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About diabetes (detailed)


Disclaimer: This fact sheet is for educational use only. Please consult your doctor or other health professional to make sure this information is right for your child.

What is diabetes?

Insulin is a hormone that is needed to convert sugar, starches and other food into the energy needed for daily life. It is produced by the pancreas. Diabetes occurs when the pancreas is unable to make enough insulin or when there is resistance to the effects of insulin.
 

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What is the difference between type 1 and type 2 diabetes?

In type 1 diabetes, the main problem is insulin deficiency. The pancreas is unable to make enough insulin.
 
In type 2 diabetes, the main problem is resistance to insulin. The pancreas is able to produce insulin but the insulin is not able to work well because the cells in the body are resistant to its effects. Sometimes, the pancreas becomes exhausted and insulin deficiency and insulin resistance are both present.
 

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What causes diabetes?

Type 1 (used to be known as insulin dependent diabetes) diabetes is caused by a combination of genetic and environmental factors. If a person who has inherited a tendency to develop diabetes comes in to contact with a trigger in the environment, then diabetes may develop.
 
Many people who are at risk do not get diabetes, so researchers are trying to find out more about what the environmental triggers are. These triggers are poorly understood, but may be common things in our environment which are harmless to most people, such as viruses or things we eat. The trigger may be different for different people.
 
If diabetes is triggered, the body’s immune system, which normally protects us from infection, begins to attack the insulin making cells which are called beta cells, in the pancreas. The immune system seems to have been tricked into thinking that the beta cells are foreign to the body and starts to destroy them, causing a decrease in insulin production. It can take from a few weeks to a few years for all the beta cells to be destroyed.
 
The pancreas has many beta cells to spare, so symptoms of diabetes do not occur until more than 90 percent of the cells have been destroyed. This means that it is difficult to tell if a person is developing diabetes, that is, in the prediabetes phase, until the symptoms of diabetes occur. The use of blood tests that might predict developing type 1 diabetes is not recommended as there is no treatment that can stop diabetes developing.
 
It is important to remember the following points:
  • diabetes cannot be caught from another person - it is not contagious
  • type 1 diabetes is not caused by eating too much sugar or any other foods
  • there is nothing you could have done differently to prevent your child from getting type 1 diabetes
  • your child cannot grow out of type 1 diabetes - it does not change to type 2 diabetes as they get older
Type 2 (used to be known as non insulin dependent diabetes) diabetes is by far the most common form of diabetes (80 to 90 percent of diabetes) and effects mainly older people. In recent years there has been growing concern about the global increase of type 2 diabetes and the falling age of onset for type 2. Type 2 diabetes has a stronger genetic basis than type 1, yet it also depends more on environmental factors.
 
The major environmental risk factor for getting type 2 diabetes is being overweight (obesity). Being overweight is often related to lifestyle factors such as not getting enough physical activity and eating too much of certain types of foods such as sugar, fats and fast foods.
 
It is important to remember the following points:
  • type 2 is becoming more common in younger populations
  • the risk of getting type 2 diabetes lessens when improvements are made to a person’s lifestyle - this can be achieved by eating healthily and becoming physically active

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How long will the condition last?

Both forms of diabetes are life long conditions. Once diagnosed as having type 1 or type 2 diabetes, your child will always have it. However, if they are well supported, manage their diabetes proactively and participate in their care and ongoing good health, long term risks and complications can be minimised.
 
While type 2 diabetes is a lifelong condition, the symptoms may lessen if the person loses weight, becomes physically active and engages in a healthier lifestyle.
 

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What puts my child at risk of getting diabetes?

Genetics and environmental factors are two of the known risk factors for developing diabetes. How these factors impact on a persons’ predisposition to get either type 1 or type 2 diabetes, is an area of research.
 
TrialNet1 is a network of 18 clinical centres dedicated to the study, prevention and early treatment of type 1 diabetes. The clinical centers work in cooperation with screening sites throughout the United States, Canada, Finland, United Kingdom, Italy, Germany, Australia, and New Zealand. The local site for Australia is based in Melbourne2 and you can find information on a number of studies being run. There are links to centres in New Zealand that are recruiting for participants in a natural history of type 1 diabetes study.
 

