Diabetes mellitus causes hyperglycemia due to a lack of insulin production (type 1) or peripheral insulin resistance (type 2). Polydipsia, polyphagia, polyuria, and weight loss are common early indications of hyperglycemia. Diabetes mellitus (Diabetes) in children is comparable to that in adults; however, psychosocial complications might complicate therapy.
What’s the Current Standing of Diabetes in Children?
Type 1 diabetes is the most frequent in children, accounting for two-thirds of all new cases in all ethnic groups. It is one of the most prevalent chronic childhood disorders, affecting one in every 350 children by the age of 18; the prevalence has lately increased, particularly in children under the age of five.
Although type 1 diabetes can arise at any age, it is most common between the ages of four and six or between the ages of ten and fourteen. Type 2 diabetes, which was historically uncommon in children, is becoming more common in tandem with the rise in juvenile obesity. It usually appears after puberty, with the peak prevalence between the ages of 15 and 19.
Monogenic types of Diabetes, formerly known as Maturity-Onset Diabetes of youth (MODY), are rare (1 to 4% of cases) and are not classified as type 1 or type 2.
Prediabetes is defined as poor glucose control, which results in intermediate glucose levels that are too high to be expected but do not fulfil diabetes criteria. Prediabetes in kids with obesity may be temporary or proceed to Diabetes, particularly in adolescents who gain weight repeatedly. Prediabetes in kids is often associated with metabolic syndrome ( which shows the signs of impaired glucose regulation, dyslipidemia, hypertension, and obesity).
What are the Causes of Diabetes in Children?
The majority of people have type 1 or type 2 diabetes, and this difference is used to guide therapy. Clinical history, presentation, and laboratory investigations, including antibodies, are used to classify patients.
This categorization approach, however, does not fully represent the clinical variability of individuals, and some cannot be unambiguously categorised as having type 1 or type 2 diabetes in children at diagnosis.
Diabetes Type 1
The pancreas generates little to no insulin in type 1 diabetes due to autoimmune death of pancreatic beta-cells, which may be caused by environmental exposure in genetically predisposed persons. Children with type 1 diabetes are more likely to develop other autoimmune conditions, such as thyroid disease and celiac disease. Susceptibility genes are more frequent in particular cultures, which explains why certain ethnic groups have a greater frequency of type 1 diabetes.
Diabetes Type 2
The pancreas generates Insulin in type 2 diabetes, but there are various degrees of insulin resistance, and insulin production is insufficient to satisfy the increased demand produced by insulin resistance. The onset frequently corresponds with the peak of physiologic pubertal insulin resistance, which might result in hyperglycemia symptoms in previously compensated teenagers.
The reason is not autoimmune beta-cell death but rather a complicated combination of several genes and environmental variables that vary between groups and people. Type 2 diabetes is distinct from type 1 diabetes, and type 2 diabetes in children is different from type 2 diabetes in adults. The reduction in beta-cell activity and the development of diabetes-related problems are hastened in youngsters.
Monogenic Diabetes
Because monogenic Diabetes is caused by genetic abnormalities inherited in an autosomal dominant manner, patients usually have one or more afflicted family members. There is no autoimmune destruction of beta-cells or insulin resistance, unlike type 1 and type 2 diabetes in children. The onset is generally before the age of 25.
What are the Symptoms of Diabetes in Children?
Symptoms of Type 1 Diabetes
The early signs of diabetes in children range from asymptomatic hyperglycemia to life-threatening diabetic ketoacidosis. However, most children develop symptomatic hyperglycemia without acidosis, with urine frequency, polydipsia, and polyuria lasting many days to weeks.
Polyuria can present as nocturia, bedwetting, or daytime incontinence; parents may notice an increase in the frequency of wet or heavy diapers in children who are not toilet-trained. Weight loss and development impairment are signs of diabetes in children as a result of increased catabolism.
Initial symptoms may include fatigue, weakness, candida rashes, impaired vision (because of the hyperosmolar condition of the lens and vitreous humour), and/or nausea and vomiting (related to ketonemia).
Symptoms of Type 2 Diabetes
The manifestation of type 2 diabetes in children varies greatly. Children are frequently asymptomatic or very mildly affected, and their disease may only be found via standard testing. However, some children experience a severe form of symptomatic hyperglycemia, HHS, or, contrary to popular belief, DKA.
What are Some Diabetes Complications in Children?
Diabetic Ketoacidosis
Diabetic ketoacidosis is widespread amongst type 1 diabetes in children; it affects 1 to 10% of patients each year, mainly as a result of not taking their Insulin. Prior DKA episodes, stressful social conditions, depression or other psychological problems, concurrent sickness, and usage of an insulin pump are all risk factors for DKA. Clinicians can assist in reducing the impact of diabetes symptoms in Children by offering information, counselling, and support.
