Diabetes is a disease where the individual has an elevated blood sugar due to an insufficiency of insulin a hormone produced by the pancreas. Insulin is key to the regulation of blood sugar or glucose. After a teen has a meal, the food is digested and carbohydrates are metabolized into simpler sugars including glucose. Proteins are metabolized into amino acids. Both glucose and amino acids are absorbed directly from the intestine into the bloodstream resulting in a rise of blood glucose levels. As blood glucose levels rise, signals are sent to the pancreas to release insulin into the bloodstream. Insulin will enable glucose and amino acids to enter the body’s cells where these nutrients are necessary for metabolic functions. As the cells utilize glucose, the blood sugar will drop, and the pancreas reduces the production and release of insulin.
There are two types of diabetes. Type I, previously termed childhood or juvenile diabetes, is the type that adolescents would most probably develop. In this type of diabetes, the beta cells in the pancreas that produce insulin are gradually destroyed, so that eventually no insulin is produced. There are several hypotheses to explain the cause of Type I diabetes. Some researchers feel that in certain genetically susceptible individuals, a viral infection such as mumps may produce a protein that is similar to a pancreatic beta cell protein. The body is tricked into attacking this beta protein as well as the virus and this can lead to destruction of pancreatic beta cells. Others feel that Type I diabetes is a progressive autoimmune process. In this situation, T lymphocytes produce a substance called cytokines that destroy the beta cells in the pancreas. It is not known what triggers the initiation of this autoimmune process, but a genetic predisposition and a viral infection may be key.
Some researchers feel that genetic abnormalities may lead to Type I diabetes. There are at least eighteen genetic locations that have a relationship to Type I diabetes. These locations appear to involve abnormal interactions among normal genes in those individuals who have diabetes. The mechanism of how diabetes develops in these individuals is not fully explained.
Type II previously called adult onset diabetes mellitus is more common than Type 1 diabetes, and it is now diagnosed more frequently in adolescents. Most adolescents with this type of diabetes produce normal or variable amounts of insulin. In this situation, liver and muscle cells resist the action of the insulin. Although insulin attaches to the receptors in the cells, glucose does not enter into the cells; this is termed insulin resistance. Many of the adolescents with Type II diabetes cannot secrete enough insulin to overcome the insulin resistance, and elevated blood glucose levels occur.
Who is likely to develop diabetes?
Type I diabetes usually begins in childhood or adolescence; males and females are equally at risk for this disease. It is predominantly a disease of Caucasians and rare in Japanese, Chinese, Native Americans and certain other peoples. It is not associated with obesity. By age twenty, about 260 per 100,000 late adolescents will have Type I diabetes. Some researchers feel that Type I diabetes is more common in children who were not breast fed, have older mothers or whose mothers have Type I diabetes.
The mode of inheritance for Type I diabetes is unknown. However, there is an increased prevalence for this type of diabetes in brothers or sisters of an individual afflicted with the disease. Type I diabetes is more common in people who have an increased incidence of other autoimmune disorders including Hashimoto’s thyroiditis, Addison’s disease or Grave’s disease. It is also more common in northern European individuals as well as specific Mediterranean groups including Sardinians.
Type II diabetes, in adolescents, usually begins around puberty. It is more common in African-Americans, Hispanic-Americans and Native-Americans. It is strongly associated with obesity. In Type II diabetes, the pancreas continues to produce insulin, although the insulin may be made at lower rates. In addition, the body may have developed insulin resistance so that the body requires more insulin for metabolic needs than that produced.
What are the symptoms of diabetes?
As the beta cells in the pancreas are destroyed, the ability of the pancreas to synthesize insulin diminishes in Type I diabetes. When the insulin production reaches a low point, the blood sugar will rise. When blood sugar is abnormally high, it will pass into the urine through the kidneys and the sugar will bring water along with it. As a result, the teen will urinate more frequently and in larger volumes often arising at night to urinate. This is termed polyuria. Some teens begin to wet the bed. The loss of sugar will also mean the loss of calories in the urine, and the teen will begin to lose a dramatic amount of weight. As a result, the adolescent will become weak, extremely fatigued, very hungry and crave sweet cold drinks. The craving for fluids is termed polydipsia and the craving for food is termed polyphagia. Other symptoms may including apathy and school function issues.
