For a parent who has a child with type 1 diabetes, monitoring her blood sugar, regulating her insulin level, helping her to eat a certain way and staying on top of her physical activity are a never-ending fact of life.
"People talk about every day being different, but it's really every hour," says Karen Wade, whose 7-year-old daughter, Camille, has type 1 diabetes. Her blood sugar is affected not only by insulin and what she ate a few minutes before, but by her mood or whether she's in a growth spurt.
Type 1 diabetes is a chronic disease in which the body doesn't produce insulin, the hormone needed to convert sugar, starches and other foods into energy. The villain is the body's own immune system, which misguidedly attacks and destroys insulin-producing cells in the pancreas. [U.S. News will host a #KidsDiabetes Twitter chat April 25, 2013, from 2 p.m. to 3 p.m. Eastern on both type 1 and type 2 diabetes, which historically has been an adult illness but is showing up increasingly in children. Details below.]
Camille was diagnosed on New Year's Eve in 2011. "The symptoms came so fast," Wade recalls. Camille seemed to be very tired, but Wade was always able to attribute the fatigue to something else. Over the winter holidays, she realized that Camille urinated frequently and was extremely thirsty — classic symptoms, she knew from 11 years working as a nurse before becoming a stay-at-home mom, of type 1 diabetes.
"The desperation in her drinking was the kicker," she says; she could never seem to get enough water. She picked up a box of urine strips from the local pharmacy. Sure enough, Camille's blood sugar was elevated. And an appointment at Le Bonheur Children's Hospital in Memphis, Tenn., confirmed the diagnosis. Even given the symptoms, it was something of a surprise. Neither Wade nor her husband, Tim, had a family history of the disease, which is influenced by genetics.
Camille now uses a continuous glucose monitor, which automatically checks blood sugar levels throughout the day. She can then through a separate pump inject insulin into her bloodstream, since her body cannot produce it naturally. As with other patients who have type 1 diabetes, she has to see a doctor every three months.
She is home-schooled for now; her school lacked a full-time nurse or a diabetes-trained administrator, and no other child among the 800 kindergartners through second graders had the condition.
Type 1 diabetes represents 75 to 80 percent of pediatric diabetes cases, says Steven Willi, medical director of the Diabetes Center for Children at the Children's Hospital of Philadelphia. The nature of the disease is evolving, however. Doctors are identifying type 1 diabetes at younger ages — and type 2 diabetes, traditionally viewed as an adult disease, is a recent and upsetting phenomenon in children.
Type 2 diabetes in children is associated with rising childhood obesity rates and lack of exercise. In type 2 diabetes, unlike type 1, the pancreas manufactures insulin, but not enough, or the body's cells ignore the insulin it does produce.
One in very 400 children and adolescents has diabetes. Children from minority groups are particularly affected. As with type 1, the therapies typically used for type 2 diabetes are healthy eating, exercise and insulin injections.
The changing nature of type 1 diabetes has several working explanations, says Willi. Some researchers blame environmental toxins. Others say overly antiseptic environments lead the immune system to attack the body itself. Other theories, he says, point to increased numbers of childhood immunizations, or cow's milk versus breast milk. Little evidence supports the last two hypotheses, he says, but both have been examined.
Diabetes can't be cured, but lifestyle changes can get people with type 2 to the point that they no longer need to use insulin injections or take medication.
Managing type 1 is even more arduous. Besides carefully monitoring everything they eat and however they exercise, for their entire lives they have to check their blood glucose levels and administer insulin four to 10 times a day.