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Pediatric Patient Diagnosed With Juvenile Diabetes

Pediatric Type 1 Diabetes Mellitus

Pediatric Type 1 Diabetes Mellitus

Author: William H Lamb, MD, MBBS, FRCP(Edin), FRCP, FRCPCH; Chief Editor: Sasigarn A Bowden, MD more... Type 1 diabetes is a chronic illness characterized by the bodys inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Most pediatric patients with diabetes have type 1 and a lifetime dependence on exogenous insulin. [ 1 ] The image below depicts the effects of insulin deficiency. Signs and symptoms of type 1 diabetes in children include the following: See Clinical Presentation for more detail. Blood glucose tests using capillary blood samples, reagent sticks, and blood glucose meters are the usual methods for monitoring day-to-day diabetes control. Diagnostic criteria by the American Diabetes Association (ADA) include the following [ 2 ] : A fasting plasma glucose (FPG) level 126 mg/dL (7.0 mmol/L), or A 2-hour plasma glucose level 200 mg/dL (11.1 mmol/L) during a 75-g oral glucose tolerance test (OGTT), or A random plasma glucose 200 mg/dL (11.1 mmol/L) in a patient with classic symptoms of hyperglycemia or hyperglycemic crisis Measurement of HbA1c levels is the best method for medium-term to long-term diabetic control monitoring. An international expert committee composed of appointed representatives of the American Diabetes Association, the European Association for the Study of Diabetes, and others recommended HbA1c assay for diagnosing diabetes mellitus. [ 3 ] The ADA recommends using patient age as one consideration in the establishment of glycemic goals, with different targets for preprandial, bedtime/overnight, and hemoglobin A1c (HbA1c) levels in patients aged 0-6, 6-12, and 13-19 years. [ 4 ] Benefits of tight glycemic control include not only continued reductions in the rates of microvascular complications but als Continue reading >>

Symptoms Of Type 1 Diabetes In Children: Signs Of Diabetes In Children

Symptoms Of Type 1 Diabetes In Children: Signs Of Diabetes In Children

Type 1 diabetes is a serious autoimmune disease where the pancreas stops producing insulinwhich allows the body to get energy from food. It strikes suddenlyand its not related to lifestyle or diet. Theres no way to prevent this disease and, as of now, there is no cure. Thats why its crucial that you be aware of the symptoms of diabetes in children so youre able to recognize them early. What to look for: Symptoms of type 1 diabetes in children One of the early signs of diabetes in children is increased urination and thirst. When blood-sugar is high it triggers a reaction in the body that pulls fluid from tissues. This will leave your son or daughter constantly thirsty, resulting in a need for more bathroom breaks throughout the day. Below are some other warning signs that you should be aware of. Fatigue: If your child is constantly tired it may be a sign that his or her body is having trouble turning sugar in the bloodstream into energy. Changes in vision: High blood sugar levels can lead to blurred vision or other eyesight problems. Fruity smelling breath: If your kids breath smells fruity, it could be a result of excess sugar in the blood. Extreme hunger and unexplained weight loss: When your son or daughters muscles and organs arent receiving enough energy, it can trigger extreme hunger. And sudden weight lossespecially if he or she is eating moreshould not be ignored. Unusual behavior: If your child seems more moody or restless than normaland its in conjunction with the symptoms aboveit could be cause for concern. Be on the lookout if your child is lethargic, shows heavy breathing, or experiences nausea and vomiting. When it goes untreated, type 1 diabetes can be life-threatening. If youre concerned that your son or daughter is showing signs of childhood diabetes it Continue reading >>

