices and proactive measure, such as:

Type 1 diabetes prevention: 

Currently, there is no known way to definitively prevent type 1 diabetes in children. However research is going on for preventive strategies to delay or prevent its onset, and there are ways to manage the condition and prevent complications.

Type 2 diabetes prevention: Type 2 diabetes largely preventable, relies on addressing modifiable risk factors like obesity and sedentary lifestyles through lifestyle interventions:

• • Eating balanced foods:  If your kids diagnosed with T2D, as a parent choosing balanced diet for your kid with plenty of fruits, vegetables and whole grains can promote healthy weight improving insulin sensitivity, regulating blood sugar levels and reduces the risk of obesity. It is recommended to limit the sugary drinks, processed foods and excessive portion sizes is essential.
  • Increasing physical activity: Encourage your kid to regularly physically active for at least 60 minutes most days of the week.
  • Early intervention: Regular health screenings and check ups for risk factors like obesity can help to detect and address potential issues early on.
• Family-based approach: What the parents does, kids follow that whether they are good habits or bad habits. Hence healthy habits should be adopted by the whole family with parents acting as role models.

Preventive strategies

Preventing childhood diabetes involves focusing on healthy lifestyle choices and proactive measures, such as:

Type 1 diabetes prevention:

Currently, there is no known way to definitively prevent type 1 diabetes in children. However, research is going on for preventive strategies to delay or prevent its onset, and there are ways to manage the condition and prevent complications.

Type 2 diabetes prevention: 

Type 2 diabetes is largely preventable, relying on addressing modifiable risk factors like obesity and sedentary lifestyles through lifestyle interventions:

• Eating balanced foods: If your kids are diagnosed with T2D, as a parent, choosing a balanced diet for your kids with plenty of fruits, vegetables, and whole grains can promote a healthy weight, improve insulin sensitivity, regulate blood sugar levels, and reduce the risk of obesity. It is also recommended to limit sugary drinks, processed foods, and excessive portion sizes.
• Increasing physical activity: Encourage your kid to regularly be physically active for at least 60 minutes most days of the week.
• Early intervention: Regular health screenings and check-ups for risk factors like obesity can help detect and address potential issues early on.
• Family-based approach: What the parents do, kids follow that, whether they are good habits or bad habits. Hence, healthy habits should be adopted by the whole family, with parents acting as role models.

Conclusion:

Childhood diabetes, including both Type 1 and Type 2, is becoming increasingly common. Type 1 diabetes, an autoimmune condition, cannot be prevented but can be effectively managed with insulin therapy, regular monitoring, and support from a pediatric endocrinologist. In contrast, Type 2 diabetes is often linked to obesity and poor lifestyle habits and can be largely prevented through early intervention, healthy eating, and physical activity. Early detection and a family-centered approach are crucial for managing both types and ensuring better long-term health for children.