Diabetes Issues For Children And Teenagers

Overview

Diabetes is a condition where the level of sugar (glucose) in the blood stays too high. Glucose comes from food and is the body's main fuel. A hormone called insulin, made by the pancreas (an organ behind the stomach), works like a key that lets glucose move out of the blood and into the body's cells. In diabetes, that key is missing or does not work properly, so glucose builds up in the blood instead. In children and teenagers, the most common type is type 1 diabetes, where the body stops making insulin. Type 2 diabetes, where the body still makes insulin but does not respond to it well, is also being found in teenagers more often than before.

Yes. Type 1 diabetes is one of the most common long-term conditions in childhood, and the number of children diagnosed has been rising. Type 2 diabetes was once thought of as an adult condition, but it is now being diagnosed in teenagers more often, particularly where there is excess weight and a family history.

Type 1 diabetes can start at any age, but it often appears in children around 4 to 7 years old, or around 10 to 14 years old during puberty. It affects boys and girls equally. Type 2 diabetes in young people is more likely in teenagers who are overweight, who have a parent or sibling with type 2 diabetes, or who are of South Asian, African, Caribbean or Middle Eastern heritage. Puberty itself makes blood sugar harder to control, because growth hormones work against insulin.

Symptoms

Common symptoms

• Feeling very thirsty all the time
• Peeing much more often, including getting up at night
• Being very tired, low in energy or sleeping more than usual
• Losing weight without trying, even though appetite may be normal or bigger
• Feeling hungrier than usual
• Blurred vision
• Cuts, grazes or spots that heal slowly
• Infections that keep coming back, such as thrush or skin infections
• Being grumpy, tearful or not themselves

Symptoms in children

• Wetting the bed or wetting pants again in a child who had been dry
• Needing a new, bigger nappy size, or heavy wet nappies, or thrush in the nappy area
• Being unusually cross, clingy or sleepy
• Not growing or gaining weight as expected
• Tummy aches and feeling sick
• Findings may be picked up at a routine check, such as sugar in a urine sample

Symptoms in older adults

• This topic is about children and teenagers, but it helps to know diabetes looks different at different ages.
• In older adults, type 2 diabetes often builds up slowly with few clear symptoms — tiredness, thirst, or infections that keep returning.
• Grandparents and other adult carers who have diabetes can still help with a child's care, and shared family habits around food and activity affect a child's risk too.

Causes

Main causes

• Type 1 diabetes: the immune system, which normally fights infection, mistakenly attacks the insulin-making cells in the pancreas. We do not yet fully understand why this happens. It is not caused by eating sugar and it is not caused by anything a parent did.
• Type 2 diabetes: the body's cells stop responding well to insulin (this is called insulin resistance), and over time the pancreas cannot make enough extra insulin to keep up. Genes and body weight both play a part.
• Rarer types: some forms run in families (called monogenic diabetes), some are linked to other conditions such as cystic fibrosis, and some medicines — steroid treatment, for example — can raise blood sugar.

Risk factors

• A parent, brother or sister with type 1 diabetes (this raises risk only slightly)
• Other autoimmune conditions in the child or family, such as thyroid problems or coeliac disease
• For type 2: carrying extra weight, especially around the middle
• A family history of type 2 diabetes
• South Asian, African, Caribbean or Middle Eastern heritage (higher risk of type 2)
• Puberty — growth hormones increase insulin resistance
• Long-term steroid medicines or other medicines that raise blood sugar
• Polycystic ovary syndrome in teenage girls (linked to a higher risk of type 2)

When to see a doctor

See a doctor urgently if:

• New, heavy thirst with lots of weeing, or bedwetting returning in a child who was dry — ask for a same-day check
• Losing weight quickly without trying
• Vomiting, tummy pain or fast breathing in a child who has diabetes
• Any illness in a child with diabetes where they cannot keep food or fluids down
• Ketones found on testing, or blood sugar that will not come down
• A hypo that does not respond to fast sugar, or repeats within a short time

Book a routine appointment if:

