Diabetes in Children
This article is being written towards the end of a prolonged period of social isolation for most of our families, and although this was necessary due to the nature of the pandemic it did not stop children and young people developing other potential life threatening illnesses, but it did deter parents and carers from seeking health care advice and help.
One illness which continued to cause significant problems during this time is Diabetes – a condition when the body cannot control glucose (sugar) levels in the body, due to one of two major reasons:
either a deficiency of insulin - Type 1 Diabetes
an insensitivity to Insulin – Type 2 Diabetes
Both types occur in children and young people, but Type 1 is by far the most common in childhood, and Type 2 has a stronger tendency to run in families.
In the UK there are an estimated 31,500 children and young people with Diabetes, under the age of 19, in the UK. About 95.1% have Type 1 Diabetes; about 1.9% have Type 2 Diabetes; and 2.73% have an indeterminate type – sometime called Maturity Onset Diabetes in a Young person – MODY. In England Diabetes occurs in 1 in every 450 children. 97% of children with Diabetes have Type 1 Diabetes Mellitus. Type 2 Diabetes in children is still uncommon.
One survey found that only 14% of parents know the main warning signs of Type 1 Diabetes. As a result, children can struggle for weeks or months with undiagnosed Type 1 Diabetes, and for much longer with undiagnosed Type 2. Nearly 30% of newly diagnosed children have had at least one related medical visit before diagnosis. Doctors, parents and others with responsibility for the care of children are missing the early signs.
Type 1 Diabetes is five times more common than Meningitis, but is not always recognised by doctors and parents until the child presents with vomiting, abdominal pain, and rapid breathing, when the body’s chemistry fails. This delay in diagnosis, sadly has increased due to an associated delay in seeking help during the pandemic lockdown, and is a condition called Diabetic Keto-Acidosis (DKA) but is reversible with expert treatment.
The 4 T’s which may indicate your child has Diabetes
Parents are advised to take their children to see a doctor if they notice any symptoms associated with Type 1 Diabetes, the 4 commonest (the 4T’s) are:
Toilet - Going to the toilet a lot, bed wetting by a previously dry child or heavier nappies in babies
Thirsty - Being really thirsty and not being able to quench the thirst i.e. waking at night to drink large volumes of liquid
Tired - Feeling more tired than usual
Thinner - Losing weight or looking thinner than usual
By making sure children and young people get a quick diagnosis and early treatment, you can avoid them becoming seriously ill with Diabetic Keto-Acidosis (DKA).
Other symptoms in addition to the 4T’s can include: hunger, blurred vision, abdominal pain, vomiting and thrush.
Doctors may not ask about frequent urination (polyuria) and excessive drinking (polydipsia) and adolescents may ignore the symptoms.
In children under 2 years, the symptoms of Diabetes can be non-specific. However frequent urination (polyuria) and excessive drinking (polydipsia) are the main symptoms in all age groups. New onset bedwetting (nocturnal enuresis) in a previously “dry” child can be one of the first symptoms in 89% of children over the age of 4 years. Recurrent infections can also be a presentation. Oral or genital thrush can be present.
Type 1 Diabetes can be diagnosed with a single finger-stick blood glucose test if the proper technique is followed. The diagnostic criteria for Diabetes in adults and children is a random sample blood glucose concentration over 11.1 mmol/L. If the symptoms are suggestive of diabetes then this must be ruled out. Children and young people should NOT wait for fasting blood glucose tests. The finger sticks capillary test will be confirmed with a lab test of the blood glucose once the child arrives at the hospital. Urine testing should not be not used to make the diagnosis.
A child or young person with a high blood glucose level should be referred promptly on the same day to specialist care.
Children with type 1 Diabetes will require insulin. For most children, insulin will be started on the day of referral. Support and Education are carried out by a multidisciplinary team consisting of Doctors, Diabetes Specialist Nurses, and Dietitians, and of course parents and carers who rapidly become specialists!
You need to get a simple and quick blood test done straight away. If the GP cannot do this straight away and A&E is a long wait you can always go to a Chemist and if they won’t do a test, then buy a test unit. It is a simple clean wipe of the finger, prick the finger and add the blood drop to the testing unit - anything higher than 11.1 mmol/L and you need to go to A&E straight away.