Diabetes in children and adolescents -
This content does not have an English version. This content does not have an Arabic version. Overview Type 1 diabetes in children is a condition in which your child's body no longer produces an important hormone insulin. Request an appointment.
Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. By Mayo Clinic Staff. Show references AskMayoExpert.
Type 1 diabetes mellitus. Mayo Clinic. Kliegman RM, et al. Diabetes mellitus in children. In: Nelson Textbook of Pediatrics. Elsevier; Accessed Nov.
Sperling MA, ed. Diabetes mellitus. In: Sperling Pediatric Endocrinology. What is type 1 diabetes? Centers for Disease Control and Prevention. American Diabetes Association. Standards of medical care in diabetes — Diabetes Care. Neu A, et al. Diagnosis, therapy and follow-up of diabetes mellitus in children and adolescents.
Penn M. Primary care considerations for children and adolescents with type 1 diabetes. Current Problems in Pediatric and Adolescent Health Care.
Craig ME, et al. Early-life factors contributing to type 1 diabetes. Dayan CM, et al. Changing the landscape for type 1 diabetes: The first step to prevention.
The Lancet. Hypoglycemia low blood sugar. Hyperglycemia high blood glucose. DKA ketoacidosis and ketones. FDA approves first automated insulin delivery device for type 1 diabetes. Food and Drug Administration.
FDA authorizes first interoperable, automated insulin dosing controller designed to allow more choices for patients looking to customize their individual diabetes management device system. Kumar S expert opinion. Related Continuous glucose monitor and insulin pump.
Associated Procedures A1C test Pancreas transplant. News from Mayo Clinic Mayo Clinic Minute: Does your child have diabetes? Mayo Clinic Press Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press.
Mayo Clinic on Incontinence - Mayo Clinic Press Mayo Clinic on Incontinence The Essential Diabetes Book - Mayo Clinic Press The Essential Diabetes Book Mayo Clinic on Hearing and Balance - Mayo Clinic Press Mayo Clinic on Hearing and Balance FREE Mayo Clinic Diet Assessment - Mayo Clinic Press FREE Mayo Clinic Diet Assessment Mayo Clinic Health Letter - FREE book - Mayo Clinic Press Mayo Clinic Health Letter - FREE book.
Show the heart some love! Give Today. Help us advance cardiovascular medicine. Find a doctor. Explore careers. Sign up for free e-newsletters. About Mayo Clinic. About this Site. Contact Us.
Health Information Policy. Media Requests. News Network. The diagnosis of diabetes is a two-part process. Doctors first determine whether children have diabetes and then determine the type.
Children who appear to have complications also have other testing. Doctors suspect diabetes when children have typical symptoms or when a urine test done during a routine physical examination reveals glucose. The diagnosis is confirmed by measurement of the blood glucose level.
Blood glucose levels can be measured in the morning before children eat called the fasting glucose level or without regard to meals called the random glucose level. Children are considered to have diabetes if they have both typical symptoms of diabetes and a high blood glucose level.
Doctors also measure the level of a protein in the blood called hemoglobin A1c HbA1c. Hemoglobin is the red, oxygen-carrying substance within red blood cells Red Blood Cells The main components of blood include Plasma Red blood cells White blood cells Platelets read more.
When blood is exposed to high blood glucose levels over a period of time, glucose attaches to the hemoglobin and forms HbA1c. Because HbA1c takes a relatively long time to form and to break down, levels change only over weeks to months rather than from minute to minute like blood glucose levels do.
HbA1c levels thus reflect blood glucose levels over a 2- to 3-month period of time. People whose HbA1c level is 6. HbA1c levels are more helpful in the diagnosis of type 2 diabetes in children who do not have typical symptoms. Another kind of blood test called an oral glucose tolerance test may be done in children who have no symptoms or whose symptoms are mild or not typical.
