Q. How is Type 1 diabetes in children different from type 2?

Answer.

There are many differences between type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). These include age of onset, inheritance pattern and initial presenting symptoms. However, the main difference that I emphasize to my patients when asked this question is the difference in the amount of insulin that is produced by the pancreas (endogenous insulin) and how sensitive the cells in our body are to the insulin that is produced (insulin receptor sensitivity).

In T1DM, there is very little to no insulin being produced by the pancreas. This is a result of the production of antibodies that attack the cells that produce insulin within the pancreas called beta cells. In contrast, in T2DM there are extremely high levels of endogenous insulin but the cells of the body have become resistant to the effects of the insulin, requiring abnormally large amounts of insulin to keep the blood sugar within the normal range. The pancreas, in an attempt to keep the blood glucose normal, must secrete more and more insulin until finally it simply cannot meet the demand. The result is abnormally high blood glucose.

Therefore, a type 1 diabetic has abnormally low endogenous insulin but normal insulin receptor sensitivity while the type 2 diabetic has high levels of endogenous insulin with low receptor sensitivity.

Q. At what age can my child with diabetes administer his own insulin safely?

Answer.

There is no specific age at which a child with diabetes is considered safe to administer his or her own insulin. This depends on their level of maturity rather than their age. When a child can understand how to monitor blood glucose and can master the proper handling, administration and disposal of the insulin and needles then it is safe for the child to manage his or her own insulin.

In my opinion, the best way to start is for the parent to be properly trained first by either the child’s pediatrician or a diabetic nurse educator. Then the parent should administer the insulin explaining each step of the monitoring, administration and disposal process to the child. Eventually, under close supervision, the parent should let the child take over one aspect of the process at a time. Ultimately, the parent should let the child take control over each step in the process until the parent is confident that the child has developed adequate mastery over the entire process.

I believe it is never too early to start this educational process with a child. Usually, the parent knows best when their child is ready to safely manage their own insulin.

Q. What kind of physical activity should children with diabetes be doing?

Answer.

A person with T1DM can engage at any level of activity they choose. It is very important to emphasize to a child with T1DM that they are in control of their diabetes and that they should not let the diabetes control them. I recommend a normal level of moderate physical activity. However, Jay Cutler is a good role model for children who aspire to compete in physically demanding sports at a professional level. Nick Jonas is another good role model for children with T1DM. He has a successful career as a teen idol (just ask my daughter) while successfully managing his T1DM.

I believe it is important to utilize role models like these to show children that despite their diabetes that they can and should pursue all of their goals and aspirations.

Q. Will my child with diabetes be able to eat sweets at all, or are they always forbidden?

Answer.

Yes, a child can and should have sweets. However, sweets should be limited in the same manner they should be limited in any child. Unfortunately, the average North American diet contains way too much carbohydrate in the form of concentrated sweets. For the reasons mentioned above, from a psychological standpoint it is important to maintain as normal a lifestyle as possible when dealing with T1DM. Fortunately, with all the new types of insulin and with advances in monitoring and insulin pump technology, it has become easier to maintain a fairly normal lifestyle while managing T1DM.

It is also important to remember that T1DM is not caused by poor eating habits. It has the same general pathophysiology as other auto immune disease such as Lupus, rheumatoid arthritis or psoriasis. It can be thought of as an immune mediated insulin deficiency.