• Concerns about growth, energy, mood or school performance
• Review appointments with the children's diabetes team
• Planning ahead for school trips, holidays, exams or sleepovers
• Questions about food, activity, or managing diabetes during sport
• Teenagers starting to drive, drink alcohol, or take on their own care
• Dental check-ups and foot checks
• Catching up on routine vaccinations

Diagnosis

A doctor can check for diabetes quickly with a finger-prick blood sugar test or a urine dipstick in the clinic. If that suggests diabetes, a blood sample is sent to the laboratory to confirm it. When diabetes is confirmed, the family is usually seen by the children's diabetes team the same day, and treatment starts straight away.

Tests that may be done

• Finger-prick blood sugar test (a few seconds, a drop of blood)
• Urine test for sugar and ketones
• Laboratory blood glucose test to confirm
• HbA1c blood test — a picture of average blood sugar over the past few weeks
• Blood ketone test, which shows whether the body is burning fat instead of glucose
• Antibody blood tests, which can show whether it is type 1
• Tests of how much insulin the body still makes
• Screening for related conditions such as thyroid problems and coeliac disease
• Growth and blood pressure checks

What to expect at your appointment

The first days can feel like a lot to take in. Most families meet a team that includes a children's diabetes doctor, a specialist nurse, a dietitian and a psychologist or social worker. You will learn how to check blood sugar, how to give insulin or use a pump, how to treat a hypo, what to do on sick days, and how to plan meals and activity. Staff will also help you talk to your child's school or nursery. Write questions down as they come to you — it is completely normal to forget things on the day and to need them explained more than once.

Treatment

Diabetes is managed rather than cured. The goal is to keep blood sugar in a healthy range so a child can grow, learn, sleep and play normally, while keeping the risk of low blood sugar (hypos) low. Children's diabetes teams aim to give families the knowledge, tools and confidence to do this day to day, with regular reviews as the child grows.

Self-care at home

• Check blood sugar as often as your team advises, and more often when your child is ill, exercising or travelling
• Keep a fast-acting sugar close at all times — glucose tablets, glucose gel, sugary drink or juice — for hypos
• Always carry a diabetes kit with testing supplies, insulin, and a snack
• Have a written sick-day plan and follow it whenever your child is unwell
• Test for ketones when blood sugar is high or your child is ill, as your team has shown you
• Make sure the school or nursery has a clear care plan, spare supplies and staff who know what to do
• Wear or carry medical ID so others know about the diabetes in an emergency
• Keep feet clean and dry, and check them for cuts and blisters
• Brush teeth twice a day and see the dentist regularly — high blood sugar makes gum problems more likely
• Encourage sleep, activity and steady meals as part of normal family life

Medical treatments

For type 1 diabetes, the body no longer makes insulin, so insulin has to be replaced — usually by injections several times a day, or through an insulin pump worn on the body. Your team will teach you how to match insulin to food and activity. Many children also use a continuous glucose monitor, a small sensor worn on the skin that shows sugar levels through the day and night. For type 2 diabetes, treatment usually starts with changes to food and activity, alongside support for the whole family; if that is not enough, the team may add tablets or other medicines, and sometimes insulin. Everyone with diabetes should also have a clear plan for treating low blood sugar, a plan for sick days, and regular reviews of growth, blood pressure, eyes, kidneys and feet. Psychological support is part of good care too, not an extra.

When is surgery considered?

Surgery is not a treatment for diabetes in children. Devices such as insulin pumps and glucose sensors are worn on the body, but they do not involve an operation. Occasionally a child with diabetes needs surgery for an unrelated reason, and the diabetes team will plan carefully with the surgical team to keep blood sugar steady before, during and after. Pancreas transplantation is a major operation used only in a small number of adults with very severe diabetes, not as a routine treatment for children.

