If you have a child who has been diagnosed with diabetes, you’re not alone. Every year in the United States, 13,000 children are diagnosed with type 1 diabetes, and more than 1 million American kids and adults deal with the disease every day.

Diabetes is a chronic (long-lasting) condition that needs close attention. But with some practical knowledge, you can become your child’s most important ally in learning to live with the disease.

About Diabetes

Diabetes is a disease that affects how the body uses glucose, the main type of sugar in the blood. Glucose comes from the foods we eat and is the major source of energy needed to fuel the body’s functions.

After you eat a meal, your body breaks down the foods you eat into glucose and other nutrients, which are then absorbed into the bloodstream from the gastrointestinal tract. The glucose level in the blood rises after a meal and triggers the pancreas to make the hormone insulin and release it into the bloodstream. But in people with diabetes, the body either can’t make or can’t respond to insulin properly.

Insulin works like a key that opens the doors to cells and allows the glucose in. Without insulin, glucose can’t get into the cells (the doors are “locked” and there is no key), so it stays in the bloodstream. As a result, the level of sugar in the blood remains higher than normal. High blood sugar levels are a problem because they can cause a number of health problems.

What Is Type 1 Diabetes?

There are two major types of diabetes: type 1 and type 2. Both type 1 and type 2 diabetes cause blood sugar levels to become higher than normal. However, they cause it in different ways.

Type 1 diabetes (formerly called insulin-dependent diabetes or juvenile diabetes) results when the pancreas loses its ability to make the hormone insulin. In type 1 diabetes, the person’s own immune system attacks and destroys the cells in the pancreas that produce insulin. Once those cells are destroyed, they won’t ever make insulin again.

Although no one knows for certain why this happens, scientists think it has something to do with genes. But just getting the genes for diabetes isn’t usually enough. A person probably would then have to be exposed to something else — like a virus — to get type 1 diabetes.

Type 1 diabetes can’t be prevented, and there is no practical way to predict who will get it. There is nothing that either a parent or the child did to cause the disease. Once a person has type 1 diabetes, it does not go away and requires lifelong treatment. Kids and teens with type 1 diabetes depend on daily insulin injections or an insulin pump to control their blood glucose levels.

Type 2 diabetes (formerly called non-insulin-dependent diabetes or adult-onset diabetes) is different from type 1 diabetes. Type 2 diabetes results from the body’s inability to respond to insulin normally. Unlike people with type 1 diabetes, most people with type 2 diabetes can still produce insulin, but not enough to meet their body’s needs.

Signs and Symptoms of Type 1 Diabetes

A person can have diabetes without knowing it because the symptoms aren’t always obvious and they can take a long time to develop. Type 1 diabetes may come on gradually or suddenly.

Parents of a child with typical symptoms of type 1 diabetes may notice that their child:

• urinates frequently. The kidneys respond to high levels of glucose in the bloodstream by flushing out the extra glucose in urine (pee). A child with diabetes needs to urinate more frequently and in larger volumes.
• is abnormally thirsty. Because the child is losing so much fluid from peeing so much, he or she becomes very thirsty to help avoid becoming dehydrated. A child who has developed diabetes drinks a lot in an attempt to keep the level of body water normal.
• loses weight (or fails to gain weight as he or she grows) in spite of a good appetite. Kids and teens who develop type 1 diabetes may have an increased appetite, but often lose weight. This is because the body breaks down muscle and stored fat in an attempt to provide fuel to the hungry cells.
• often feels tired because the body can’t use glucose for energy properly.

But in some cases, other symptoms may be the signal that something is wrong. Sometimes the first sign of diabetes is bedwetting in a child who has been dry at night. The possibility of diabetes should also be suspected if a vaginal yeast infection (also called a Candida infection) happens in a girl who hasn’t started puberty yet.

If these early symptoms of diabetes aren’t recognized and treatment isn’t started, chemicals called ketones can build up in the child’s blood and cause stomach pain, nausea, vomiting, fruity-smelling breath, breathing problems, and even loss of consciousness. Sometimes these symptoms are mistaken for the flu or appendicitis. Doctors call this serious condition diabetic ketoacidosis, or DKA.

In addition to short-term problems like those listed above, diabetes also can cause long-term complications in some people, including heart disease, stroke, vision impairment, and kidney damage. Diabetes also can cause other problems throughout the body in the blood vessels, nerves, and gums. These problems don’t usually affect kids or teens with type 1 diabetes who have had the disease for only a few years. But they can appear in adulthood in some people with diabetes, particularly those who haven’t managed or controlled their diabetes well.

