Type 1 diabetes is five times more common that meningitis, but diagnosis is often delayed.
A report by Dr Julie Edge, a consultant paediatric diabetologist at the John Radcliffe Hospital Oxford, was published in the British Medical Journal in 2011. It reports that 25% of newly diagnosed children of all ages are referred late, seriously ill with Diabetic Ketoacidosis (DKA). Many of the affected children are under 5 years old.
Every year about 2,000 children are diagnosed with type 1 diabetes but a quarter of them will be seriously ill with DKA, a metabolic catastrophe, before the diagnosis has been made.
Diabetic Ketoacidosis (DKA) is the main cause of mortality and morbidity in children with type 1 diabetes. 10 children a year die from DKA in the UK. Most of these deaths are due to cerebral oedema, swelling of the brain tissue, which is more common when DKA occurs.
Type 1 diabetes is five times more common than meningitis, but is not always being recognised by doctors and parents until the child presents with vomiting, abdominal pain and rapid breathing. Tragically, some children are going into a coma and are close to death before they are diagnosed and the correct treatment is given.
Parents are advised to take their children to see a doctor if they notice any symptoms associated with Type 1 diabetes, which can include excessive thirst, frequent urination, bed wetting, weight loss, hunger, blurred vision, abdominal pain, vomiting, thrush, lethargy.
In England diabetes occurs in 1 in every 450 children. 97% of children with diabetes have type 1 diabetes mellitus. Type 2 diabetes in children is still uncommon.
Nearly 30% of newly diagnosed children have had at least one related medical visit before diagnosis. Doctors and parents are missing the early signs.
Doctors may fail to ask about frequent urination (polyuria) and excessive drinking (polydispia) Adolescents may ignore the symptoms.
In children under 2 years the clinical presentation can be non specific. However polyuria and polydipsia are the main symptoms in all age groups. As parents may not mention these symptoms a doctor must carefully draw out this information. Also bedding wetting (Nocturnal enuresis) in a previously “dry” child can be one of the first symptoms in 89% of children over the age of 4 years. Recurrent infections can also be a presentation. Oral or genital thrush can be present.
If diabetic ketoacidosis (DKA) has already occurred, the symptoms can include vomiting and abdominal pain; deep sighing breathing called Kussmaul breathing and reduced levels of consciousness. All these symptoms can be misdiagnosed as acute asthma/pneumonia or possible gastroenteritis/appendicitis, if the doctor is not aware of polyuria and polydipsia.
Type 1 diabetes can be diagnosed with a single finger- stick blood glucose test if the proper technique is followed. Scrupulously clean hands washed and thoroughly dried. The diagnostic criteria for diabetes in adults and children, is a random sample blood glucose concentration over 11.1 mmol/L. If the symptoms are suggestive of diabetes then this must be ruled out. Children and young people should NOT wait for fasting blood glucose tests. The finger stick capillary test will be confirmed with a lab test of the blood glucose once the child arrives at the hospital.
A child or young people with a high blood glucose level should be referred promptly on the same day to secondary care.
Children with type 1 diabetes will require insulin. There are various regimens and insulin will be started on the day of referral. Support and Education is carried out by a multidisciplinary team consisting of doctors, diabetes specialist nurses and dieticians.
In Italy, a hard-hitting, inexpensive campaign of information aimed at doctors and the public about the early symptoms of type 1 diabetes, greatly reduced the incidence of DKA at diagnosis. A similar campaign is needed in the UK
Knowing the symptoms of type 1 diabetes, trusting your instincts and getting medical help immediately, can save lives.
Signs and Symptoms of Diabetes:
- Nocturnal Enuresis (night time bed-wetting)
- Polydipsia (excessive thirst)
- Polyuria (frequent urination)
- Weight Loss
- Abdominal pain
- Unusual hunger
- Lethargy (abnormal lack of energy)
- Kussmaul Breathing (rapid laboured breathing)
- Blurred vision
- Fruity breath
- Candidiasis (thrush infections)
- Dehydration (sunken in eyes, dry skin, dry mucous membranes)
- Flu-like symptoms
- Bedwetting at night in a previously “dry” child, is one of the commonest symptoms
- Frequent urination and excessive drinking (polyuria, polydipsia)
- Weight loss
- A single immediate capillary blood glucose tests with a value above 11.1 mmol/L indicates diabetes.
- Refer children with raised blood glucose levels to secondary care the same day.
- Do not wait for other tests (blood /urine) as this may allow DKA to occur.
Photos Alfie Max Moss, Lilly by Kylie Banks
BMJ article by Julie Edge