Adolescents with Type I diabetes can present in an emergency condition called diabetic ketoacidosis. This is a life-threatening complication of Type I diabetes. High blood glucose can cause an accelerated breakdown of fats that increases the production of fatty acids. These fatty acids are converted into ketones that are toxic to the body at high levels. A teen with ketoacidosis may have nausea, vomiting, rapid breathing, dehydration and alteration in pulse and blood pressure. Untreated ketoacidosis it can lead to coma and death. Sometimes, the adolescent with new onset and unrecognized diabetes may first present with ketoacidosis.
Type II diabetes has a more graduate and insidious start. This illness may be heralded by a dark coloration to the skin on the back of the neck with a velvety feel.
How is diabetes evaluated?
In a teen who has symptoms suggestive of diabetes, screening tests should be performed. A fasting blood glucose can be ordered to determine the level of blood glucose after eight hours of fasting. If elevated, then the teen may have diabetes. A glucose tolerance test can be done also. In this test, the teen drinks a special glucose solution and the blood glucose is determined in a fasting state as well as periodically up to two or three hours after the drink. An adolescent with diabetes will have elevated blood sugars after the drink. Antibodies against the beta cells and insulin levels may be determined as well as the level of glycosylated hemoglobin, which is elevated in patients with diabetes.
How is diabetes treated?
Most teens with Type I diabetes are hospitalized on diagnosis even if they are in stable condition. The goal of treatment is to keep the blood glucose levels as close to normal as possible since this may prevent diabetic complications. Meticulous control of diabetes requires patient and family education as well as a commitment of time, effort and money.
To keep the blood glucose as close to normal as possible, several doses of insulin are injected by the adolescent into his or her body each day. The teen must do self-monitoring of the glucose in order to determine how much insulin needs to be administered. Usually, a type of insulin is given before each meal as well as an evening injection. The initial teaching for diabetes is done in the hospital. This includes information about the disease, diet, the types of insulin used for treatment, how to give injections and do blood glucose determinations, complications, diabetes and exercise as well as treatments in emergency situations. Family are always involved.
Some adolescents with diabetes are treated with continuous subcutaneous insulin infusion. This allows for meticulous regulation of the blood glucose as well as a more flexible lifestyle. The teen wears a portable insulin infusion device that delivers insulin through a tiny needle that is positioned underneath the skin of the abdomen. The needle is connected by a small catheter to a pump and the needle site is changed at least every other day.
The adolescent with diabetes needs frequent follow up visits with his or her physician. Monitoring for compliance and complications is necessary. Adolescents usually require a multidisciplinary team including a primary care physician, an endocrinologist, dietician, diabetes educator and psychosocial support for optimal care. Given the issues of body image and self-esteem as well as growth and development during adolescence, teens with diabetes may have significant problems with management of their illness. Female adolescents with diabetes may also independently develop an eating disorder. This is extremely serious since proper caloric intake is necessary for good diabetic control. Some data suggest that teenagers with diabetes may have some delay in areas such as ego development or self-esteem. Interestingly, teen diabetics may participate in less risky behaviors related to substance abuse or sex. Young diabetics may also be more prone to depression.
Over the long term, diabetics are prone to complications. These may involve the eye including loss of vision or blindness, kidney failure, early onset of coronary artery disease as well as problems with the peripheral nerves and feet. Meticulous control of blood glucose and compliance are very helpful in preventing complications.
Teens with Type II diabetes will benefit from weight loss and exercise. Drugs such as metformin may be prescribed to raise the amounts of insulin in the blood stream.
How is diabetes prevented?
Since Type I diabetes is an autoimmune process, and the process begins years before the beta-cell destruction is complete, there is a window of opportunity for prevention. Tests for autoantibodies can determine those teens at high risk for Type I diabetes. A number of strategic approaches to prevent diabetes are under investigation at this time. Type II diabetes may be prevented by weight control and exercise.
Related topics:
Academics, bed wetting, blindness, body image, chronic illness, compliance, counseling, depression, exercise, genetic disease, growth and development, kidney disorders, risk-taking, self-esteem, sexuality.
