Type 1 diabetes mellitus is a chronic disease that is characterised by complete insulin deficiency due to autoimmune destruction of Langerhans beta cells in the pancreas. The frequency of Type 1 diabetes is increasing at a constant rate, without us being able to justify the cause. As it is an autoimmune disease, it seems to follow the increased incidence trend of these diseases. Moreover, it appears to be occurring more and more often in young children (under the age of 6). One would think that it is treated easily with insulin, but this theory has been disproven in practice. The challenges and traps encountered by both the doctor and patient first appear in diagnosis and are unfailingly exacerbated by the young age of the patient.

On communicating the diagnosis to the patient and family, a period of “mourning” invariably follows. The family of newly diagnosed diabetic children, particularly in cases where the child is very young, believe that the “end” has come. This feeling can be overcome quickly with the assistance of specialists and educators, as well as the willingness of the family.

The education of the diabetic family covers several areas: the insulin available on the market, new types of insulin, hypoglycaemia, hyperglycaemia, exercise, illnesses, diet, insulin delivery, blood sugar measurement, and the daily routine, psychology and goals for the treatment of the diabetes and patient. These goals must be realistic, and depend on the age of the patient and the level of the family, but should not overlook proper monitoring. For a better and more in-depth education, as well as to maintain contact with the family, a team of specialists is paramount: nurse trained in diabetes, dietician, psychologist and last, but by no means the most important, the doctor. Each member of the team will focus on the part of the treatment they know best. This team should communicate with each other in order to assess the particularities of the patient and his or her family.

Regulating diabetes mellitus, regardless of age, demands a balance of insulin, nutrition and physical activity. This very balance intimidates the parents of young children with diabetes: Will the child accept the measurements and injections? Will they be able to control their diet and activity? Will they be able to understand the hypoglycaemia? The fact that children are young actually works to their advantage. Their behaviour can be shaped and taught. In this, the parents and treatment team pay a key role. There is no doubt whatsoever that insulin delivery systems (pen or pump) and the technologies to control blood sugar levels, with many colours, shapes and requiring only a miniscule amount of blood (3ml), are extremely child-friendly. Children possess an innate ability to familiarise themselves with this equipment that is admirable. Restrictive diets for patients with diabetes are a thing of the past. In conjunction with new insulin, we can now be more flexible with the nutrition plan for young children with diabetes, as regards the quantity of food and meal times. As for hypoglycaemia, frequent monitoring and time will work their magic.


Many parents of young children with diabetes are worried they will develop complications, as they will suffer from the disease for longer than an older child. This does not appear to be true. Studies have shown that the age the diabetes is diagnosed does not play a role in the occurrence of complications. However, monitoring the diabetes definitely does and that is what the team and family should focus on.

In conclusion, diabetes in young children should not be frightening. Children are able to adapt extremely well to all challenges. New technologies achieve improved monitoring, albeit in the most complicated yet most child-friendly manner. Parents, after their initial disappointment, should be optimistic about their child. LIFE BEGAN JUST A SHORT TIME AGO!!!!!

Dr Nikolaos Kefalas

Paediatrician – Endocrinologist

October 31st, 2017