Living with this condition

Life with diabetes settles into a routine. Meals, insulin and activity become part of the family rhythm rather than the whole day. Children can and should take part in school trips, sleepovers, clubs and parties, with a little planning and a kit packed in advance. As children grow, they gradually take on more of their own care — many teenagers start to check their own sugar and give their own insulin, with parents staying close by for support. Expect bumps: blood sugar is affected by growth, illness, stress, weather and hormones, so some days simply will not go to plan. That is normal and not a sign of failure.

Lifestyle tips

• Keep regular meals and snacks, and learn how different foods affect blood sugar
• Build activity into the week — sport, walking, cycling, dancing — and plan for how it affects sugar levels
• Carry fast sugar and a snack for activity days
• Get enough sleep; tiredness makes blood sugar harder to manage
• Plan ahead for parties, holidays, exams and festivals
• Involve the school so staff know what to do and your child is not singled out
• Teenagers: talk openly about alcohol, vaping, drugs and driving, and agree safe plans together
• Keep vaccines up to date, including the flu vaccine each year if it is offered to your child

Diet and exercise

There is no special 'diabetes diet' for children. The aim is ordinary healthy family food: regular meals, plenty of vegetables and fruit, whole grains, beans and lentils, dairy or dairy alternatives, and protein at meals. Sugary drinks are best kept for treating hypos rather than as everyday drinks. A dietitian on your team can help with counting carbohydrates, packed lunches, fussy eating and growth spurts. Activity is just as important — children with diabetes should aim for the same activity as any other child, usually about an hour a day of moving about. Exercise lowers blood sugar, so check levels before, during and after, and keep fast sugar to hand.

Mental health and emotional wellbeing

Diabetes affects mood as well as blood sugar. Many children and teenagers feel angry, embarrassed or worn down by it at times, and parents often feel anxious and exhausted too. Teenagers may feel 'diabetes burnout' and skip checks or insulin, and some develop difficult relationships with food or body image. These are common and treatable — not weaknesses. Tell your diabetes team early if your child seems low, withdrawn, anxious, or is skipping care; a psychologist who understands diabetes can help a lot. If your child or teenager talks about not wanting to be here, harming themselves, or you are worried they are in crisis, contact your local emergency number or an urgent mental health service straight away, and stay with them. You do not have to manage this alone.

Prevention

Type 1 diabetes cannot currently be prevented — there is no diet or lifestyle change that stops it, and families should never feel blamed. Type 2 diabetes in young people can often be delayed or prevented. The most effective approach is a whole-family one: regular activity, healthy meals, less sugary drink, enough sleep, and support with weight if needed — without focusing on a child's weight in a shaming way. Research into preventing type 1 is ongoing, including studies that test relatives of people with type 1 to spot it early.

Vaccines

There is no vaccine against diabetes. Children with diabetes should have all their routine childhood vaccinations on time, and are usually advised to have the flu vaccine each year — ask your doctor or pharmacist what is recommended where you live.

Screening programmes

There is no general screening programme for type 1 diabetes in children. Some research studies offer blood tests to relatives of people with type 1 to find early signs. Teenagers at higher risk of type 2 diabetes may be offered a blood test by their doctor. Once a child has diabetes, regular checks of eyes, kidneys, blood pressure, growth and feet are offered — usually starting around the early teens — to catch small problems before they become big ones.

Complications

If left untreated

• Diabetic ketoacidosis (DKA) — a medical emergency where the body burns fat for fuel and the blood becomes acidic
• Severe low blood sugar, which can cause seizures or loss of consciousness
• Poor growth and delayed puberty if blood sugar stays high
• More infections, slower healing and dental problems
• Long-term damage to eyes, kidneys, nerves and blood vessels if blood sugar stays high over years
• Emotional strain, anxiety, low mood and difficulties at school if diabetes is not well supported

Long-term outlook

The outlook today is good and getting better. Modern insulin, pumps, sensors and well-trained children's teams mean most young people with diabetes grow up healthily, finish school, go to university or work, travel, play sport and have families of their own. Good blood sugar control, regular reviews and looking after emotional wellbeing make long-term problems much less likely. There will be hard days, and that is part of it — the aim is steady progress over years, not a perfect score every day.

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