Juvenile Diabetes Characteristics

Juvenile diabetes is an increasingly common disease in children under five. Learn more about this condition and how it's treated in this article.

Written and verified by the doctor Leonardo Biolatto.

Last update: 25 July, 2022

There are two different types of juvenile diabetes, but the most frequent one is type 1 diabetes. This type of diabetes is insulin-dependent, which means it requires an external insulin supply. Overall, it’s the most common since type 1 diabetes represents over 90% of the cases of diabetes diagnosed in children under fourteen.

Diabetes is a disorder of the endocrine system characterized by the low production of insulin in the pancreas, which leads to the accumulation of high levels of sugar (glucose) in the blood. It’s usually of an autoimmune origin since the body itself destroys those cells of the pancreas that are no longer functional. On other occasions, insulin production may be normal, but cells cannot properly use it due to a defect. This is mainly the case in type 2 diabetes.

Diagnostic criteria for juvenile diabetes

The diagnosis of juvenile diabetes consists of measuring fasting blood glucose levels (glycemia), which shouldn’t exceed 126 mg/dl. This is according to the criteria of the International Association of Pediatric and Adolescent Diabetes ADA-ISPAD 2014.

Blood glucose is high when fasting, so doctors will also do other tests to confirm juvenile diabetes. They must find out what type it is and rule out other diseases that also present themselves with hyperglycemia. This is because the treatment of these diseases is different and the prognosis will be worse if not diagnosed in time.

After a diagnosis, the patient must begin treatment immediately to control their blood glucose levels. Also, this helps prevent the appearance of ketoacidosis. This is because this could complicate the prognosis.

Frequency and age of onset

Juvenile diabetes mellitus type 1 is increasingly common and typically manifests between the ages of 1 day old to 14 years of age. Doctors diagnose about 10 to 25 cases for every 100,000 children in this age range. However, there’s a significant increase in children under 5 years.

Signs and symptoms of juvenile diabetes type 1

To avoid diagnostic errors, doctors measure blood glucose levels on at least two separate days. They consider the following a positive for type 1 childhood diabetes:

• Blood sugar: greater than 200 mg/dl.
• Blood glucose after eight hours of fasting: greater than 126 mg/dl.
• Glycemia after two hours after eating carbohydrates: greater than 200 mg/dl

Patients with childhood diabetes usually present the 3 P chart:

• Polyuria: They urinate a lot.
• Polydipsia: They drink a lot.
• Noticeable weight loss.

Therefore, the typical scenario of a child with juvenile diabetes who arrives at the emergency department usually presents these symptoms:

• Polyuria, which is sometimes responsible for bedwetting.
• Polydipsia.
• Weight loss, due in part to ketonemia (the accumulation of acid radicals due to improper sugar metabolism), which in turn leads to extreme weight loss.
• Sometimes there is nonspecific abdominal pain and even vomiting.
• There’s usually no fever.
• Much decline of their general state in the form of drowsiness, weight loss, and sunken eyes.
• Fast and shallow breathing and must do so through the mouth, which leads to a dry tongue.
• Their breath “smells like green apples,” due to ketonemia.
• Finally, they usually maintain their normal blood pressure and central pulse.

Differential diagnosis of juvenile diabetes

Even though the most frequent cause of hyperglycemia is diabetes mellitus, it’s important to also consider the possibility of other diseases such as:

• Cases of hyperglycemia and glycosuria (presence of glucose in the urine)
• Stroke
• Intravenous therapy
• Dehydration with high levels of sodium in the blood

The symptoms of presenting ketoacidosis:

• Sudden and severe abdominal pain
• Acetylsalicylic acid (aspirin) poisoning
• Recurrent ketotic hypoglycemia

The symptoms of severe ketoacidosis:

• Acetylsalicylic acid (aspirin) poisoning
• Hypoglycemic coma
• Hyperosmolar coma
• Stroke
• Lactic acidosis

Treatment for juvenile diabetes

Overall, the treatment of this disease aims to control metabolic levels and avoid complications that are both acute and chronic. Typically, these are the symptoms that may affect the development of children with juvenile diabetes. In the treatment of juvenile diabetes, the education and training of the child and the family are very important. This allows them to control the disease and avoid complications.

Thus, there are three fundamental pillars in the treatment of diabetes:

• First, insulin to provide adequate doses of this hormone because the body cannot produce or use them properly.
• Second, a proper diet to avoid overloading the insulin system by regulating the contribution of carbohydrates from ingestion.
• Third, exercise to increase glucose expenditure by the muscles and achieve a balance between what the person ingests and what they expend.

Advances and expectations of available treatments

Fortunately, there’s also a great effort going on for the proper training and education of children regarding diabetes. However, some of the challenges are:

• Simplifying insulin application devices
• Editing educational materials to make them more interesting to children
• Finally, convening training courses, workshops, and summer schools. These help children to become aware of and normalize the disease.

Also, the advances we expect soon will ease the lives of diabetic children. Overall, systems and procedures will likely fewer punctures and less frequency in the supply of insulin. Plus, we can also expect advances in new gene therapies and the synthesis of insulin compounds to improve the lives of patients. There are a lot of children with diabetes. However, there’s a bright future when it comes to controlling it.