Type 1 diabetes, or T1DM, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow glucose to enter cells to produce energy. Glucose is the main type of sugar in the blood. It comes from the foods we eat and is the major source of energy for the body’s functions. Large chains of glucose molecules are called carbohydrates. 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 (type 1) or can’t respond to insulin properly (type 2). Insulin works like a key that opens the doors to the cells of the body 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 health problems. Hyperglycemia is the technical term for high blood glucose (blood sugar). High blood glucose happens when the body has too little insulin or when the body can’t use insulin properly. on the contrary, hypoglycemia is a low blood glucose level occurring in a person with diabetes mellitus. It is one of the most common types of hypoglycemia seen in emergency departments and hospitals.

The subsequent lack of insulin leads to increased blood and urine glucose. The classical symptoms are polyuria (frequent urination), polydipsia (increased thirst), polyphagia (increased hunger), weight loss and tierdness. The cause of diabetes mellitus type 1 is unknown. Various factors may contribute to type 1 diabetes, including genetics and exposure to certain viruses. Although type 1 diabetes usually appears during childhood or adolescence, it also can begin in adults. Despite active research, type 1 diabetes has no cure. But it can be managed. With proper treatment, people with type 1 diabetes can expect to live longer, healthier lives than did people with type 1 diabetes in the past. 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.

Complications

Untreated, diabetes can cause many complications. In addition to short-term problems like those listed above, diabetes can also cause long-term complications in some people, including heart disease, stroke, vision impairment, foot ulcers and kidney damage. The acute complications include diabetic ketoacidosis and nonketotic hyperosmolar coma.  These problems don’t usually show up in kids or teens with type 1 diabetes who have had the disease for only a few years. However, they can occur in adulthood if the diabetes is not managed or controlled properly. Furthermore, complications may arise from low blood sugar caused by excessive treatment.

Treatment

In type 1 diabetes, the body can no longer make insulin, so it has to be injected. It is usually injected into the fatty layer under the skin of the abdomen, hips/buttocks, or thighs. This can be done twice- or four times daily by means of an insulin pen, or continuously by a special insulin pump. There is no-one-size-fits-all insulin schedule — the types of insulin used will depend on the diabetes management plan and the number of daily injection is at least four injections. Administration of insulin is essential for survival. Insulin therapy must be continued indefinitely and does not usually impair normal daily activities. People are usually trained to manage their diabetes independently; however, for some this can be challenging. Treatment goals for children with diabetes are to control the condition in a way that minimizes symptoms, prevents short- and long-term health problems, and helps them to have normal physical, mental, emotional, and social growth and development. To do this, parents and kids should aim for the goal of keeping blood sugar levels as close to normal as possible.

In general, kids with type 1 diabetes need to:

  • take insulin as prescribed
  • monitor blood sugar levels several times a day by testing a blood sample from a finger prick
  • eat a healthy, balanced diet, paying special attention to the amount of carbohydrates in each meal and the diabetes meal plan
  • get regular physical activity

Another blood sugar test, the glycosylated hemoglobin (hemoglobin A1c or HbA1c) test, indicates what blood sugar levels have been over the past few months. The treatment of diabetes in children mostly is guided by a team, consisting of doctors, diabetes nurses, a dietician, a psychologist and a social worker, in close cooperation with the child and the parents. Diabetes mellitus type 1 accounts for between 5% and 10% of cases of diabetes. Globally, the number of people with DM type 1 is unknown, although it is estimated that about 80,000 children develop the disease each year. Type 1 diabetes is not currently preventable. Some researchers believe it might be prevented at the latent autoimmune stage, before it starts destroying beta cell.

Text validated by the paediatric & diabetological units of Hospital Gelderse Vallei (NL) and Ospedale San Raffaele (IT).