Key learning points:
– Symptoms can become very serious, very quickly
– Type 1 diabetes is treated by injecting insulin or by an insulin pump
Type 1 diabetes develops when the insulin-producing cells in the body have been destroyed and the body is unable to produce any insulin.
Type 1 diabetes accounts for about 10% of all diabetes cases, and is treated by daily insulin injections or an insulin pump, a healthy diet and regular physical activity. Type 1 diabetes can develop at any age but it especially appears in childhood. It is by far the most common form of diabetes to be found in children, and 96% of all children have Type 1. More children under the age of five are being diagnosed with Type 1 diabetes, so as a health visitor it is important to be aware of the condition.
It is vital to be aware of the signs and symptoms of diabetes in young children and babies, especially as the symptoms can become very serious, very quickly. Leaving Type 1 diabetes untreated can lead to diabetic ketoacidosis (DKA) – a serious condition when the body has such a severe lack of insulin that it starts to break down other body tissue as an alternative energy source – which can result in a potentially fatal coma.
There are four main symptoms of Type 1 diabetes:
– Toilet: you may notice the child passing urine a lot more than usual, especially at night. Toddlers might be asking to use the potty more than usual, and babies may need a change of nappy more frequently. A previously dry child may begin to wet the bed at night.
– Thirsty: the child or baby may be drinking much more than usual.
– Tired: you may notice that the child seems more lethargic than usual or sleeping for much longer than they normally do.
– Thinner: as the body uses up alternative energy stores, the child may start to lose weight. This can happen quite rapidly.
There are other, less common symptoms of diabetes to be aware of, including episodes of thrush or constipation. In children under the age of two especially, the symptoms may not be immediately obvious and the child may appear unwell with less specific symptoms. If in doubt, they should have a capillary blood glucose test taken straight away. Once diagnosed, the symptoms of diabetes are relieved very quickly.
Type 1 diabetes is treated by injecting insulin or by an insulin pump.
Parents with young child with Type 1 diabetes may need extra support when it comes to injecting their child and testing blood glucose levels. Getting used to the constant testing and injecting can be very stressful, especially if the child is too young to understand why they need to be injected.
The needles used to inject insulin are very small as the insulin is injected subcutaneously. There are three main areas where insulin can be injected – stomach, buttocks and thighs. All these areas cover a wide skin area, and insulin should be injected at different sites within each of them.
It is important to rotate injection sites, as injecting into the same site can cause lipohypertrophy (a build-up of fat tissue under the skin) which may lead to erratic absorption of the insulin.
This can affect control of blood glucose levels. However, injecting into areas of lipohypertrophy is less painful, so young children may be unwilling to rotate their injection site. Parents may need support in encouraging their child to try different places for their injection.
Parents may also need to get up throughout the night to test their child’s blood glucose levels and treat a high or low blood glucose level. Tiredness can increase stress levels, so it’s important to give them time to express their worries and offer appropriate support.
Neonatal diabetes is a form of diabetes that is diagnosed under the age of nine months. It is a different type of diabetes than the more common Type 1 diabetes as it’s not an autoimmune condition (where the body has destroyed its insulin producing cells). It is very rare – currently there are less than 100 people diagnosed with it in the UK.
Neonatal diabetes is caused by a change in a gene which affects insulin production. This means that levels of blood glucose (sugar) in the body rise very high.
The main feature of neonatal diabetes is being diagnosed with diabetes under the age of six months, and this is where it is different from Type 1, as Type 1 doesn’t affect anyone under six months. As well as this, about 20% of people with neonatal diabetes also have some developmental delay (e.g muscle weakness, learning difficulties) and epilepsy.
There are two types of neonatal diabetes – transient and permanent. As the name suggests, transient neonatal diabetes doesn’t last forever and usually resolves before the age of 12 months. But it usually recurs later on in life, generally during the teenage years. It accounts for 50-60% of all cases. Permanent neonatal diabetes as you might expect, lasts forever and accounts for 40-50% of all cases.
Around 50% of people with neonatal diabetes do not need insulin and can be treated with a tablet called Glibenclamide (a drug once commonly used to treat Type 2 diabetes) instead.
These people have a change in the KCNJ11 or ABCC8 gene and need higher doses of Glibenclamide than would be used to treat Type 2 diabetes.
As well as controlling blood glucose levels, Glibenclamide can also improve the symptoms of developmental delay. It is vital to have the child diagnosed with neonatal diabetes, so then they can be put on the right treatment.
Genetic testing for neonatal diabetes is offered free of charge for all people diagnosed with diabetes before nine months of age. Confirming the diagnosis by molecular genetic testing is essential before considering any change to treatment.
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