There’s good news, though — proper treatment can stop or control these diabetes symptoms and reduce the risk of long-term problems. Doctors can say for sure if a person has diabetes by testing blood samples for glucose. If you think your child has symptoms of diabetes, talk to your doctor.

If diabetes is suspected or confirmed, the doctor may refer your child to a pediatric endocrinologist, a doctor who specializes in the diagnosis and treatment of kids with diseases of the endocrine system, such as diabetes and growth disorders.

Living With Type 1 Diabetes

Kids and teens with diabetes need to monitor and control their glucose levels. They need to:

• check blood sugar levels a few times a day by testing a small blood sample
• give themselves insulin injections, have an adult give them injections, or use an insulin pump
• eat a balanced, healthy diet and pay special attention to the amounts of sugars and starches in the food they eat and the timing of their meals
• get regular exercise to help control blood sugar levels and help avoid some of the long-term health problems that diabetes can cause, like heart disease
• work closely with their doctor and diabetes health care team to help achieve the best possible control of their diabetes and be watched for signs of diabetes complications and other health problems that happen more frequently in kids with type 1 diabetes

Living with diabetes is a challenge, no matter what a child’s age, but young kids and teens often have special issues to deal with. Young kids may not understand why the blood samples and insulin injections are necessary. They may be scared, angry, and uncooperative.

Teens may feel different from their peers and may want to live a more spontaneous lifestyle than their diabetes allows. Even when they faithfully follow their treatment schedule, teens with diabetes may feel frustrated if the natural body changes of puberty make their diabetes somewhat harder to control.

Having a child with diabetes can seem overwhelming at times, but you’re not alone. Your child’s diabetes care team is not only a great resource for dealing with blood sugar control and medical issues, but also for supporting and helping you and your child cope and live with diabetes.

What’s New in the Treatment of Type 1 Diabetes?

Doctors and researchers are developing new equipment and treatments to help kids cope with the special problems of growing up with diabetes.

Some kids and teens are already using devices that make blood glucose testing and insulin injections easier, less painful, and more effective. One of these is the insulin pump, a mechanical device that can deliver insulin more like the pancreas does. There’s also been progress toward the development of a wearable or implantable “artificial pancreas.” This consists of an insulin pump linked to a device that measures the person’s blood glucose level continuously.

Doctors and scientists are investigating a potential cure for diabetes. This involves transplanting insulin-producing cells into the body of a person with diabetes. Researchers are also testing ways to stop diabetes before it starts. For example, scientists are studying whether diabetes can be prevented in those who may have inherited an increased risk for the disease.

Until scientists have perfected ways to better treat and possibly even prevent or cure diabetes, parents can help their kids lead happier, healthier lives by giving constant encouragement, arming themselves with diabetes information, and making sure their children eat properly, exercise, and stay on top of blood sugar control every day. This will let their kids do all the things that other kids do while helping them grow up to be healthy, well-adjusted, productive adults.

The diagnosis of type 2 diabetes is becoming more common in U.S. kids and teens, especially in those who are overweight. Some studies report that between 8% and 45% of children who’ve been newly diagnosed with diabetes have the form known as type 2.

Diabetes is a chronic condition that needs close attention, but with some practical knowledge, you can become your child’s most important partner in learning to live with the disease.

About Diabetes

Diabetes is a disease that affects how the body uses glucose, the main type of sugar in the blood.

Our bodies break down the foods we eat into glucose and other nutrients needed to fuel body functions, which are then absorbed into the bloodstream from the gastrointestinal tract. The glucose level in the blood rises after a meal and triggers the pancreas to make the hormone insulin and release it into the bloodstream. But in people with diabetes, the body either can’t make or can’t respond to insulin properly.

Insulin works like a key that opens the doors to cells and allows the glucose in. Without insulin, glucose can’t get into the cells (the doors are “locked” and there is no key) and so it stays in the bloodstream. As a result, the level of sugar in the blood remains higher than normal. High blood sugar levels are a problem because they can cause a number of symptoms and health problems.

About Type 2 Diabetes

The two types of diabetes are type 1 and type 2. Both cause blood sugar levels to become higher than normal but do so in different ways.

Type 1 diabetes (formerly called insulin-dependent diabetes or juvenile diabetes) happens when the immune system attacks and destroys the cells of the pancreas that produce insulin. Kids with type 1 diabetes need insulin to help keep their blood sugar levels within a normal range.