In this test, children fast, have a blood sample taken to determine the fasting glucose level, and then drink a special solution containing a large amount of glucose. Doctors then measure blood glucose levels 2 hours later. This test is similar to the test that pregnant women have to look for gestational diabetes Gestational diabetes For women who have diabetes before they become pregnant, the risks of complications during pregnancy depend on how long diabetes has been present and whether complications of diabetes, such To help distinguish type 1 diabetes from type 2, doctors do blood tests that detect antibodies to various proteins produced by the insulin -producing cells in the pancreas.
Such antibodies are usually present in children with type 1 diabetes and are rarely present in children with type 2 diabetes. Children who are diagnosed with type 1 diabetes usually have other blood tests to look for autoimmune disorders such as celiac disease Diagnosis Celiac disease is a hereditary intolerance to gluten a protein found in wheat, barley, and rye that causes characteristic changes in the lining of the small intestine, resulting in malabsorption These tests are done at diagnosis and every 1 to 2 years thereafter.
Doctors sometimes do tests to look for other problems such as a disorder of the adrenal glands Addison disease Adrenal Insufficiency In adrenal insufficiency, the adrenal glands do not produce enough adrenal hormones.
Adrenal insufficiency may be caused by a disorder of the adrenal glands, a disorder of the pituitary gland read more , joint and muscle disorders such as rheumatoid arthritis Rheumatoid Arthritis RA Rheumatoid arthritis is an inflammatory arthritis in which joints, usually including those of the hands and feet, are inflamed, resulting in swelling, pain, and often destruction of joints read more , and additional digestive tract disorders such as inflammatory bowel disease Overview of Inflammatory Bowel Disease IBD In inflammatory bowel diseases, the intestine bowel becomes inflamed, often causing recurring abdominal pain and diarrhea.
The 2 primary types of inflammatory bowel disease IBD are Crohn Children who are diagnosed with type 2 diabetes have blood tests to determine how their liver and kidneys are functioning and urine tests.
At diagnosis, children who have type 2 diabetes are also tested for other problems, such as high blood pressure High Blood Pressure High blood pressure hypertension is persistently high pressure in the arteries. read more fats , and fatty liver Diagnosis Fatty liver is an abnormal accumulation of certain fats triglycerides inside liver cells.
People with fatty liver may feel tired or have mild abdominal discomfort but otherwise have no symptoms read more , because these problems are common among children with type 2 diabetes. Other tests are done depending on symptoms. For example, children with daytime sleepiness who snore are tested for obstructive sleep apnea Diagnosis Sleep apnea is a serious disorder in which breathing repeatedly stops long enough to disrupt sleep and often temporarily decrease the amount of oxygen and increase the amount of carbon dioxide read more and adolescent girls who are hairy and have acne or menstrual irregularities are tested for polycystic ovary syndrome Diagnosis Polycystic ovary syndrome is characterized by irregular or no menstrual periods and often obesity or symptoms caused by high levels of male hormones androgens , such as excess body hair and Because prompt measures such as changes in food choices, an increase in physical activity, and weight loss may help prevent or delay the start of type 2 diabetes, children at risk of type 2 diabetes Type 2 diabetes Diabetes mellitus is a disorder in which blood sugar glucose levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced read more should be screened with a blood test that measures the hemoglobin A1C levels.
This test should first be done when children are 10 years old or when puberty starts if puberty occurred at a younger age and should be repeated every 3 years if normal.
Some risk factors for type 2 diabetes can be prevented. For example, children who are obese should lose weight, and all children should get regular exercise see Nutrition and exercise Nutrition and exercise Diabetes mellitus is a disorder in which blood sugar glucose levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced For type 1 diabetes, injections of insulin.
For type 2 diabetes, metformin by mouth and sometimes injections of insulin or liraglutide. The main goal of diabetes treatment is to keep blood glucose levels as close to the normal range as can be done safely.
However, no treatment completely maintains blood glucose at normal levels. When people try very hard to keep blood glucose levels normal, they increase the risk that their blood glucose levels will sometimes become too low.
