Introduction ^
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Diabetes is one of the most serious health problems facing the world
today. In the United States each year, more than 13,000 children are
diagnosed with type 1 diabetes. Increasingly, health care providers
are finding more and more children and teens with type 2 diabetes,
a disease usually seen in people over age 40. Although there are no
national data, some clinics report that one-third to one-half of all
new cases of childhood diabetes are now type 2. African American,
Hispanic/Latino and American Indian children who are obese and have
a family history of type 2 diabetes are at especially high risk for
this type of diabetes.
What is Diabetes? ^
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Diabetes is a chronic disease in which the body does not make or properly
use insulin, a hormone that is needed to convert sugar, starches,
and other food into energy. People with diabetes have increased blood
glucose (sugar) levels due to a lack of insulin, insufficient insulin,
or resistance to insulin's effects. High levels of glucose build
up in the blood, and spill into the urine and out of the body. As
a result, the body loses its main source of fuel.
Taking care of diabetes is important. If not treated, diabetes can
lead to serious problems. Diabetes can affect the eyes, kidneys, nerves,
gums, teeth, and blood vessels. Diabetes is the leading cause of adult
blindness, lower limb amputations, and kidney failure. It can cause
heart disease and stroke, and even death if untreated. Some of these
problems can occur in teens and young adults who develop diabetes
during childhood. Research in adults shows that these problems can
be greatly reduced or delayed by keeping blood glucose levels near
normal.
What are Special Concerns for Children and Adolescents with Diabetes? ^
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Diabetes presents unique issues for children and teens with the disease.
Simple things - like going to a birthday party, playing sports,
or staying overnight with friends - need careful planning. Every
day, children with diabetes may need to take insulin or oral medication.
They also need to check their blood glucose several times during the
day and remember to make correct food choices. For school-age children,
these tasks can make them feel "different" from their
classmates. These tasks can be particularly bothersome for teens.
For any child or teen with diabetes, learning to cope with the disease
is a big job. Dealing with a chronic illness such as diabetes may
cause emotional and behavioral challenges. Talking to a social worker
or psychologist may help a child or teen and his or her family learn
to adjust to lifestyle changes needed to stay healthy.
What Can Families and Others Do? ^
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Managing diabetes in children and adolescents is most effective when
the entire family makes a team effort. Families can share concerns
with physicians, diabetes educators, dietitians, and other health
care providers to get their help in the day-to-day management of diabetes.
Extended family members, teachers, school nurses, counselors, coaches,
day care providers, or other resources in the community can provide
information, support, guidance, and help with coping skills. These
individuals also may help with resources for health education, financial
services, social services, mental health counseling, transportation,
and home visiting.
Diabetes is stressful for both the children and their families. Parents
should be alert for signs of depression or eating disorders and seek
appropriate treatment. While all parents should talk to their children
about avoiding tobacco, alcohol, and other drugs, this is particularly
important for children with diabetes. Smoking and diabetes each increase
the risk of cardiovascular disease and people with diabetes who smoke
have a greatly increased risk of heart disease and circulatory problems.
Binge drinking can increase the risk of hypoglycemia (low blood sugar)
and symptoms of hypoglycemia can be mistaken for those of intoxication
and not properly treated. Local peer groups for children and teens
with diabetes can provide positive role models and group activities.
What Are the Types of Diabetes? ^
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There are two main types of diabetes. Type 1 and type 2 diabetes are
described below. A third type-gestational diabetes-occurs only during
pregnancy and often resolves after pregnancy. Women who have had gestational
diabetes are more likely to develop type 2 diabetes later in life.
(See "Resources" for information on
gestational diabetes.)
Type 1 Diabetes
Type 1 diabetes is a disease of the immune system, which is the body's
system for fighting infection. In people with type 1 diabetes, the
immune system attacks the beta cells, the insulin-producing cells
of the pancreas, and destroys them. The pancreas can no longer produce
insulin, so people with type 1 diabetes need to take insulin daily
to live. Type 1 diabetes can occur at any age, but the disease occurs
most often in children and young adults.
- Symptoms. The symptoms of type
1 diabetes usually develop over a short period of time. They include
increased thirst and urination, constant hunger, weight loss, and
blurred vision. Children may also feel very tired all the time. If
not diagnosed and treated with insulin, the child or teen with type
1 diabetes can lapse into a life-threatening diabetic coma, known
as diabetic ketoacidosis (KEY-toe-asi-DOE-sis) or DKA.
- Risk Factors. Though scientists
have made much progress in predicting who is at risk for developing
type 1 diabetes, they do not know exactly what triggers the immune
system's attack on beta cells. They believe that type 1 diabetes
is due to a combination of genetic and environmental factors. Researchers
are working to identify these factors and stop the auto-immune process
that leads to type 1 diabetes.
Type 2 Diabetes
The first step in the development of type 2 diabetes is often a problem
with the body's response to insulin, called insulin resistance.
For reasons scientists do not completely understand, the body cannot
use the insulin very well. This means that the body needs increasing
amounts of insulin to control blood glucose. The pancreas tries to
make more insulin, but after several years, insulin production may
drop off.
