Diabetes is a chronic (long-term) condition, in which a high level of glucose (sugar) is present in the bloodstream. A hormone called insulin allows glucose to move from the blood to the body's cells, which then use the glucose for energy. Insulin is made in the pancreas and diabetes occurs when there is either not enough insulin, or the body doesn't respond correctly to insulin. There are two main types of diabetes:

• Type 1 diabetes: the most common type of diabetes affecting children and teenagers in Australia. Type 1 diabetes is caused by the body not having enough insulin. Without insulin, glucose levels will build up in the blood. Type 1 diabetes is treated by replacing the insulin and managing blood glucose levels.
  
• Type 2 diabetes: rarely occurs during childhood and adolescence. Type 2 diabetes is caused by the body being resistant to insulin. Type 2 diabetes is treated with diet, weight loss and oral medications in the majority of cases.

This fact sheet will focus on type 1 diabetes, as this is the most common form that affects children.

Signs and symptoms of type 1 diabetes

Your child may have type 1 diabetes if they show the following symptoms:

• extreme thirst
  
• constant hunger
  
• sudden weight loss
  
• frequent urination (weeing)
  
• blurred vision
  
• nausea and vomiting
  
• lethargy (feeling very tired).

You may also notice that your child is more prone to infections.

When there is not enough insulin the blood, glucose levels build up and eventually 'spill over' into the urine. This results in excessive urine production and thirst.

The body's cells still require a source of energy, and without glucose, the body's fat stores begin to break down, resulting in the production of ketones, which is an alternative fuel source. The breakdown of fat leads to weight loss and the production of ketones (a type of acid) results in the blood becoming acidic.

Without treatment, the child will eventually become dehydrated, start vomiting and lose consciousness (go into a coma). This is called diabetic ketoacidosis (DKA) and is life-threatening.

When to see a doctor

If your child has been unusually thirsty and had increased urination for more than a week, see your GP. If your child shows the other symptoms, take them to see the GP so the cause can be investigated.

DKA is a medical emergency. Take your child to the nearest hospital emergency department if your child is dehydrated and vomiting. Signs that your child is severely dehydrated include: dark-coloured urine, being pale, cold hands or feet, fast breathing, sunken or dark eyes. See our fact sheet Dehydration.

If your child loses consciousness, call an ambulance immediately.

Your child may be referred to an endocrinologist (diabetes doctor). Your child will need to have some tests to determine whether they have diabetes. These tests involve blood samples being taken from a vein.

Treatment for type 1 diabetes

When children are first diagnosed with type 1 diabetes, the initial focus will be treating the dehydration and acidic blood. Insulin will be given, to replace the missing insulin from the body. They will usually be required to stay in hospital for a short period of time.

Type 1 diabetes is a chronic (life-long) disease that has no cure. The treatment of type 1 diabetes involves the replacement of insulin. Insulin can be replaced in the body either via insulin injections or with insulin pump therapy.

Testing blood glucose levels is a crucial part of managing diabetes. It provides information on how much glucose is currently in the bloodstream and is the only way to know if the body is getting the correct amount of insulin that it needs. The most common method for checking blood glucose levels is with a tiny needle that pricks a finger. A drop of blood is then analysed quickly on a small machine (glucometer) to give a result. Continuous glucose monitoring using wearable technology is also an option that can be used in conjunction with blood glucose testing.

Diabetes education

Managing diabetes involves balancing insulin, food (in particular, glucose-containing foods) and exercise.

While your child is in hospital, they will begin to have diabetes education, which can then be finished as an outpatient after they are discharged from hospital. These education sessions will be with a diabetes nurse educator, dietitian, and social worker. You will be taught:

• how to give insulin
  
• how to do a blood glucose test
  
• how to keep a blood glucose record book
  
• what to do for a low blood glucose reading (hypoglycaemia)
  
• what ketones are
  
• healthy eating for people with diabetes.

The goal of diabetes education is to provide the information and support you and your child need to be comfortable and confident with managing the diabetes in day-to-day life. 

Diabetes action and management plans

You will be given a Diabetes Action Plan (for what to do in an emergency) and a Diabetes Management Plan (for daily management and what to do when there is a problem) for your child. Your child's school, childcare centre or kindergarten should have up-to-date versions of these plans to ensure they know how to care for your child properly.

Follow-up

Your child will have an appointment with an endocrinologist, diabetes nurse educator and diabetes dietitian a few weeks after their diagnosis. Following this appointment, diabetes care involves an outpatient appointment every three to four months with the endocrinologist.

The nurse educators, dietitians and social workers are available to be contacted in between your child's endocrinologist appointments for support with diabetes management.

Key points to remember

• Type 1 diabetes is the most common type of diabetes affecting children and teenagers and is caused by the body not having enough insulin.
  
• Symptoms include extreme thirst and excessive urination (weeing).
  
• The treatment of type 1 diabetes involves the replacement of insulin and checking blood glucose levels.
  
• Managing diabetes involves balancing insulin, food, and exercise.
  
• Follow-up care involves appointments every three to four months with an endocrinologist.

For more information

• The Royal Children's Hospital: Diabetes at the RCH
  
• Diabetes Victoria; ph. 1300 437 386
• Diabetes Australia

Developed by The Royal Children's Hospital Endocrinology and Diabetes department. We acknowledge the input of RCH consumers and carers.

Reviewed September 2020.

Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.