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What are the signs and symptoms?

Both type 1 and type 2 can present with these symptoms:

  • excessive thirst and drinking
  • frequent passing of urine
  • weight loss
  • tiredness
  • mood changes
  • bed wetting
  • hunger
  • fungal Infections
  • dark skin pigmentation in certain areas on the body (type 2)
In type 1, the symptoms generally come on rapidly. In type 2, the symptoms usually develop gradually. Many people with type 2 will have no symptoms and are only diagnosed after screening on a routine medical check.
 

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When should I seek help?

If your child displays any of the signs and symptoms referred to earlier, and you are concerned that he or she is unwell, go to your family doctor or health professional for advice. If you can’t see a doctor for whatever reason, take your child to the nearest emergency department.
 

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How is diabetes diagnosed?

In most cases the diagnosis of diabetes is simple. If symptoms suggest diabetes, your doctor will request a urine test to check if there is glucose (sugar) and / or ketones in the urine. Your doctor will also want a blood test to find out what the blood glucose level is.
 
Under normal circumstances there should not be glucose in the urine. Glucose only spills over into the urine when the blood glucose is high. Glucose in the urine in an otherwise healthy individual is highly suggestive of diabetes. A blood test with a high glucose level is then used to confirm the diagnosis. In most cases no other test is necessary. Occasionally in some cases where the diagnosis of type 2 diabetes is unclear, a diabetes specialist may recommend a more detailed blood test called a glucose tolerance test.
 

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What treatments are required?

Type 1 diabetes: key points for effective treatments

  • insulin therapy is required to replace the insulin that the body cannot make
  • a healthy food plan and a regular intake of carbohydrates is needed to balance insulin and activity levels  
  • physical activity is part of a healthy lifestyle. It is important to understand how physical activity affects blood glucose levels  
  • education and knowledge - there is a lot to learn about diabetes, in order to maintain good control of the condition. This learning involves the whole family and is an ongoing process

Type 2 diabetes: key points for effective treatment

  • adjustments to lifestyle - many people do well with healthy eating, an increase in physical activity and weight loss. They may not require medical treatment for a number of years
  • most people will require additional measures at some stage. These may include tablets, insulin or a combination of both

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What are the possible complications that go with diabetes?

Key points to remember:

  • the risk of diabetes complications may be minimised by having good long term blood glucose control
  • screening is important to allow for early detection
  • smoking increases the risk of complications

Complications can include:

  • Eye problems - Retinopathy occurs when there is damage to the retina. The retina is the thin layer of tissue at the back of the eye. It contains small blood vessels and nerve endings for vision. Other diabetes related eye conditions which can occur are cataracts and blurred vision. Regular screening will help to minimise any damage.
    The current recommendation for screening for retinopathy is:
    - once a year, beginning two years after diagnosis, in adolescents.
    - once a year, beginning five years after diagnosis in children before puberty.
  • Kidney problems - The kidneys act as a filter for our bodies, passing waste into the urine to be removed from the body. Nephropathy refers to kidney damage associated with diabetes. Most at risk are people who have poor diabetes control over a long period of time. Regular screening for protein in the urine (microalbuminuria) will help to minimise any damage that this condition may cause.
    The current recommendation for screening for nephropathy is:
    - once a year, beginning two years after diagnosis, in adolescents
    - once a year, beginning five years after diagnosis in children before puberty
  • Nerve problems - Neuropathy refers to nerve damage associated with diabetes. Good control and regular screening are the best method of minimising the effects of this condition.
  • Vascular (blood vessel) disease increases the risk of heart attacks and strokes. A person with type 2 diabetes has an increased risk of getting vascular disease at an early age.
  • Foot problems, due to decreased blood flow or nerve problems, are unlikely to occur in children or young people. However feet need to be well cared to prevent problems in later life. Podiatrists (people who treat foot disorders) can help.

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How can I care for my child at home and at school?

