Juvenile Diabetes: Diagnosis, Treatment and Coping When Your Child has Diabetes

Childhood diabetes, also known as Juvenile Diabetes or, today, more commonly as Type 1 diabetes is a serious condition that requires immediate, consistent medical treatment. But the diagnosis is often missed because the symptoms can easily be overlooked or mistaken for another malady.

Each day in the United States, another 80 people are diagnosed with Type 1 diabetes. Today, more than 3 million people in the U.S. are living with the disease. There is no cure, and the patient will be insulin-dependent (via shots or insulin pump) for the rest of their life. More children than adults are initially diagnosed with Type 1 diabetes, which results from a malfunctioning auto-immune response to illness or significant stress.¹ The body attacks itself, killing the cells in the pancreas that produce insulin.

Without insulin, a person cannot survive long. Insulin is the hormone that "unlocks" our body's cells so that glucose (blood sugar from carbohydrates that we ingest) can be used for energy. Without adequate insulin, blood sugars build up to dangerous levels and must be expelled from the body as waste. The child goes into starvation mode because nutrients from food are not being utilized. This is why an undiagnosed diabetic is thirsty all the time, urinates more frequently and loses significant amounts of weight very quickly.

Without energy from food, the body begins breaking down muscle for energy, releasing acids called ketones into the blood (ketoacidosis). As blood chemistry becomes more and more acidic, the child risks coma or death unless the high blood sugars are treated by administering proper doses of insulin.

If you suspect your child may have juvenile diabetes, do not "wait and see." Immediately take them to the doctor or emergency room for a simple blood test that could save their life!

¹Note, however, that I was diagnosed with Type 1 diabetes at age 34. While this is unusual, it still may occur. So, watch for warning signs of diabetes, described below, at any age.

Unlike Type 2 diabetes, which progressively develops over time, Type 1/Juvenile diabetes comes on very suddenly. Your child may be healthy one week, and just 7-10 days later could be in the hospital as a result of childhood diabetes.

When the body is working to fight off an infection, or heal from another injury, it releases antibodies to fight infection. With an autoimmune disorder like Type 1 diabetes, something goes wrong and the body mistakenly attacks healthy cells as well.

Unfortunately, the symptoms of juvenile diabetes are often missed as a result because parents and caregivers may assume that the child is just trying to get better from the original condition.

Symptoms of juvenile diabetes include the following, some or all of which may be present:

• Dramatic weight loss (5-10% of body weight) in a short period of time
• Excessive thirst
• Bed wetting, frequent urination, regression to diapers
• Lethargy, very tired despite adequate sleep
• Irritability
• Increased appetite - when coupled with weight loss - that is not explained
• Blurred vision
• Confusion
• Heavy, labored breathing
• Fainting/unconsciousness

If your child exhibits a combination of these symptoms, particularly over a period of several days to a week, you should immediately have a blood sugar (blood glucose) test to determine whether diabetes is present.

A nondiabetic person will have blood sugars in the range of 80-120 mg/dl (milligrams per deciliter). Your child's doctor will diagnose juvenile diabetes with a blood sugar level of over 150 mg/dl (fasting - i.e., overnight) or over 200 mg/dl 2 hours after a meal.

Often, pre-diagnosis levels of blood sugars can be dangerous high. My levels were 450-550 mg/dl at the time of diagnosis. My cousin was over 700 mg/dl when he was diagnosed at age 9 with Type 1 diabetes. At these levels, a child will likely be hospitalized for several days or longer to stabilize blood sugar levels and determine proper dosing of insulin.

After a diagnosis of juvenile diabetes, the patient and his or her family will meet with a team of doctors and other medical professionals to determine proper treatment, based on individual factors.

A diabetes team consists of:

• Endocrinologist - a doctor specializing in endocrine disorders like diabetes
• Pediatrician
• Nutritionist - to help with planning healthy meals and snacks to stabilize blood sugars
• Nurse or nurse practitioner
• Diabetes educator - to work with the patient and their family to learn how to properly test blood sugars at home and administer shots or use an insulin pump

You may also wish to consider a family counselor or psychiatrist to help deal with feelings of grief or overwhelm. Although juvenile diabetes is very manageable and patients can usually live long lives notwithstanding the disease, many parents and caregivers experience fear and anxiety in the months following a diagnosis.

