Type 1 diabetes is one of the most common chronic diseases in children. It is an autoimmune disorder that typically develops in genetically predisposed individuals during childhood. In this article, we’ll explore how it impacts children, the process of diagnosis and treatment, and practical strategies for effectively managing your child’s diabetes care.

What is type 1 diabetes?

Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition in which the body is unable to produce enough insulin due to the destruction of insulin-producing beta cells in the pancreas. Normally, insulin helps move glucose (sugar) from the bloodstream into cells to be used for energy. Without enough insulin, glucose builds up in the blood instead of being used by the cells for energy. High blood sugar levels can be dangerous and can cause long-term damage if not managed properly.

Children are not born with type 1 diabetes mellitus—the condition usually develops gradually over time. While no single trigger has been identified, it is widely believed that a combination of genetic predisposition and environmental factors contribute to its onset.

Why can’t the body produce enough insulin in type 1 diabetes?

In T1DM, the body’s immune system wrongfully attacks and destroys the pancreatic beta cells, treating them as if they were harmful invaders. Over time, the body becomes unable to produce enough insulin to regulate blood sugar levels properly.

Symptoms of type 1 diabetes in children

• Frequent urination (polyuria)

• Increased thirst (polydipsia)

• Increased appetite (polyphagia) or periods of extreme hunger

• Fatigue 

• Weight loss 

• Blurred vision 

• Dehydration 

• Irritability

• Headaches 

In younger children, symptoms of T1DM may include bedwetting or very heavy diapers from frequent urination. Another early sign can be recurring yeast infections. If left untreated, T1DM can progress to a serious, life-threatening condition called diabetic ketoacidosis (DKA). This can cause symptoms such as:

• Nausea and vomiting

• Weakness or drowsiness

• Rapid heartbeat

• Abdominal pain

• Fruity or nail polish remover-like odor on the breath

• Loss of consciousness

DKA happens when the body is unable to use glucose for energy and starts breaking down fat instead. When the body breaks down fat, it produces ketones, which provides an alternative energy source but is extremely acidic. When ketone levels become too high, they can damage the body. 

Diagnosing type 1 diabetes in children 

Type 1 diabetes (T1DM) can develop at any age but is most commonly diagnosed during childhood or adolescence, typically between the ages of 4 and 14, with a peak around ages 10 to 14.

To diagnose T1DM, your pediatrician will look for common symptoms and measure your child’s blood sugar levels. This usually includes:

• Fasting blood sugar test: Measures blood sugar after your child hasn’t eaten for 8 to 12 hours.

• Random blood sugar test: Measures blood sugar at any time of day, regardless of when your child last ate.

• Hemoglobin A1c (HbA1c) test: Measures your child’s average blood sugar levels over three months to evaluate blood sugar control.

• Urine test: Detects the presence of ketones, 

• Autoantibody blood test: Identifies if the immune system is attacking its own insulin-producing cells, to confirm it’s an autoimmune-related issue.

Here’s a quick breakdown of blood sugar values to determine whether your child’s blood sugar is within a healthy range or if further evaluation is needed:

• Normal fasting blood sugar in children: 99 mg/DL or lower 

• Abnormal fasting blood sugar in children: 126 mg/dL or higher

• Normal random blood sugar test: Less than 200 mg/dL

• Abnormal random blood sugar test: 200 mg/dL or higher 

• Normal HbA1c test: Below 5.7%

• Abnormal HbA1c test: 6.5% or higher

Risk factors for developing type 1 diabetes

Several factors can increase a child’s risk of developing type 1 diabetes, including:

• Genetics 

• Family history

• Environmental triggers, like viral infections

Interestingly, children diagnosed with T1DM do usually have a first-degree relative with it too, because genetic susceptibility is a major risk factor. “While most children with type 1 diabetes do not have a family history, those who do are more likely to have inherited a higher burden of genetic risk variants, and possibly shared environmental exposures, which together increase their risk of developing the disease” explains Borieux. And unlike type 2 diabetes, there's no strong link to lifestyle factors like diet or exercise.

