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Diabetes and Children

by Tom Seman MD FAAP November 8th, 2012 | Pediatrician on Call
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My 4 year old son has been toilet  trained for he last 12 months and has been dry at night for at least the last 6 months. Over the past 2 weeks, he has been  wetting the bed and having accidents. Should I be concerned?

Fitting question for November since it is National Diabetes month. Type 1 Diabetes Mellitus (Type1 DM) or Insulin Dependent Diabetes Mellitus was once known as Juvenile Diabetes since it most frequently occurred in children. It received its name, mellitus, from the Greek word for honey.

Type 1 DM occurs when the body does not produce enough insulin. Insulin is a hormone that circulates through the blood stream and allows the different tissues in the body to take up glucose (sugar) into its cells for use as energy. Without insulin the cells cannot easily take up sugar and cannot function.

Developing antibodies against the cells in the pancreas, called beta islet cells, is the main cause for the decreased insulin production. These antibodies form spontaneously sometimes after certain viral infections. Once a susceptible person gets the virus, the body start to make an antibody to the virus that looks the same as the surface of the islet cells in the pancreas. Where most people’s bodies would shut down the production of these antibodies, a susceptible person’s body does not, and the immune system continues to make the antibodies that attack and destroy the cells. Hence diabetes is considered a form of an autoimmune disease.

So what are the signs of diabetes? The typical signs are increased thirst and appetite, increased urination, and in children like the boy in our question, often reverting back to wetting the bed and having daily accidents as well. Further symptoms include abnormal weight loss even with the increased appetite and decreased energy. Abdominal pain and vomiting can also occur, as can rashes that are difficult to treat. Blood sugar (glucose) that rises too high causes an abnormally sweet smelling breath, sort of like that of fruit punch. If the glucose rises too high, the brain can swell due to the extra fluid that occurs.

Any child with these symptoms should seek medical help since treatment for diabetes needs to start immediately. Typically this includes multiple injections of insulin at mealtimes and at night to help regulate the blood sugars so that they will stay at more normal levels.

Of course, we are hearing that Type 2 Diabetes is on the rise and associated with the increased percentage of youth and adults who are overweight or even obese. Type 2 Diabetes is caused by the body’s cells resistance to insulin. Thus the body needs to make more insulin to have the cells take up the same amount of glucose. This increases the strain placed on the islet cells. Furthermore, more insulin floating around also increases the chance that the body will start making antibodies to the insulin, further blocking its actions on the cell. Blood sugars rise more slowly than in Type 1 DM, but the severe issues are still there.

Should anyone have any of the symptoms above, they should see their physician and will most likely have some blood and urine tests performed to make the diagnosis. There are severe consequences to poorly controlled diabetes. Kidney damage, liver damage, high cholesterol, and cardiovascular disease are common. Progressive blindness can also occur, as can poor circulation in the hands and feet which may lead to amputation of these limbs as can premature death. These events can occur in both Type 1 and Type 2 Diabetes Mellitus.

Thus, stop for a moment and take diabetes seriously. There is continued research going on to try and find preventive measures for both types as well as improved treatment options.For further information, seek out the American Diabetes Association at www.diabetes.org or the CDC at www.cdc.gov or the consumer page of the AmericanAcademy of Pediatrics at www.HealthyChildren.org.

Good luck,

DRTOM

 

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All health and medical information is provided for educational purposes and is not meant to replace the medical advice or treatment of your healthcare professional.