Vascular disorders
Vascular problems are seldom clinically visible in children. However, early pathologic alterations and functional abnormalities with type 1 diabetes in children may be apparent a few years after illness onset; sustained poor glucose control is the most significant long-term risk factor for the development of vascular problems. Diabetic nephropathy, retinopathy, and neuropathy are examples of microvascular consequences.
Microvascular problems are more prevalent with type 2 diabetes in children than with type 1 diabetes, and diabetes symptoms in children may be evident at diagnosis or early in the disease course in type 2 diabetes.
Diagnosis and Treatment of Children’s Diabetes
Diabetes and prediabetes in children are diagnosed in the same way as adults are, using fasting or random plasma glucose levels and/or HbA1c levels and the presence or absence of symptoms. Diabetes in children can also be diagnosed by observing common diabetes symptoms and taking blood glucose tests.
Initial testing for diabetes in children should include a basic metabolic panel, including electrolytes and glucose, as well as urine analysis. Venous or arterial blood gas, liver tests, and calcium, magnesium, phosphorus, and hematocrit values are also included in testing for diabetes in children.
Testing For Diabetes Related Complications
Type 1 diabetes in children should be evaluated for additional autoimmune conditions such as celiac disease and thyroid-stimulating hormone, thyroxine, and thyroid antibodies. Thyroid and celiac disease testing should be repeated every 1 to 2 years after that. Various autoimmune illnesses, such as primary adrenal insufficiency, rheumatologic disease, other gastrointestinal problems, and skin disease, may arise with type 1 diabetes in children but are not routinely screened for.
Type 2 diabetes in children needs confirmation from liver tests, a fasting lipid profile, and a urine microalbumin: creatinine ratio performed at the time of diagnosis because such children (unlike those with type 1 diabetes, where complications develop over time) frequently have comorbidities at the time of diagnoses, such as fatty liver, hyperlipidemia, and hypertension.
Children with clinical symptoms suggesting problems should be evaluated as well:
- Obesity
- If the children have hirsutism, acne, or menstrual abnormalities, you should be tested for polycystic ovary syndrome.
Treatment of Type 1 Diabetes
Insulin is the foundation of type 1 diabetes treatment. Adult insulin formulations are available. Except for small children whose intake at any particular meal is difficult to anticipate, Insulin should be administered before a meal.
Dosage needs differ depending on age, activity level, pubertal state, and time from initial diagnosis. Many individuals have a brief drop in insulin needs after a few weeks of their initial diagnosis due to residual beta-cell activity.
After a few months to two years, insulin needs usually vary from 0.7 to 1 unit/kg/day. Patients require greater doses throughout puberty to combat insulin resistance induced by increasing pubertal hormone levels.
As with type 1 diabetes in children, lifestyle changes such as better nutrition and more physical exercise are critical.
Treatment of Type 2 Diabetes
Metformin is one of the medications recommended for children with diabetes. To avoid nausea and stomach discomfort, Metformin should be begun at a low dose and taken with meals.
Liraglutide and extended-release exenatide are GLP-1 receptor agonists licensed for use in children over the age of 10 with type 2 diabetes, and they can help lower HbA1c levels.
These non insulin injectable antihyperglycemic medications boost glucose-dependent insulin secretion and delay gastric emptying. Both medications aid in weight loss, most likely through the effects of delayed stomach emptying and appetite suppression.
If Metformin is not tolerated or if HbA1c goal levels are not met with Metformin alone within three months, liraglutide and exenatide can be administered.
Treatment for monogenic Diabetes in children
Managing monogenic diabetes in children is customised and dependent on the subtype. Because children are not in danger of long-term problems, the glucokinase subtype normally does not require therapy. Most individuals with hepatic nuclear factor 4-alpha and hepatic nuclear factor 1-alpha types respond to sulfonylureas, but some require Insulin in the end. Metformin and other oral hypoglycemics are often ineffective.
How are Complications of Diabetes Managed in Kids?
Complications discovered during an examination or screening are first addressed with lifestyle modifications such as increased activity, dietary adjustments (significantly lowering saturated fat intake), and smoking cessation (if applicable).
Children who have microalbuminuria on repeat blood tests or who have consistently raised blood pressure readings and do not respond to lifestyle modifications often require antihypertensive medication, most commonly with an angiotensin-converting enzyme inhibitor.
If low-density lipoprotein (LDL) cholesterol stays > 160 mg/dL or > 130 mg/dL and one or more cardiovascular risk factors persist despite lifestyle modifications in children over the age of 10, statins might be explored, albeit long-term safety has not been shown.
Conclusion
When talking about diabetes in children they have symptomatic hyperglycemia without acidosis, with urinary frequency, polydipsia, and polyuria lasting many days to weeks. Children with type 1 diabetes, and occasionally type 2 diabetes, may present with diabetic ketoacidosis. Type 2 diabetes in children is first treated with Metformin and/or Insulin. However, while the majority of children who require Insulin upon diagnosis may be effectively transferred to metformin monotherapy, around half eventually require insulin treatment.