Reviewed by: Steven Chessler, M.D., Ph.D. 5/18.
Type 1 diabetes mellitus (T1DM) is the most common metabolic endocrine disease in children. It is a clinical condition whereby a child’s pancreas stops producing an important hormone called insulin. Insulin is a hormone produced by the beta cells in the pancreas. It facilitates the entry of glucose into the cells and also plays a role in regulating blood glucose levels.
T1DM in Children
Type 1 diabetes is a chronic autoimmune disease. It was previously known as insulin-dependent diabetes mellitus (IDDM) or juvenile diabetes. T1DM is increasing year by year all over the world. There has been a significant increase in the number of new cases in the past few years.
After its onset, T1DM progresses through a pre-symptomatic state (normal sugar) to a symptomatic state. Decreasing beta cells also lowers the production of insulin over a period of time. An important fact to consider is that symptoms of T1DM may appear suddenly and may only be noticed once a child becomes very sick.
In worst case scenarios, a child affected by T1DM may go into a coma, which is often caused by diabetic ketoacidosis (DKA), a common and acute life-threatening complication of T1DM.
In Western countries, it is estimated that 25-40% of T1DM cases are diagnosed following a life-threatening bout of DKA. A missed diagnosis of DKA may prove fatal. That is why it is absolutely critical to be aware of the early signs of T1DM.
Signs and Symptoms in Children
Many of the signs and symptoms of T1DM may be subtle and develop slowly over time. Others may come on suddenly and can be frightening to the children and parents who are affected. Look out for these 10 signs and symptoms of T1DM in children:
- Polyphagia (increased appetite or excessive hunger) – Whatever we eat is converted into glucose, but insulin is needed to properly utilize this glucose. Since children with T1DM no longer produce insulin, they become hungrier.
- Polyuria (producing abnormally large volumes of urine)– Usually the kidneys reabsorb all the sugar in the body. However, once the sugar crosses the kidney’s threshold to reabsorb, it is all excreted in urine, which pulls more water out of the body and increases the frequency of urination. Nocturnal enuresis (involuntary urination) during sleep is a very common symptom in children affected by T1DM. Secondary nocturnal enuresis is also a common symptom; this occurs when a child goes through a period (at least 6 months) of dryness at night and then reverts to nighttime wetting, along with other symptoms. Polyuria, nocturnal enuresis and secondary nocturnal enuresis should all raise suspicion of T1DM.
- Polydipsia (excessive thirst)– The increased frequency of urination leads to increased thirst in children with T1DM.
- Weight loss – It may seem unintuitive, but weight loss is often observed in children with T1DM despite more food intake than usual. This is because the glucose available to the child cannot be utilized as a source of energy. Instead, the child’s body fat is burned to provide energy.
- Fruity-smelling urine – As the body burns fat for energy, it produces ketones, which impart a fruity smell to the urine.
- Excessive fatigue – Glucose uptake is impeded by a lack of insulin, resulting in tiredness.
- Blurry vision — blackouts, or dizziness
- Delayed healing of wounds – Due to high amounts of sugar in the blood, blood flow becomes impeded and immune cells function poorly, resulting in delayed wound healing.
- Fungal infections – Children often suffer from fungal infections, such as vaginal candidiasis (yeast infection).
- Diabetic ketoacidosis – Though this is not an early sign of diabetes, a lot of new T1DM cases may be diagnosed by determining that the child’s symptoms are caused by DKA. Symptoms of this life-threatening condition include the following:
- Abdominal pain
- Breathing that is deep, heavy, or rapid
- Fruity odor
- Diminished neurocognitive function
Since many of the signs and symptoms of T1DM can be attributed to a tired or hungry child (or other types of health issues), it is very important to pay attention to these warning signs and not brush them aside. Remember, T1DM is a common condition that could develop at any time throughout a child’s development.
1. Nelson Textbook of Pediatrics, 20th edition. ISBN: 978-1-4557-7566-8.
2. Type 1 Diabetes mellitus in children and adolescents in India, ISPAE Clinical Practice Guidelines 2017, 2nd edition.
Steven Chessler, M.D., Ph.D., is an associate professor and physician-scientist in the Department of Medicine, Division of Endocrinology, at the UC Irvine School of Medicine. He treats patients with diabetes and a variety of other endocrine disorders and, in the laboratory, carries out diabetes- and pancreatic-islet-related research.