Diabetes in children

Being told that your child has diabetes can have a big impact on everyday family life but it’s important to remember that every child and their family will cope with the diagnosis differently.

The condition doesn't have to take away your child's freedom or end your usual family life. 

We explore the symptoms of diabetes in children, how type 1 and type 2 are treated and what measures schools should have in place for diabetic children.

Types of diabetes

Type 1 diabetes 

In type 1 diabetes, the insulin-producing cells in the pancreas are destroyed by the immune system and so can’t produce insulin.

The exact cause of the immune system attacking these cells isn’t clearly understood. Unlike type 2 diabetes, which is usually slow to develop, type 1 comes on very quickly, often within days or weeks.

Type 2 diabetes 

In type 2 diabetes, the pancreas either produces inadequate amounts of insulin, or the body is unable to use the insulin that’s produced (insulin resistance). It’s typically slow to develop, with some people being unaware of the condition for many years.

Cases of type 2 diabetes have become more common in young adults, teens and children¹, with a connection to the increasing levels of obesity due to excess body weight and lack of physical activity.

Diabetes symptoms

The signs and symptoms for type 1 and type 2 are very similar but may not be as obvious in type 2, as the onset is much more gradual than type 1. Symptoms for type 2 can for example take weeks of months to develop.

Diabetes UK² have identified these symptoms as the ‘four T’s’:

Toilet: As a result of producing excess urine - going to the toilet a lot, bed wetting by a previously dry child or heavier nappies in babies.

Thirsty: Being really thirsty and not being able to quench the thirst.

Tired: Feeling more tired than usual, and a lack of energy.

Thinner: Losing weight or looking thinner than usual.

Diagnosis

Diagnosis for type 1

A child with undiagnosed type 1 diabetes will appear unwell with severe deterioration of the above four T’s.

A GP will conduct a urine test to check blood glucose levels and if they suspect diabetes, then you'll be taken to hospital for blood tests to help confirm.³

Sometimes, a child with type 1 diabetes can display significant changes in their normal behaviour before their diagnosis is confirmed. This condition is called diabetic ketoacidosis.

Diabetic ketoacidosis (DKA)

This a life-threatening condition that requires urgent medical attention. It is when you have high blood glucose levels and when you’re ill, your body may start to produce ketones. Ketones make your blood very acidic, hence the term ketoacidosis. 

The NHS state under 0.6mmol/L is normal however you must call 999 or go to A&E if:

• you have a high level of ketones over 3mmol/L in your blood
• or if you do not know your ketone levels but have symptoms of diabetic ketoacidosis, such as feeling thirsty and needing to pee more often, feeling sleepy or confused, and breath that smells fruity (like pear drop sweets or nail polish remover)
• or if you have symptoms of diabetic ketoacidosis and have not been diagnosed with diabetes yet.⁴

Diagnosis for type 2

If your child displays any of the symptoms listed above, then take them to your GP, where they will carry out a blood glucose test using a finger prick test.

If this indicates high blood sugar, your GP will refer your child to a specialist diabetes team or hospital, and the test will be sent to the lab to diagnose diabetes.

What support is available?

As a newly diagnosed diabetic you and your child will be introduced to a children's (paediatric) diabetes care team until they're around 17 or 18⁵.

The diabetic team will offer you practical sessions on:

• how and when to test your child's blood glucose level using the finger-prick test
• diet
• how you and they can give them their medication, which may be tablets, a pump, or insulin injections.
• how to talk to your child's school teacher or nursery.

The diabetic team will initially need to check on your child every couple of weeks, but this will reduce to every 3 months once you're managing ok.

They’ll make sure that you have a good understanding of how food and exercise affect your child's blood glucose level, and how to manage this with insulin.

The three-month review with your diabetic team will involve checking injection sites, blood glucose levels, height and weight.

From the age of 12, these visits should include a comprehensive health check at least once a year. Your child will be checked for signs of damage to their eyes, feet, circulation and kidneys.

Medication

Medication will vary depending on the type of diabetes that your child is diagnosed with.

A child with type 1 diabetes will need insulin injections.

A child with type 2 diabetes may start with advice about diet but may progress to need oral medications and may need insulin after some time.

Your child will start on a regime, prescribed, and directed by, the Paediatric Consultant and supported by the Specialist Nurses.

This may consist of injections twice or four times a day of a medication called insulin.

The image above shows where the injections need to be given. The blue areas represent the injection sites.

These sites need to be rotated. This means that your child doesn’t inject in the same place all the time which prevents the build-up of fatty tissue.

Fatty tissue will inhibit the absorption of insulin getting into the bloodstream. The insulin won’t be able to work effectively and your blood glucose levels will be unstable.

School and diabetes

Your child should have a sharps bin in their school so that they can change their needles regularly and dispose of them safely.

The school, diabetic team and diabetic child’s parents will need to establish the needs of the individual child and make appropriate arrangements.

Key subjects to discuss that a school-aged child will need:  

• Your school should help you with diabetes. You should have a safe place to keep emergency insulin, and your school should give you somewhere private to test blood glucose and use insulin injections.
• Your school will need to understand about diabetes, and they might need to ask you about your condition. Your doctors and nurses can give your school more information about diabetes.
• Young people with diabetes should be able to eat snacks, whether they are in the middle of a lesson or not.
• Young people with diabetes should be allowed to go to the toilet whenever they need to, without any questions.
• Key people in the school should know how to recognise and treat hypoglycaemia.
• Taking part in sports or gym shouldn’t be affected, but adequate precautions should be taken, and blood glucose levels should be monitored.
• Diabetic children should be issued with an identity card to allow them to access school dinners earlier if required.

For further information about school and diabetes visit Diabetes UK.

References

1. Diabetes (type 1 and type 2) in children and young people - NICE
2. Symptoms of diabetes in children - Diabetes UK
3. Getting tested for type 1 diabetes - NHS
4. Diabetic ketoacidosis - NHS
5. Type 1 diabetes in children - NHS