Type 1 Diabetes Mellitus in children, also known as juvenile diabetes, is a chronic autoimmune disease in which the child’s body (immune system) attacks and destroys insulin-producing cells in the pancreas, which leads to a complete absence of the hormone. Type 1 Diabetes demands constant care, regular medical monitoring and administration of insulin.
Type 1 Diabetes Mellitus: What is the role of insulin?
Insulin is produced in the pancreas, more specifically in beta cells. It is a hormone that plays an extremely important role in metabolism and the way the body produces energy through the digestion of food.
Every time we eat a meal, the digestive system breaks down the carbohydrates, sugars and starch contained in foods into glucose. Glucose enters the bloodstream and produces energy for the body. Insulin helps the tissue (mainly in the liver, muscles, adipose tissue) to absorb glucose and regulate blood levels.
Its presence is necessary because it relates to the maintenance of energy reserves (to enable development), and the proper functioning of the brain (it helps to improve memory and contributes to learning).
Type 1 Diabetes Mellitus: What problems arise from insulin deficiency?
In children with Type 1 Diabetes, the body destroys beta cells in the pancreas and the body does not produce enough insulin. Therefore, instead of being distributed to the tissue to provide the necessary nutrients and energy, glucose accumulates in the blood causing:
- Frequent urination (polyuria) and increased thirst (polydipsia): The body tries to expel excessive glucose through fluids, leading to frequent urination. However, in addition to the loss of glucose, a large quantity of water is also lost and the child often feels thirsty.
- Extreme hunger: Because there is not enough insulin available to distribute glucose to the cells, muscles and organs lack energy, making the child feel hungry.
- Weight loss: one of the first signs of Type 1 Diabetes is unexplained weight loss. The child begins to lose weight quickly, as fat stores shrink without the energy glucose provides tissues.
- Fatigue: Decreased levels of glucose in the cells make the child feel tired.
- Long-term damage: Elevated blood glucose levels can cause long-term damage to the nervous system and blood vessels.
- Ketoacidosis: The body attempts to replace the energy glucose would have given it by breaking up fat cells (adipose tissue) for fuel. This decomposition produces ketones, organic substances used to generate energy. Accumulation of ketones in the blood increases acidity. The combination of this acidity and the accumulation of glucose (due to lack of insulin) is called ketoacidosis and requires immediate treatment. It is characterised by fruity-scented breath.
Type 1 Diabetes Mellitus: Why does it occur? Is there a way to prevent it?
The exact cause of Type 1 Diabetes has not been determined. It can be due to genetic factors, i.e. the presence of genes that increase the risk of the disease, or environmental factors, i.e. a virus or toxin that has activated the immune system. Children with a family history of diabetes mellitus undergo specific genetic, immunological and metabolic marker tests.
What are the symptoms of Type 1 Diabetes Mellitus?
The onset of Type 1 Diabetes Mellitus may be sudden and some symptoms often go unnoticed. The child may display:
- Increased thirst (polydipsia)
- Extreme hunger
- Vomiting and nausea
- Frequent urination (polyuria)
- Blurred vision
- Fatigue
- Skin or urinary tract infections
- Abdominal pain
- Confusion
- Muscular weakness
Type 1 Diabetes Mellitus: How is it diagnosed?
The doctor will order a series of tests to determine if the child is suffering from the disease. Blood tests are performed for the blood glucose level, as well as glycosylated haemoglobin, antibodies, biochemical and thyroid tests.
Type 1 Diabetes Mellitus & Nutrition
The nutritional needs of a child with Type 1 Diabetes are similar to those of any other child. However, there are certain high-fat foods that can maintain a high level of glucose for several hours, so great care must be exercised. With the help of a specialised nutritionist, parents can design a diet that includes the correct quantities of each nutrient category that a child should consume daily to avoid large fluctuations in blood glucose levels, and to develop and grow and normally.
Type 1 Diabetes Mellitus: What is the treatment?
Type 1 Diabetes (insulin-dependent) requires the administration of insulin, which is available as follows:
- Rapid-acting insulin (lasts 4 hours)
- Short-acting insulin (lasts 4-6 hours)
- Intermediate-acting insulin (lasts 12-24 hours)
- Long-acting insulin (lasts 20-36 hours)
The absorption rate of the insulin varies depending on the dose, blood flow, position and technique of injection.
The most effective treatment involves the steady flow of insulin (insulin pump). This technique mimics the normal secretion of insulin from beta cells. This treatment allows good glucose control and improves the quality of life of the patient. Nonetheless, it requires training and regular monitoring. It is a compact device that is connected to the patient 24-hours a day with a thin tube connected to a small subcutaneous catheter (in the thigh or abdomen). The insulin is administered slowly to the patient, ensuring that the basic insulin requirements are met. Moreover, the patient enters the meal data and glucose levels into the device and the pump calculates the additional units of insulin required. Another device that communicates wirelessly is also available. This device records the patient’s blood glucose levels 24-hours a day through a sensor placed in the abdominal wall and is changed once a week.
The Paediatric-Adolescent Diabetes clinic at MITERA Children’s Hospital is run by Dr Nikolaos Kefalas, Paediatrician-Endocrinologist. The team is comprised of nurses, paediatric endocrinologist, psychologist and clinical dietician-nutritionist who oversee the treatment, support and education of children with Type 1 and Type 2 diabetes, at both the initial diagnosis and during the subsequent progression of the disease.