Low blood glucose is called hypoglycemia Hypoglycemia Diabetes mellitus is a disorder in which blood sugar glucose levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced read more and can be dangerous.
Although advances in diabetes technology have improved quality of care and control of blood glucose, not all people have benefited. Low-income and non-Hispanic Black children remain at higher risk of complications and negative outcomes because of poor control of blood glucose.
Children with diabetes should carry or wear medical identification such as a bracelet or tag to alert emergency care providers to the presence of diabetes. This information allows providers to start life-saving treatment quickly, especially in the case of injury or change in mental status.
General nutritional management and education are particularly important for all children with diabetes. Dietary recommendations for children with diabetes are based on healthy eating recommendations for all children and aim to maintain ideal body weight and optimal growth and to prevent short-term and long-term complications of diabetes.
All children should eat regularly and not skip meals. Although most dietary regimens allow some flexibility in carbohydrate intake and meal times, having meals and scheduled snacks at about the same time each day and that contain similar amounts of carbohydrates is important for optimal glucose control.
Because carbohydrates in food are turned into glucose by the body, variations in carbohydrate intake cause variations in blood glucose levels.
Choosing healthy foods can help control blood glucose and protect heart health. Children should focus on eating fruits and vegetables, whole grains, and high-fiber foods for example, foods that have at least 3 grams fiber or more per serving.
Food should not contain many highly processed refined carbohydrates Carbohydrates Carbohydrates, proteins, and fats are the main types of macronutrients in food nutrients that are required daily in large quantities.
read more , particularly candy, baked goods such as cookies, donuts, and pastries , and sugary drinks. They should avoid regular soda, sweetened iced tea, lemonade, fruit punch, and sports drinks altogether.
Children also should avoid foods with saturated fats Kinds of fat Carbohydrates, proteins, and fats are the main types of macronutrients in food nutrients that are required daily in large quantities.
read more , such as baked goods, snack foods such as potato chips and corn tortilla chips , deep-fried foods such as french fries , and fast food.
Some of these foods may still contain trans fats Fat in the diet Carbohydrates, proteins, and fats are the main types of macronutrients in food nutrients that are required daily in large quantities.
read more , common ingredients in certain commercial foods, which are being removed because they have been shown to be associated with an increased risk of heart disease. In type 1 diabetes, parents and older children are taught how to gauge the carbohydrate content of food and to develop a meal plan.
In most children with type 1 diabetes, food intake is not rigidly specified and is based on the child's usual eating patterns and insulin doses are matched to actual carbohydrate intake.
Infants and preschool-aged children present a particular challenge to parents because they do not eat consistent amounts of food and because they may develop hypoglycemia Hypoglycemia Diabetes mellitus is a disorder in which blood sugar glucose levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced read more but may not be able to communicate symptoms of hypoglycemia to their parents.
In type 2 diabetes, lifestyle modifications focus on weight in the majority of children. Steps to improve food choices and manage food intake include eliminating sugary drinks, controlling portion size, switching to low-fat foods, and increasing fiber by eating more fruits and vegetables.
Regular exercise is important because it improves glucose control and makes it easier to lose weight. Children with diabetic ketoacidosis Diabetic Ketoacidosis Diabetic ketoacidosis is an acute complication of diabetes that occurs mostly in type 1 diabetes mellitus.
Symptoms of diabetic ketoacidosis include nausea, vomiting, abdominal pain, and a characteristic read more DKA are usually treated in an intensive care unit.
They often require fluids given by vein intravenously to correct dehydration. They often also need intravenous potassium solutions to correct low potassium levels. Children often require intravenous insulin during DKA. To prevent the development of DKA and minimize the need for hospitalization, children and families should use ketone test strips to check for ketones in blood or urine.
Blood testing may be preferred in younger children and in others in whom it is difficult to obtain a urine sample, those who have frequent episodes of DKA, and insulin pump users. Ketone testing should be done whenever children become ill regardless of the blood glucose level or when the blood glucose is high.
