Recognizing the Signs of Childhood Diabetes — A Silent Threat Every Parent Should Understand

• There are two common types of childhood diabetes: type 1, which can appear in very young children, and type 2, which is increasingly seen in older children with obesity.
• Treatment for childhood diabetes includes insulin injections or oral blood sugar-lowering medication, alongside proper diet and appropriate exercise.
• Diabetes cannot be cured, but it can be managed to minimize symptoms.

1. What is childhood diabetes?
2. Types of childhood diabetes and how they differ
   2.1 Type 1 diabetes
   2.2 Type 2 diabetes
3. How symptoms of childhood diabetes differ by type
4. Risk factors for childhood diabetes
5. The dangers of childhood diabetes and the serious complications if treatment is delayed
6. Warning signs parents should look out for
7. Diagnosis and screening of childhood diabetes
8. Treating childhood diabetes to restore quality of life
9. How parents can care for children with diabetes
10. Can childhood diabetes be prevented?
11. Frequently asked questions
    11.1 When should a child be screened?
    11.2 Are overweight children at risk?
    11.3 How does childhood diabetes differ from adult diabetes?
12. Early treatment to reduce complications and restore quality of life at Samitivej Children’s Hospital

Childhood diabetes is a condition where a child has abnormally high blood sugar levels due to the body’s inability to produce enough insulin or due to insulin resistance.

There are two main types:

2.1. Type 1 diabetes
Type 1 diabetes is the most common form in children. It results from the destruction of pancreatic beta cells due to genetic factors and immune dysfunction, leading to insufficient insulin production. Without insulin, sugar builds up in the blood, increasing the risk of both acute and chronic complications.

2.2. Type 2 diabetes
In this type, the pancreas still produces insulin, but either it’s not enough or the body is resistant to it. Obese children have an increased risk of developing type 2 diabetes.
While type 1 remains the more common form, the rate of type 2 incidence has been rising in recent years alongside the increase in childhood obesity.
 

The symptoms of both type 1 and type 2 diabetes in children are quite similar. Common early signs include:

• Frequent urination: High blood sugar levels cause the kidneys to struggle to reabsorb all the glucose, leading to excess sugar being passed in the urine. This process draws more water from the body, increasing urine volume and frequency. Some children may start wetting the bed again despite having previously gained bladder control. As the body loses more water, children also become increasingly thirsty, with some asking to drink constantly.
• Other symptoms include persistent hunger, eating more than usual yet still losing weight, and feeling tired or weak. If the condition becomes severe, it may lead to diabetic ketoacidosis (DKA)—a serious complication caused by high blood sugar and ketone levels. Children with this condition may experience nausea, vomiting, deep or labored breathing, rapid heartbeat, low blood pressure, confusion, and even loss of consciousness.

Type 1 diabetes typically appears suddenly, making DKA more likely. In contrast, symptoms of type 2 diabetes develop gradually and are more chronic. It is more frequently found in children with obesity and may be accompanied by darkened patches of skin around the neck, armpits, groin, or other body folds.

Childhood diabetes is classified as a multifactorial disorder, meaning it arises from a combination of several contributing factors, including:

• Genetics: If a parent or family member has a history of diabetes, the child has a higher risk of developing the condition.
• Obesity or being overweight: Excess body weight can lead to insulin resistance, increasing the risk of type 2 diabetes in these children.
• Ethnicity: Children of African, Asian or Pacific Islander descent tend to have a higher susceptibility to diabetes.
• Children of mothers who experienced diabetes during pregnancy, or those with a birth weight over 4 kilograms, are at greater risk.
• Unhealthy eating habits: Diets high in carbohydrates and sugars can raise blood sugar levels and contribute to the onset of diabetes.

Type 1 diabetes is considered particularly dangerous in children if diagnosis and treatment are delayed. Without proper blood sugar control, complications can easily arise, such as diabetic retinopathy, skin infections and coronary artery disease.
Type 1 diabetes progresses relatively quickly, and children are often brought to the doctor only after symptoms have become quite severe. Symptoms of type 1 diabetes include:

• Shortness of breath or labored breathing
• Severe headaches
• Dehydration
• Diabetic ketoacidosis (DKA)
• In some cases drowsiness, loss of consciousness or low blood pressure

In contrast, type 2 diabetes develops more gradually. If it is not well managed or remains untreated over a long period, it can lead to complications such as blurred vision from diabetic retinopathy, kidney failure, nerve damage causing numbness in the hands and feet, coronary artery disease, heart failure, or diabetic foot ulcers.

