Juvenile Diabetes

Type 1 diabetes is a disease that affects your body’s ability to regulate blood glucose (sugar) levels—there are various types of diabetes, which you can read more about in our other diabetes condition centers. This type of diabetes is often referred to as juvenile diabetes, because of its tendency to develop during childhood or adolescence, type 1 diabetes can actually develop at any age. In type 1 diabetes, the body does not produce enough insulin, a hormone that allows for the movement of sugar (food) into the body’s cells, resulting in dangerously high levels of glucose in the blood that the body cannot convert into energy. This is thought to be caused by the body’s immune cells mistakenly attacking and destroying the insulin-producing Islet cells of the pancreas, though research on the exact cause is still ongoing.

The Juvenile Diabetes Research Foundation reports that as many as three million American have type 1 diabetes. The number of children diagnosed with type 1 diabetes in the U.S. each year is more than 15,000. Of the people in the U.S. who are living with type 1 diabetes, 85% are adults and 15% are children. The prevalence of type 1 diabetes in children and teens between 2001 and 2009 increased by 23%.

What Causes Juvenile Diabetes

Risk Factors For Juvenile Diabetes

The risk factors for the developing juvenile diabetes differ from person to person, but there are a number of things that have been shown to increase risk. Below are the possible risk factors for Type 1 diabetes:

Family history. Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of developing the condition. Research done at the University of Michigan and published in the June 2014 issue of the journal Cell found that a defect in Clec16a, a gene responsible for getting rid of old mitochondria (the powerhouses of cells), disrupts the ability of beta cells to produce insulin, resulting in type 1 diabetes.
Environmental Factors: In 2006, an international team of scientists formed a research effort called The Environmental Determinants of Diabetes in the Young (TEDDY), which has centers in four countries and screens a total of 50,000 children a year. However, the reasons for the environmental triggers have still not been definitively established.
Viral exposure. Exposure to Epstein-Barr virus, Coxsackie virus, mumps virus, or cytomegalovirus may trigger the disease, as they are all connected to other autoimmune disorders.
Geography. The incidence of type 1 diabetes tends to increase as you travel away from the equator. According to the Mayo Clinic, type 1 diabetes is more common in European countries than in African or South American countries. Finland has the highest rate of type 1 diabetes in the world. No scientific reason for this phenomenon has been established but some researchers theorize that there is a connection between type 1 diabetes and cold weather.
Consuming certain foods as an infant. Early introduction of both cow’s milk and cereal to a baby’s diet may increase the risk of type 1 diabetes. A Finnish review of the literature regarding infant feeding, published in the American Journal of Clinical Nutrition in 2010 reported contradictory data about early introduction of cow’s milk proteins contained in infant formulas. Some surveys have indicated that early introduction of cow’s milk increases the risk of type 1 diabetes whereas others have shown no association at all. As for wheat, a study done at the University of Colorado and published in JAMA in 2003 found that children initially exposed to cereals between the ages 0 and 3 months had a higher risk of developing type 1 diabetes compared with those who were exposed during the fourth through sixth months. Both gluten-containing and non-gluten-containing cereals conferred the increased risk.
Having a mother younger than age 25 when she gave birth to you.
Having a mother who had preeclampsia during pregnancy. Preeclampsia is a condition involving high blood pressure and protein in the urine that develop after the 20^th week of pregnancy. The connection to diabetes is unknown.
Being born with jaundice.
Having a respiratory infection just after birth.

Diagnosing Juvenile Diabetes

Diabetes can be diagnosed by measuring blood glucose levels. Consistently high blood glucose levels, combined with symptoms of fatigue, excessive thirst, and frequent urination indicate the lack of insulin and/or insulin resistance associated with diabetes.