High ketone levels may indicate DKA, especially if children also have abdominal pain, vomiting, drowsiness, or rapid breathing. To control blood glucose, children with type 1 diabetes take injections of insulin.
When type 1 diabetes is first diagnosed, children are usually hospitalized. Children with type 1 diabetes are given fluids to treat dehydration and insulin. They always require insulin because nothing else is effective.
Children who do not have DKA at diagnosis typically receive two or more daily injections of insulin. Insulin treatment is usually begun in the hospital so that blood glucose levels can be tested often and doctors can change insulin dosage in response.
Less commonly, treatment is started at a regular doctor visit. Once children are released from the hospital, they must take insulin regularly. Doctors work with children and their family to determine which insulin regimen is best.
There are several types of insulin regimens:. Insulin pump therapy. Premixed insulin regimen less common. Most children who have type 1 diabetes should be treated with MDI regimens or with insulin pump therapy.
With MDI regimens, a basal-bolus insulin regimen is preferred. This regimen involves taking one injection of a longer-acting insulin basal dose every day and then separate supplemental injections bolus doses of a short-acting insulin immediately before meals.
Each bolus dose can be different depending on how much food the child is going to eat or what the blood glucose level is at that time. An advantage of the basal-bolus regimen is that it allows for flexibility as to when meals are eaten and how much is eaten.
Fixed forms of MDI regimens are less commonly used. If a basal-bolus regimen is not an option for example, if adequate supervision is not available, such as when an adult is not available to give injections at school or daycare , fixed forms of MDI regimens can be an option.
In these regimens, children typically receive a specific fixed amount of shorter-acting insulin before eating breakfast and dinner and a fixed dose of longer-acting insulin at bedtime. Fixed regimens provide less flexibility, require a daily set schedule for meals, and have been largely replaced by basal-bolus regimens wherever possible.
In insulin pump therapy, the basal dose of insulin is delivered through a small, flexible tube catheter that is left in the skin. Supplemental boluses that are given at mealtime or that are given to correct a high blood glucose level are given as separate injections of rapid-acting insulin via the insulin pump.
Insulin pump therapy is increasingly being used in children. Potential benefits include better glucose control, safety, and user satisfaction compared to MDI regimens. This therapy is preferred for younger children, such as toddlers and preschoolers, and overall offers an added degree of control to many children.
Premixed insulin regimens use a fixed mixture of two forms of insulin : one that works quickly and lasts for only a few hours, and one that takes longer to work but lasts longer. Children are given one injection at breakfast and one at dinner.
An advantage of premixed regimens is that they require fewer injections and are easier to manage. However, premixed regimens have less flexibility with respect to timing and amount of meals and cannot be adjusted as frequently. Thus, these regimens do not control blood glucose levels as well as other regimens.
Insulin can be injected in several ways:. Some children use a vial and syringe. In this method, each dose of insulin is drawn up into a syringe from a vial and is injected under the skin, usually in the arm, thigh, or abdominal wall. Small syringes with very thin needles make the injections nearly painless.
The amount of insulin the syringe will hold varies depending on the amount of insulin needed per injection. An insulin pen, is a convenient way for many children to carry and use insulin , especially for children who take several injections a day outside the home.
The pen contains a cartridge that holds enough insulin for several doses. The dose delivered on each injection is adjusted by turning the top of the pen.
Another device is an insulin pump, which automatically pumps insulin continuously from a reservoir through a catheter that is left in the skin. The catheter site must be changed every 2 to 3 days.
More and more children, even young children, are using insulin pumps. The pump more closely mimics the way the body normally delivers insulin. Pumps are programmed to release small doses of insulin continuously over 24 hours called the basal dose and can be triggered manually to deliver extra insulin called the bolus dose with meals or to treat high blood glucose.
Unlike other methods, insulin pumps use only short-acting insulin. Children do not need longer-acting insulin because they are continually receiving a small amount of insulin in the basal dose.
