Parents often worry about diabetes, but most are really concerned about type 1 diabetes -- the kind that typically starts in childhood and requires treatment with insulin shots.
That is actually the least common type of diabetes, though, affecting only 5% of people with diabetes. Type 2 diabetes, which used to be thought of as "adult-onset" diabetes, is much more common. In fact, with the increase in childhood obesity -- a major risk factor for the disease -- pediatricians now look for type 2 diabetes in teenagers.
Let's take a look at the two types of diabetes.
Type 1 Diabetes Symptoms
The symptoms of type 1 diabetes, which typically develop over a short period of time (days to weeks) include:
- frequent urination (polyuria)
- being very thirsty or drinking a lot (polydipsia)
Many parents bring their children for an evaluation for diabetes because they have frequent urination and increased thirst. The only problem is that many children, especially toddlers and preschoolers will ask for and drink as much juice as you let them have, even if they aren't necessarily thirsty. And if they drink a lot of juice, they are going to have to urinate a lot.
That's why kids who go to their pediatrician with just those symptoms usually don't end up having diabetes.
The chances increase if you add other diabetes symptoms, such as:
- eating a lot or extreme hunger (polyphagia)
- unusual weight loss
- extreme fatigue and irritability
- blurred vision
Weight loss is an especially important red flag symptom for type 1 diabetes. If a child has frequent urination, increased thirst, and weight loss -- the classic symptoms of diabetes -- a pediatrician will likely strongly suspect diabetes even before a urinalysis or blood sugar test is completed. On the other hand, if a child has other diabetes symptoms without weight loss, then although they will likely still do the same tests, but the results will more than likely be a different cause. At any rate, don't hesitate to see your pediatrician if you think your child might have any symptoms of diabetes.
Also keep in mind that when children have frequent urination associated with diabetes, it is usually large amounts of urine each time. Children who have urinate frequently, but only void a small amount each time, likely have another cause instead of diabetes, especially if they don't have other diabetes symptoms.
Type 2 Diabetes Symptoms
Unfortunately, children with type 2 diabetes may have no symptoms at all, which can make early diagnosis difficult.
Many type 2 diabetes symptoms are actually late symptoms of the condition, which develop gradually, after many years of having diabetes. These signs and symptoms can include:
- type 1 diabetes symptoms, including frequent urination, increased thirst, weight loss, and extreme hunger, etc.
- frequent infections
- increased risk of infections or frequent infections
- cuts and bruises that heal slowly
- blurred vision
- numbness or tingling in the hands and feet
Because children with type 2 diabetes may not have any classic diabetes symptoms, pediatricians and parents should instead look for other signs and risk factors for type 2 diabetes. These can include being overweight, having acanthosis nigricans (areas of darkened skin - usually on the back of a child's neck) or striae (stretch marks), and a positive family history of type 2 diabetes. These high-risk kids then get routinely screened for diabetes, including a HbA1c test.
Infections in Kids
Children with type 1 diabetes also may have symptoms of an infection, such as fever, cough, vomiting, or sore throat, as it is often an infection that triggers the diagnosis.
The infection doesn't cause the child to have diabetes, but before the infection -- whether it is the flu, strep throat, or a stomach virus -- the child may have been able to drink plenty of fluids to keep up with his frequent urination, but falls behind once he gets sick. That can lead to dehydration and worsening symptoms - even progression to diabetic ketoacidosis, which can be a medical emergency.
Diabetes Symptoms - What You Need to Know
Diabetes is not something that you want to miss, as kids with type 1 diabetes can end up in a diabetic coma if the diagnosis is delayed too long. That makes it important to know how to recognize diabetes symptoms, especially since some of them, like being thirsty and urinating a lot, are very non-specific symptoms that many children normally have.
In addition to knowing the classic symptoms of diabetes, parents should know that:
- About 10% of children with diabetes have type 1 diabetes.
- The peak ages to be diagnosed with type 1 diabetes are between ages 5 and 7 years and then again at the start of puberty.
- Although genetics is a risk factor for developing type 1 diabetes, as the risk is about 2% if a child's mother has type 1 diabetes and 7% if his father has diabetes, 85% of kids with type 1 diabetes have no family history of diabetes.
- The weight loss in children with type 1 diabetes can occur because of dehydration (water loss from urinating a lot) or from a loss of body fat (calorie loss from increased sugar in the child's urine) or from both.
- Most children with type 2 diabetes have a family history of type 2 diabetes.
- Craving sugar is not typically a symptom of diabetes. In fact, children with diabetes have too much sugar in their blood.
- Frequent infections and having cuts and bruises that heal slowly are not usually early symptoms of type 1 diabetes.
Kliegman: Nelson Textbook of Pediatrics, 19th ed.
Melmed: Williams Textbook of Endocrinology, 12th ed.