Care Of Children And Adolescents With Type 1 Diabetes

Care Of Children And Adolescents With Type 1 Diabetes

A statement of the American Diabetes Association ADA, American Diabetes Association AER, albumin excretion rate CVD, cardiovascular disease DCCT, Diabetes Control and Complications Trial DKA, diabetic ketoacidosis EDIC, Epidemiology of Diabetes Interventions and Complications EMA, endomysial autoantibody MDI, multiple daily insulin injection NCEP, National Cholesterol Education Program NCEP-Peds, National Cholesterol Education Program for Pediatrics SMBG, self-monitoring of blood glucose tTG, tissue transglutaminase During recent years, the American Diabetes Association (ADA) has published detailed guidelines and recommendations for the management of diabetes in the form of technical reviews, position statements, and consensus statements. Recommendations regarding children and adolescents have generally been included as only a minor portion of these documents. For example, the most recent ADA position statement on “Standards of Medical Care for Patients With Diabetes Mellitus” (last revised October 2003) included “special considerations” for children and adolescents (1). Other position statements included age-specific recommendations for screening for nephropathy (2) and retinopathy (3) in children with diabetes. In addition, the ADA has published guidelines pertaining to certain aspects of diabetes that apply exclusively to children and adolescents, including care of children with diabetes at school (4) and camp (5) and a consensus statement on type 2 diabetes in children and adolescents (6). The purpose of this document is to provide a single resource on current standards of care pertaining specifically to children and adolescents with type 1 diabetes. It is not meant to be an exhaustive compendium on all aspects of the management of pediatric diabetes. Howeve Continue reading >>

Information For Parents Of Children With Type 1 Diabetes | Joslin Diabetes Center

Information For Parents Of Children With Type 1 Diabetes | Joslin Diabetes Center

Click here for more information on type 1 diabetes research at Joslin . Insulin cant be given orally because it is a protein and would be digested instead of getting to the bloodstream where it is needed. Just about all of the commercially available insulins now are genetically engineered as human insulin. Insulin comes in a variety of preparations that differ according to how fast it takes effect, when that effect is the greatest, and how long it continues to work in the body. What seems overwhelming now will eventually become routine. One of the first hurdles to get over is that to help your child, you must prick him or her with a needle. This will get easier for all involved. There are new devices as well as some in development that make blood glucose testing and insulin injections less painful, easier and more precise. To live successfully with diabetes essentially means to learn how to be a pancreas. You have to learn how to monitor blood glucose levels and adjust the levels of insulin needed accordingly. To do this, you must consider several factors: Blood glucose levels, measured several times a day. The timing and content of meals eaten (specifically, considering type and amount of carbohydrates in the foods). The amount of physical activity, which requires more glucose and thus more insulin. And then based on need, getting doses of insulin through multiple injections or an insulin pump into the body multiple times a day. Your healthcare team will be your main helpline. But you will find many more resources as you are ready to seek more information. We have more informationin our online libraryinformation sheets on such topics as "Diabetes at a Glance," "Getting High Quality Medical Care Amid Changes in Healthcare Insurance," and on monitoring, insulin, nutriti Continue reading >>

Type 1 Diabetes In Children

Type 1 Diabetes In Children

Overview Type 1 diabetes in children is a condition in which your child's body no longer produces an important hormone (insulin). Your child needs insulin to survive, so you'll have to replace the missing insulin. Type 1 diabetes in children used to be known as juvenile diabetes or insulin-dependent diabetes. The diagnosis of type 1 diabetes in children can be overwhelming at first. Suddenly you and your child — depending on his or her age — must learn how to give injections, count carbohydrates and monitor blood sugar. Type 1 diabetes in children requires consistent care. But advances in blood sugar monitoring and insulin delivery have improved the daily management of the condition. Symptoms The signs and symptoms of type 1 diabetes in children usually develop quickly, over a period of weeks. These signs and symptoms include: Increased thirst and frequent urination. Excess sugar building up in your child's bloodstream pulls fluid from tissues. As a result your child might be thirsty — and drink and urinate more than usual. A young, toilet-trained child might suddenly experience bed-wetting. Extreme hunger. Without enough insulin to move sugar into your child's cells, your child's muscles and organs lack energy. This triggers intense hunger. Weight loss. Despite eating more than usual to relieve hunger, your child may lose weight — sometimes rapidly. Without the energy sugar supplies, muscle tissues and fat stores simply shrink. Unexplained weight loss is often the first sign of type 1 diabetes to be noticed in children. Fatigue. Lack of sugar in your child's cells might make him or her tired and lethargic. Irritability or behavior changes. In addition to mood problems, your child might suddenly have a decline in performance at school. Fruity-smelling breath. Bu Continue reading >>