The following tests can be used to determine blood glucose levels:

Fasting blood glucose level test—Fasting blood glucose level tests measure a person’s blood glucose level after eight hours of not eating or drinking. According to the American Diabetes Association, normal fasting blood glucose is 70-100 mg/dL (3.9-5.6 mmol/L). Diabetes is typically diagnosed if blood glucose levels are higher than 126 mg/dL in two separate readings. Because of the fasting component of the test, fasting blood glucose level tests are usually scheduled in the morning, Because it is able to collect a blood glucose level without the variable of it being affected by a sugary meal or drink, fasting blood glucose levels are often used to make suspicions of diabetes definite. The test is usually scheduled in the morning to help ensure a complete fast beforehand.
Random (nonfasting) blood glucose level test – Nonfasting blood glucose level tests are taken right after eating. The normal blood glucose level after eating a meal is less than 180 mg/dL (10mmol/L) Blood glucose levels higher than 200 mg/dL can be signs of type 2 diabetes, however this must be confirmed with a fasting test. Results of random blood glucose level tests are largely dependent on what was last eaten and when.
Oral glucose tolerance test – During this test, an initial sample of blood is taken before the patient is asked to drink a solution containing glucose (typically 75 grams). Blood is then taken every 30 to 60 minutes after consuming the solution for up to three hours, recording the rate at which glucose is broken down by the body. Diabetes is diagnosed if the glucose level is higher than 200 mg/dL.
Hemoglobin A1c test — The hemoglobin A1c test can be used to diagnose diabetes as well as gauge how well someone is managing their diabetes over the course of 2-3 months. A1c is a component of hemoglobin that glucose is able to stick to as it carried throughout the blood stream. With a higher percentage of A1c, the blood is able to retain more glucose. During the Hemoglobin A1c test, blood is drawn either at a lab or through a finger prick at a general physician’s office, and tested for the percentage of hemoglobin A1c. This shows the average level of blood sugar (glucose) over the previous three months, indicating whether or not you properly digest glucose, and, if you do have diabetes, how well you are controlling your condition. Normal levels of A1c are around 4.5 – 6%, and individuals with levels of 6.5% and higher are typically diabetic. Levels of 7.5% and higher can be indicative of poorly controlled diabetes. Like many other of the diagnostic tests, it is best performed on two separate occasions to rule out any sugary meal or drink interference.
Ketone test – Your body breaks down fat and creates substances called ketones if you are not consuming sufficient carbohydrates to supply your body with glucose or if you don’t metabolize glucose correctly. Ketones can be toxic A ketone test can be done using a urine or blood sample. It is used when the following warning signs or conditions warrant the confirmation or ruling out of a complication called diabetic ketoacidosis:

– – When the blood sugar is higher than 240 mg/dL

– – During an illness such as pneumonia, heart attack, or stroke

– – When nausea or vomiting occur

– – During pregnancy

Symptoms of Juvenile Diabetes

Prognosis

Living With Juvenile Diabetes

When you maintain a healthy lifestyle, you are helping to control your diabetes.

Here are eight tips for living well with Type 1 diabetes:

Test your blood sugar. Monitoring blood sugar levels can help you understand your body’s needs at different times of the day. Depending on your levels, you may need to adjust your physical activity, meals, or insulin treatment.
Keep a food diary. It’s important to keep your body weight and blood sugar under control. Details such as what time you ate, how hungry you are before and after you eat, and what foods you choose, can help you learn to eat a healthy diet and understand how certain foods affect your blood glucose levels.
Quit smoking. While not immediately relevant (we hope) for those with juvenile diabetes, this could become an issue in adolescence and beyond. Diabetes symptoms and complications are worse for smokers than nonsmokers. According to the Centers for Disease Control, smokers are 30–40% more likely to develop type 2 diabetes than non-smokers. While this does not directly apply to those with juvenile diabetes – it could become an issue as your child grows up. The CDC also reports that people with diabetes who smoke are more likely than non-smokers to have trouble with insulin dosing and with controlling their disease^.In addition, smokers with diabetes have higher risks for serious complications, including heart and kidney disease, poor blood flow in the legs and feet that can lead to amputation, retinopathy (an eye disease that can cause blindness), peripheral neuropathy (damaged nerves to the arms and legs that causes numbness, pain, weakness, and poor coordination)
Limit alcohol. While not an immediate issue for those with juvenile diabetes, alcohol is something to be mindful of as your child enters adolescence. Heavy drinking can negatively impact those with type 1 diabetes, as alcohol contains a large amount of sugar that can disrupt blood glucose levels.
Maintain healthy teeth and gums. Diabetes may lead to higher levels of glucose in your saliva, which puts you at a higher risk for tooth decay and gum disease. To keep your teeth and gums healthy, brush at least three times a day, floss daily, and make regular visits to your dentist for examinations and cleanings.
Take good care of your feet. Some people with diabetes get tingling or numbness in their feet due to nerve damage, called neuropathy. That is why it is important to take good care of your feet. Wash your feet daily and wear clean, dry socks throughout the day. Always wear something on your feet to protect them from cuts or bruises, even inside the house. Check your feet every day to make sure there are no blisters, swelling, or other problems. Discuss any foot problems you may have with your doctor or podiatrist.
Exercise regularly and with care. Exercise is important to help maintain a healthy weight, regulate blood sugar levels, and boost your mood. However, diabetics might experience complications like increased susceptibility to infection and gangrene after an injury, or hypoglycemia (low blood glucose), so it’s important to take the proper precautions. Wear comfortable footwear and socks to prevent damage to the feet, drink plenty of water to keep your body hydrated, keep an eye on the temperature and amount of sun exposure, and carry your glucose pills and monitor with you in case of hypoglycemia during or after exercise.
Get your eyes examined every year. Prolonged and inadequate blood glucose control can damage and weaken the small blood vessels in the retina.

Screening

Prevention

Common Treatment

The treatment for diabetes can vary from type to type. Below are the main medications for each type of diabetes:

Insulin is the primary medication used to treat type 1 diabetes. Up until the 1980s, medical grade insulin was made from purified pig or cow insulin. Today, medical grade insulin is made in laboratories using genetic recombinant technology to allow pancreatic cells in laboratory cultures to produce insulin.

There are four different types of insulin that can be taken. These are:

Rapid-acting (Humalog, Novolog, Apidra): begins to work after 15 minutes, peaks in 30 to 90 minutes, and has a duration of three to four hours.
Short-acting (Humulin R, Velosulin – for use with a pump): begins to work in 30 to 60 minutes, peaks in two to three hours, and has a duration of three to six hours.
Intermediate-acting (NPH): begins to work in 90 minutes to six hours, peaks in four to 14 hours, and has a duration of up to 24 hours.
Long-acting (Lantus, Levernir): begins to work in six to 14 hours and remains effective for 24 to 36 hours.

Insulin is administered by injection several times throughout the day so that it can avoid the digestive enzymes of the stomach, which would otherwise destroy it. Insulin injections come in the form of:

Syringe and vial. When insulin injections are done properly, most people find that they are relatively painless. Insulin is usually given as a subcutaneous injection, meaning that the needle is inserted into the fat layer between the skin and the muscle and deposits the insulin there.
Insulin pens look like an old-fashioned cartridge pen, except that it is disposable, has a needle, and holds a pre-filled cartridge of insulin. Pens are particularly useful for people who travel frequently, whose coordination is impaired, or those who have visual difficulties. They are also more useful for people who require very small doses of insulin.
Pump. This is a computerized device about the size of a beeper that is worn on the belt or in a pocket. It delivers a steady, measured dose of insulin through a flexible plastic tube called a cannula. With the aid of a small needle, the cannula is inserted through the skin, usually in the abdominal region, and is taped in place. In some products, the needle is removed and only a soft catheter remains in place. Pumps can deliver very precise insulin doses for different times of the day.
Symlin (pramlintide) is an injectable medication that is always used in combination with insulin and never alone. Symlin is a synthetic version of the body’s natural amylin, a peptide hormone co-secreted with insulin by the pancreas. Symlin is used to control high blood sugar that can occur after meals.

