We keep hearing about the increasing incidence of diabetes worldwide and this unfortunate trend is also affecting children. It is important to be aware of this disease since early detection can make all the difference.

The most common signs and symptoms of diabetes are similar regardless of the type of diabetes that you have. When you have diabetes, you basically have too much glucose (a simple sugar) in your blood and not enough in the cells of your body. Glucose is the body’s main source of energy. Insulin is the hormone that is responsible for transporting glucose from the bloodstream into the cells where it can be used for energy production. In type 1 diabetes, the body does not make enough insulin. In type 2 diabetes, the body can make insulin but is resistant to its effect. In both types of diabetes, the end effect is an accumulation of glucose in the bloodstream, and it is this excess glucose in the blood and lack of glucose in the cells that causes the signs and symptoms of diabetes. Some of these symptoms can be very subtle at the onset and diabetes can go undetected for a long time. Other symptoms can seem to appear quite suddenly.

Frequent trips to the bathroom
Does your child seem to be going to the bathroom all the time? Is he getting up at night to make frequent trips to the bathroom? Is she all of a sudden starting to wet the bed again? Or in the case of an infant, are you suddenly using many more diapers and do they always seem to be heavy with urine? Frequent urination is sometimes a consequence of too much glucose in the blood. When there is not enough insulin or the insulin is not working, excess glucose gets filtered out of the body thru the kidneys. The kidneys are overwhelmed with the amount of glucose and draw out water from the blood in order to get rid of the extra glucose. Hence, the frequent urination. When this urine is checked, it will have glucose in it—another sign of diabetes.

Extreme thirst
You might think that the reason your child is making so many frequent trips to the bathroom is because he is always drinking. This thirst seems unquenchable. Again it is all about the glucose in the blood. If the kidney is pulling out water from the blood to get rid of the extra glucose, causing frequent trips to the bathroom, then the body will be dehydrated and will need to replace the lost water. Thus, the unquenchable thirst. This can be quite striking.

Despite drinking constantly, children can have signs and symptoms of severe dehydration such as a dry mouth, sunken eyeballs, weight loss, a lack of tears and even a low blood pressure and yet still be urinating (which is usually another sign of dehydration). This confusing picture is classic of diabetes.

Insatiable hunger and unexplained weight loss
Is your child hungry all the time and yet is getting thinner? These two go hand in hand. We like to say that with diabetes there is starvation amidst plenty. There is so much glucose in the blood, and yet, because it cannot be used, the cells of the body are actually starving. It is no wonder that these children are so hungry. Your child may seem to be eating everything in sight. Despite this, they actually start to lose weight. The weight loss can be very dramatic especially the sicker they get.

This happens because the cells are not getting the glucose they need and the body, in desperation, starts to use up the fat and muscle as an alternative to glucose for energy.

Fatigue or weakness
Glucose is the main source of energy for the body. If the body cannot use glucose, it cannot produce energy. This accounts for the fatigue or weakness that is seen at the onset of this disease. Frequently the child with diabetes has difficulty getting out of bed and out the door. It’s not laziness; they literally just do not have the energy to get this done.

Other signs and symptoms
Frequent infections, especially yeast infections such as thrush in infants or a vaginal yeast infection even in young girls, are another sign of diabetes. In many cases, the infections can be recurrent and go on for a long time before one even suspects the presence of diabetes. Another telltale sign of diabetes in children is a slowdown in growth. If the body cannot produce enough energy, a common casualty is growth. Usually though, this is something that is more commonly seen in retrospect. When a child is diagnosed with diabetes, if you look back at the growth chart you may see that growth has slowed down in the past months. This would be more of a subtle sign. Blurry vision is another sign of diabetes, although this is less common in children compared to adults.

The presence of any of these signs and symptoms should clue you in to the possible presence of diabetes. But it must be remembered that you do not have to have all these signs and symptoms before a diagnosis can be made. In most children that I have seen who have diabetes, the frequent urination and unquenchable thirst are still the most prominent initial signs. Weight loss can be dramatic, especially in type 1 diabetes. Most of them also seem to be tired all the time. All the other signs are much more variable.

In the end, it is most important that the possibility of diabetes be entertained. As mentioned, it is occurring more frequently now even in children. The consequence of a missed diagnosis is that the child may become very sick—sick enough to be admitted to an intensive care unit. In these cases, the children have had the symptoms of frequent urination and extreme thirst for a while and actually come in to the doctor already with significant weight loss, dehydration, and a fruity odor to their breath. These cases can be avoided with increased awareness and early diagnosis. Just remember that children can have diabetes too.

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