Some symptoms may serve as early warning signs of childhood diabetes. Parents should not ignore any unusual changes and should take their child to see a doctor for screening and proper diagnosis as early as possible. Watch out for the following signs:

• Frequent urination throughout the day, as the body attempts to expel excess sugar.
• Daily bedwetting more than once a night in children aged 5–6 years and older.
• Constant thirst, with children often asking for drinks due to excessive fluid loss from urination.
• Increased appetite without exertion yet still frequently feeling hungry.
• Weight loss despite eating large amounts of food.
• Fatigue, low energy, and difficulty concentrating—caused by the body’s inability to use sugar for energy.
• Frequent skin infections.
• In some girls vaginal infections may occur, with itching, redness, swelling around the genital area, and abnormal discharge.
• In infants or very young children who cannot yet communicate clearly, parents may notice unusually frequent diaper changes due to excessive urination, constant crying from thirst or fatigue, or weight loss.

The methods used to diagnose childhood diabetes are the same as those used for adults:

• Fasting blood sugar test: levels exceeding 126 mg/dL after fasting for at least 8 hours, confirmed on at least two occasions.
• Oral glucose tolerance test: levels exceeding 200 mg/dL two hours after consuming 75 grams of glucose.
• Random blood sugar test: levels exceeding 200 mg/dL without fasting, accompanied by symptoms of diabetes.
• HbA1c test: A result equal to or greater than 6.5%.
• For type 1 diabetes, additional tests may be performed to check for autoimmune markers that attack the pancreas.

Type 1 diabetes in children requires lifelong insulin replacement therapy, typically involving 3-4 insulin injections per day. This is combined with finger-prick blood sugar checks 4-5 times per day (before each of the three main meals and before bedtime). Alternatively, a continuous glucose monitoring system (CGM) can be used to track blood sugar levels in real time, helping maintain better control and reducing the risk of complications.

For type 2 diabetes, treatment usually involves oral medications to lower blood sugar and improve the body's response to insulin. This must be combined with lifestyle changes, such as eating a nutritious, well-balanced diet and engaging in regular physical activity. These changes can significantly improve the child’s overall condition. In more severe cases, the doctor may also recommend insulin injections.

Once a diagnosis is confirmed and a treatment plan is in place for either type of childhood diabetes, parents play a crucial role in helping achieve the main goal of keeping the child’s blood sugar levels within a normal range. Parents should prepare well-balanced meals that provide complete nutrition, while also calculating carbohydrate intake to ensure the correct insulin dosage. Additionally, screen time should be reduced, and children should be encouraged to move more and engage in regular physical activity, as these habits contribute to better overall health and improved blood sugar control.

At present, there is no known way to prevent type 1 diabetes in children. However, type 2 diabetes, which is primarily linked to obesity, can be prevented. Parents should pay close attention to their child’s nutrition, ensuring meals are varied and include all five essential food groups. Foods high in saturated fat and sugar, such as fried foods, fatty snacks, sweets, fast food, and baked goods, should be avoided.

Dietary control should go hand in hand with lifestyle adjustments. Children should not spend excessive time looking at screens. Instead, they should be encouraged to take part in physical activities that help them burn energy. Regular exercise—at least 30 minutes per day—can significantly reduce the risk of developing childhood diabetes.

11.1 When should screening start?
Screening for type 2 diabetes in children is recommended from the age of 10 onwards, especially when certain risk factors are present. These include a family history of diabetes, a mother who had diabetes during pregnancy, a birth weight of 4 kilograms or more, or visible signs of insulin resistance, such as dark patches of skin on the neck or armpits. If more than two of these risk factors are present, screening is strongly advised.

11.2 Are overweight children at risk?
Childhood diabetes is closely linked to overnutrition. Children who are overweight due to unhealthy eating habits are more likely to develop insulin resistance than their peers. This puts extra strain on the pancreas, gradually damaging it over time and causing blood sugar levels to rise, thereby increasing the risk of developing diabetes.

11.3. 11.3 How is childhood diabetes different from adult diabetes?Type 2 diabetes in children is similar to that in adults, as most adult cases are also type 2. However, treatment for children tends to be more complex and detailed, with a higher risk of complications. This is because children generally have more difficulty managing their diet and lifestyle compared to adults.

Childhood diabetes occurs when the pancreas cannot produce enough insulin or when the body becomes resistant to insulin, leading to elevated blood sugar levels. Children with diabetes often experience frequent urination, excessive thirst, and increased appetite with unexplained weight loss. If the condition is left untreated, they also face a high risk of complications.

For effective screening and treatment, Samitivej International Children's Hospital offers dedicated care at the Growth, Endocrine and Diabetes Center. This center focuses on childhood development and hormonal disorders, including diabetes in children and adolescents. Care is provided by a team of specialist pediatricians across departments, including experts in pediatric endocrinology and metabolism, pediatric nutrition, and other pediatric subspecialties to support patients with complications such as diabetic retinopathy and kidney disease, offering peace of mind to both children and their families.

Childhood diabetes is not something to fear. If properly treated and managed, children can go on to live happy and healthy lives, especially if it is diagnosed early. Parents are therefore encouraged to pay close attention to their child’s nutrition and to schedule regular health check-ups to detect diabetes early and ensure optimal control of symptoms.