Other treatments include:

Artificial pancreas: an upcoming treatment option will be an implanted device that will simultaneously measure glucose and deliver appropriate insulin continuously. Clinical trials are promising and this new treatment could provide very effective glucose control and avoid many diabetic health complications.
Low carbohydrate diet: by consuming less carbohydrates there will be less glucose in the bloodstream, which lowers the required level of insulin to control the body’s blood sugar
Combination of medications and insulin to better control and manage their condition. Your physician and the other members of your care team will help determine what is best for you.

Complementary and Alternative Treatment

Care Guide

Many people with diabetes live happy, healthy lives.

In order to keep your symptoms in check and your blood glucose levels within range, follow these tips:

Monitor your insulin carefully. Don’t attempt to make adjustments without your doctor’s oversight.
Maintain a healthy weight. Excess body fat causes cells to become resistant to insulin.
Eat small, frequent meals to keep blood sugar in a healthy range. Eating large meals can flood the bloodstream with glucose.
Keep refined starches and sugars to a minimum, choosing foods with a low glycemic index. Examples of “good” carbohydrates include sweet potatoes, winter squash and beans.
Eat fish several times a week, emphasizing wild, cold-water fish high in omega-3 fatty acids, such as Alaskan salmon and sardines. Or take molecularly distilled omega-3 supplements.
Increase your activity level. Aerobic activity improves insulin sensitivity in muscle cells, which allows more glucose to enter the cells. Aim for 30 minutes a day.
Keep up-to-date with the latest advances in the treatment of diabetes.
Connect with others who are also dealing with the disease, either with support groups in your community or online.
Check your blood glucose regularly.
Take your medication as prescribed.
Get help for depression. Depression and diabetes are linked. A recent study in the Annals of Family Medicine found that treating both conditions helped people stay on top of their diabetes medications and led to improved blood sugar levels, as well as reducing depression symptoms.
Inspect your feet daily. If you find a sore that isn’t healing, speak with your doctor immediately.
Identify yourself. Wear a medical alert bracelet or, at the very least, carry an identification card that tells people you have type 2 diabetes to help health professionals treat you in case of emergency.

HEALTHY EATING

There’s no juvenile or type 1 diabetes diet – contrary to popular thinking. Your child will need plenty of fruits, vegetables, and whole grains – foods high in nutrition, and low in both fat and calories. Your child’s nutritionist will likely recommend that your child – along with the rest of the family – make the conscious choice to consume fewer animal products and refined sweets. While sugary foods are OK every once in a while, they should be limited, and budgeted into your child’s meal plan, particularly for special occasions. A registered dietitian can be a great member of your team – advising on everything from what foods are best for your child, how much, recipes and food sources, lifestyle and more. There are some places in which greater vigilance is needed; particularly with foods that have high fat content – because fat slows digestion, and foods with high sugar content as they affect insulin directly. Each individual processes food differently, with your nutritionist you can build a plan that works best for you and your child.

EXERCISE

While everyone needs regular exercise, children with type 1 diabetes are no exception – but remember that physical activity often lowers blood sugar, sometimes affecting levels for up to 12 hours after exercise. Check your child’s blood sugar more often than usual after more vigorous exercise or starting a new activity to learn how his or her body reacts. You may need to adjust your child’s meal plan or insulin dose to compensate. Do encourage your child to do all sports that kids non-type-1 dis do – anything from ballet to basketball to swimming. If it’s fun, they’re more likely to participate! Incorporate movement and physical activity into part of your child’s daily routine.

