Ruchi Kaushik, MD, MPH, FAAP
Assistant Professor, Pediatrics
Medical Director, ComP-CaN (Comprehensive Peds for Complex Needs)
Medical Director, The Children’s Hospital of San Antonio Blog
Baylor College of Medicine
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 lowers blood sugar levels by allowing it to be taken up by our cells so we can use it for energy. One analogy describes insulin as the “key” to opening the door to cells for sugar 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 sugar cannot enter cells and cannot be used for energy because the “key,” insulin, is missing. This is dangerous because sugar is the most important source of energy for our body. There are two types of diabetes–type 1 and type 2.
In type 1 diabetes, the cells of the pancreas are either absent or destroyed. These children 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 sugar levels, and injecting insulin. Most children are managed by a pediatric endocrinologist, 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 problems, heart disease, and stroke.
If you need help finding a pediatrician, visit our website at www.chofsa.org/findadoc.