Treatment of juvenile diabetes will require multiple daily injections of insulin. Because the body is incapable of making the hormone itself, it must be administered externally, either through needles, or via an infusion site on the abdomen along with an insulin pump.

Your diabetes team will prescribe ratios of insulin to carbohydrates for your child, to help you determine how much medication is required, based on the food to be ingested (for me, 1 unit of insulin covers 15 grams of carbohydrates).

They will also establish an insulin sensitivity level to help you figure out how much insulin is required to drop your child's high blood sugar levels to healthy levels (for me, 1 unit of insulin drops me 80 points; to get back to 100 mg/dl from a reading of 300, I will take about 2.5 units of insulin).

Insulin dosing will change over time, as your child matures and goes through puberty. Illness and other stressors will temporarily increase the need for insulin, as well. Be sure to ask your child's endocrinologist about required adjustments.

In order to determine how much insulin to take at each meal, whether insulin is required to address hyperglycemia (high blood sugar), or whether a low blood sugar (hypoglycemia) event must be treated with fruit juice or sugar tabs, a diabetic child will have to test blood sugar with a meter and lancet at least 4-6 times per day.

Prescriptions for a diabetic patient will include: diabetes meter, lancet, blood sugar test strips, insulin, syringes (even with a pump you will need back up), ketone test strips (for urine), and pump supplies - along with an insulin pump.

Any one that is diagnosed with Type 1 diabetes, or has a child that has been diagnosed with the disease should make several changes, most of which are not difficult to make - even though they require some forethought.

Diet should eliminate white bread, rice and pasta and replace with 100% whole grain options. Sugary desserts and candy should be reserved for special occasions, only. Soda and fruit juice can be kept on hand to address hypoglycemia (low blood sugar), but should not otherwise be consumed.

The following foods are very difficult for diabetics to process without experiencing high blood sugar: pizza, french fries, potato chips, Chinese food, macaroni and cheese, Chicken Alfredo, white sauces/soups (clam chowder), sourdough bread, regular jello, ice cream. An older teen or young adult should avoid consuming alcoholic beverages.

A child with juvenile diabetes will have to get used to testing blood sugar frequently and making insulin and/or nutrition adjustments accordingly. It is advisable to test before bed and first thing in the morning, too.

Get adequate sleep, keep stress at manageable levels, exercise frequently, and watch glucose levels more carefully during illness.

Q: Can my child eat any sugar with diabetes?

A: It depends. Provided that proper insulin dosing is administered and the child is otherwise healthy, sugar may be enjoyed - with doctor's permission - as an occasional treat. Excessive sugar or simple carbohydrates are not recommended, however.

Q: Can my child participate in sports with diabetes?

A: Generally yes. A very active child will need to test blood sugars more frequently to ensure that low blood sugar (hypoglycemia) does not result. Your child's diabetes team should recommend specific insulin pump settings and nutrition schedules during the times they are active in sports/

Q: Can a child with diabetes go to birthday parties?

A: Again, it depends. If your child is healthy and their diabetes is well-managed, they should be able to participate in most activities enjoyed by classmates. However, any activity to which you send your child - whether a birthday party, scout meeting, play date or sleepover - should be accompanied with written instructions to the adult in charge, glucose tablets and/or juice in case of hypoglycemia, and an emergency phone number.

Q: Will my child outgrow his or her diabetes?

A: No. Type 1/juvenile diabetes is not currently curable. Insulin helps treat the disease, but it is a permanent condition; the pancreas is unable to be re-generated to begin producing insulin again.

Q: Is diabetes fatal?

A: Left untreated, or poorly managed, diabetes (Type 1 or Type 2) can lead to death. Hyperglycemia or hypoglycemia - blood sugar extremes at either end - may result in fainting, loss of consciousness or coma. Over time, damage from poorly managed diabetes can affect eyesight, cause heart disease or stroke. Diabetes should not be underestimated.

Yet, most children diagnosed with juvenile diabetes today have the prospect of a very long life. Most complications occur later in life, after one has lived with the disease for years. Diabetes-related deaths in children and young adults are often attributable to combining insulin with alcoholic beverages, or due to an insulin reaction from taking too much medication.

Consistent testing and control is the key to a healthy life with diabetes!