Management Of Type 1 Diabetes Mellitus In Children And Adolescents

Management Of Type 1 Diabetes Mellitus In Children And Adolescents

INTRODUCTION Type 1 diabetes mellitus, one of the most common chronic diseases in childhood, is caused by insulin deficiency resulting from the destruction of insulin-producing pancreatic beta cells. (See "Pathogenesis of type 1 diabetes mellitus".) There are unique challenges in caring for children and adolescents with diabetes that differentiate pediatric from adult care. These include the obvious differences in the size of the patients, developmental issues such as the unpredictability of a toddler's dietary intake and activity level and inability to communicate symptoms of hypoglycemia, and medical issues such as the increased risk of hypoglycemia and diabetic ketoacidosis (DKA). Because of these considerations, the management of a child with type 1 diabetes must take into account the age and developmental maturity of the child. Although most children with type 1 diabetes present with the classic signs and symptoms of hyperglycemia without accompanying acidosis, approximately 30 percent of children in the United States present with DKA [1,2]. The management of these patients is discussed in detail separately. (See "Treatment and complications of diabetic ketoacidosis in children and adolescents".) The management of the child or adolescent with type 1 diabetes, who either did not present with ketoacidosis or who has recovered from ketoacidosis, will be reviewed here. The term parent will be used throughout the discussion, with recognition that the primary caregiver may not be a parent. Other aspects of childhood-onset type 1 diabetes are discussed in separate topic reviews: Continue reading >>

Type 1 Diabetes Mellitus In Children

Type 1 Diabetes Mellitus In Children

What is type 1 diabetes in children? Diabetes is a condition in which the body can't make enough insulin, or can't use insulin normally. Type 1 diabetes is an autoimmune disorder. The body's immune system damages the cells in the pancreas that make insulin. Insulin is a hormone. It helps sugar (glucose) in the blood get into cells of the body to be used as fuel. When glucose can’t enter the cells, it builds up in the blood. This is called high blood sugar (hyperglycemia). High blood sugar can cause problems all over the body. It can damage blood vessels and nerves. It can harm the eyes, kidneys, and heart. It can also cause symptoms such as tiredness. Type 1 diabetes mellitus is a long-term (chronic) condition. It may start at any age. Only 5% of people with diabetes have type 1. Insulin from the pancreas must be replaced with insulin injections or an insulin pump. There are two forms of type 1 diabetes: Immune-mediated diabetes. This is an autoimmune disorder in which the body's immune system damages the cells in the pancreas that make insulin. This is the most common kind of type 1 diabetes. Idiopathic type 1. This refers to rare forms of the disease with no known cause. What causes type 1 diabetes in a child? The cause of type 1 diabetes is unknown. Researchers think some people inherit a gene than can cause type 1 diabetes if a trigger such as a virus occurs. Which children are at risk for type 1 diabetes? A child is more at risk for type 1 diabetes if he or she has any of these risk factors: A family member with the condition Caucasian race Being from Finland or Sardinia Is age 4 to 6, or 10 to 14 What are the symptoms of type 1 diabetes in a child? Type 1 diabetes often appears suddenly. In children, type 1 diabetes symptoms may be like flu symptoms. Symptoms ca Continue reading >>

