Approximately 1.25 million Americans have type 1 diabetes, including more than 18,000 youths newly diagnosed every year, reports the 2014 National Diabetes Statistics Report. Type 1 diabetes results from the body’s immune cells destroying the insulin-producing islet cells of the pancreas. As a result, the body does not produce any insulin and has to rely on injections or an insulin pump to provide this important hormone. The classic symptoms of diabetes -- increased thirst, urination and weight loss -- reflect not only the effects of limited or no insulin in the body but also the body's attempt to compensate for the excess sugar or glucose in the blood. Other symptoms may also be present, including some that indicate a medical emergency.
Excessive Thirst, Urination and Fatigue
The body needs insulin to move sugar from the blood into cells, and without insulin, blood sugar levels become too high. As the kidneys filter the blood, they send some of this extra sugar to the bladder, causing more urine to be produced. Thus, one of the first symptoms of diabetes is more frequent urination -- called polyuria. A child may ask to use the restroom more often, have more accidents, start wetting the bed again or, in very young children, wet more diapers. A child experiencing high blood sugars may also be extremely thirsty and drink more than usual -- called polydipsia, so they may be asking for water, juice or milk more frequently. With body cells not getting adequate glucose, a child may lack energy, become tired easily and show little interest in physical play.
Physical and Behavioral Changes
Because high blood sugars cause excess glucose to be lost through the urine, this loss of calories will cause many children to lose weight even though they may be hungry and eating well. Weight loss can also be attributed to dehydration, and because insulin plays a role in building muscle and storing fat -- a lack of insulin causes fat and muscle to be broken down for energy. Blurred vision is a common symptom as high blood sugars cause the lens of the eye to swell. Also, because of dehydration, a child may have dry mouth or dry, itchy skin. Children with diabetes may also be more susceptible to infections, such as skin or urinary tract infections, or have sores that are slow to heal. Some children may become irritable and moody when their blood sugar levels are running high.
In some children, these early symptoms quickly progress to a medical emergency. When too little insulin is available to allow the body to use glucose for energy, the body uses fat as an alternative energy source. This causes the body to make ketones, and without insulin, the body is forced to make excessive ketones, making the blood very acidic and leading to diabetic ketoacidosis, or DKA. Along with the classic high blood sugar symptoms, children with DKA may appear to have a stomach virus and complain of stomach pain, nausea and vomiting. A child's breath may smell fruity or even smell like nail polish remover. The increased blood acidity may also cause drowsiness, confusion, headache or rapid and deep breathing. DKA is a medical emergency that can lead to coma and death. If DKA is suspected, immediate medical attention is required.
Warnings and Next Steps
If high blood sugar symptoms are observed, a child needs to see a doctor right away. If symptoms are severe or DKA is suspected, a visit to urgent care or the emergency department is necessary. A doctor will test blood glucose levels to confirm a diagnosis of diabetes, and depending on the blood and urine test results, the child may require a hospital stay. Early diagnosis is important because untreated type 1 diabetes can lead to coma and death, and if blood glucose levels are not well controlled in the long term, severe health complications can result. However, with insulin replacement via injections or an insulin pump and daily self-care that includes testing blood sugars and monitoring food intake, blood sugars can be well controlled, and children with diabetes can lead a healthy, productive life.