Type 2 diabetes (formerly called non-insulin-dependent diabetes) is different. Unlike someone with type 1 diabetes, a person with type 2 diabetes still produces insulin but the body doesn’t respond to it normally. Glucose is less able to enter the cells and do its job of supplying energy (this is called insulin resistance). This causes the blood sugar level to rise, making the pancreas produce even more insulin. Eventually, the pancreas can wear out from working overtime to produce extra insulin and may no longer be able to produce enough insulin to keep blood sugar levels normal.

People with insulin resistance may or may not develop type 2 diabetes — it all depends on whether the pancreas can produce enough insulin to keep blood sugar levels normal. Repeatedly high blood sugar levels are a sign that a person has developed diabetes.

Kids and teens with type 2 diabetes use diet, exercise, and medicines that improve the body’s response to insulin to control their blood sugar levels. Some may need to take insulin shots or use an insulin pump, too.

Who Gets Type 2 Diabetes?

Although no one knows for sure what causes type 2 diabetes, there seems to be a genetic risk. In fact, it’s estimated that 45% to 80% of affected kids have at least one parent with diabetes and may have a significant family history of the disease. In some cases, a parent may be diagnosed with type 2 diabetes at the same time as the child.

Most people who develop type 2 diabetes are overweight. Excess fat makes it harder for the cells to respond to insulin. And being inactive further reduces the body’s ability to respond to insulin. In the past, doctors called this type of diabetes adult-onset diabetes because it almost exclusively affected overweight adults. Today, that description is no longer accurate. More kids and teens are being diagnosed with type 2 diabetes, probably because more kids and teens are overweight.

Certain ethnic groups also tend to be more prone to developing type 2 diabetes, including people of Native American, African American, Hispanic/Latino, or Asian/Pacific Island descent. Also, kids in puberty are more likely to develop the disease than younger kids, probably because of normal rises in hormone levels that can cause insulin resistance during this stage of rapid growth and physical development.

Signs and Symptoms

The symptoms of type 2 diabetes aren’t always obvious and they can take a long time to develop. Sometimes, there are no symptoms. It’s important to remember that not everyone with insulin resistance or type 2 diabetes develops these warning signs, and not everyone who has these symptoms necessarily has type 2 diabetes.

But kids or teens who develop type 2 diabetes may:

• Urinate frequently. The kidneys respond to high levels of glucose in the blood by flushing out the extra glucose in urine (pee). Kids with high blood sugar levels need to urinate more frequently and in larger volumes.
• Drink a lot of liquids. Because they’re peeing so often and losing so much fluid, they can become very thirsty and drink a lot in an attempt to keep the levels of body water normal.
• Feel tired often. This is because the body can’t use glucose for energy properly.

Complications of Diabetes

Sometimes, kids and teens with type 2 diabetes, insulin resistance, or obesity might develop thick, dark, velvet-like skin around the neck, armpits, groin, between fingers and toes, or on elbows and knees — a cosmetic skin condition called acanthosis nigricans.

Polycystic ovary syndrome (PCOS) in girls is also often associated with insulin resistance. PCOS is a hormone problem that can cause the ovaries to become enlarged and develop cysts (fluid-filled sacs). Girls with PCOS often have irregular periods, might stop having periods altogether, and may develop excess facial and body hair growth. PCOS also can cause fertility problems.

People with insulin resistance or type 2 diabetes are also more likely to develop hypertension (high blood pressure) or abnormal levels of blood fats (cholesterol and triglycerides). When these problems cluster together, doctors call this metabolic syndrome. People with metabolic syndrome have a greater risk of developing heart disease, stroke, and other health problems.

Diabetes also can cause long-term complications, including heart disease, stroke, eye problems, kidney disease, nerve damage, and gum disease. While these problems don’t usually show up in kids or teens who’ve had type 2 diabetes for only a few years, they can affect them in adulthood, particularly in those whose diabetes hasn’t been well controlled.

Doctors can determine if a person has diabetes by testing blood samples for glucose. Even if a child or teen doesn’t have any symptoms of type 2 diabetes, doctors might do blood tests to check for it in kids who are more likely to get it — like those who are overweight.

If you think your child has symptoms of diabetes, talk to your doctor, who may refer you to a pediatric endocrinologist, a doctor who specializes in the diagnosis and treatment of diseases of the endocrine system (such as diabetes and growth disorders) in kids.

