do you know the signs of type 1 diabetes?

Drinking a lot of water, regressing to wetting the bed, eating a lot. These are all common things in kids, and are often nothing more than a sign that they are thirsty or hungry! Sometimes, however, they can be a sign of type 1 diabetes. Moira Pfeifer, MD, endocrinologist at Dayton Children’s Hospital, shared with us some tips on when these symptoms could be a sign of something more, and what to do if you think your child may be showing signs of type 1 diabetes.

What are the symptoms of type 1 diabetes?
While the symptoms of type 1 diabetes are somewhat common, the order of the symptoms is a key sign in recognizing type 1 diabetes. Here are some of the symptoms, and what is happening in the body with each symptom.

1. Going to the bathroom all the time. Kids who are potty-trained may start wetting the bed. When you’re in the car, kids need to stop every 10 minutes to use the bathroom.
   1. What’s happening: Once your blood sugar is over 180, it spills into your urine. This results in fluid following the sugar into your urine. The result is an increase in your urine output, meaning more bed wetting or frequent trips to the bathroom. 
2. Drinking all the time. This is not just a little thirstier, but a drastic change in the amount your child was drinking. For example, kids may wake up in the middle of the night thirsty and needing to drink. They may also frequently ask for something to drink at school or at home, when they normally would not.
   1. What’s happening: You are getting dehydrated! Since your body is pulling and releasing all of its fluid, it now needs to intake fluids to stay hydrated.
3. Hungry all the time. A child is hungry all the time and eating a lot, but can’t satisfy their hunger. Kids may also start losing weight at this point.
   1. What’s happening: Their body is losing thousands of calories in the urine as it gets rid of sugar, so it’s trying to compensate by taking in food.
4. Nausea/stomach pain
   1. What’s happening: The body’s first source of energy is sugar. So even though there is a lot of sugar in the body, the insulin isn’t processing that sugar correctly. So, the body switches to its second source of energy: fat. When your body breaks down fat, it develops ketones. If you get enough ketones, you can become nauseous or have stomach pain.
5. Diabetic ketoacidosis (DKA). At this point, your child may be throwing up a lot.
   1. What’s happening: The acidity in your body has changed because of the number of ketones it’s producing. A child with diabetes who is having repeated episodes of vomiting is in ketoacidosis until proven otherwise.

Other signs and symptoms include blurred vision, fatigue and irritability. Kids could also have fruity breath if they are making ketones.

What if your child starts showing these symptoms?
If your child is early on in their symptoms (steps 1 through 3), a visit to their pediatrician/primary care doctor is usually enough. The doctor will likely do a urine test and find glucose in the urine. At that point, they may refer your child to a pediatric endocrinologist, a specialist who cares for kids with diabetes and hormone and metabolic disorders.

If your child has experienced the first three symptoms and is nauseous or throwing up, it is probably time for a visit to an emergency department. “Once children start throwing up, it’s a sign they have acid in their blood and that is very dangerous. They could be in diabetic ketoacidosis (DKA) and would require immediate attention.” Dr. Pfeifer says.

What causes type 1 diabetes? Can COVID-19 cause diabetes?
Certain people are essentially predisposed to having type 1 diabetes. They have a dormant (non-active) gene that becomes activated when the body is under some kind of stress. Any kind of virus, like the flu, can be a stressor. Since COVID-19 is a virus, it is possible that COVID-19 could also activate the gene. “So far we haven’t seen any diabetes related to COVID-19 at Dayton Children’s, but any kind of virus that stresses your body could activate diabetes,” Dr. Pfeifer shares.

Are type 1 symptoms ever confused for other illnesses?
Sometimes! If a patient is urinating frequently, it may be thought to be a urinary tract infection (UTI). However, when a urine sample is taken, it won’t have bacteria or any sign of infection, but it will have glucose.

If a child is vomiting, it may be thought to be just a stomach bug. However, a blood test will show signs of diabetes like abnormal electrolytes and an elevated glucose.

Finally, if children are in DKA and at the point of being admitted to the hospital, they may start breathing really fast. Their body is trying to get rid of some of the acid by breathing it out. The first thought may be asthma or another respiratory illness. However, when providers listen to the lungs, there won’t be any wheezing. Again, a blood test will show signs of diabetes.

What if type 1 diabetes is not cared for? How can you as a parent, or as a teen caring for your diabetes, help manage diabetes?
Type 1 diabetes is deadly if not treated appropriately. However, if you do take care of yourself and follow your care team’s plan, people with type 1 diabetes go on to live long, healthy lives. There are also tools now that can help make managing diabetes easier, like pumps and sensors that help track blood sugar and provide insulin when needed.

Dr. Pfeifer emphasizes “You do not have a choice to get diabetes, but you have a choice to take care of it. If you rally around as a family and work together with your diabetes team, we’ll get through this. Each week will get a little easier. We are always here for our patients, whenever you need us, and will walk with you through this journey.”