Common symptoms of Type 1 diabetes can often go unnoticed, so it’s vital for early years practitioners to be able to spot them, says Diabetes UK…
Around 26,500 children and young people have Type 1 diabetes in the UK, and around 2,000 cases are diagnosed every year. The condition develops when the insulin producing cells in the body have been destroyed and the body is unable to produce any insulin. Insulin is a hormone which helps our bodies get energy from the food we eat. It acts like a key that unlocks the door to the body’s cells. Once the door is unlocked glucose can enter the cells where it is used as fuel. With Type 1 diabetes there is no key to unlock the door and the glucose builds up in the blood. Nobody knows for sure why these insulin-producing cells have been destroyed but the most likely cause is the body having an abnormal reaction to the cells. This may be triggered by a virus or other infection. It’s not known why this happens in some people and not others, but it has nothing to do with lifestyle or weight. Type 2 diabetes can be related to lifestyle factors, such as being overweight. Although it can develop in young people, it is very rare in children.
The symptoms of Type 1 diabetes can go unnoticed. In fact, as many as one in three children under five years old are not diagnosed with Type 1 diabetes until their blood glucose levels are running dangerously high. This is known as diabetic ketoacidosis (DKA) and is a life-threatening condition that requires urgent medical attention. Developing DKA can be a traumatic time for children and parents, so everything should be done to spot the symptoms before a child reaches this stage.
The most common symptoms are known as the ‘4 Ts’ of diabetes. These are Toilet, Thirsty, Tired and Thinner.
● Toilet: passing urine frequently, bed-wetting in a previously ‘dry’ child or having heavier nappies.
● Thirsty: having an unquenchable thirst, asking for extra drinks and finishing them very quickly.
● Tired: being very tired and lethargic, falling asleep, taking more naps in the daytime than usual.
● Thinner: losing weight without a known reason.
If you notice any of these symptoms in a child, it is extremely important that you raise the issue immediately with their parent or carer, and suggest that they take their child to the doctor straight away. Making sure a child gets a quick diagnosis means that they can get the right treatment and care to manage their diabetes as soon as possible.
All children with Type 1 diabetes are treated with insulin, administered either by injection or continuous subcutaneous insulin infusion – also known as an insulin pump. Insulin injections are mostly done with an insulin ‘pen’ injector device, which have a short needle and are fairly easy to use. Insulin needs to be injected under the skin – not into a muscle or a vein. Once injected, the insulin is taken into the bloodstream where it gets to work. Most children will take an insulin injection with every meal as well as one in the morning and/or in the evening.
An insulin pump is attached to the body 24 hours a day and delivers a varied dose of insulin continually throughout the day and night. Extra insulin is given through the pump by pressing a combination of buttons with each meal and significant snack.
In order to work out how much insulin a child needs and manage their condition properly, it is important to regularly test their blood glucose levels. This involves using a finger-pricking device to get a drop of blood and applying it to a testing strip.
A child’s parents or carer will have information on how often blood needs to be tested and what the readings mean. As a general guide, children with Type 1 diabetes should have a reading of between 4 and 8 mmol/l before meals and less than 10mmol/l two hours after meals. Children will need to have their blood glucose levels tested at least four times a day.
Every child’s condition is different so it’s important to keep in close contact with the child’s parents or carers to find out how to monitor them, how regularly to test blood glucose levels, and how and when to administer insulin. A paediatric diabetes team should also be involved in helping to put together a child’s individual healthcare plan.
Children with Type 1 diabetes can eat all the same foods and be involved in all the same activities, games and play as other children their age. In order to manage their condition well, they must eat a healthy and balanced diet with plenty of fruit and vegetables. It is a myth that children with the condition shouldn’t eat sugar.
Hypoglycaemia (or hypo) means blood glucose levels are low, below 4mmol/l. They can come on quickly and children with Type 1 diabetes will tend to develop symptoms that warn them that their blood glucose levels are dropping too low. Typical symptoms include going pale, feeling tired and changes in behaviour such as feeling tearful, stroppy or moody. Young children might not notice these symptoms so it’s important to look out for them. Babies can go floppy, look pale or go very quiet.
If there is time, you could do a blood glucose test to make sure that what they’re experiencing is a hypo. If a child is having a hypo, they will need to consume something sugary in order to bring their blood glucose levels back up to a safe measurement. If not, get them to eat first and test later.
The best hypo treatments are sugary, quick-acting carbohydrates such as glucose tablets, jelly babies or ordinary (not diet) drinks. Chocolate doesn’t work quickly enough, so avoid it to treat a hypo. The child will need to sit down and be calm until they feel better. Around 10 minutes after they’ve had something sugary, you can check their blood glucose again to see that it has gone up. Some children will need a longer-acting carbohydrate such as a piece of fruit, biscuit, small sandwich or their next meal if it’s due. This will prevent their blood glucose levels from dropping again.
Parents, carers or the paediatric diabetes team will be able to advise if an extra snack is needed, and on the amount of drink or food needed to treat a hypo, as this will vary from child to child.
Diabetes UK and the Juvenile Diabetes Research Fund have produced a short video, called #type1aware, to raise awareness of the signs and symptoms of Type 1 diabetes. Watch it, share it, and help raise awareness!