Diabetes Mellitus

Diabetes mellitus is a disorder in which there is impairment in the transfer of glucose (blood sugar) from the bloodstream into the body’s cells. The accumulation of glucose in the blood, and its decreased availability within cells, to serve as fuel for many biochemical functions, can result in a variety of short and long-term consequences.

About 20 percent of all cases of diabetes – and nearly all cases in children – result from a failure of the pancreas to produce insulin, a hormone necessary to allow glucose to enter cells. Vulnerability to diabetes is inherited, and it appears that the disease develops when the pancreatic cells that produce insulin are destroyed. These children are said to have insulin-dependent (also called Type I or juvenile) diabetes, because without daily injections of this hormone they will become severely ill. (Before insulin was available to treat diabetes, this form of the disease was uniformly fatal.) The other 80 percent of diabetics produce adequate amounts of insulin, but for a variety of reasons the hormone does not interact normally with cells, and glucose levels in the bloodstream rise. This form of the disease, called non-insulin-dependent (also called Type 2 or adult onset)diabetes, nearly always occurs in adults and is treated with diet, exercise, and)or medications.

An infant or child who is developing diabetes will begin producing abnormally large amounts of urine and as a result will be continually thirsty. He may also be constantly hungry and yet lose weight. If the problem is not diagnosed and the metabolic consequences worsen, vomiting, dehydration, profound abnormalities in body chemistries – a condition called diabetic ketoacidosis – and eventually coma and death will follow. Diabetes might first be discovered during a routine exam when glucose is detected in a child’s urine; during an evaluation for symptoms such as weight loss, increased hunger, or abnormal thirst; or during an acute and unexpected deterioration of a child’s overall condition – usually an episode of diabetic ketoacidosis requiring intensive medical care.

Once diabetes is identified and stabilized, a comprehensive care plan will be needed. This will involve the combined skills of a physician, a dietitian, and frequently a specially trained diabetes educator. This disease cannot be treated casually; it requires detailed understanding of dietary principles, monitoring of blood sugar using a glucose meter and test strips at home, and proper use of insulin to control day-to-day glucose levels. Such detailed care is necessary for two reasons. First, it is important to prevent the immediate and sometimes dangerous problems that arise from extremely high or low levels of glucose. (Low blood sugar, or hypoglycemia, can result from a mismatch of insulin, food, and activity at a given point in time.) Second, ongoing elevation of blood glucose (or hyperglycemia) may not be high enough to cause acute symptoms but can nevertheless contribute to long-term disease in many organs or organ systems, including the eyes, kidneys, nervous system, and/or blood vessels. These potential complications and strategies to avoid them are normally explained in detail during diabetic-instruction sessions.

Depending upon age and maturity level, the child should gradually be given increasing responsibility for managing his diabetes. Continued education and troubleshooting by one or more experienced health-care providers will be necessary. Often emotional support is important for the child or adolescent who feels “stuck” with this disease. Despite all the extra effort involved in carrying out his everyday routines the diabetic child should not be restricted from participating in normal activities, including team sports and other athletic pursuits. It may be necessary to remind him from time to time that, with proper self-care (including diet and exercise) and attention to the details of managing glucose, he should be able to live a long and healthy life.