Diagnosing Type 1 Diabetes In Children

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Diagnosing type 1 diabetes in children

Do you suspect your child has diabetes? Perhaps you want to know which symptoms to look out for, or are not sure what the diagnostic process is for the condition?

In this guide, we will cover everything on type 1 diabetes in children, such as how to tell if your child has diabetes, the signs, and symptoms you should be aware of, and the process to get diagnosed.

Symptoms of type 1 diabetes in children

Your child’s diabetes symptoms are caused by some or all of the glucose remaining in their blood, rather than being converted into energy by the body. As the body attempts to reduce the levels of glucose in the blood, symptoms can occur.

Let’s look at the type 1 diabetes symptoms your child may experience in more detail:

  • Frequent need to urinate – your child may urinate more frequently due to the body flushing out excess glucose in urine. This might cause bedwetting in a child who has been toilet trained
  • Being thirsty – this symptom is directly linked to urinating more than normal. Rather than being thirsty at certain times, such as when not drinking enough water or eating something spicy, your child may feel parched all the time
  • Unintentional weight loss – a consequence of your child having diabetes is insulin insufficiency, which prevents glucose from being converted into energy This can cause the body to start burning fat and muscle to use as energy, which can lead to weight loss
  • Tiredness – your child could appear to be constantly tired, or unusually tired at certain times of the day. This can be due to insulin resistance or insulin hormone deficiency that prevents the cells from getting the energy that they need, which causes your child to feel tired
  • Intense hunger – when your child’s blood sugar levels are abnormally high due to glucose not being able to enter the cells, his or her body isn’t able to convert all the food they eat into energy. It is this inability to use food for ‘fuel’ that can cause a drop in energy, and consequently, hunger
  • Fruity breath – if you notice your child’s breath is fruity or sweet-smelling, this could be a diabetes sign. When the body can’t get its energy from glucose, it begins to burn fat. When fats are burned, there is a process that involves a build-up of acids called ketones. High levels of ketones in a child who already has diabetes can cause breath that smells fruity
  • Behavioural changes – if you have picked up on behavioural changes in your child – such as irritability, mood swings, and feeling low – this could be due to the fluctuations in their blood sugar level which is caused by diabetes

Diagnosing type 1 diabetes in children

If your child is displaying signs and symptoms which could indicate type 1 diabetes, there are a number of tests that are used to make a diagnosis.

He or she could be required to take several blood tests, including:

  • Random blood sugar test – the primary screening test for the condition, involving a blood sample being taken at a random time. If the blood sugar level is found to be higher than 11.1 mmol/L or 200 mg/dL, this suggests diabetes
  • Fasting blood sugar test – this is a test that involves a blood sample taken after your child has fasted overnight. If the blood sugar level is found to be higher than 7.0 mmol/L or 126 mg/dL this suggests type 1 diabetes
  • A1C (glycated haemoglobin) test – this is a test to track the average of your child’s blood sugar level over the previous three months. If the A1C level is found to be higher than 6.5 percent in two different tests, this is an indication of diabetes

There are additional tests that could be used to determine whether your child has type 1 or 2 diabetes, these can include:

  • Urine test – to check for ketones that suggest type 1 rather than type 2 diabetes. This can be done through a GP, or you can buy your own testing strips online for less than £5 if you are concerned and want to monitor your child’s ketone levels
  • Additional blood tests – to check for antibodies that are normal in type 1 diabetes

Testing blood sugar level

Testing your child’s blood sugar level regularly helps to monitor the levels and keep on top of things, as well as see what might be causing spikes or drops. When your child is young, testing them can be tricky for both you and them, but it is an important part of diabetes management and a way to look after your child’s health on a daily basis, helping to prevent problems related to diabetes when they are older.

You can monitor your child’s blood sugar level by using a blood glucose meter provided to you by your paediatric diabetes team. It will come with a finger pricking device, lancets (to take a blood drop from their finger), and a supply of testing strips (to which the drop of blood is applied to show the result of the test).

