By Dr. Ruchi Kaushik
The Children’s Hospital of San Antonio
Diabetes mellitus is a chronic disease caused by a lack of insulin. Insulin is a hormone produced by the pancreas, is essential to life, and helps in the metabolism of glucose, a simple sugar derived from the carbohydrates (“carbs”) in our diet. It lowers blood glucose (glucose = sugar) levels by helping glucose enter our muscle cells so we can then use it for energy. One analogy describes insulin as the “key” to opening the door to muscle cells for glucose to come in. An absence or deficiency of insulin leads to high blood sugar levels; conversely, an excess of insulin results in hypoglycemia, or low blood sugar levels. Importantly, in diabetes, even though blood sugar levels are high, the glucose cannot enter muscle cells and cannot be used for energy because the “key,” insulin, is missing. This is dangerous because glucose is the only energy source for red blood cells and the brain.
Diabetes mellitus is of two types, type 1 and type 2. In type 1 diabetes, the cells of the pancreas are either absent or destroyed. These individuals have a lifetime dependence on injectable insulin. Type 2 diabetes is more complicated. The body’s cells have become resistant to insulin. Essentially, the cells have changed their “locks.” Traditionally, type 2 diabetes has been a disease of adults; however, with increased rates of childhood obesity, as many as one-third of all new cases of diabetes in adolescents is of type 2.
Type 1 diabetes is a serious disease that develops very suddenly. Symptoms include increased thirst, increased urination, and increased hunger. Despite this hunger, children lose weight. Your pediatrician can diagnose diabetes with a simple urine and blood test. Without treatment, children become severely dehydrated and may progress to the potentially fatal diabetic ketoacidosis. Treatment of type 1 diabetes is injectable insulin. Treatment of diabetic ketoacidosis involves hospital admission for intravenous insulin and fluid therapy. If your child is diagnosed with diabetes, she may spend a few days in the hospital to be treated as well as to be educated regarding diet, checking blood glucose levels, and injecting insulin. Most children are managed by a pediatrician who specializes in the treatment of diabetes.
In contrast to type 1 diabetes, the onset of type 2 diabetes is often gradual and most often develops in children who are overweight or obese. Your pediatrician can perform a simple blood test, preferably fasting, to diagnose your child. It is important to remember that although children with type 2 diabetes typically have close relatives who also have the disease, your pediatrician will encourage your family to defy genetics and control blood sugar levels with lifestyle changes including nutrition recommendations, exercise, and weight control before discussing medication.
Diabetes is a lifelong disease. Closely following your pediatrician’s recommendations can prevent long-term complications such as blindness, high blood pressure, kidney disease, nerve disease, heart disease, and stroke.
If you have questions about your child’s health or risk of diabetes, talk to your pediatrician. If you need a pediatrician, visit our website: www.chofsa.org/findadoc