Living With Type 2 Diabetes

Kids or teens with type 2 diabetes may need to:

• Eat a healthy diet to help achieve a normal body weight while getting the nutrients needed to grow and develop. Doctors may recommend a low-salt or low-fat diet, especially if they have conditions such as high blood pressure or abnormal blood fat levels.
• Participate in physical activity regularly. Exercise helps increase the body’s response to insulin, and it helps the body burn more calories, which can promote the loss of excess body fat.
• Get to and maintain a normal body weight.
• Monitor blood sugar levels regularly.
• Take insulin or other medicines that help the body respond to insulin more effectively.
• Work closely with their doctors and diabetes health care team to get the best possible diabetes control.
• Be monitored for signs of complications and other health problems that can affect people with type 2 diabetes.

Living with diabetes is a challenge for anyone, but kids and teens often have special issues to deal with. Young kids might not understand why blood testing and medicines are necessary. They might be scared, angry, and uncooperative.

Teens may feel different from their peers and want a more spontaneous lifestyle than their diabetes allows. Even when they faithfully follow their treatment schedule, they might feel frustrated if the natural body changes of puberty make their diabetes somewhat harder to control.

Having a child with diabetes may seem overwhelming at times, but you’re not alone. Your child’s diabetes care team is not only a great resource for dealing with medical issues, but also for supporting and helping you and your child.

What’s New in the Treatment of Type 2 Diabetes?

Doctors and researchers are developing new equipment and treatments to help kids deal with the special problems of growing up with diabetes.

Some kids and teens already use new devices that make blood glucose testing and insulin injections easier and more effective. One of these is the insulin pump, a mechanical device that can be programmed to deliver insulin more like the pancreas does.

Researchers are also testing ways to stop diabetes before it starts. For example, scientists are studying whether diabetes can be prevented in those who may have inherited an increased risk for the disease.

Until scientists have perfected ways to better treat and possibly even prevent or cure diabetes, parents can help their kids lead happier, healthier lives by giving constant encouragement, learning all they can about the disease, and making sure their kids eat properly, exercise, and stay on top of glucose levels every day. This will help their kids do all the things that other kids do, while helping them grow up to be healthy, well-adjusted, productive adults.

I’m not diabetic, but my doctor told me that I have gestational diabetes. What does that mean? And will it last beyond my pregnancy?
– Trish

Gestational diabetes is a kind of diabetes that comes on during pregnancy. When a woman has it, the sugar levels in her blood are high. That makes the unborn baby’s blood sugar levels go higher, too.

A big worry about gestational diabetes is what it can do to a baby. Babies born to mothers who have gestational diabetes are more likely to:

• be born early (prematurely)
• grow very large
• have breathing problems
• have jaundice
• have low blood levels of calcium or glucose just after they’re born

These and other kinds of problems from gestational diabetes can make babies need to stay in the hospital longer for extra treatment.

If you have gestational diabetes, your doctor will probably start you on a treatment plan. Most women can get their blood sugar levels under control with a healthy food plan and daily exercise. Some women also need to take daily insulin shots and test their blood sugar until they give birth.

Gestational diabetes usually goes away after a baby is born. A mom may get it again during future pregnancies, though. Some women who have it will get diabetes when they’re older.

Sometimes a woman may have had diabetes before the pregnancy but not know it. When that happens, the diabetes does not go away after the baby is born.

Lately, it seems as though your child is looking up to classmates — literally. The other kids in the class have been getting taller and developing into young adults, but your child’s growth seems to be lagging behind. Classmates now tower over your child.

Is something wrong? Maybe, maybe not. Some kids just grow more slowly than others because their parents did, too. But others may have an actual growth disorder, which is any type of problem that prevents kids from meeting realistic expectations of growth, from failure to gain height and weight in young children to short stature or delayed sexual development in teens.

Variations of Normal Growth Patterns

A couple of differences seen in the growth patterns of normal children include these common conditions, which are not growth disorders:

Constitutional growth delay: This condition describes children who are small for their ages but who are growing at a normal rate. They usually have a delayed “bone age,” which means that their skeletal maturation is younger than their age in years. (Bone age is measured by taking an X-ray of the hand and wrist and comparing it with standard X-ray findings seen in kids the same age.)

These children don’t have any signs or symptoms of diseases that affect growth. They tend to reach puberty later than their peers do, with delay in the onset of sexual development and the pubertal growth spurt. But because they continue to grow until an older age, they tend to catch up to their peers when they reach adult height. One or both parents or other close relatives often had a similar “late-bloomer” growth pattern.

Familial (or genetic) short stature: This is a condition in which shorter parents tend to have shorter children. This term applies to short children who don’t have any symptoms of diseases that affect their growth. Kids with familial short stature still have growth spurts and enter puberty at normal ages, but they usually will only reach a height similar to that of their parents.

