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The Centers for Disease Control and Prevention (CDC) reports that there are 1.25 million people in the United States living with type 1 diabetes. Having a child diagnosed with a life-long condition like diabetes can be very overwhelming, difficult and frustrating, but being informed can help you and your child manage this disease.
Type 1 diabetes occurs due to a lack of insulin. When people eat carbohydrates, they are broken down into glucose in the body, which is the main source of energy for cells. Insulin is a hormone which allows the body to use glucose. If there is not enough insulin, glucose builds up in the blood and causes the symptoms and complications that are associated with diabetes.
The lack of insulin in type 1 diabetes is autoimmune in nature. In people with diabetes, the immune system develops auto-antibodies that attack insulin producing cells. It is largely unknown what triggers this to occur. Studies have shown that genetics play some role as do environmental factors.
Type 1 diabetes affects people of all ages, backgrounds, races and ethnicities. The majority of people with diabetes are non-Hispanic white, however people from all racial and ethnic backgrounds can be affected. The CDC reports that 17,900 children under the age of 20 were diagnosed with type 1 diabetes between the years 2011 and 2012. The average age of diagnosis is 12 to 14 years old, however diabetes can develop anywhere between the first few years to the middle decades of life.
Symptoms of diabetes can be very subtle but worsen over time. As glucose levels increase, the body compensates by flushing glucose out through the kidneys. The result is increased urination, increased thirst and even bedwetting. Because the body is not able to use the glucose for energy, this causes fatigue, weight loss and increased appetite. If the glucose levels get very high, this can cause a life-threatening illness called diabetic ketoacidosis (DKA) which is also associated with vomiting, dehydration and lethargy. This is a medical emergency and requires immediate attention.
Diagnosis of type 1 diabetes is made by laboratory testing. If you suspect that your child has or is developing diabetes, please go to a pediatrician or a pediatric emergency room for evaluation immediately. The doctors will examine your child and check blood and urine glucose levels. They will also obtain a special test known as a hemoglobin A1C, which says what the average blood sugar has been over the last three months. They may also send a blood test to check for the auto-antibodies associated with type 1 diabetes.
Type 1 diabetes is treated by giving insulin injections every day. Once a diagnosis is made, the child is admitted to the hospital to begin insulin therapy. The needles used to administer insulin are short and thin, and do not go into the muscle like vaccinations do. Families receive in depth education about how to properly dose insulin, as well as information on how to manage nutrition, exercise, sports, illness and other aspects of daily life.
There is no such thing as a “diabetic diet.” Nutritional recommendations are not much different than those given to any healthy growing child. This includes a balance of carbohydrates, proteins and healthy fats, eating proper portions from each food group daily and avoiding foods with high sugar content on a regular basis. The main difference is that people with diabetes should not skip meals and will typically need to monitor and count how much carbohydrate is in each meal.
Taking care of diabetes is a team effort. Diabetes care is complex and requires routine follow up at least four times a year with a team specifically trained in diabetes care and management. This includes doctors, nurses, diabetes educators, dietitians, social workers and psychologists. The child’s personal support system is equally, if not more, important to their well-being and success in managing diabetes. Family members, school nurses, friends, significant others and other caregivers can all be integral parts of the support and care team, and are welcome to participate in education and training.
Advancements in technology are changing the way we take care of diabetes. Thanks to the work of researchers and scientists around the globe, there are now devices that allow us to care for diabetes in more sophisticated ways. This includes insulin pumps and continuous glucose monitors (CGMs). Pumps are fairly discrete wearable devices that are individually programmed to deliver the proper amount of insulin directly into the body. CGMs are also wearable devices, and utilize blue tooth technology to relay real time blood sugar readings to the wearer and their families. These devices increase safety and capabilities of diabetes management and are prescribed by the diabetes doctors.
It’s all about good habits and control! Many teens and children with diabetes lead full, healthy lives, participate in competitive in sports, travel the world and achieve their goals. Some well-known individuals affected by diabetes include singer Nick Jonas, Olympic gold medal winning swimmer Gary Hall, Jr., Supreme Court Justice Sonia Sotomayer and former NFL quarterback Jay Cutler. The goal of diabetes care is to make diabetes fit into one’s life, not the other way around. With proper care this is absolutely possible.
Aurelia Wood, MD, FAAP is a physician in the Section of Endocrinology at Nationwide Children’s Hospital and an assistant professor of clinical pediatrics at The Ohio State University College of Medicine.
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