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Diabetes in Childhood: A Condition on the Rise by LAUREN LIPESKI, M.D., ATTENDING PHYSICIAN
When the blood sugar is elevated, the glucose is filtered through the kidney into the urine, which causes increased urination and thirst. Additional symptoms may include weight loss, fatigue, abdominal pain and vomiting. If your child begins waking at night to urinate, starts bedwetting, or urinates more frequently during the daytime or has increased thirst, he or she should be seen by a pediatrician immediately to be evaluated for diabetes. Early diagnosis is very important to prevent severe illness, such as an alteration in the level of consciousness, dehydration or difficulty breathing, which can occur if a diagnosis is delayed.
Type I, the most common form in childhood, typically occurs over days to weeks. The children are usually of normal weight and most commonly there is no family history of diabetes. It can occur at any age from infancy through adolescence. Because patients with Type I diabetes do not produce sufficient insulin, the only therapy is replacement of the hormone insulin, which currently is given by injection. Type I diabetes is an autoimmune disease which occurs when the body produces antibodies (which usually fight infections) that injure the insulin-producing cells in the body. Although we have a significant amount of knowledge as to why this occurs, we unfortunately have no way to prevent it at the current time.
Another risk factor for Type II diabetes is a ring of dark pigment on the neck, which may feel velvety. This is called acanthosis and is a sign that your child may be at greater risk for Type II diabetes. The presentation of Type II diabetes can be less dramatic than Type I with milder symptoms over months; however it can also be associated with severe illness so early evaluation by your pediatrician is important. People with Type II diabetes produce insulin; however the activity of this insulin in the body is inefficient. They may be treated with oral medications that improve the function of the insulin being produced or by the use of additional insulin to add to that already being produced. The Weight Factor As noted above, most patients with Type II diabetes are overweight. In fact, being overweight is a more important risk factor for developing Type II diabetes than the occurrence of a family history of Type II diabetes. The increasing incidence of Type II diabetes in childhood is thought to be strongly linked to the increasing rates of childhood obesity. Is your child overweight? To help answer this question start by calculating your child’s body mass index (BMI), which is a value that identifies children who are overweight. The formula to calculate BMI is provided in Table 1 with an example. If your child’s BMI is greater than the value listed for his or her age and sex, then he or she might be considered overweight. Although a BMI above those listed typically is associated with being overweight, your child’s body build can influence this (size of bones and degree of muscularity). For a specific diagnosis, your child should be evaluated by a pediatrician. Some studies suggest that up to 25 percent of children are overweight. If your child is overweight, it is very important to begin lifestyle modifications, such as increased activity and improved nutritional habits, early. The longer that your child is overweight the more likely it is that the obesity will persist into adulthood. In addition, both the duration and degree of excess weight are risk factors for the occurrence of Type II diabetes. Recently, the results of an important clinical trial by the Diabetes Prevention Program were published. These were very encouraging results because they established that lifestyle modifications associated with a modest weight loss resulted in a 50 percent reduction in the incidence of Type II diabetes in a group of high risk individuals. Although Type II diabetes is increasing in children and adults it should be possible to reverse this trend by decreasing the number of children in our society who are overweight. If your child is overweight, he or she should see a pediatrician for an evaluation and guidance. Lowering your child’s risk of Type II diabetes by prevention and treatment of obesity is within your power. To reach the Division of Pediatric Endocrinology, please call [ top ] |
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Diabetes is caused by either insufficient production of the hormone insulin (Type I diabetes) or insufficient action of the insulin which is produced (Type II diabetes). Both forms of diabetes can occur in children and adults, although Type II is by far the most common form in adults, accounting for 95 percent of the cases of diabetes in those over 18 years of age. 
Type II diabetes is less common in childhood. However, the incidence of this form has increased dramatically over the past 10-15 years and it now represents up to 30 percent of the new cases of diabetes in children. Children with Type II diabetes are typically overweight and in early- to mid- puberty. There is usually a family history in the parents, grandparents, aunts and uncles. Type II diabetes is more common in minority populations and females, but occurs in all ethnic groups and in males. 