The pump can be programmed to give different amounts of insulin at different times of day and night. Insulin pumps may be used with continuous glucose monitoring systems see Treatment Treatment Diabetes mellitus is a disorder in which blood sugar glucose levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced read more to better track trends in blood glucose throughout the day.
Newer insulin pumps have been developed that combine insulin pump therapy with continuous glucose monitoring systems in one device. For some children, the pump offers an added degree of control, whereas others find wearing the pump inconvenient or develop sores or infections at the catheter site.
Children must rotate their injection and pump sites to avoid developing lipohypertrophy. Lipohypertrophy is an accumulation of fatty lumps of tissue under the skin.
The lumps occur at injection sites that have been overused for insulin and can cause blood glucose levels to vary because they can prevent insulin from being absorbed consistently. Children with type 2 diabetes usually are not treated in the hospital unless the diabetes is severe.
Usually they are given drugs to lower blood glucose levels antihyperglycemic drugs at a regular doctor's office visit. Children with severe diabetes may need to be hospitalized to start insulin treatment.
Less commonly, children with type 2 diabetes develop severe dehydration or, as in type 1 diabetes, DKA. Metformin is the main drug given by mouth orally for children and adolescents.
It is started at a low dose and often increased over several weeks to higher doses. It can be taken with food to prevent nausea and abdominal pain. Liraglutide and exenatide are injectable drugs that can be given to children over 10 years of age who have type 2 diabetes.
These drugs may lower HbA1c levels and may also reduce appetite and promote weight loss. They may be given to children who are taking metformin but whose HbA1c level is not in the target range or they can be given instead of metformin to children who cannot tolerate that drug.
Other drugs used for adults with type 2 diabetes may help some adolescents, but they are more expensive, and there is limited evidence for their use in children.
Insulin is given to children who are hospitalized. Insulin can often be stopped after several weeks once glucose levels return to normal after treatment with metformin. About half of adolescents with type 2 diabetes ultimately require insulin. Some children who lose weight, improve their food choices, and exercise regularly may be able to stop taking the drugs.
Low blood glucose hypoglycemia Hypoglycemia Hypoglycemia is abnormally low levels of sugar glucose in the blood.
Hypoglycemia is most often caused by medications taken to control diabetes. Much less common causes of hypoglycemia include read more occurs when too much insulin or too much of an antihyperglycemic drug is taken or when the child does not eat regularly or exercises vigorously for a long period of time.
To treat hypoglycemia, children are given sugar in any form, such as glucose tablets, hard candies, glucose gel, or a sweet drink, such as a glass of fruit juice. If children are unable to eat or drink for example, because they are confused, disoriented, are having a seizure, or are unconscious , an injection of glucagon is given.
If untreated, severe hypoglycemia causes weakness, confusion, and even coma or death. In adults, adolescents, and older children, episodes of hypoglycemia rarely cause long-term problems. However, frequent episodes of hypoglycemia in children younger than 5 years of age may impair intellectual development.
Also, young children may not be aware of the warning symptoms of hypoglycemia. To minimize the possibility of hypoglycemia, doctors and parents monitor young children with diabetes particularly closely and use a slightly higher target range for their blood glucose level.
Continuous glucose monitoring systems Type 1 diabetes treatment Diabetes mellitus is a disorder in which blood sugar glucose levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced read more can help children because they sound an alarm when glucose falls below a specified range.
In type 1 diabetes, blood glucose levels should be checked up to 6 to 10 times per day and should be measured before all meals and before a bedtime snack. A fingerstick glucose test is most often used to monitor blood glucose. Most blood glucose monitoring devices glucose meters use a drop of blood obtained by pricking a fingertip fingerstick with a small implement called a lancet.
The lancet holds a tiny needle that can be jabbed into the finger or placed in a spring-loaded device that easily and quickly pierces the skin. The drop is placed on a test strip and the test strip is read by a machine. The machine reports the result on a digital display. Because exercise can lower glucose levels for up to 24 hours, glucose should be measured more frequently on days children exercise or are more active.
