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Juvenile Diabetes: Symptoms, Causes, Risk Factors And How To Manage

| Reviewed By Dr. Arya Krishnan

Every year, the month of November is observed as the Diabetes Awareness Month - celebrated globally to raise awareness about both Type 1 and Type 2 diabetes. And, 14 November is observed as World Diabetes Day which is the birthday of Sir Frederick Banting, who co-discovered insulin along with Charles Best in 1922.

The theme of World Diabetes Day and Diabetes Awareness Month 2019 is 'Family and Diabetes'. [1] . The day was initiated in 1991 by the IDF and the World Health Organization as a response to growing concerns about the escalating health threat posed by diabetes.

One of the most common health conditions to affect people, irrespective of age and gender, diabetes is of two types, type 1 and type 2. About 90 per cent of the cases diagnosed worldwide is type 2 [2] .

In the current article, we will take a look at juvenile diabetes or type1 diabetes and how it can be managed.

What Is Juvenile Diabetes?

Juvenile diabetes is now known as type 1 diabetes, which is mostly diagnosed in children and young adults. The condition develops when your immune system destroys beta cells in your pancreas which are responsible for the production of insulin [2] .

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When the child's body no longer produces the necessary insulin, it has to be manually replaced. The condition can be initially devastating for both the child and the parent due to the associated implications such as giving injections, monitoring the blood sugar levels, learning to use a medical syringe and so on.

Symptoms Of Juvenile Diabetes

The sings of the condition usually develop quickly in children and are as follows [3] :

  • Weight loss
  • Extreme hunger
  • Fatigue
  • Irritability
  • Behavioural change
  • Fruity-smelling breath
  • Increased thirst and frequent urination
  • Yeast infection
  • Blurred vision

Causes Of Juvenile Diabetes

Genetics and environmental factors are said to play a role in causing the condition in children. Consequently, the exact cause of juvenile or type 1 diabetes in children is unknown. It has been noted that, in children with type 1 diabetes, the body's immune system mistakenly destroys insulin-producing (islet) cells in the pancreas [4] .

With no functioning islet cells in the body, the child's body will not be able to produce the right amount of insulin or any amount of insulin at all - causing life-threatening complications.

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Risk Factors For Juvenile Diabetes

  • Genetic susceptibility, such as the presence of certain genes which can increase the risk of developing type 1 diabetes.
  • Race
  • Family history
  • Certain viruses
  • Diet

Complications Of Juvenile Diabetes

The complications about the condition develop gradually and can be life-threatening. Complications for the condition are as follows [5] :

  • Osteoporosis, as the condition can lead to lower than normal bone mineral density, increasing your child's risk of osteoporosis as an adult.
  • Heart and blood vessel disease such as coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure later in life.
  • Eye damage, as the condition can damage the blood vessels of the retina, which may lead to poor vision and even possibly causing blindness. Diabetes can also lead to cataracts and a greater risk of glaucoma.
  • Skin conditions
  • Nerve damage
  • Kidney damage

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Diagnosis Of Juvenile Diabetes

To medically examine the condition in children, the doctor will carry out the following tests [6] :

  • Glycated haemoglobin (A1C) test
  • Random blood sugar test
  • Fasting blood sugar test
  • Blood tests to check for antibodies that are common in type 1 diabetes
  • Urine tests to check for the presence of ketones
  • Blood tests for cholesterol levels, thyroid function and kidney function

The doctor will also regularly asses your child's blood pressure and growth and recommend regular eye examinations. The doctor may screen your child for celiac disease, depending on your child's age and symptoms [7] .

Treatment For Juvenile Diabetes

The medical care provided for the condition is lifelong and includes blood sugar monitoring, insulin therapy, healthy eating and regular exercise for kids. As the child grows up, the treatment plan will also change accordingly [8] .