Where To Begin When Your Child Is Diagnosed With Type 1 Diabetes

Where To Begin When Your Child Is Diagnosed With Type 1 Diabetes

I work with families every day who get the news their child has been diagnosed with diabetes. Many parents have questions. Our Pediatric Endocrinology department has teamed up with HealthPartners Institute Patient Education to create a special diabetes care guide. It’s called Successfully Managing Diabetes: Your Care Guide for Type 1 Diabetes. And it helps answer a lot of those questions that families have. Here are 5 tips from the guide to get you started with adjusting to life after a type 1 diabetes diagnosis: Make sure your child sees a specialist and has a care team. A pediatric endocrinologist visit every 3 months is important. Changes in diabetes care are needed as your child grows. And changes with activities and schedules can affect diabetes care, too. Your child’s diabetes care team includes: Certified diabetes educators (a registered nurse and registered dietitian nutritionist) School nurse Your child and your family also are part of the team. Let your child be a child. Treating children with type 1 diabetes just like other children is important. Let your child take part in all childhood activities while still taking care of their diabetes. Start successful diabetes management with the basics. Remember “TIE.” Test. Test blood glucose at least 5 times a day. Test before meals, before an afternoon snack and at bedtime. Or, use a continuous glucose monitor device. Insulin. Give insulin before eating. Eat. Eat healthy meals and snacks. Measure and count carbs in all foods to match insulin doses. Reduce the amount of high sugar foods you have in your home. These include candy, soda, donuts and cookies. They have little nutritional value. And if they are eaten without taking extra insulin, blood sugar level (glucose) will increase. Promote ongoing education Continue reading >>

M A N A G E M E N T A N D T R E A T M E N T O F

M A N A G E M E N T A N D T R E A T M E N T O F

This care process model (CPM) was developed by Intermountain Healthcare’s Pediatric Clinical Specialties Program. It provides guidance for identifying and managing type 1 diabetes in children, educating and supporting patients and their families in every phase of development and treatment, and preparing our pediatric patients to transition successfully to adulthood and adult diabetes self-management. This CPM is based on guidelines from the American Diabetes Association (ADA), particularly the 2014 position statement Type 1 Diabetes Through the Life Span, as well as the opinion of local clinical experts in pediatric diabetes.ADA1,CHI Pediatric Type 1 Diabetes C a r e P r o c e s s M o d e l F E B R U A R Y 2 0 1 7 2 0 17 U p d a t e Why Focus on PEDIATRIC TYPE 1 DIABETES? Diabetes in childhood carries an enormous burden for patients and their families and represents significant cost to our healthcare system. In 2008, Intermountain Healthcare published the first CPM on the management of pediatric diabetes with the overall goal of helping providers deliver the best clinical care in a consistent and integrated way. What’s new: • Separate CPMs for type 1 and type 2 pediatric diabetes to promote more- accurate diagnosis and more-focused education and treatment. • Updated recommendations for diagnostic testing, blood glucose control, and follow-up care specifically related to pediatric type 1 diabetes. • A more comprehensive view of treatment for pediatric type 1 diabetes — one that emphasizes psychosocial wellness for patient and family and lays a foundation for better health over the lifespan. • Information and tools to support pediatric type 1 diabetes care by nonspecialist providers — important for coping with the ongoin Continue reading >>

The Facts About Type 1 Diabetes

The Facts About Type 1 Diabetes

WHAT IS TYPE 1 DIABETES? Type 1 diabetes is an autoimmune disorder in which the body’s immune system damages the pancreas so that it can’t make enough insulin. Insulin is a hormone that helps blood sugar (glucose) get into the cells of the body to be used as fuel. When glucose can’t enter the cells, it builds up in the blood, causing high blood sugar. High blood sugar can cause problems with blood vessels, nerves, eyes, kidneys, the heart and other areas of the body. DIAGNOSIS AND TREATMENT Type 1 diabetes often appears suddenly. In children, type 1 diabetes symptoms may be similar to the flu. Symptoms can include unusual thirst, frequent urination, extreme hunger yet with weight loss, loss of appetite, blurred vision, nausea and vomiting. Diagnosis is usually done with a blood test. Children with type 1 diabetes must have multiple daily injections of insulin to keep the blood glucose level within normal ranges. Insulin is given either by injection or insulin pump. Treatment also includes eating the right foods at the right time to manage blood sugar, and regular blood testing to check glucose levels. “Type 1 diabetes is a long-term, chronic condition, with potential, though rare, fatal consequences if not managed regularly,” CHOC Children’s endocrinologist Dr. Mark Daniels says. “An endocrinologist can help a child and his or her family come to terms with the disease and find ways to fit it into their lives.” TYPE 1 VS. TYPE 2 Only 5 percent of all people with diabetes have type 1. The remainder have another kind called type 2 diabetes, which is much more common in adults. While type 1 diabetes occurs when the body cannot produce enough insulin, type 2 diabetes occurs when the body isn’t able to use insulin properly, even when it is present. Type 1 di Continue reading >>

