Understand the difference in Type 1 and Type 2 diabetes and the warning signs to watch for in your child.

In the past, diabetes has mainly been associated with adults, but it is actually one of the most common diseases found in school-age children. In 2010, about 215,000 people under the age of 20 had diabetes. Predicting who will get the disease is not easy, but knowing the symptoms and understanding your child’s risk can help you plan for the treatment he or she needs before the disease inflicts any serious harm.

There are two forms of diabetes: Type 1 and Type 2. Type 1 is much more common in children than Type 2, especially in children under age 10. In that age group, only 2 percent of those diagnosed have Type 2, which used to be referred to as adult-onset diabetes. The numbers undergo a shift in the adolescent and teen years, when it is estimated that up to 31 percent of children with diabetes develop the Type 2 variety. Pediatric endocrinologists began recognizing this changing trend in children during the early 1990’s. The challenge was determining how much the incidence has actually increased over the past two decades, versus simply recognizing diabetes as Type 2 rather than the assumed Type 1.

Understanding Type 1 diabetes

The immune system, meant to protect the body from dangerous bacteria and viruses, goes haywire in children with Type 1. Instead of targeting only outside invaders, the immune system starts attacking healthy insulin-producing cells in the pancreas, making it difficult for the body to regulate its glucose (blood sugar) levels.

Because its signs mimic those of other diseases such as the flu and can be slow to progress over months or years, Type 1 diabetes may be overlooked as a diagnosis or difficult for parents to recognize. Typically, the first signs are weight loss, excessive thirst and frequent urination/ bed-wetting. Other possible symptoms include fatigue, lethargy, irritability, sudden vision changes and increased appetite as cells struggle to get the fuel they need. If you notice these symptoms and you think your child might have diabetes, call your doctor immediately. If left untreated, Type 1 diabetes can develop into a serious condition called diabetic ketoacidosis, which causes rapid breathing, a fruity odor on the breath and an altered level of consciousness.

While it is difficult to forecast who will get Type 1 diabetes, there are certain factors that put a child at higher risk. Most notable is a family history of Type 1 diabetes. While the condition occurs in roughly one out of every 300 children, this risk increases if a child has a sibling or parent with the condition. Autoimmune disorders such as celiac disease and thyroid disorders are also associated with Type 1 diabetes. Blood tests can help to predict the occurrence of the disease, but they are not definitive. A negative test today could turn positive in a year or two.

Understanding Type 2 diabetes

Similar to Type 1 diabetes, Type 2 is marked by excessive thirst and frequent urination, and it may or may not be preceded by a period of weight loss. Children with Type 2 diabetes are almost always moderately to severely overweight and often have a darkening of the skin around the neck.

Unlike Type 1, which is triggered by the immune system, Type 2 occurs when the body’s need for insulin exceeds what the pancreas can produce. Puberty (most diagnoses occur around age 13), being overweight or obese, and having a family history of Type 2 diabetes can drive an increased need for insulin. Certain ethnic minorities (African- Americans, Asian/Pacific Islanders, American Indians and Hispanics) are also at increased risk.

Treatment options

Type 1 diabetes must be treated with insulin injections or an insulin pump to avoid diabetic ketoacidosis, which can be fatal if not treated promptly. Type 2 diabetes is treated with a combination of lifestyle intervention (increased physical activity and a weight-neutral or weight loss diet) and medication. Insulin can be utilized, but oral medications may be effective as well. Unfortunately, the safety and effectiveness of most oral medications have not yet been tested in children with Type 2 diabetes.

Ultimately, neither Type 1 nor Type 2 diabetes has been proven reversible. The important thing to understand for both your children and you is that diabetes can be managed effectively with a healthy lifestyle that includes exercise and a nutritious diet low in sugar.

Steven Willi, M.D., is the Medical Director of the Diabetes Center for Children at The children’s Hospital of Philadelphia. Board certified in Pediatrics and Pediatric Endocrinology, he has research interests in Type 1 and Type 2 diabetes and their relationship to premature cardiovascular disease. Dr. Willi has performed a number of physiologic studies in the etiology and characterization of diabetes in children.