Child diabetes: could you spot the signs?

With more than a third of diabetes cases in the USA occurring in people over the age of 65, the illness is often referred to as an age-related condition. But around 208,000 children and adolescents are estimated to have diabetes, and this number is increasing.

A study found that incidence of type 1 diabetes in children aged up to 9 years increased by 21% between 2001 and 2009.

Type 1 diabetes is the most common form of the condition among children and adolescents. A 2009 report from the Centers for Disease Control and Prevention (CDC) revealed that type 1 diabetes prevalence stands at 1.93 in every 1,000 children and adolescents, while type 2 diabetes affects 0.24 in every 1,000.

Earlier this year, a study published in JAMA revealed that rates of both type 1 and type 2 diabetes have increased significantly among American children and teenagers.

The study found that incidence of type 1 diabetes in children aged up to 9 years increased by 21% between 2001 and 2009, while incidence of type 2 diabetes among youths aged 10-19 years rose by 30.5%.

"The increases in prevalence reported herein are important because such youth with diabetes will enter adulthood with several years of disease duration, difficulty in treatment, an increased risk of early complications and increased frequency of diabetes during reproductive years, which may further increase diabetes in the next generation," the researchers note.

Diabetes in children: what to look out for

Type 1 diabetes in children, previously called juvenile diabetes, occurs when the pancreas is unable to produce enough of the hormone insulin. Children with the condition will require lifelong insulin injections and blood sugar monitoring, and a change in diet may be needed.

Type 2 diabetes, although less common in very young children, can occur when not enough insulin is produced or it is not working properly. As a result, glucose can accumulate in the bloodstream. The condition can often be managed through a change in diet, increasing exercise and maintaining a healthy weight, although some patients may require diabetes medication - such as metformin - or insulin therapy.

The most common symptoms of both type 1 and type 2 diabetes among children and adolescents include increased thirst and urination, fatigue and weight loss. Some children may also experience increased hunger and blurred vision, while girls with type 1 diabetes may develop a yeast infection.

Symptoms of type 1 diabetes in children tend to develop rapidly over a period of a few weeks, while type 2 diabetes symptoms develop more slowly.

Parents should take their child to the doctor if they notice any of the above symptoms. But despite an increase in diabetes prevalence among children and adolescents, it seems there is a lack of awareness when it comes to identifying symptoms of the condition.

Only 14% of parents can identify the four main symptoms of diabetes

According to a 2012 survey from leading UK charity Diabetes UK, only 9% of parents were able to identify the four main symptoms of type 1 diabetes. A more recent survey from the charity found that this percentage had increased to 14%.

But according to researchers, this is far from good enough:

"In too many cases, children with type 1 diabetes are not diagnosed until they are seriously ill, and in a few tragic cases, this delay in diagnosis can even be fatal."

Children with a delayed diagnosis of type 1 diabetes - and very rarely, a delayed diagnosis of type 2 diabetes - can develop diabetic ketoacidosis (DKA). It is the leading cause of mortality in children with type 1 diabetes.

If the body experiences a serious lack of insulin, it is unable to use glucose for energy. As a result, the body begins to break down other tissues for energy, which leads to the production of poisonous chemicals called ketones. A build-up of these chemicals causes DKA, in which the body becomes acidic.

If diabetes is diagnosed early and managed effectively, DKA is highly preventable. Unfortunately, however, this does not happen often enough.

Doctors failing to identify diabetes in children

It is not only parents who may be blind to diabetes symptoms among children. Earlier this year, researchers from the UK warned that many health professionals also fail to identify the signs of the condition and are putting children's lives at risk.

In a study published in the journal Archives of Disease in Childhood, researchers analyzed 261 children aged between 8 months and 16 years who had been diagnosed with type 1 diabetes. Symptoms leading up to their diagnosis were assessed.

The researchers found that by the time children under the age of 2 years were clinically diagnosed with type 1 diabetes, 80% of them had already developed DKA.

Researchers at Southampton Children's Hospital in the UK, comment:

"When symptomatic children with undiagnosed type 1 diabetes had multiple contacts with health professionals, they were more likely to present with DKA and this is very concerning, as we know early diagnosis is essential to enable treatment with insulin and avoid complications."

A 2008 study, published in the journal Pediatric Endocrinology, Diabetes and Metabolism, found that among 335 children under the age of 17 with new-onset type 1 diabetes, the initial diagnosis was incorrect in more than 16% of cases.

The study revealed that among these cases, doctors initially diagnosed 46.3% of children with a respiratory system infection, while others received a diagnosis of perineal candidiasis (16.6%), gastroenteritis (16.6%),urinary tract infection (11.1%), stomatitis (11.1%) or appendicitis (3.7%).

Furthermore, the researchers found that incidence of DKA was more frequent among children who received an incorrect - and therefore delayed - diagnosis of type 1 diabetes.

Although children and adolescents with diabetes usually experience four main symptoms, Young notes that having all four symptoms is "the exception rather than the rule," noting that many children may only have one or two. In some cases, no symptoms will appear.

As such, a child suddenly becoming more thirsty or tired may not ring diabetes alarm bells for a parent. And because diabetes is much rarer among very young children, doctors may attribute any symptoms to other, more common illnesses.

The '4 Ts'

So what can be done to ensure that children who have symptoms of diabetes are diagnosed early and receive adequate treatment?

"As a nation, we need to emphasize that diabetes is common and the incidence is increasing. "It can present in babies and young children and it should be at the top of the list in any child with increased toileting - including heavy wet nappies and bedwetting - but also weight loss and fatigue."

In 2012, Diabetes UK launched the "4 Ts" campaign - aimed at increasing awareness of the symptoms of type 1 diabetes that children may experience.

Campaigns that aim to increase awareness of child diabetes symptoms have proved successful in the past. A 2012 study, published in the journal Pediatric Diabetes, revealed that during such a campaign in Australia, the rate of DKA at initial diagnosis of type 1 diabetes in children reduced by 64%.

The 4 Ts that Diabetes UK say people should be aware of in children are:

• Toilet - using the toilet frequently, heavier nappies in babies or bedwetting from a previously dry child
• Thirsty - drinking more fluids than usual but being unable to quench thirst
• Tired - feeling more tired than usual
• Thinner - weight loss.

A video providing more information on the 4 Ts can be viewed below:

The organization says that if a child is showing any of the 4 Ts, parents should take them to the doctor straight away and insist on an immediate type 1 diabetes test. This consists of a finger-prick test in which the child's blood is analyzed to determine their glucose level.

The research team says:

"As well as making parents and those who look after and work with children aware of the symptoms, we need to increase understanding that a child who has any of the 4 Ts needs to be tested straight away.

This is because onset can be so quick that a delay of a matter of hours can be the difference between being diagnosed at the right time and being diagnosed too late."

This month is American Diabetes Month, an annual campaign that aims to raise awareness of diabetes among the general population. For more information on this campaign or diabetes in general, visit the American Diabetes Association.