Diabetes In Children

By Gary Wenick, MD_

All cells in our body require energy to function. The energy is derived from sugar (glucose) which is obtained from the diet. After being broken down and absorbed by the gastrointestinal tract the various nutrients and the sugar are transported via the blood stream. The hormone insulin helps the cells absorb sugar from the blood. This hormone is produced by cells in the pancreas. After the sugar is absorbed into the cells there is still sugar left in the bloodstream. Diabetes means that the sugar level in the blood is abnormally high.

Diabetes in children is different than in adults. In adults diabetes is usually due to poor response of the body to elevated sugar levels (Type II). There is enough insulin but the cells do not respond to it very well. The consequence is that sugar is not absorbed into the cells and its level in the blood is elevated. Diet, exercise and sometimes oral medications usually achieve reasonable control of sugar levels in this type of diabetes.

The incidence of diabetes in children is about two per every thousand. Children tend to be affected by Type I diabetes, due to lack of insulin. In this type of diabetes insulin has to be administered to the patient. It is felt that the immune system in these patients attacks and destroys the cells of the pancreas which produce insulin. Over weeks or months insulin production decreases and sugar levels in the blood increase. The kidneys eliminate some of the excess sugar and this is followed by increase in the amount of urine the patient produces. This leads to excessive fluid losses and increased thirst. It may also lead to bedwetting in children who are toilet trained. In addition, due to the fact that the sugar does not enter the cells and energy is deficient the children are hungry but lose weight.

Since the patient does not utilize sugar, the body starts using fat for energy. By-products of breakdown of fat are acids, also known as ketones. The accumulation of ketones in the body leads to fatigue and vomiting. At times the accumulation of ketones may cause abdominal pain which will be suspected to be appendicitis. Excessive accumulation of ketones, if not diagnosed on time and treated, may lead to death.

Testing the blood and urine of diabetic children reveals high concentrations of sugar. The treatment in these cases, as mentioned above, is insulin.

The incidence of diabetes is similar in boys and girls. Most patients are diagnosed between the ages of 5-7 years and at puberty. Most cases are also diagnosed in the autumn and winter.

Genetic studies have enabled scientists to identify children at higher risk for diabetes. Certain features on chromosome number 6 suggest a tendency for the disease. It is also suspected that certain environmental factors increase the risk of diabetes. This happens by increasing in the number of antibodies, which attack the pancreas. Research is being conducted now to try and prevent the production of these antibodies.

Children who start bedwetting after having control, or who have increased thirst, increased urination and start losing weight should be evaluated for the possibility of diabetes.

Dr Gary Wenick is a pediatrician and a pediatric endocrinologist with the Department of Pediatrics, Danbury Hospital.