Identifying Type 1 diabetes mellitus in children

You might be aware of the story of Kycie Terry.

She is the 5-year-old girl who is known on Facebook and other social media sites (“Kisses for Kycie”) for suffering from the results of undiagnosed Type 1 diabetes. She had symptoms for a few weeks before declining in health and eventually was diagnosed with a serious diabetic condition known as diabetic ketoacidosis.

At the time she was identified with DKA, she was transported from her local medical center to a children’s hospital in Salt Lake City. She later acquired cerebral edema and brain damage.

Kycie’s hospital course was prolonged and involved rehabilitation for the nervous system damage and permanent disability. She eventually was discharged but soon after was readmitted for pneumonia. She died a little over five months after she was diagnosed because of respiratory complications, not from high blood sugar.

This child’s story is extreme. The majority of children who are newly diagnosed with Type 1 diabetes do not progress to chronic nervous system damage or death. But it does shed light on the problem of missed diagnoses.

The Test One Drop campaign was developed to help increase awareness of the symptoms of new onset diabetes and how a simple blood or urine test could help lead to treatment.

Signs and symptoms of new onset diabetes:

▪ Excessive thirst

▪ Increase in urination

▪ Bedwetting in a child who no longer wets the bed​　

▪ Increased appetite and sometimes weight loss

Other complaints might include:

▪ Abdominal pain

▪ Headaches

▪ Vision changes/blurriness

▪ Irritability or mood changes

If a child has prolonged high blood-sugar levels, he or she might go into DKA. Symptoms of DKA include nausea and vomiting, weakness or fatigue, labored breathing, muscle or leg cramps, fruity/acetone-scented breath (smells like fingernail polish remover), drowsiness or confusion. 　　　

DKA is a medical emergency, and the child should be taken to an emergency room to be evaluated. While being evaluated, the child’s blood glucose (sugar) level and/or urine glucose will be checked along with other labs. Most children are dehydrated when identified and require IV fluids and frequent lab checks. Later, insulin will be given to help lower the sugar levels.

Testing that can be done in the physician’s office if DKA is not suspected include drawing blood for a hemoglobin A1c and blood glucose level. Some offices have urine testing available and will check for glucose in the urine as well as ketones.

Diabetes in childhood is usually due to an autoimmune process and is a lifelong disease. However, we now have improved treatment options, including rapid-acting insulin and technology such as insulin pump devices that allow fine-tuning of insulin dosing (and less needle sticks). Some children use continuous glucose monitor devices that allow their glucose levels to be monitored every few minutes with only two finger-stick checks a day. Parents like CGM technology since they can often monitor their child’s glucose levels on their smartphone while the child is at school, etc.

If you suspect your child has diabetes, please contact your family physician. If he or she has symptoms that are consistent with DKA, then being seen in an ER might be more efficient.

To learn more about diabetes, please visit www.diabetes.org.

This story was originally published January 30, 2017 at 3:32 PM with the headline "Identifying Type 1 diabetes mellitus in children."