Type 1 Diabetes in Children and Adolescents
Imagine how one’s life would change if they were diagnosed with a life-threatening disease, and were told that it is incurable. Now, imagine if that person were a child going into his/her adolescent years (i.e. the prime years of their life). There are many such diseases and/or conditions out there, but what is specifically pertaining to the topic at hand is “diabetes mellitus”, otherwise known by its common name, “diabetes”. According to the American Diabetes Association1, diabetes can most clearly be defined as a metabolic disease that is characterized by a group of disorders resulting in hyperglycemia (i.e. level of glucose in the blood are higher than average), which, in turn, resulted from a defect in insulin secretion, insulin action, or both. In other words, when too much glucose is floating around in the body due to an inability to use the hormone, insulin, a person may be diagnosed as a diabetic. The first mentioning of what might be described as diabetes is in an Egyptian papyrus, dating back to about 1500 B.C., noting2 that a specific medicine was used to treat a condition, that, given time, would drive away the passing too much urine. Since the disease is described as a “group of disorders”, this implies that there are multiple, different conditions that can lead to a diagnosis of diabetes mellitus. This paper will go into further discussion of one of the main conditions, known as type 1 diabetes, and break down what it means through the lives of children and adolescents.
There are three major types of diabetes mellitus. Type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes all fall under the category of diabetes mellitus, as explained in the introduction. Noted on KidsHealth.org3, type 1 diabetes is when the pancreas loses its ability to make the hormone known as insulin. A person with type 1 diabetes has an immune system that attacks and extinguishes the cells that make and/or produce insulin in the pancreas.3 In other words, there is no going back once the immune system attacks these cells, and these cells won’t ever be to make insulin again. The next main type of diabetes is type 2 diabetes. It is known as the most common form of diabetes mellitus and according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)4, it can occur, most often, in patients 45 years of age or older, however it can develop at a younger age, even during childhood. The NIDDK also states4 that it is habitually brought on due to a family history of diabetes, being overweight or obese, physical inactivity, and/or already occurring health problems (i.e. high blood pressure). It is fascinating to think that none of these factors cause a diagnosis of type 1 diabetes. However genetic factors may play a more devastating role in the diagnosing both forms of this disease. Noted in an interview with a professional, who specializes in pediatric endocrinology, incidents in siblings is 5% higher, incidence of a child with a diabetic mother is 3% higher, and incidence of a child with a diabetic father is 8%. The last main form of diabetes is recognized as gestational diabetes. This type is not as prevalent as the others because it is only found during pregnancy, however, it still brings significance to the overall topic. When a woman is diagnosed with gestational diabetes, her and her unborn baby’s blood glucose levels are higher than normal, the baby’s being especially higher than its mother’s.5 This is the biggest worry from both the parents and doctors because of what it can do to the baby. Babies are more likely to: be born prematurely, grow very large due to the increasing amount of sugar they are absorbing, have breathing problems, as well as jaundice, and can have low levels of calcium or glucose in the blood just after they are born.5 These complications as well as many others, not previously explained, may cause a baby to stay in the hospital for a longer period of time, just after their birth.
The diagnosing of diabetes can be as complex as it seems. It can happen suddenly and unexpectedly, and when it occurs, T1D commonly presents itself as the common cold or flu, and also has known to have been brought on by food poisioning.6 Found by the NIDDK7, statistics showed that a total of 30.3 million individuals have diabetes. Of that 30.3 million, 1.25 million Americans have T1D (including both children and adults).8 To break that down even further 200,000 youths, under the age of 20, are living with T1D.8 Each year, more than 15,000 children are diagnosed with diabetes in the US (i.e. 40 children per day).9 As previously stated, it can affect both adults and children, although, people can be diagnosed at any age and there is nothing anyone can do to prevent it from occurring. Symptoms can include10: being very thirsty and urinating often, increased appetite or drowsiness, losing weight without trying, having sores that heal slower than normal, having dry, itch skin, loss of feeling in your feet or having a tingling sensation in your feet, having blurry vision. Realizing these symptoms can be very dramatic for the individual, and they should not be taken lightly, as with any disease.