Sometimes levels need to be measured during the night. In type 2 diabetes, blood glucose levels should be measured regularly but typically less often than in type 1 diabetes.
Several factors determine the frequency of self-monitoring, including children's glucose levels between meals and after eating.
The frequency of monitoring should increase to at least 3 times a day if children do not have good control of their glucose, during illness, or when symptoms of hypoglycemia or hyperglycemia are felt.
Once glucose is controlled, home testing is limited to a few between-meal and after-meal blood glucose measurements per week. Once experience is gained, parents and many children can adjust the insulin dose as needed to achieve the best control. In general, by 10 years of age, children start to become interested in testing their own blood glucose levels and injecting insulin themselves.
Parents should encourage this independence but make sure the child is being responsible. Doctors teach most children how to adjust their insulin dosage in accordance with the patterns of their home blood glucose records.
Children with either type of diabetes typically see their doctor several times a year. The doctor evaluates their growth and development, reviews blood glucose records that a family member keeps, provides guidance and counseling about nutrition, and measures glycosylated hemoglobin levels hemoglobin A1C— see Diagnosing diabetes Diagnosing diabetes.
The doctor usually screens for long-term complications of diabetes Complications Diabetes mellitus is a disorder in which blood sugar glucose levels are abnormally high because the body does not produce enough insulin or fails to respond normally to the insulin produced read more , doing tests to look for nerve damage, and doing eye examinations.
Screening tests may be done once a year or every other year. Continuous glucose monitoring CGM systems are an increasingly common method of monitoring blood glucose levels and can replace routine self-monitoring of blood glucose for some children.
In CGM systems, a small glucose sensor placed under the skin measures blood glucose levels every 1 to 5 minutes, 24 hours a day. They transmit real-time results of blood glucose levels wirelessly to a device that may be built into an insulin pump or to a wireless monitor that can be worn on a belt.
The systems also record results for the doctor to review. Alarms on CGM systems can be set to sound when blood glucose levels drop too low or climb too high, so the devices can help people quickly identify worrisome changes in blood glucose that they can treat right away.
Use of CGM devices may help lower HbA1c levels. Real-time CGM can be used in children 2 years of age and older. This type of system automatically transmits a continuous stream of glucose data to the user in real time, provides alerts and active alarms, and also transmits glucose data to a receiver, smartwatch, or smartphone.
Real-time CGM should be done as close to daily as possible for maximum benefit.
Diabetes comes with various challenges, especially for young people. But, with early detection, chilvren and Diabetes in children and adolescents Powerful physical exertion learn to manage diabetes adolescenst stay as healthy as possible. Early Tackle water retention in children can include Tackle water retention thirst cgildren urination. The National Diabetes Statistics Report states that aroundchildren and teenagers under the age of 20 years in the United States have diagnosed diabetes. Type 1 diabetes is much more common in young people than type 2 diabetes. However, the rates of both types in young people are increasing. In —, doctors diagnosed type 1 diabetes in around 18, young people aged 10—19 years and type 2 diabetes in around 5, young people. Diabetes Tackle water retention is a disorder in which blood sugar glucose levels are abnormally high because the chjldren does znd Tackle water retention enough adolescentz or fails to respond normally to the Mental focus techniques produced. Diabetes describes a group of conditions with high Adolescentw glucose levels Enhancing natural glow caused by Tackle water retention insulin production, decreased effect of insulinor both. Treatment depends on the type of diabetes but includes insulin injections or other drugs and changes in food choices, exercise, and weight loss if overweight. The symptoms, diagnosis, and treatment of diabetes are similar in children and adults see Diabetes Mellitus DM Diabetes Mellitus DM Diabetes mellitus is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar glucose levels to be abnormally high. Symptoms of diabetes may read more. However, management of diabetes in children may be more complex.
0 thoughts on “Diabetes in children and adolescents”