You might think of diabetes as being as adult condition but it is becoming increasingly common in children. Currently, it is estimated that it affects one in 700 children and one study, carried out in the Oxford area, suggested that the number is rising by four per cent every year.

It is not clear why this is happening in the case of type 1, insulin dependent, diabetes. But there is growing evidence that the rise in childhood obesity might account for the increase in the number of children with type 2, non-insulin dependant, diabetes.

This form of the condition is more often associated with a later onset, affecting adults over the age of 40.

It is important that parents know about diabetes, and are aware of the what signs and symptoms to look out for. If treated early, and effectively, it is possible to minimise the risk of complications in later life.

What is diabetes? Diabetes is where the amount of glucose in the bloodstream is too high because the body can’t use it properly. Glucose comes from the digestion of starchy foods such as pasta and potatoes, from sugar and other sweet foods and is also produced in the liver. Insulin, a hormone produced by the pancreas, helps glucose to enter the cells where it is used as fuel by the body.

There are two types of diabetes. Type 1 affects children and young people. This type of diabetes means you need insulin injections and diet to control the body’s blood glucose level. It appears before the age of 40 and is different from type 2 diabetes, which is generally controlled by diet alone.

In type 1 diabetes, the insulin producing cells in the pancreas have been destroyed by the body’s immune system, resulting in little or no production of insulin. For some reason, the body fails to recognise these cells as "self" and attacks them. When this happens, the level of glucose in the bloodstream rises dramatically. If untreated, diabetes can be fatal.

What causes a child to develop diabetes? There are no definite answers. We do know that a child can be genetically predisposed to the condition. The inherited genetic code is complex and the genes responsible have not yet been identified but it is thought that at least six genes are involved. However genetic factors are less strong for type 1 diabetes than type 2. Other events have to trigger the process.

There are various theories linking viral infections or even too much milk protein to the onset of type 1 diabetes.

When does it usually appear? Common ages of onset are around six and seven, after starting school, and again at 12 or 13, a time when the body is full of growth hormone which is antagonistic to insulin.

What are the signs and symptoms? The first signs of diabetes are that your child is excessively thirsty, passes a lot of urine and always seems hungry but is not putting on weight.

How is it diagnosed? A simple urine test carried out by your child’s GP will show glucose in the urine. A blood sample is taken to confirm the diagnosis, to assess the level of salt and potassium in the bloodstream and determine whether a child is dehydrated.

What’s the treatment? Children are referred to a specialist diabetic team. This should include a consultant paediatrician with particular expertise in diabetes, a nurse specialising in children’s diabetes, a paediatric dietician and a paediatric clinical psychologist who will liaise closely with your family doctor.

The main aim of treatment is to achieve near normal blood glucose levels. Bringing glucose levels down is not difficult, but once treatment has started it needs to be kept in balance. And maintaining blood glucose levels within an ideal narrow band is a delicate balancing act. It involves checking the child’s blood glucose level at least four times per day by a finger prick test which is easy to carry out using a small machine at home. A drop of blood is squeezed on to a pad and the machine measures the level of glucose present and that then determines the amount of insulin needed. The level of glucose varies enormously depending on what a child has eaten and the amount of exercise taken. It can swing too high or too low very quickly.

A fall in glucose level (hypoglycaemia) causes symptoms such as shakiness, sweating and dizziness. Children learn to recognise these symptoms and the problem is quickly rectified by a sugary drink or snack to increase the blood glucose level. Untreated, a child would lose consciousness.

A child will need to see the team regularly in the weeks and months after diagnosis. Once the whole family feels comfortable managing the condition, clinic visits are usually four times a year.

Is sugar off the menu? No. In fact many parents are surprised to find that their child’s diet isn’t restricted very much. A child needs to eat enough to allow normal growth and development. They should steer away from saturated fat to help avoid heart problems in the future, and be encouraged to eat complex carbohydrates such as pasta.

Sweets can be eaten before exercise when a readily available supply of refined sugar may be needed and can be quickly used. Diabetic sweets, chocolate and cakes aren’t necessary. They have no particular benefit over ordinary products as they often contain the same amount of fat and can have a laxative effect especially in children.

Any complications? These are rare in children and good diabetes control greatly reduces the risk. Damage, if it occurs, will come at a later stage and can include eye problems such as cataracts and blindness, kidney problems and heart disease caused by high blood pressure and peripheral neuropathy which means that the nerves are affected and it is difficult to feel things properly. Feet are particularly at risk.

What research is being carried out? A great deal - much of it focusing on what might trigger diabetes, finding more effective treatments and whether it might be possible to prevent it developing in the future. One idea being tried is to produce pancreatic beta cells, which produce insulin in the pancreas, artificially. Another is a pill which can be taken instead of insulin injections. Pancreatic transplantation is also now possible, although there are substantial risks associated with suppressing the body’s immune system which is necessary in transplantation.

In summary Diabetes in children is on the increase. If your child is excessively thirsty and passing more urine than usual, especially if they’ve recently started school or are in the 12 to 13 age bracket, it is important to rule out diabetes.

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