Nutrition is going to play an even more crucial component when dealing with a child diagnosed as a type 1 diabetic. Children are already affected by how important adequate nutrition is to their diet as it can prevent complications as they age. It is very important to keep in mind that good nutritional habits are essential when keeping in good health. Noted in an article co-authored by E. Matteucci and O. Giampietro11, an individualized medical nutrition therapy plan is necessary for a person with diabetes, as it can allow for some cost-saving benefits and better provisions of outcomes. The most important goal that any diabetic should be mindful of is to keep blood glucose levels in range, while they are finding the best regimen that will fit based on who they are and what their schedule consists of. To do that, each individual should “achieve and maintain glycemic goals” (i.e. keeping blood glucose levels below 140).11 The major determining factor of how much insulin to give oneself before meal, and getting the best outcome when it comes to post-prandial glucose response, is total carbohydrate content of the meal eaten.11 In other words, individuals will have to count how many carbohydrates they have consumed in a meal/snack, and give themselves they correct dosage, at mealtime, based on the calculations set by their doctor. These calculations can be adjusted overtime, by the doctor, to fit the individual’s need of insulin.
There will be many complications caused by diabetes if left untreated, or uncontrolled blood glucose levels. Remarked in the previous mentioned article11, it stated the importance of keeping HbA1c levels to ≤7.0 on 13.0 scale for diabetic individuals. However, that number has been shown too high, so it is likely that doctors will suggest keeping it below 6.0 for an optimal outcome. If it higher than 6.0, it can likely cause many complications in the body (e.g. diabetic ketoacidosis (DKA), cardiovascular disease, kidney disease, eye disease, nervous system damage, and depression).12 In particular, DKA is a prolonged period of hyperglycemia, that will lead to hospitalization, or death, if left untreated.13 There are also, specific, complications relating to each gender caused by diabetes. For example, males are at an increased risk for erectile dysfunction (ED) as a result from nerve and circulatory damage due to high blood sugar levels.12 This could also have serious complications with heart health as it has been shown that ED in diabetic men is an early warning sign for future cardiovascular disease and a significant increase risk for heart disease and stroke.12 Furthermore, a female’s health is also impacted by diabetes, some could say more severely. As it was previously stated, uncontrolled blood glucose levels could significantly impact a woman during pregnancy, as well as the baby, especially. Diabetes can also impact menstrual cycles, as they can become more irregular than average (i.e. delays in the beginning of each cycle – type 1 diabetics; earlier onset of menopause).12 This could, definitely, have a big impact on a female’s fertility, as they could have trouble conceiving. Fertility rates, however, will improve when blood glucose levels are managed.12 Overall, if blood glucose levels aren’t adequately managed, then an individual is at an increased risk for some serious health complications to follow. For a young adult, this could be very detrimental, because there is a chance they could inhabit these complications at an earlier stage in their lifetime and have to live with them longer.
Treatment is and should be the main goal for someone who is diagnosed with diabetes, especially type 1. It requires the completion of a daily adherence of behaviors that can include multiple daily blood glucose checks, carbohydrate counting, and accurate insulin dosage.14 In caring for children with diabetes, it is important to understand that the entire family unit must be educated, emphasizing age and developmentally appropriate self-care.9 The goal should be a gradual transition toward self-management throughout the early teen years.9 It is known fact that insulin is the key hormone in treating patients with type 1 diabetes, and it wasn’t until 1921 that discovery of insulin injections would be the key maintaining the condition. This is a major breakthrough for diabetics, because it would mean that wouldn’t be subject to a death sentence any longer. Children with diabetes often require multiple daily doses of insulin, using a combination of rapid-, short-, intermediate-, and long-acting insulin before meals and at bedtime to maintain optimal blood sugar levels.9 Furthermore, there are a variety of options to choose from, when giving oneself insulin. For example, most diagnosed patients, especially children and adolescents, could start off using pens and giving manual injections through needles. The next option would be to go on a pump. This means that an individual would still have to give injections, but through a system that sticks to an optimal injection site, and automatically injects oneself through a specific glucose monitor. They will be on an automatic insulin drip throughout the time they are wearing the pump (which should, normally, last three days), and not need long-acting insulin as do those individuals who don’t have the insulin drip (i.e. manual injections by pens). Additionally, studies have shown cases of patients who take metformin along with their injections allowing insulin to be directed better within the body. Most often, metformin is used for patients who need that little extra help. Overall, there is no wrong option to choose from, however, there might be some instances where a doctor recommends trying one or the other, depending on the situation.
