About Diabetes (diabetes mellitus)

 

What is Diabetes?

Diabetes is a disease where the body does not manage glucose (sugar) correctly, leading to an increase in the level of glucose in the blood. Diabetes is a life-long chronic disorder, where high blood glucose levels (also known as hyperglycaemia) need to be treated in order to make the best use of food as fuel for the body to remain healthy.

Cells in the body need the hormone insulin to be able to use glucose for energy. Insulin is produced in the pancreas, which is a leaf-shaped organ that sits in the upper abdomen.  In diabetes, the pancreas can no longer produce enough insulin to manage blood glucose levels properly.

Children with untreated diabetes can become very sick very quickly, so it is vitally important for a child suspected of having diabetes to go to hospital as an emergency and be referred to a paediatric endocrinologist.

It is just as important to remember that while there is currently no cure for diabetes, it can be treated, controlled and managed successfully.

 

Anatomy of Diabetes - What parts of the body does diabetes affect?

Anatomy of Diabetes

Cells in the body need the hormone insulin to be able to use glucose for energy. Insulin is produced by specialised cells (called beta cells) in the pancreas, which is a leaf-shaped organ that sits in the upper abdomen just below the stomach. In diabetes, the pancreas cna no longer produce enough insulin to manage blood glucose levels properly. 

After eating, food is digested and absorbed through the gut causing the level of glucose (sugar) in the blood to rise. In response the pancreas releases insulin into the blood, which then picks up the glucose and helps it move into the body's cells to be used as fuel. In diabetes, there may be little or no insulin produced by the pancreas, or the body's cells have become resistant to the action of insulin, causing increased blood glucose levels (hyperglycaemia).

High blood glucose levels can cause increased thirst and hunger, frequent urination, weight loss, blurry vision, headaches, and difficulty concentrating. Untreated hyperglycaemia without insulin can also lead to stomach pain and vomiting. If this happens it is vitally important for a child suspected of having diabetes to go to hospital as an emergency and be referred to a paediatric endocrinologist.

If blood glucose levels remain high over a prolonged period, this can damage the heart, blood vessels, eyes, kidneys and nerves. 

 

What are the Symptoms of Diabetes in Children?

The main symptoms of diabetes in children and adolescents are

  • Feeling thirsty, and drinking more
  • Hunger
  • Weight loss
  • Passing urine more often, including waking up to pass urine over night
  • Tiredness and difficulty concentrating
  • Headaches
  • Fungal infections
  • Blurry vision, and
  • Dark colouring (pigmentation) with velvety texture in certain areas of the body, such as neck creases and arm pits

As the loss of insulin production progresses, the child may develop:

  • Stomach pain
  • Vomiting
  • Sweet smelling breath
  • Increasing tiredness and lethargy

These are symptoms of Diabetic Keto-Acidosis (DKA). Children can become very sick if diabetes goes untreated, and some children may need admission to an intensive care unit. It is vitally important for a child suspected of having diabetes to go to hospital as an emergency and be referred to a paediatric endocrinologist

 

What is the Impact of Diabetes?

Diabetes is a chronic condition that requires lifelong medication and attention to lifestyle factors such as diet and exercise. 

Regular monitoring of blood glucose levels will be required.

What are the Types of Diabetes?

The main types of diabetes are:

  • Type 1 diabetes: Most children diagnosed with high blood glucose levels (hyperglycaemia) are said to have Type 1 Diabetes. Their own immune system has mistakenly attacked the pancreas, so that it is producing little or no insulin to convert sugar into energy. It is also called insulin-dependent diabetes, or juvenile diabetes, and is seen more commonly in children.
  • Type 2 diabetes: In Type 2 diabetes, the body becomes resistant to insulin, meaning more insulin is needed to manage blood glucose levels. This may also be called non-insulin dependent diabetes and is seen more commonly in adults. Type 2 diabetes is often considered to be ‘lifestyle related’, and responds well to changes in diet and exercise. In addition, tablets and / or insulin may be needed to keep blood glucose levels well controlled.
  • Monogenic diabetes: (MODY - Maturity Onset Diabetes of the Young) is a genetic form of diabetes affecting about 5% of people with diabetes. It is caused by a single gene abnormality that cause diabetes, and in some forms, can be managed with tablets.
  • Secondary diabetes: this results from other conditions affecting the pancreas such as cystic fibrosis, hormonal disorders, adverse effects of medications, insulin receptor abnormalities, and some of the genetic disorders.
  • Gestational diabetes: This form of diabetes is similar to type 2 diabetes that occurs during pregnancy due to hormones produced by the placenta. This occurs in some women, resolving soon after childbirth, but increases the risk of them developing the condition later in life.

 

What Causes Diabetes in Children?

Type 1 Diabetes

Type 1 diabetes is caused by an autoimmune response of the body’s own immune system, where it wrongly considers the insulin-producing beta cells of the pancreas to be harmful and attacks them, destroying many of the cells.

This leads to lowered production of insulin. However, as the immune system does not target the body’s ability to use insulin, insulin injections can be administered to make up for the low levels.