Here is the normal process:

1. Ensure your child’s hands are washed
2. Prick the side of the finger instead of the tip as this is less painful for your child. Don’t use the index finger or the thumb. Be careful not to prick the nail
3. Put a test strip into your blood glucose meter. This should turn the meter on
4. Apply one drop of blood to the test strip and allow the meter to read the results (this happens automatically)
5. Note down the test results, to assist you and your child’s peadiatric diabetes team in establishing blood sugar level patterns

You can get supplies for finger-prick testing from your GP, or purchase them from an online or high street pharmacy. When you are getting your blood glucose meter, you’ll be advised on how to give it a quality check periodically.

Complications of type 1 diabetes

Type 1 diabetes can affect your child’s body from top to toe. If their blood glucose levels are persistently high, they can progressively damage their small blood vessels. Over time, diabetes can affect the blood supply to different organs and body systems, but the cells in the back of their eyes, kidneys, heart, and feet are more at risk.

The good news is that excellent diabetes control reduces the risk of them developing the long-term complications of diabetes. They can also have regular screening to identify problems at an early stage so that they can have treatment to safeguard their future health.

Type 1 diabetes can cause:

Cardiovascular disease: Diabetes can affect the heart and the blood vessels, increasing the risk of stroke, angina, heart attacks, and circulation problems in the limbs. However, heart disease is not inevitable; careful diabetes control can reduce the danger

RetinopathyRetinopathy is an eye disease that develops in diabetes, particularly if it is poorly controlled. The small blood vessels supplying the back of the eye become damaged and can bleed. Laser therapy can prevent the progress of the disease, but if it is not treated promptly, it can cause visual disturbance and blindness

Nephropathy: The kidneys produce urine, get rid of waste products and carefully balance the body’s salts and acidity. If their function is affected, it can be critical for your health. The small vessels in the kidneys can be damaged by diabetes, so it is vital to have regular checks to ensure they’re working properly

Foot damageHigh sugar levels for a prolonged time can affect the circulation in their feet and damage the nerves, making them feel numb. Cuts, blisters, and infections take longer to heal-and without pain; they can be easy to ignore. People with diabetes are 15 times more likely to have a limb amputated. So, it’s crucial to take foot care and diabetes monitoring and management seriously

Treating type 1 diabetes in children

Children with type 1 diabetes should have an individualised care plan to treat their diabetes, prevent complications and educate them about their condition. They will need treatment to replace insulin by an injection or a pump, but effective diabetes care is about more than insulin; there should be a holistic approach supporting their health, wellbeing and lifestyle:

Blood sugar monitoring: Careful checking of blood glucose levels is key to controlling diabetes. Regular finger-prick testing is one option, but for children, continuous glucose monitors can reduce painful pricking, improve sugar monitoring, and raise the alarm if the glucose is too low or high.

Insulin injections: Your child will need a basal level of slow-acting insulin throughout the day; they will also need an extra ‘bolus’ dose of fast-acting insulin around meals. Insulin pumps are often prescribed to provide better control and more flexibility around meals. Pumps also reduce the risk of hypos and provide more stable blood glucose levels.

Weight management: Children need food to grow and live an active life. Modern insulin regimes and insulin pumps can help children eat normally without rigid routines, meals, and snacks. A healthy balanced diet is vital for all children and can help children with diabetes control their blood sugar levels. Focus on plenty of fresh fruits and vegetables, lean meat and protein, dairy produce for calcium and complex carbohydrates in whole grains. Try to avoid too much sugar and processed carbohydrates, but there’s no need to totally ban sweet treats. A dietician and your child’s diabetes team can teach you and your child to count carbohydrates and balance the insulin dose, as well as providing help, support and guidance.

Exercise: Activity is vital for children’s health and wellbeing. It’s an integral part of a healthy lifestyle – and it’s fun. All children, with or without diabetes, should enjoy at least an hour of exercise each day, that could be a sport like football or netball, dancing, games, swimming, or energetic play.

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Carol Willis - Diabetes Clinic Facilitator

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