Type 2 diabetes used to be found mainly in adults who were overweight
and age 40 or older. Now, as more children and adolescents in the
United States become overweight and inactive, type 2 diabetes occurs
more often in young people. Type 2 diabetes is also more common in
certain racial and ethnic groups, such as African Americans, American
Indians, Hispanic/Latinos, and some Asian and Pacific Islander Americans.
To control their diabetes, children with type 2 diabetes may need
to take oral medication, insulin, or both.
- Symptoms. Type 2 diabetes develops slowly in some children, but
quickly in others. Symptoms may be similar to those of type 1 diabetes.
A child or teen can feel very tired, thirsty, or nauseated (sick to
the stomach), and have to urinate often. Other symptoms may include
weight loss, blurred vision, frequent infections, and slow healing
of wounds or sores. Some children or adolescents with type 2 diabetes
may show no symptoms at all when they are diagnosed. For that reason,
it is important for parents and caregivers to talk to a health care
provider about testing children or teens who are at high risk for
the disease.
- Risk Factors. Being overweight, being older than 10 years of age,
experiencing puberty, and having a family member who has type 2 diabetes
are risk factors for the disease. Certain populations, as noted above,
are at higher risk. In addition, physical signs of insulin resistance,
such as acanthosis nigricans (A-can-tho-sis NIG-reh-cans), may appear:
the skin around the neck or in the armpits appears dark, thick, and
velvety. High blood pressure also may be a sign of insulin resistance.
For children and teens at risk, health care providers can encourage,
support, and educate the entire family to make lifestyle changes that
may delay - or prevent - the onset of type 2 diabetes. Such
lifestyle changes include keeping at a healthy weight and staying
active.
What Should a Child or Teen With Diabetes Do Every Day? ^
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To control diabetes and prevent complications, blood glucose levels
must be as close to a "normal" range as safely possible.
Families should work with a health care provider to help set a child's
or teen's targets for blood glucose levels. (See for Resources
information on target ranges.) The provider can help develop a personal
diabetes plan for the child and discuss ways to manage hypoglycemia
(low blood glucose) and hyperglycemia (high blood glucose).
A Personal Diabetes Plan
A personal diabetes plan ensures that a daily schedule is in place
to keep a child's diabetes under control. A health care provider
develops this plan in partnership with a child or teen and his or
her family. The plan shows the child or teen how to follow a healthy
meal plan, get regular physical activity, check blood glucose levels,
and take insulin or oral medication as prescribed.
- Follow a Healthy Meal Plan.
A child or teen needs to follow a meal plan developed by a physician,
diabetes educator, or a registered dietitian. A meal plan outlines
proper nutrition for growth. A meal plan also helps keep blood glucose
levels in the target range. Children or adolescents and their families
can learn how different types of food - especially carbohydrates
such as breads, pasta, and rice - can affect blood glucose levels.
Portion size, the right amount of calories for the child's age,
and ideas for healthy food choices at meal and snack time also should
be discussed. Family support for following the meal plan and setting
up regular meal times is a key to success, especially if the child
or teen is taking insulin.
- Get Regular Physical Activity.
A child or teen with diabetes needs regular physical activity. Exercise
helps to lower blood glucose levels, especially in children and adolescents
with type 2 diabetes. Exercise is also a good way to help children
control their weight. If possible, a child or teen should check blood
glucose levels before beginning a game or sport. A child or teen should
not exercise if blood glucose levels are too low.
- Check blood glucose levels regularly.
A child or teen should check blood glucose levels regularly with a
blood glucose meter, preferably a meter with a built-in memory. A
health care professional can teach a child how to use a blood glucose
meter properly and how often to use it. Blood glucose meter results
show if blood glucose levels are in the target range, too high, or
too low. A child should keep a journal or other records of blood glucose
results to discuss with his or her health care provider. This information
helps the provider make any needed changes to the child's or
teen's personal diabetes plan.
- Take all diabetes medication as prescribed.
A child or teen should take all diabetes medication as prescribed.
Parents, caregivers, school nurses, and others can help a child or
teen learn how to take medications properly. For type 1 diabetes,
a child or teen takes insulin shots at regular times each day. Some
children and teens use an insulin pump, which delivers insulin. Some
children or teens with type 2 diabetes need oral medication or insulin
shots or both. In any case, all medication should be balanced with
food and activity every day.
Hypoglycemia and Hyperglycemia
Keeping blood glucose levels within the target range is the goal of
diabetes control. However, extremes in blood glucose levels can occur
for several reasons. The parent or caregiver should talk with a health
care provider about how to deal with these potential problems related
to a child's or teen's diabetes.
- Blood glucose levels can sometimes drop too low - a condition
called hypoglycemia (hi-po-gly-SEE-me-uh).
Taking too much diabetes medicine, missing a meal or snack, or exercising
too much may cause hypoglycemia. A child or teen can become nervous,
shaky, and confused. When blood glucose levels fall very low, the
person can lose consciousness or develop seizures. Talk to the child's
or teen's health care provider about how to deal with this serious
but manageable condition.