Type 2 Diabetes

Typically affecting older people, type 2 diabetes is being increasingly diagnosed in Australian children presenting with weight issues, particularly where there is a family history of type 2 diabetes.

Lifestyle factors such as

  • An unhealthy diet
  • Sedentary lifestyle (often related to too much screen time), and
  • Obesity

can contribute to the development of type 2 diabetes. Conversely it can often be managed through improving diet and exercise. Blood glucose monitoring can assist in knowing how well these changes are working to manage diabetes.

How is Diabetes Diagnosed?

The only thing required to diagnose diabetes is

  • Random blood glucose and
  • Blood ketones 

If there is a Blood Glucose Level (BGL) of 7-10 mmol/L or higher on a random finger-prick sample, your doctor may want to contact QPE urgently to discuss the next steps in diagnosis.

Your doctor may order the following tests to diagnose diabetes:

  • Urine test: This is done to check for the presence of glucose or ketones in the urine. Presence of glucose in the urine is highly suggestive of diabetes.
  • HbA1c test: This is a blood test that measures the amount of glucose accumulated over the previous 3 months.
  • Oral Glucose Tolerance Test (OGTT): This is done to confirm type 2 diabetes. It measures how quickly glucose can be cleared from the blood. Following an overnight fast, your blood is tested for glucose. This is compared with further blood tests taken for the next two hours after drinking a sugar solution. Levels more than  11.1 mmol/L after two hours indicates diabetes, and levels 7.8  to 11.0 mmol/L  indicates pre-diabetes.
  • Fasting blood sugar test: Blood glucose (sugar) level is tested after an overnight fast. Levels of 5.55  to 6.94  mmol/L  is classed as pre-diabetes, while levels more than 6.94 mmol/L  on two or more separate tests on different days indicates diabetes.
  • Random blood sugar test: Blood is tested at a random time of the day for glucose (sugar) levels. Blood glucose levels of 11.1 mmol/L or higher indicate diabetes.

What is the Treatment for Diabetes?

The treatment options for diabetes depends on the type:

  • Type 1 diabetes: Because the body produces little or no insulin in type 1 diabetes, insulin needs to be given. Insulin is a protein, so needs to be given by injections and cannot be given in tablet form. It is also important to pay close attention to food, drink and exercise to maintain a steady level of glucose in the blood.
  • Type 2 diabetes: Healthy eating and increased physical activity promoting a healthy weight is important. You may be also prescribed medication to regulate the levels of insulin in your body. These may be taken orally or as injections.

What’s involved in treating my child with Type 1 Diabetes?

  • Diabetes cannot be cured – yet.
  • It can be managed.
  • The management of Type 1 Diabetes involves a combination of insulin by injection or pump, exercise, diet management and regular blood sugar measurements.
  • Queensland Paediatric Endocrinology recommends that all newly diagnosed children with Type 1 Diabetes start on an insulin pump as soon as possible (within 1 month). This requires a short admission into hospital: Mater Children’s or Wesley in Brisbane or St Vincent’s in Toowoomba. If your child has been admitted into a public hospital, hospital transfer can be arranged.
  • While we advocate insulin pumps, some families choose multiple daily injections of insulin: our experienced diabetes educators teach correct injection techniques.
  • Children with Type 1 Diabetes need regular specialist care as their medical needs change as they grow. Activities and illness also affect their treatments.
  • Queensland Paediatric Endocrinology provides the team back-up needed for your child to develop to their full potential.

What if Diabetes is Untreated?

If left untreated, blood glucose can reach abnormally high levels leading to a condition called hyperglycaemia. When there is not enough insulin to use sugar (glucose) as fuel, the body produces ketones as an alternative source of energy. Without insulin, ketones continue to accumulate and cause the blood to become acidic, leading to diabetic keto-acidosis (DKA). DKA causes stomach pain, vomiting, sweet smelling breath, and drowsiness. Children can become very sick if diabetes goes untreated, and may need admission to an intensive care unit to manage blood glucose and ketone levels. It is vitally important for a child suspected of having diabetes to go to hospital as an emergency and be referred to a paediatric endocrinologist. 

Over many years, uncontrolled diabetes can result in complications such as damage to tiny blood vessels of the eyes, heart, kidneys and brain, leading to heart disease, stroke, blindness and kidney disease. Other problems include nerve damage, which can cause loss of sensitivity in various parts of the body, and poor blood flow to the feet. Feet with nerve damage are especially vulnerable to poorly healing cuts and blisters that may become chronically infected, and sometimes require amputation.

Is Diabetes Curable?

Currently diabetes does not have a cure. Treatment will have to be continued throughout life to control the symptoms of diabetes, and to prevent long term complications.

Timely treatment and lifestyle changes can help control diabetes and its symptoms, and a good start goes a long way towards preventing serious complications. 

Diabetes Treatment Research

Please ask us about new developments and research for treatments of diabetes

Are there Alternative Treatments for Diabetes?

Unfortunately there are no alternative treatment for Type 1 Diabetes.