BUILDING FELXIBILITY INTO YOUR PLAN

Even with a careful insulin schedule, sugar levels in your child’s blood can vary unpredictably at times. With help from your child’s diabetes treatment team, you’ll learn what might trigger blood sugar level changes so that you can be prepared. Here are some possible triggers to be mindful of:

Food – How much – and what – your child eats are they two key things that have the greatest impact on your child’s blood sugar levels. This can prove challenging for parents of very young kids with juvenile diabetes, as young children don’t always finish their meals. This can be an issue if you’ve given an insulin injection to cover a larger meal than was consumed. Speak to your diabetes team if this becomes a recurring issue.
Exercise – Engaging in physical activity moves sugar from the bloodstream into the cells – and the more active your child is, the lower his or her blood sugar levels will be. You may need to lower your child’s insulin does prior to vigorous physical activity to compensate, or perhaps your child might have a pre-exercise snack to help keep levels more steady.
Illness – If your child has a fever, it will increase metabolism – which affects insulin dose needed. Similarly, with a cold or other illness, hormonal fluctuations can increase blood sugar levels. Therefore during any type of illness, insulin doses need to be more carefully calibrated, and perhaps adjusted.
Medication – Insulin is critical for a child with type 1 diabetes to maintain steady blood sugar levels, but other types of medication may affect blood sugar levels as well – which may require changes to your child’s diabetes treatment plan.
Puberty and growth spurts – This hews to the adage that change is the only constant; as your child grows, especially during times of growth spurts, he or she may not be getting enough insulin. Hormones come into play when your child enters puberty, affecting insulin requirements – especially for teenage girls when they begin to menstruate.
Sleep – For most children, blood sugar levels dip during the night, which is why blood sugar levels tend to be slightly higher before bed than they are in the morning. Monitoring the range of normal is a good rule of thumb to make sure your child is doing well:
- Children younger than 6: pre-bedtime levels from 110 to 200 mg/dL
- Children between 6 and 12: pre-bedtime levels from 100 to 180 mg/dL
- Teenagers and adolescents: pre-bedtime levels from 90 to 150 mg/dL

When To Contact A Doctor

Questions For Your Doctor

If you suspect you have diabetes, schedule a visit with your Primary Care Physician (PCP) for a complete physical to rule out other possible causes of your symptoms. Your doctor will then give you referrals to specialists. According to the American Diabetes Association (ADA), your diabetic care team should include a:

Primary doctor: Usually an internist or family medical doctor, who you’ll see for general checkups and when you get sick. Your primary care doctor should be experienced in treating people with diabetes and will likely head up your diabetes care team.
Endocrinologist: This is a doctor who has special training and experience in treating people with diabetes.
Dietician: A registered dietitian (RD) is trained in the field of nutrition. Your dietitian can help you figure out the best diet based on your needs and health goals.
Nurse educator: A nurse/diabetes educator or diabetes nurse practitioner is a registered nurse (RN) with special training and background in caring for and teaching people with diabetes. Nurse educators often help you learn the day-to-day aspects of diabetes self-care.
Eye Doctor: Diabetes can affect the blood vessels in the eyes. The eye doctor will be either an ophthalmologist (a doctor who can treat eye problems both medically and surgically) or an optometrist (someone who is trained to examine the eye for certain problems, such as how well the eye focuses). You should see your eye doctor at least once a year.
Podiatrist: Foot care is important because diabetes can cause nerve damage in the extremities. Podiatrists have a Doctor of Podiatric Medicine (DPM) degree from a college of podiatry. They have also done a residency (hospital training) in podiatry.
Dentist: People with diabetes are at somewhat greater and earlier risk of gum disease because excess blood sugar in your mouth makes it a welcoming place for bacteria; this can lead to infection. You should see your dentist every six months.

To find a specialist in your area, search on the Healthgrades web site. Here are links to articles on ThirdAge.com about this service:

Healthgrades: Find the Best Healthcare for You

Healthgrades 2014 Hospital Quality Report

Visit the American Association of Diabetes Educators online for more information on diabetes experts in your area