Children and diabetes

Type 1 diabetes in U.S. children and adolescents may be increasing and many more new cases of type 2 diabetes are being reported in young people. Standards of care for managing children with diabetes issued by the American Diabetes Association in January 2005 provide helpful guidance. To update primary care providers and their staff members about this rapidly changing area of diabetes care, the National Diabetes Education Program (NDEP) has developed this overview of the current literature.

What Is Diabetes?

Diabetes mellitus is a group of diseases characterized by high levels of glucose in the blood resulting from defects in insulin production, insulin action, or both. Diabetes can be associated with serious complications and premature death, but people with diabetes can take steps to control the disease and lower the risk of complications. Type 1 Diabetes Type 1 diabetes is an autoimmune disease in which the immune system destroys the insulin-producing beta cells of the pancreas that help regulate blood glucose levels.

Type 1 diabetes mostly has an acute onset, with children and adolescents usually able to pinpoint when symptoms began. Onset can occur at any age, but it most often occurs in children and young adults. Since the pancreas can no longer produce insulin, people with type 1 diabetes are required to take insulin daily, either by injection or via an insulin pump. Other methods to deliver insulin are being investigated. Children with type 1 diabetes are at risk for long-term complications (damage to the cardiovascular system, kidneys, eyes, nerves, blood vessels, skin, gums, and teeth).

Type 1 diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes, but is the leading cause of diabetes in children of all ages, and in those less than 10 years of age, type 1 accounts for almost all diabetes. A diabetes management plan for young people includes insulin therapy, self-monitoring of blood glucose, healthy eating, and physical activity. The plan is designed to ensure proper growth and prevention of hypoglycemia. New management strategies are helping children with type 1 diabetes live long and healthy lives.

Symptoms. The immunologic process that leads to type 1 diabetes can begin years before the symptoms of type 1 diabetes develop. Symptoms become apparent when most of the beta-cell population is destroyed and develop over a short period of time. Early symptoms, which are mainly due to hyperglycemia, include increased thirst and urination, constant hunger, weight loss, and blurred vision. Children also may feel very tired.

Visiting the Health Care Team

Because most newly diagnosed cases of type 1 diabetes occur in individuals younger than 18 years of age, and more children and teens are now getting type 2 diabetes, care of this group requires integration of diabetes management with the complicated physical and emotional growth needs of children, adolescents, and their families, as well as consideration of teens’ emerging autonomy and independence. Diabetes care for children and teens should be provided by a team that can deal with these special medical, educational, nutritional, and behavioral issues. The team usually consists of a physician, diabetes educator, dietitian, social worker or psychologist, along with the patient and family. Children should be seen by the team at diagnosis and in follow-up, as agreed upon by the primary care provider and the diabetes team.

-Establish the goals of care and required treatment.
-Begin diabetes self-management education about healthy eating habits, daily physical activity, and insulin/medication administration, and self-monitoring of blood glucose levels if appropriate. A solid educational base is needed so that the individual and family can become increasingly independent in self-management of diabetes. Diabetes educators play an important role in this aspect of management.
- Provide nutritional therapy by an individual experienced with the nutritional needs of the growing child and the behavioral issues that have an impact on adolescent diets.
- Conduct a psychosocial assessment to identify emotional and behavioral disorders.
- Check lipids in children with a significant family history*
- Check for microalbumin in type 2 diabetes.
-Provide ophthalmologic examination shortly after diagnosis in type 2 diabetes.

Each Quarterly Visit

Most young people with diabetes are seen by the health care team every 3 months.
At each visit, the following should be monitored or examined:
- A1C, an indicator of average blood glucose control
- Growth (height and weight)
- BMI
- Blood pressure
- Injection sites
- Self-testing blood glucose records
- Psychosocial assessment

Annually:
- Evaluate nutrition therapy
- Provide ophthalmologic examination (less often on the advice of an eye care professional)*
- Check for microalbuminuria (once the child is 10 years old and has had diabetes for 5 years)
- Perform thyroid function test (for children with type 1 diabetes)
- Administer influenza vaccination
- Examine feet.

For children with type 2 diabetes, the first examination should be shortly after diagnosis. Helping Children and Adolescents Manage Diabetes The health care professional team, in partnership with the young person with diabetes and parents or other caregivers, needs to develop a personal diabetes management plan and daily schedule.
The plan helps the child or teen to follow a healthy meal plan, get regular physical activity, check blood glucose levels, take insulin or oral medication as prescribed, and manage hyperglycemia and hypoglycemia. Follow a healthy meal plan Young people with diabetes need to follow a meal plan developed by a registered dietitian, diabetes educator, or physician. For children with type 1 diabetes, the meal plan must ensure proper nutrition for growth. For children with type 2, the meal plan should outline appropriate changes in eating habits that lead to better energy balance and reduce or prevent obesity. A meal plan also helps keep blood glucose levels in the target range.

Children or adolescents and their families can learn how different types of food — especially carbohydrates such as breads, pasta, and rice — can affect blood glucose levels. Portion sizes, the right amount of calories for the child’s age and activity level, and ideas for healthy food choices at meal and snack time also should be discussed, including reduction in soda and juice consumption. Family support for following the meal plan and setting up regular meal times is a key to success, especially if the child or teen is taking insulin.

Article funded through the Asian Health Initiative of Tufts Medical Center