How To Manage Your Kid's Type 1 Diabetes

How To Manage Your Kid's Type 1 Diabetes

If your child has recently been diagnosed with type 1 diabetes, your family will have a learning curve as you get the hang of proper care and a new routine. Your lives will change, but in time you'll get more comfortable with this "new normal." As you make adjustments, you can take comfort in knowing this autoimmune disease doesn’t have to limit your child. "Kids with diabetes can do everything other kids can do," says Andrea Petersen Hulke of the Juvenile Diabetes Research Foundation. Hospitals offer educational courses that can give your family and caregivers the insight needed to help manage this new situation. The main change is learning to frequently check and adjust blood glucose levels (also called "blood sugar"). It may need checking 10 to 12 times a day. How much insulin your child needs will depend on the timing of meals, the types of food eaten, and her activity levels. It can take a bit of math skill to keep blood sugar levels within a healthy range. But it will get easier with practice. Even if you make a mistake, once you learn the symptoms of how your child reacts when her levels are too low or high, you’ll know how to fix it. "The math was freaky at first, but there are so many tools to help," says Lisa Sterling, who found out her daughter (now 17) had type 1 when she was 11. Logs, meters, and online trackers will help you stay on top of things. Insulin can be given by shots (syringe or pen) or by pump. Doctors often start with shots while families learn the basics. A pump is a small computer that gives a steady dose of insulin. You still need to track blood sugar levels to help the pump work right. You, your doctor, and child will decide together which device your child should use. "The goal is to manage diabetes around your child's life,” not the Continue reading >>

Type 1 Diabetes: A Guide For Families

Type 1 Diabetes: A Guide For Families

What is Type 1 Diabetes? Type 1 diabetes is a disease caused by a lack of insulin. Insulin is needed to allow sugar to move from the bloodstream into the cells to be used for energy. Nutrients in food are changed into a sugar called glucose. People with type 1 diabetes cannot make insulin, and without insulin, glucose is "stuck" in the bloodstream, leading to a high level of glucose in the blood. Type 1 diabetes affects about 1 in 400 children, adolescents, and young adults under 20 years of age. Currently, once diagnosed, type 1 diabetes is a lifelong disease that cannot be cured. However, the administration of insulin is a very effective treatment for type 1 diabetes. What Causes Diabetes? Type 1 diabetes is caused by the inability of the pancreas to produce insulin. Insulin is produced in special cells (called beta cells) in the pancreas, which is an organ located in the belly. In children with type 1 diabetes, the immune system "misbehaves." Normally, the immune system produces special proteins called antibodies that defend the body against infections, but in type 1 diabetes, the immune system attacks its own beta cells by producing antibodies against them. This ongoing attack results in over 90% destruction of beta cells, which may occur quickly or over a period of years, and ultimately leads to an inability to produce adequate levels of insulin. Symptoms The symptoms of type 1 diabetes are largely due to the lack of energy caused by an inability to use the nutrients eaten and by the high sugar levels in the bloodstream pulling water from the body into the bloodstream and spilling into the urine, causing dehydration (lack of fluids). These symptoms include: Hunger, at times extreme, and associated with weight loss Increased thirst and increased urination – the la Continue reading >>

