- School-Aged Child: These children will note that they are very thirsty, going to the bathroom to urinate all the time and having accidents, which is very embarrassing to them. They also exhibit an incredible appetite and want to eat all the time. The caregiver may note that the child actually looks taller and think that he/she is undergoing a growth spurt. In reality, they are simply thinning out and losing weight, giving the appearance of increased stature. These children also may be extremely tired, opt out of play dates, sporting events, and want to sleep. Sometimes, however, these children exhibit no or very few symptoms and diabetes is discovered serondipititously after a routine school physical in which glucose/ketones are found in the urine. Blood glucose should be obtained to confirm the diagnosis. Most of these children have type 1 diabetes. However, sometimes, as we have seen more frequently, more school-aged and adolescent children are being diagnosed with type 2 diabetes. These children usually have a family history, elevated BMI, and in many cases, have a velvety dark rash around their neck, in their arm pits, or in the groin area (intradigenous areas) called acanthosis nigricans. This velvety rash indicates insulin resistance and the child should be checked for the possibility of impaired glucose tolerance or diabetes. Many school aged children are diagnosed after school begins due to virus or other disease exposure which triggers the autoimmune response that destroys the pancreatic islet cells.
- Adolescent and Young Adult: This group is often very busy and will deny that anything is wrong. It is important that they continue all their activities and visit with peers and thus may put off letting the caregivers know that something is amiss. The teen and young adult will often exhibit urinary frequency, increased drinking, increased hunger, weight loss, and extreme fatigue. They may come home from school and go straight to bed, emerging only to eat and go to the bathroom to urinate. Many adolescents think they have developed mononucleosis which prompts a trip to the PCP and an ultimate diagnosis of diabetes. These students also will appear to be taller due to weight loss, which may lead family members to suspect that they are going through a growth spurt. Teenage girls may develop vaginal yeast infections. This is an important clue that should not be ignored. Lastly, puberty may precipitate the onset of diabetes due to presence of pubertal hormones, which contribute to insulin resistance and put further stress on the pancreas to produce insulin. Type 1 and 2 diabetes are both diagnosed in this age group. Acanthosis nigricans is often seen in adolescents with type 2 diabetes. We do see teens that present to our emergency department in Diabetic Ketoacidosis even after a very short duration of symptoms, as well as diagnosis of diabetes in asymptomatic young adults at the routine yearly physical. If the adolescent has no symptoms, it is really difficult to relay the new diagnosis to the very shocked family. Sometimes, the type of diabetes may be misdiagnosed. Young adults may indeed, have type 1 diabetes, but because of their age, are thought to have type 2 diabetes. These young adults are often started on oral medications with worsening of symptoms. Thus, the primary care provider/college health clinic staff must be alert to the fact that type 1 diabetes is a possibility in this age group. Keep in mind that the diagnosis of type 1 diabetes may occur up till around age 45 years.
In summary, common things are commonly. Although diabetes is the second most common chronic disease of childhood (asthma is first), the incidence is only 0.3 percent. It is important to be aware of the signs and symptoms of diabetes in the various age groups to get a quick diagnosis and perhaps avoid diabetic ketoacidosis with a stay in the intensive care unit.
Published On: October 04, 2011