- Blood glucose levels can sometimes rise too high - a condition
known as hyperglycemia (hi-per-gly-SEE-me-uh).
Forgetting to take medicines on time, eating too much, and getting
too little exercise may cause hyperglycemia. Being ill also can raise
blood glucose levels. Over time, hyperglycemia can lead to serious
health problems and cause damage to the eyes, kidneys, nerves, blood
vessels, gums, and teeth.
Are There Legal Considerations for Children and Teens with Diabetes? ^
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Several Federal and state laws provide protections to children with
disabilities, including children or teens with diabetes. These children
must have full access to public programs, including public schools,
and to most private schools as well. Students with diabetes are entitled
to accommodations and modifications necessary for them to stay healthy
at school and have the same access to an education as other students
do.
A child's or teen's school should prepare a plan that
outlines how the child's special health care needs will be met.
The plan should identify school staff responsible for making sure
the plan is followed. The parents should be present during development
of the plan. Any changes to the plan should be made only with the
parents' consent. Ideally, the plan should be updated every
year. For information or questions about the Americans With Disabilities
Act, call 1-800-514-0301 or 1-800-514-0383 (TDD), or go to www.usdoj.gov/crt/ada/
on the World Wide Web.
Are researchers studying diabetes in children and adolescents? ^
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As the lead Federal Government agency for diabetes research, the National
Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducts
and supports a wide range of research aimed at finding ways to prevent
and treat diabetes and its health complications. The Institute's
research on type 1 diabetes focuses on understanding its causes, improving
treatment, and developing new therapies that could prevent or cure
diabetes. In addition, NIDDK recently created Trialnet, a clinical
trials network to test new ways to prevent type 1 diabetes and to
preserve beta cell function in people who already have diabetes.
NIDDK is also setting up clinical centers to study the prevention
and treatment of type 2 diabetes in children and adolescents. Treatment
trials will look at lifestyle changes and drug therapy. Prevention
trials will develop programs that can be used in schools and communities
to lower risk factors for the disease. Other NIDDK-supported research
on type 2 diabetes seeks to understand the causes of the disease,
improve diagnosis, and develop new treatments. For more information
about NIDDK research on children and adolescents with diabetes, visit
www.niddk.nih.gov/patient/patient.htm
on the Internet.
In 2000, the Centers for Disease Control and Prevention (CDC) began
funding a 5-year multi-center study of childhood diabetes. Participating
centers are located in California, Colorado, Hawaii, Ohio, South Carolina,
and Washington. The goals of the program are to 1) develop population-based
registries of childhood diabetes, 2) characterize the types of diabetes,
3) develop case definitions and study the prevalence and incidence
of the different types of childhood diabetes, and 4) describe the
natural history and the quality of care received during follow-up.
For more information, call 1-877-232-3422 or visit http://www.cdc.gov/diabetes/projects/cda2.htm
on the Internet.
NIDDK and CDC are joint sponsors of the National Diabetes Education
Program (NDEP). The goal of this program is to reduce illness and
death associated with diabetes and its complications. The NDEP has
developed an initiative to help health care providers identify, diagnose,
and treat children and teens with type 2 diabetes. In addition, the
NDEP will launch an initiative to increase awareness in the school
setting about the importance of helping children and teens with diabetes
manage their disease.
Resources ^
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For more information about diabetes, target goals for blood glucose
levels, educational materials, and support programs for people with
diabetes and their families and friends, contact:
National Diabetes Education Program (NDEP)
1 Diabetes Way
Bethesda, MD 20892-3600
Toll-free: 800-438-5383
Web site: www.ndep.nih.gov
For more information about type 1, type 2, and gestational diabetes,
as well as diabetes research, statistics, and education, contact:
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Toll-free: 800-860-8747
Phone: (301) 654-3327
Fax: (301) 907-8906
Email: ndic@info.niddk.nih.gov
Web site: www.niddk.nih.gov/health/diabetes/diabetes.htm
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
1600 Clifton Road
Atlanta, GA 30333
Toll-free: 800-311-3435
Phone: (404) 639-3311
Fax: (770) 448-5195
Web site: www.cdc.gov/nccdphp/index.htm
CDC Division of Diabetes Translation
Public Inquiries/Publications
P.O. Box 8728
Silver Spring, MD 20910
Toll-free: 877-CDC-DIAB or 877-232-3422
Fax: (301) 562-1050
Email: diabetes@cdc.gov
Web site: www.cdc.gov/diabetes
American Diabetes Association
1701 N. Beauregard Street
Alexandria, VA 22311
Toll-free: 800-DIABETES or 800-342-2383
Phone: (703) 549-1500
Email: customerservice@diabetes.org
Web site: www.diabetes.org
Juvenile Diabetes Foundation International
120 Wall Street, 19th Floor
New York, NY 10005
Toll-free: 1-800-223-1138
Phone: (212) 785-9500
Web site: www.jdf.org |