Diabetes is a medical condition characterised by high blood glucose (sugar) levels. It occurs due to an absolute or relative lack of insulin, the hormone responsible for regulating blood sugar.

There are two main types of diabetes: Type 1 diabetes (previously called insulin dependent diabetes) and Type 2 diabetes (non-insulin dependent).

Type 1 diabetes is commonest in people under 30-years-old and may appear in early childhood. People with Type 1 diabetes have a genetic predisposition to the disease but an environmental trigger is needed. Viruses are thought to be such a trigger.

It occurs because the body is unable to make insulin due to an autoimmune process in which, it is believed, the body's white cells kill the islet cells in the pancreas where insulin is produced. Type 1 diabetes must be treated with insulin injections.

Type 2 diabetes is the commonest form of diabetes and is most prevalent among the older population. However, it is becoming increasingly common in younger people, including adolescents, mainly due to lifestyle factors such as rising obesity levels, poor diet and lack of exercise.

In people with Type 2 diabetes, the body is able to produce insulin (sometimes it is overproduced) but is unable to use it properly. Type 2 diabetes can be controlled with a proper diet and medication.
At present here is no cure for diabetes. However, it can be treated through insulin therapy, monitoring blood glucose levels, following a balanced diet and taking regular exercise.

How can I tell if my child has diabetes?

If your child presents with the following symptoms you should make an appointment to visit your GP:

• Passing large volumes of urine;
• Feeling thirsty and drinking a lot;
• Weight loss;
• Failure to thrive in an infant;
• Fatigue;
• Blurred vision;
• Recurrent skin infections (e.g. thrush).

If your doctor suspects diabetes, he/she will confirm the diagnosis by means of urine and blood tests. If your child has diabetes glucose can spill over into the urine and this can be picked up by a urine dipstick test. Blood tests are used to measure the level of glucose in the blood to confirm the presence of diabetes. A further blood test called HbA1c may be used to monitor diabetes control over a three month period.

Will I have to give my child insulin injections?

If your child has Type 1 diabetes, insulin replacement by means of an injection is an essential part of treatment. Unlike Type 2 diabetes, Type 1 does not respond to tablets as insulin is not absorbed well when taken orally. Therefore, it must be given as an injection. Your doctor will advise you and your child on how often to inject and which insulin preparation to use.

Insulin injections are given subcutaneously i.e. into the layer of tissue between the skin and muscle. Injection sites include the abdomen, upper arm, thighs and buttocks. It is important to rotate the site of injection frequently to prevent the area from becoming lumpy. Insulin injections are now available in pen devices, which are much easier for children to use than syringes.

If your child is very young, you may be responsible for injecting insulin and monitoring glucose levels. But as he gets older he is encouraged to test and inject himself (initially under parental supervision). All children with diabetes should wear a Medi Alert bracelet to alert people about the presence of diabetes in the case of an emergency.

How do I manage my child's blood glucose?

You will be able to monitor your child's blood sugar level using a glucose meter. A drop of blood from a finger prick is sufficient to get a reading. When the blood is applied to the strip it will return a glucose reading. Monitoring is usually done before meals and at bedtime. It may also be required before and after exercise.

Teach your child how to keep accurate records of his blood sugar readings. This is important as insulin doses can be changed in accordance with these figures; if blood sugar readings are consistently high, the insulin dose may be increased; if they are too low the insulin dose is reduced.

When the blood sugars are high and in times of illness, the urine can be tested for ketones (products of fat breakdown). When insulin is missing fat breakdown is used to provide energy for the body.

Is diet important?

It can be difficult at the best of times to get children to eat a healthy, balanced diet but if your child has diabetes you must monitor their diet carefully. Children with diabetes should be educated about the importance of diet in managing their condition.

It is also essential that parents are educated about the impact of diet on their child's diabetes as parents often have the greatest influence over their childrens' food choices.

What your child eats during the day will have an impact on the amount of insulin that needs to be injected. In particular, you will need to monitor your child's intake of carbohydrates such as pasta, bread, rice and potatoes. Carbohydrate foods have more an impact on blood sugars than either protein or fat. A dietician can devise a specially tailored meal plan to suit children with diabetes.

What about exercise?

Exercise is important in maintaining a healthy lifestyle - not just for people with diabetes but for everyone. Children with diabetes can lead normal lives and participate in regular everyday activities so encourage your child to take part in sports.

Exercise can have the effect of lowering blood sugar levels because the body uses sugar to fuel activity. Your child's insulin dose may, therefore, have to be adjusted for the exercise period. If you have any particular concerns, ask the vhihealthe fitness expert.

Are there any complications I should be aware of?

Complications can occur in the short- or long-term. Short-term problems include diabetic ketacidosis (DKA) and hypoglycaemia.

DKA can be precipitated by an infection or other illness or by missing insulin injections. It is characterised by high blood sugar and the presence of ketones in the blood and urine. Symptoms include nausea and vomiting, abdominal pain, deep and rapid breathing and a fruity odour to the breath. Hospital admission is required for fluids and intravenous insulin.

Hypoglycaemia (commonly called a reaction) is characterised by low blood sugar. An individual becomes hypoglycaemic when their blood sugar level is too low. It can be caused by taking too much insulin, eating too little or exercising without food. Symptoms include tremors, feeling of anxiousness, sweating, feeling the heart beat fast (palpitations), pallor, fatigue, dizziness, feeling faint, hunger, pins and needles, inappropriate behaviour, seizures and loss of consciousness

Mild hypoglycaemia is easily treated with small amounts of sugar, sweet juice or food containing sugar. However, if your child is unconscious, glucagon (a hormone that acts to raise blood sugar) and hospitalisation for intravenous glucose may be needed.

DKA and hypoglycaemia can be life threatening and can lead to a coma.

Long-term complications include problems with the eyes, the heart, the skin, nerves, kidneys and feet. They may also lead to Impotence.

Long-term complications do not usually occur until 10 years after diabetes has been diagnosed and are more associated with poorly controlled diabetes. Good blood glucose control has been shown to reduce the incidence of nerve, kidney and eye complications