How To Manage Juvenile Diabetes

Now that we have covered the basic areas of treatment, diagnosis and so on, let us take a look at the way you could manage the condition when your child is diagnosed with it. When your child is diagnosed with juvenile or type 1 diabetes, as a family and caregivers, you will be required to learn a lot of new things.

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Although it may seem overwhelming at the start, proper practice and patience can help improve your child's condition [9] . Begin by creating a diabetes management plan to help your child stay healthy and active.

As the treatment for the condition is dependent on each child's needs and the suggestions of the diabetes health care team, the approaches might differ in the types of insulin given and the schedules for giving insulin each day. The advantages and disadvantages of a plan should be considered for each child [10] .

Basics of managing juvenile diabetes: Let's start with the basics of the treatment plan. The major aspect to be learnt is frequently checking and adjusting the blood glucose or blood sugar levels, which may need checking 10 to 12 times a day. The amount of insulin required for your child depends on their timing of meals, the types of food eaten and their activity levels [11] .

Insulin can be given by shots through syringe or pen, or by the pump. Doctors often start with shots while families learn the basics. You can discuss with your doctor regarding the right kind of device for your child.

A child with diabetes is required to take insulin as prescribed. Eat a healthy and balanced diet with accurate carbohydrate counts, check blood sugar levels as prescribed and get regular physical activity.

Importance of healthy eating: Eating a balanced diet and following a diabetic-friendly meal plan is critical for children with type 1 diabetes. They will benefit from the same kind of healthy diet as those without diabetes, that is, a meal plan comprised of a variety of healthy foods that help the body grow and work properly [12] .

Your child has to balance the type and timing of their meals with the amount of insulin they take and with their activity level (which will be taught to you by the healthcare providers). Certain foods can cause blood sugar levels to go up more than others, therefore, it is necessary to avoid an excess of carbohydrates.

Your child's meal plan should be comprised of breakfast, lunch, and dinner with scheduled between-meal snacks. Although there are no extreme restrictions on the types of food to be consumed by your child, you will be guided by a nutritionist or a dietician in selecting from the basic food groups to achieve a healthy balance [13] .

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Note: The meal plans will be based on the child's age, activity level, schedule, and food likes and dislikes, and should be flexible enough for special situations like holidays, functions and such.

Regular physical activity is a must: Along with the meal plan, getting regular exercise can help your child in managing the condition [14] . It helps in keeping the blood sugar levels under control, maintaining healthy body weight, keeping the cholesterol levels and blood pressure under control and in keeping their heart, lungs, and blood vessels in good shape.

Apart from the aforementioned, it helps the child in understanding that they can do things that kids without diabetes can.

Note: To help avoid problems during exercise, kids with diabetes can have an extra snack before activity, check their blood sugar levels before, during, or after exercise and make sure the trainer is aware of their condition.

On A Final Note...

As there are no cures for type 1 diabetes, your child will be required to follow the treatment for the rest of their lives. But with proper care, they should look and feel healthy and go on to live long, productive lives, just like other kids - and be able to lead a healthy and happy adult life.

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Apart from all of this, it is important to emotionally and mentally encourage your child as diabetes can affect your child's emotions both directly and indirectly; and have an increased risk of depression and anxiety - leading to substance abuse [15] . Talk to your child, support them!

