Diabetes in Children
๐ฉธ 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.
๐งฌ Type 1 Diabetes Mellitus (T1DM)
- ๐ About:
An autoimmune disease causing destruction of pancreatic ฮฒ-cells, resulting in absolute insulin deficiency.
Accounts for the majority of diabetes cases in children.
- ๐ง Causes:
Combination of genetic susceptibility and autoimmune mechanisms, often triggered by environmental factors (e.g. viral infections).
- ๐จ Symptoms (often rapid onset):
- ๐ง Polydipsia (excessive thirst)
- ๐ป Polyuria (frequent urination, bedwetting)
- โ๏ธ Unintentional weight loss
- ๐ด Fatigue and lethargy
- ๐๏ธ Blurred vision
- โ ๏ธ May present with diabetic ketoacidosis (DKA)
- ๐ 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
๐ Type 2 Diabetes Mellitus (T2DM)
- ๐ About:
Characterised by insulin resistance with relative insulin deficiency.
Previously rare in children, now increasing due to obesity and sedentary lifestyles.
- ๐ง Causes:
- Obesity and central adiposity
- Genetic predisposition and family history
- Poor diet and physical inactivity
- Associated insulin resistance states (e.g. PCOS)
- ๐จ Symptoms (often insidious):
- ๐ง Polydipsia and polyuria
- ๐ด Fatigue
- ๐ค Acanthosis nigricans (darkened skin folds)
- Often asymptomatic and detected on screening
- ๐ Treatment:
- Lifestyle modification (nutrition + exercise)
- Metformin first-line
- Insulin therapy if poor control or at diagnosis with marked hyperglycaemia
๐ ๏ธ Management of Diabetes in Children
- ๐ Monitoring:
Frequent blood glucose checks and use of continuous glucose monitoring (CGM) where available.
- ๐ Insulin Therapy:
Essential for all children with T1DM; regimens tailored to age, activity, and lifestyle.
- ๐ฅ Diet & Nutrition:
- Balanced diet with carbohydrate awareness
- Encourage normal eating patterns and avoid stigma
- ๐ Physical Activity:
Improves insulin sensitivity, cardiovascular health, and psychological wellbeing.
- ๐ค Education & Psychosocial Support:
- Structured diabetes education for child and carers
- School support plans
- Psychological support to address anxiety, burnout, and adherence
โ ๏ธ Complications
- ๐จ Acute:
- Diabetic ketoacidosis (DKA) โ life-threatening insulin deficiency
- Hypoglycaemia โ due to insulin or oral agents
- โณ Long-term:
- Cardiovascular disease
- Diabetic nephropathy
- Retinopathy
- Peripheral neuropathy
๐ Key Teaching Pearls
- ๐ง New-onset diabetes in children is T1DM until proven otherwise.
- ๐จ Weight loss + polyuria + polydipsia = exclude DKA urgently.
- ๐ T2DM in children is increasing but remains less common than T1DM.
- ๐ค Family and school involvement is crucial for successful long-term management.