Type 1 Diabetes Symptoms

Type 1 Diabetes Symptoms

Type 1 diabetes develops gradually, but the symptoms may seem to come on suddenly. If you notice that you or your child have several of the symptoms listed below, make an appointment to see the doctor. Here’s why symptoms seem to develop suddenly: something triggers the development of type 1 diabetes (researchers think it’s a viral infection—read this article on what causes type 1 diabetes, and the body loses its ability to make insulin. However, at that point, there’s still insulin in the body so glucose levels are still normal. Over time, a decreasing amount of insulin is made in the body, but that can take years. When there’s no more insulin in the body, blood glucose levels rise quickly, and these symptoms can rapidly develop: Extreme weakness and/or tiredness Extreme thirst—dehydration Increased urination Abdominal pain Nausea and/or vomiting Blurry vision Wounds that don’t heal well Irritability or quick mood changes Changes to (or loss of) menstruation There are also signs of type 1 diabetes. Signs are different from symptoms in that they can be measured objectively; symptoms are experienced and reported by the patient. Signs of type 1 diabetes include: Weight loss—despite eating more Rapid heart rate Reduced blood pressure (falling below 90/60) Low body temperature (below 97º F) There is an overall lack of public awareness of the signs and symptoms of type 1 diabetes. Making yourself aware of the signs and symptoms of type 1 diabetes is a great way to be proactive about your health and the health of your family members. If you notice any of these signs or symptoms, it’s possible that you have (or your child has) type 1 diabetes. A doctor can make that diagnosis by checking blood glucose levels. Continue reading >>

Type 1 Diabetes | Children's Hospital Of Philadelphia

Type 1 Diabetes | Children's Hospital Of Philadelphia

Type 1 diabetes is a chronic (meaning it never goes away), autoimmune disease that causes the pancreas to produce little or no insulin. Insulin is a hormone that converts sugars into nutrients and helps move those nutrients into our cells to produce energy. Without insulin, sugar builds up in the bloodstream, causing hyperglycemia, or high blood sugar. People with type 1 diabetes must take insulin daily. If left untreated, the excess sugar in the blood can cause severe damage to the body and may even be fatal. Complications that may result from type 1 diabetes include: If your child is diagnosed with type 1 diabetes, its important to understand that there is nothing you could have done to prevent it. The exact cause of type 1 diabetes is not known. There may be a genetic link, as autoimmune conditions can sometimes be seen in families. Still, there is currently nothing that can be done to prevent the autoimmune process that attacks the insulin-producing beta cells or to prevent the onset of this form of diabetes. Type 1 diabetes often appears suddenly during childhood or infancy. Each child may experience symptoms differently, but the most common symptoms are: Increased urination (babies may need very frequent diaper changes and toilet-trained children may start wetting themselves and/or wetting the bed more often) Increased appetite, but weight loss instead of gain Type 1 diabetes is most often diagnosed in childhood and adolescence, but it can be diagnosed at any age. If you or your doctor suspect type 1 diabetes, your childs doctor will order laboratory tests, including blood and urine tests, to diagnose diabetes. Laboratory tests can show the positive diabetes antibodies that are present with type 1 diabetes. Your pediatrician should also test your childs blood sug Continue reading >>

Type 1 Diabetes: What Is It?

Type 1 Diabetes: What Is It?

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 we need, 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 lets 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. The two types of diabetes are type 1 and type 2. Both make blood sugar levels higher than normal but they do so in different ways. In type 1 diabetes, the pancreas loses its ability to make insulin because the body's  immune system attacks and destroys the cells that produce insulin. No one knows exactly why this happens, but 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. In type 2 diabetes , the pancreas still makes 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 (a problem called insulin resistance ). This raises the blood sugar level, so the pancreas works hard to make even more insulin. Eventually, this strain can make the pancreas unable to produce enough ins Continue reading >>

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