All children have needs which parents / caregivers try to accommodate. Some children need extra care and help in a particular area. A child or young person living with diabetes needs more care, help and assistance in establishing good habits that will help and support them in living with this condition. 
 
Caring for a child or young person living with diabetes includes:
  • Monitoring - assisting with testing and medication as dictated by the child’s age and independence level. Making appointments with doctors. Trying to keep the diabetes as well managed as possible.
  • Education - read as much as you can about the condition. Teach your child as much as possible about diabetes, healthy living and healthy eating, (keeping it age appropriate). Keep in close contact with the health care providers who are looking after your child.
  • Transitioning - this is the process of preparing children to move to the next stage of managing their diabetes. The movement to self management falls within a continuum from parent-managed (caregiver-managed) to the young person self-managing their diabetes. Support from parents, friends, school and the diabetes team form an essential component across this continuum.

Care at school requires some extra consideration:

  • Planning ahead helps to minimise any problems with diabetes management at school.
  • Parents need to provide a “hypo” pack for school. This would include items that would be used in the event of a low blood sugar episode. Items could include glucose tablets, gel and juice as well as carbohydrate snacks.
  • The teacher and school need to have information about diabetes and your child. The education should be provided by the health care professionals who are involved in the care of your child.
  • Talk to your school and ensure that they have the ‘Schools information pack’ available from DYNZ (Diabetes Youth New Zealand) (see Where to go for more information).

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Where to go for more information and support?

On this website
 
DNZ (Diabetes New Zealand)
DNZ is a nationwide organisation with 41 diabetes societies throughout NZ. For information about educational resources, diabetes products and membership, contact:
 
Diabetes Supplies Ltd. (for resources and products)
Address: Freepost DNZ, PO Box 54, Oamaru
Call free on 0800 DIABETES (0800 342 238)
Fax: 64 3 434 5281
Email: mailto:info@diabetes.org.nz
Website: http://www.diabetes.org.nz/
 
Diabetes New Zealand National Office (for membership enquiries)
Address: PO Box 12 441, Thorndon, Wellington
For membership enquiries call free on 0800 369 636
Email: membership@diabetes.org.nz
 
DYNZ (Diabetes Youth New Zealand)
DYNZ represents children and young people with diabetes who are under 25 years of age.
 
Head Office: 114 Amberley Avenue, Palmerston North
Phone: 64 6 353 0244
Website: http://www.diabetesyouth.org.nz/
 
For the contact details of your nearest Diabetes Youth Society, see
 
TrialNet (recruiting for participants in diabetes studies)
TrialNet is a network dedicated to the study, prevention and early treatment of type 1 diabetes. It is a network of 18 clinical centers working in cooperation with screening sites throughout the United States, Canada, Finland, United Kingdom, Italy, Germany, Australia, and New Zealand. The local site for Australia is based in Melbourne3 and you can find information on a number of studies being run. There are links to centres in New Zealand that are recruiting for participants in a natural history of type 1 diabetes study.
 

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Acknowledgements

Starship Children's Health logoFact sheet produced in collaboration with the Starship Diabetes Service.
 
 
 
 
Sources used in the preparation of this fact sheet:
 
“Caring for Diabetes in Children and Adolescents: A parent’s manual”. 2002. The New Zealand Edition. Editors: G. Ambler, V Barron, E Ambler, F Cameron. 
 
Clinical Practice Guidelines: Type 1 Diabetes in Children and Adolescents. Prepared by APEG (Australasian Paediatric Endocrine Group) for the Department of Health and Ageing. Approved by NHMRC (National Health and Medical Research Council). Australian Government. 2005. 
 
 
The American Diabetes Association Website:
 

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Links   (these are the web addresses for the numbered links in the text above)


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Endorsement

This fact sheet was endorsed by PSNZ - 14/08/2009

Copyright

Fact sheets are subject to copyright. In the interests of information sharing they may be copied but acknowledgement must be given to PSNZ and Starship Foundation.
© The Paediatric Society of New Zealand and Starship Foundation 2005 - 2010


The Paediatric Society of New Zealand
http://www.paediatrics.org.nz 		Starship Foundation
http://www.starship.org.nz