In conclusion, type I diabetes has become more prevalent in today’s society, even though it is the rarest form of the three-main conditions. Even with a strict diet regimen, with watchful eye for how much carbohydrates they consume, type 1 diabetics will still experience dangerously high or low blood glucose levels, which can be life-threatening in extreme cases. It is important, especially at a young age, to accept the condition because, for the time being, it is incurable. In the interview portion, of this assignment, it was said that family and friends are going to make up the basis of that acceptance, with their support, as well as becoming knowledgeable diligent about one’s diagnosis. It is very important for all of us to be well-informed on the topic of type I diabetes, so that, if it were to occur, one can be well-prepared for the difficult road that follows after diagnosis.
Reference List
Diagnosis and Classification of Diabetes Mellitus. American Diabetes Association Web site. http://care.diabetesjournals.org/content/27/suppl_1/s5. Published January 27, 2004. Accessed November 26, 2017.
Tattersall R. Diabetes: the biography [e-book]. Oxford: OUP Oxford; 2009. Available from: eBook Collection – EBSCOhost, Ipswich, MA. Accessed November 26, 2017.
Dowshen S, ed. Type 1 Diabetes: What Is It? KidsHealth. https://kidshealth.org/en/parents/type1.html#. Published 2015. Accessed November 27, 2017.
Type 2 Diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes. Published May 1, 2017. Accessed November 27, 2017.
Dowshen S, ed. Gestational Diabetes. KidsHealth. https://kidshealth.org/en/parents/gestational-diabetes.html?WT.ac=ctg#catendocrine. Published November 2016. Accessed November 28, 2017.
The Complexity of Diagnosing Type 1 Diabetes. JDRF. http://www.jdrf.org/about/what-is-t1d/diagnosis/. Accessed November 28, 2017.
Diabetes Statistics. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/health-statistics/diabetes-statistics. Published September 2017. Accessed November 28, 2017.
Type 1 Diabetes Facts. JDRF. http://www.jdrf.org/about/what-is-t1d/facts/. Accessed November 28, 2017.
Silverstein J, Klingensmith G, Copeland K, et al. Care of Children and Adolescents with Type 1 Diabetes. January 2005.
Diabetes Type 1. MedlinePlus | Trusted Health Information for You. https://medlineplus.gov/diabetestype1.html. Accessed November 27, 2017.
Matteucci E, Giampietro O. Dietary strategies for adult type 1 diabetes in light of outcome evidence. European Journal of Clinical Nutrition [series online]. March 2015;69(3):285-290. Available from Consumer Health Complete – EBSCOhost, Ipswich, MA. Accessed November 27, 2017.
Aberdour S. DIABETES 101. Alive: Canada’s Natural Health & Wellness Magazine [serial online]. November 2013;(373):26-33. Available from: Consumer Health Complete – EBSCOhost, Ipswich, MA. Accessed November 28, 2017.
Wilson V. Diagnosis and treatment of diabetic ketoacidosis. Emergency Nurse [serial online]. November 2012;20(7):14-19. Available from Consumer Health Complete – EBSCOhost, Ipswich, MA. Accessed November 28, 2017.
Lansing A, Crochiere R, Cueto C, Wiebe D, Berg C. Mother, father, and adolescent self-control and adherence in adolescents with type 1 diabetes. Journal of Family Psychology: JFP: Journal of the Division of Family Pschology of the American Psychological Association (Division 43) [series online]. June 2017;31(4):495-503. Available from: MEDLINE, Ipswich, MA. Accessed November 28, 2017.