Diabetes overview

Diabetes overview

Type 1 and type 2 diabetes are lifelong conditions. You can minimise the long-term risks and complications for your child.

Key points to remember

  • diabetes is a condition where the level of glucose (also known as sugar) in the blood is too high
  • that's because the body is not using the glucose properly
  • in type 1 diabetes, the main problem is that the insulin making cells in the pancreas are destroyed and not able to make enough insulin
  • in type 2 diabetes, the main problem is that the body is not able to use the insulin effectively due to resistance to insulin 
  • both forms of diabetes are lifelong conditions - once diagnosed as having type 1 or type 2 diabetes, your child will always have it
  • you can minimise the long term risks and complications for your child

What is diabetes?

Diabetes is a condition where the level of glucose (also known as sugar) in the blood is too high. That's because the body is not using the glucose properly. Insulin is a hormone that is needed to allow glucose from food to move from the blood into cells in the body where it can be used for fuel for energy. Insulin is produced by the pancreas. Diabetes occurs when the insulin making cells in the pancreas are unable to make enough insulin or when there is resistance to the effects of insulin. 

You might find it helpful to watch a Diabetes UK animation (8 minutes 44 seconds) about diabetes and the body. 

© Diabetes UK. This video has been reproduced from the Diabetes UK website with the kind permission of Diabetes UK, the charity for people in the UK with diabetes.

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

In type 1 diabetes, the main problem is that the insulin making cells in the pancreas are destroyed and not able to make enough insulin.

In type 2 diabetes, the main problem is that the body is not able to use the insulin effectively due to resistance to insulin. The insulin making cells in the pancreas are 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 leading to not enough insulin being produced in addition to the problem of insulin resistance.

What causes diabetes?

Type 1 diabetes

Type 1 diabetes is caused by a combination of genetic and environmental factors. If a person who has a genetic tendency to develop diabetes comes in to contact with a trigger in the environment, then diabetes may develop.

Many people who have a genetic tendency to develop diabetes 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 such as viruses or stress. 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 starts to destroy the beta cells, 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.

Symptoms of diabetes do not occur until more than 90 percent of the beta cells have been destroyed. This means that it is difficult to tell if a person is developing diabetes, until the symptoms of diabetes occur. 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

TrialNet

TrialNet is a network of 21 clinical centres working in cooperation with screening sites throughout the United States, Canada, Finland, United Kingdom, Italy, Germany, Australia, and New Zealand. This network is dedicated to the study, prevention, and early treatment of type 1 diabetes. You can find information on a number of studies being run by visiting the TrialNet website. Contact details for the New Zealand study centres are:

Auckland 64 9 923 7897
Christchurch 64 3 3640 448 or 64 3 3640 860
Dunedin 64 3 474 7644 or 64 3 474 0999
Wellington 64 4 806 2458

Type 2 diabetes

Type 2 diabetes is the most common form of diabetes (80 to 90 percent of diabetes) and effects mainly older people. However type 2 diabetes is becoming more common in children and young people throughout the world. The tendency to develop type 2 diabetes is inherited, yet it also depends 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 diabetes 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 healthy eating and becoming physically active

How long will the condition last?

Both forms of diabetes are lifelong conditions. Once diagnosed as having type 1 or type 2 diabetes, your child will always have it.

Long term risks and complications can be minimised by:

  • participating in your child's care and ongoing good health
  • learning as much as you can about diabetes
  • having good medical care
  • providing good family support
  • having a healthy lifestyle

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.

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.

When should I seek help?

If your child displays any of the above signs and symptoms, and you are concerned that they are unwell, please 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.

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 and / or ketones in the urine. A blood test to find out how much glucose is in the blood may also be necessary.

Generally there should not be any glucose in the urine. Glucose only spills over into the urine when the level of glucose in the blood is high. Glucose in the urine in an otherwise healthy individual is highly suggestive of diabetes. A blood test called a HbA1c will measure the amount of glucose in the blood that has accumulated over a 3 month period. A high HbA1c result confirms the diagnosis. In most cases no other test is necessary. Occasionally where type 2 diabetes is suspected, a more detailed blood test called a glucose tolerance test is recommended to confirm the diagnosis.

What treatments are required?

Type 1 diabetes: Key points for effective treatments

  • your child needs insulin therapy to replace the insulin that the body cannot make. Insulin is not available as an oral medication. You must inject it into the layer of fat under the skin
  • your child needs a healthy food plan and a regular intake of carbohydrates both for growth and development and 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 skills are important - there is a lot to learn about how to care for a child or young person with diabetes. This learning involves the whole family, extended family, and other people that are involved in the life of a child or young person - school personnel, friends, neighbours, sports coaches etc. Education and learning is an ongoing process

Type 2 diabetes: Key points for effective treatment

  • make adjustments to lifestyle - healthy eating, an increase in physical activity and weight loss may prevent the need for medical treatment
  • most young people however will require medical treatment at some stage including tablets that help the body to use insulin more effectively, insulin injections or a combination of both. Medications do not cure diabetes and most people will have to take medications for the rest of their lives
  • 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 and assistance with establishing good habits that will help and support them in living with this condition

What does caring for a child or young person living with diabetes include?

Monitoring

  • helping with testing and administration of medication depending on your child's age and independence level
  • making appointments with diabetes specialist teams
  • trying to keep your child or young person with diabetes feel as supported as possible

Education

  • read and learn about the condition
  • teach your child as much as possible about diabetes, healthy living and healthy eating, (keeping it age appropriate)
  • use the skills and knowledge of the health care team looking after your child - they can provide educational guidance through the childhood years

Transitioning

This is the process of preparing children to move to the next stage of managing their diabetes. As children grow older, so do their levels of knowledge and their ability to take on more responsibility for the management of their diabetes. Support from parents, friends, school and the diabetes team form an essential part of this developmental milestone.

  1. 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
  2. Clinical practice guidelines: Type 1 diabetes in children and adolescents. 2005. 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
  3. ISPAD (International Society for Pediatric and Adolescent Diabetes) Clinical Practice Consensus Guidelines 2014 https://www.ispad.org/?page=ISPADClinicalPract [Accessed 30/07/2015] 
  4. APEG national evidence-based guidelines for type 1 diabetes in children, adolescents and adults. November 2011. Copies available for download at www.apeg.org.au or www.diabetessociety.com.au
  5. The American Diabetes Association website: www.diabetes.org

The Paediatric Society of New Zealand acknowledges the cooperation of the Starship Children's Hospital, Auckland District Health Board.  The content on this page has been produced in collaboration with the National Clinical Network Children and Young People's Diabetes Services.

Images
The following images have been purchased from Dreamstime:
© Robhainer | Dreamstime.com - Sick Child
© Rolmat | Dreamstime.com - Boeing Airplane Photo
© Designua | Dreamstime.com - Complications Of Diabetes Mellitus Photo

This page last reviewed 14 May 2015.
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