With both constitutional growth delay and familial short stature, kids and families need to be reassured that the child does not have a disease or medical condition that poses a threat to health or that requires treatment.

However, because they may be short or may not enter puberty when their classmates do, some may need extra help coping with teasing or reassurance that they will go through full sexual development eventually. In a few children who are very short or very late entering puberty, hormone treatment may be helpful.

Growth Disorders

Diseases of the kidneys, heart, gastrointestinal tract, lungs, bones, or other body systems might affect growth. Other symptoms or physical signs in kids with these illnesses usually give clues as to the disease causing the growth delay. However, poor growth can be the first sign of a problem in some.

Growth disorders include:

Failure to thrive, which isn’t a specific growth disorder itself, but can be a sign of an underlying condition causing growth problems. Although it’s common for newborns to lose a little weight in the first few days, failure to thrive is a condition in which some infants continue to show slower-than-expected weight gain and growth. Usually caused by inadequate nutrition or a feeding problem, it’s most common in kids younger than age 3. It may also be a symptom of another problem, such as an infection, a digestive problem, or child neglect or abuse.

Endocrine diseases (diseases involving hormones, the chemical messengers of the body) involve a deficiency or excess of hormones and can be responsible for growth failure during childhood and adolescence. Growth hormone deficiency is a disorder that involves the pituitary gland (the small gland at the base of the brain that secretes several hormones, including growth hormone). A damaged or malfunctioning pituitary gland may not produce enough hormones for normal growth. Hypothyroidism is a condition in which the thyroid gland fails to make enough thyroid hormone, which is essential for normal bone growth.

Turner syndrome, one of the most common genetic growth disorders, occurs in girls and is a syndrome in which there’s a missing or abnormal X chromosome. In addition to short stature, girls with Turner syndrome usually don’t undergo normal sexual development because their ovaries (the sex organs that produce eggs and female hormones) fail to mature and function normally.

Diagnosing a Growth Disorder

The tests a doctor may recommend to detect a growth disorder depend on the findings at each step of evaluation. A short child who’s healthy and growing at a normal rate may just be observed throughout childhood, but one who has stopped growing or is growing more slowly than expected will often need additional testing.

Your doctor or an endocrinologist will look for signs of the many possible causes of short stature and growth failure. Blood tests may be done to look for hormone and chromosome abnormalities and to rule out other diseases associated with growth failure. A bone age X-ray might be done and special scans (such as an MRI) can check the pituitary gland for abnormalities.

To measure the ability of the pituitary gland to produce growth hormone, the doctor (usually a pediatric endocrinologist) may do a growth hormone stimulation test. This involves giving the child medications that cause the pituitary gland to secrete growth hormone, then drawing several small blood samples over time to check growth hormone levels.

Treating a Growth Disorder

Although the treatment of a growth problem usually isn’t urgent, earlier diagnosis and treatment can help some kids catch up with peers and increase their final height.

If an underlying medical condition is identified, specific treatment may result in improved growth. Growth failure due to hypothyroidism, for example, is usually treated with thyroid hormone replacement pills.

Growth hormone injections for children with growth hormone deficiency, Turner syndrome, and chronic kidney failure may help kids reach a more normal height. Human growth hormone is generally considered safe and effective, although full treatment may take many years and not all kids will have a good response. And the treatment can be costly (about $20,000 to $30,000 per year), although many health insurance plans cover it.

What about growth hormone treatment for short children who aren’t growth hormone deficient when tested? The U.S. Food and Drug Administration (FDA) has approved its use in such children if they’re predicted to reach a very short final height (under 4 feet 11 inches [150 centimeters] for a girl; under 5 feet 4 inches [163 centimeters] for a boy).

Talk with your doctor for more information about treatment options if you’re concerned.

Helping Your Child

You can boost your child’s self-esteem by providing positive reinforcement and emphasizing other characteristics, like intelligence, personality, and talents. Try to take the focus off of height as a measure of social acceptance.

Kids who are very self-conscious about their size might need help in coping. In some cases, evaluation and treatment by a mental health professional may be needed.

If You Suspect a Problem

If you’re concerned about your child’s growth, speak with your doctor, who may refer you to a pediatric endocrinologist, who can help diagnose and treat specific growth disorders.

It’s also important to watch for the social and emotional problems that kids with growth disorders face. It’s not easy being the shortest kid in the class and it’s never any fun being teased. Helping your child build self-esteem and emphasizing strengths — regardless of how tall he or she may grow — might be just what the doctor ordered.