Complications of type 1 diabetes

If left untreated or poorly managed, type 1 diabetes (T1DM) can lead to serious and potentially life-threatening complications that affect multiple organs and systems in the body. These include:

• Retinopathy: Damaged blood vessels in the retina, resulting in vision loss. 

• Nephropathy: Kidney damage, which may progress to chronic kidney disease or renal failure.

• Neuropathy: Nerve damage. 

• Cataracts: Clouding of the eye’s lens, leading to blurred vision.

• Gastroparesis: Delayed stomach emptying, which can cause digestive issues. 

• Hypertension: High blood pressure. 

• Coronary artery disease: Narrowing of the heart’s blood vessels.

• Peripheral vascular disease: Poor circulation in the limbs, which can result in amputations. 

Treating types 1 diabetes in children

Managing type 1 diabetes in children requires lifelong insulin therapy, as their bodies are no longer able to produce insulin on their own. Insulin can be delivered through multiple daily injections with an insulin pen or syringe or an insulin pump worn on the body for continuous insulin delivery through the skin. Management also includes:

• Frequent blood glucose monitoring to keep blood sugar levels within target range. Children can monitor their blood using a blood glucose meter, a portable device that tests a drop of blood that’s placed on a strip and then inserted into the meter or a reading, or a continuous glucose monitor (CGM), a wearable device which uses a small sensor to continuously measure glucose levels.

• Carbohydrate counting and medical nutrition therapy to balance sugars from food with insulin needs. 

• Psychosocial support to help children and families cope with the emotional and social challenges of living with diabetes.

• Mental health: Children with type 1 diabetes face significant emotional and social challenges, including anxiety and stress, depression, fear of experiencing blood sugar imbalances,and social isolation. That’s why it’s so important to offer emotional support and professional therapy (if needed) to help them cope and thrive.

Children under 10 years are not expected to independently monitor or manage their blood glucose. At this age, blood glucose monitoring is a caregiver responsibility, as young children lack the cognitive and physical maturity to self-manage.

FAQs

How often do children with type 1 diabetes have to see their doctor for routine check-ups?

Children with T1DM need routine check-ups every three months with their diabetes care team, including their pediatrician and pediatric endocrinologist. Visits may be more frequent if there are issues with blood sugar control, diet, or complications. 

Does type 1 diabetes significantly disrupt quality of life for children? 

“Yes, type 1 diabetes can affect quality of life due to daily insulin administration, frequent blood glucose monitoring, risk of hypoglycemia and hyperglycemia, and the psychosocial stress and anxiety it may cause,” explains Dr. Borieux. “It can also bring psychosocial challenges, like social stigma or feeling different.” However, with comprehensive medical care, emotional support, and effective diabetes management, most children with type 1 diabetes can lead active, fulfilling lives and fully participate in age-appropriate activities.

How is type 1 diabetes different from type 2 diabetes?

T1DM is autoimmune disease with absolute insulin deficiency and type 2 diabetes is a result of insulin resistance and relative insulin deficiency. 

Do children with type 1 diabetes need to check their blood glucose levels often?

Children with T1DM need to monitor their blood sugar multiple times a day: before meals, at bedtime, before and after physical activity, and during the night if there are concerns about low blood sugar levels (hypoglycemia). 

What are some common challenges that children face if they have type 1 diabetes?

• Managing frequent glucose checks and insulin dosing

• Fear of hypoglycemia

• Following a strict diet

• School or daycare coordination

• Social stigma or anxiety

• Balancing diabetes care with normal development and activities

What is juvenile diabetes?

“Juvenile diabetes is an older term for type 1 diabetes diagnosed in children and adolescents,” explains Dr. Borieux. “The term is less used today since type 1 diabetes can also occur in adults.”

Is there any way to prevent type 1 diabetes? 

There is currently no way to prevent type T1DM. “Ongoing research is exploring potential preventive strategies, but none have been confirmed as effective to date,” says Dr. Borieux.

If you have questions about type 1 diabetes, reach out to your local or Summer Health pediatrician for support. Summer Health is a pediatric telehealth platform offering 24/7 care, providing answers for everything from urgent concerns to everyday questions about your child’s health.