View Article References
  1. [1] Bimstein, E., Zangen, D., Abedrahim, W., & Katz, J. (2019). Type 1 Diabetes Mellitus (Juvenile Diabetes)–A Review for the Pediatric Oral Health Provider. Journal of Clinical Pediatric Dentistry, 43(6), 417-423.
  2. [2] Burckhardt, M. A., Roberts, A., Smith, G. J., Abraham, M. B., Davis, E. A., & Jones, T. W. (2018). The use of continuous glucose monitoring with remote monitoring improves psychosocial measures in parents of children with type 1 diabetes: a randomized crossover trial. Diabetes care, 41(12), 2641-2643.
  3. [3] Orabona, C., Mondanelli, G., Pallotta, M. T., Carvalho, A., Albini, E., Fallarino, F., ... & Ceccarini, G. (2018). Deficiency of immunoregulatory indoleamine 2, 3-dioxygenase 1 in juvenile diabetes. JCI insight, 3(6).
  4. [4] Edge, J., Acerini, C., Campbell, F., Hamilton-Shield, J., Moudiotis, C., Rahman, S., ... & Trevelyan, N. (2017). An alternative sensor-based method for glucose monitoring in children and young people with diabetes. Archives of disease in childhood, 102(6), 543-549.
  5. [5] Pinhas‐Hamiel, O., Levek‐Motola, N., Kaidar, K., Boyko, V., Tisch, E., Mazor‐Aronovitch, K., ... & Frumkin Ben‐David, R. (2015). Prevalence of overweight, obesity and metabolic syndrome components in children, adolescents and young adults with type 1 diabetes mellitus. Diabetes/metabolism research and reviews, 31(1), 76-84.
  6. [6] Phelan, H., Clapin, H., Bruns, L., Cameron, F. J., Cotterill, A. M., Couper, J. J., ... & Sinnott, R. O. (2017). The Australasian Diabetes Data Network: first national audit of children and adolescents with type 1 diabetes. Medical Journal of Australia, 206(3), 121-125.
  7. [7] Otto, C., Barthel, D., Klasen, F., Nolte, S., Rose, M., Meyrose, A. K., ... & Ravens-Sieberer, U. (2018). Predictors of self-reported health-related quality of life according to the EQ-5D-Y in chronically ill children and adolescents with asthma, diabetes, and juvenile arthritis: longitudinal results. Quality of Life Research, 27(4), 879-890.
  8. [8] Forlenza, G. P., Pyle, L. L., Maahs, D. M., & Dunn, T. C. (2017). Ambulatory glucose profile analysis of the juvenile diabetes research foundation continuous glucose monitoring dataset—Applications to the pediatric diabetes population. Pediatric diabetes, 18(7), 622-628.
  9. [9] Maahs, D. M. (2019). 50 Years Ago in The Journal of Pediatrics: Cortisol Secretion in Acidotic and Nonacidotic Juvenile Diabetes Mellitus.
  10. [10] Smith, L. B., Liu, X., Johnson, S. B., Tamura, R., Elding Larsson, H., Ahmed, S., ... & Rewers, M. J. (2018). Family adjustment to diabetes diagnosis in children: Can participation in a study on type 1 diabetes genetic risk be helpful?. Pediatric diabetes, 19(5), 1025-1033.
  11. [11] Slover, R. H., Tryggestad, J. B., DiMeglio, L. A., Fox, L. A., Bode, B. W., Bailey, T. S., ... & Kaiserman, K. B. (2018). Accuracy of a fourth-generation continuous glucose monitoring system in children and adolescents with type 1 diabetes. Diabetes technology & therapeutics, 20(9), 576-584.
  12. [12] Parkkola, A., Härkönen, T., Ryhänen, S. J., Uibo, R., Ilonen, J., Knip, M., & Finnish Pediatric Diabetes Register. (2018). Transglutaminase antibodies and celiac disease in children with type 1 diabetes and in their family members. Pediatric diabetes, 19(2), 305-313.
  13. [13] Kumar, K. M. P. (2015). Incidence trends for childhood type 1 diabetes in India. Indian journal of endocrinology and metabolism, 19(Suppl 1), S34.
  14. [14] Campbell, F. M., Murphy, N. P., Stewart, C., Biester, T., & Kordonouri, O. (2018). Outcomes of using flash glucose monitoring technology by children and young people with type 1 diabetes in a single arm study. Pediatric diabetes, 19(7), 1294-1301.
  15. [15] Pugliese, A. (2016). Insulitis in the pathogenesis of type 1 diabetes. Pediatric diabetes, 17, 31-36.
Arya KrishnanGeneral Medicine
MBBS
Arya Krishnan

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