Diabetes in Children
🩸 Diabetes in children is a chronic metabolic condition characterised by impaired regulation of blood glucose due to insufficient insulin action.
It requires lifelong management and a coordinated approach involving the child, family, and multidisciplinary healthcare team.
In paediatrics, diabetes most commonly presents as Type 1 diabetes, but Type 2 diabetes is increasingly recognised due to rising childhood obesity.
🧬 Type 1 Diabetes Mellitus (T1DM)
- 🔍 About:
An autoimmune disease causing destruction of pancreatic β-cells, resulting in absolute insulin deficiency.
Accounts for the majority of diabetes cases in children.
- 🧠 Causes:
Combination of genetic susceptibility and autoimmune mechanisms, often triggered by environmental factors (e.g. viral infections).
- 🚨 Symptoms (often rapid onset):
- 💧 Polydipsia (excessive thirst)
- 🚻 Polyuria (frequent urination, bedwetting)
- ⚖️ Unintentional weight loss
- 😴 Fatigue and lethargy
- 👁️ Blurred vision
- ⚠️ May present with diabetic ketoacidosis (DKA)
- 💉 Treatment:
- Lifelong insulin therapy (multiple daily injections or insulin pump)
- Regular blood glucose and ketone monitoring
- Individualised diet and carbohydrate counting
- Education on sick-day rules and hypoglycaemia management
🍔 Type 2 Diabetes Mellitus (T2DM)
- 🔍 About:
Characterised by insulin resistance with relative insulin deficiency.
Previously rare in children, now increasing due to obesity and sedentary lifestyles.
- 🧠 Causes:
- Obesity and central adiposity
- Genetic predisposition and family history
- Poor diet and physical inactivity
- Associated insulin resistance states (e.g. PCOS)
- 🚨 Symptoms (often insidious):
- 💧 Polydipsia and polyuria
- 😴 Fatigue
- 🖤 Acanthosis nigricans (darkened skin folds)
- Often asymptomatic and detected on screening
- 💊 Treatment:
- Lifestyle modification (nutrition + exercise)
- Metformin first-line
- Insulin therapy if poor control or at diagnosis with marked hyperglycaemia
🛠️ Management of Diabetes in Children
- 📊 Monitoring:
Frequent blood glucose checks and use of continuous glucose monitoring (CGM) where available.
- 💉 Insulin Therapy:
Essential for all children with T1DM; regimens tailored to age, activity, and lifestyle.
- 🥗 Diet & Nutrition:
- Balanced diet with carbohydrate awareness
- Encourage normal eating patterns and avoid stigma
- 🏃 Physical Activity:
Improves insulin sensitivity, cardiovascular health, and psychological wellbeing.
- 🤝 Education & Psychosocial Support:
- Structured diabetes education for child and carers
- School support plans
- Psychological support to address anxiety, burnout, and adherence
⚠️ Complications
- 🚨 Acute:
- Diabetic ketoacidosis (DKA) – life-threatening insulin deficiency
- Hypoglycaemia – due to insulin or oral agents
- ⏳ Long-term:
- Cardiovascular disease
- Diabetic nephropathy
- Retinopathy
- Peripheral neuropathy
📚 Key Teaching Pearls
- 🧠 New-onset diabetes in children is T1DM until proven otherwise.
- 🚨 Weight loss + polyuria + polydipsia = exclude DKA urgently.
- 🍔 T2DM in children is increasing but remains less common than T1DM.
- 🤝 Family and school involvement is crucial for successful long-term management.
