What is diabetes?

Diabetes mellitus is a condition caused by a lack of the hormone insulin in the body or resistance to its effects. The effect of insulin in the body is to control levels of sugar in the blood. Insulin is produced when a rise in blood sugar is detected, insulin acts on cells to make them mop up glucose from the blood, so reducing blood sugar level. Insulin acts with other hormones to keep steady glucose levels in the blood between meals and to smooth out rises associated with absorbing glucose into the blood when eating and drinking. If the blood sugar is too low this is called hypoglycaemia. If blood sugar is too high this is called hyperglycaemia. Both states cause unpleasant symptoms and can become life threatening if untreated. Hyperglycaemia due to lack of insulin is the hallmark of diabetes mellitus. Hyperglycaemia causes coma and death if untreated. The treatment is insulin to reduce blood sugar levels to normal limits.

Type 1 Diabetes

This is the commonest type of diabetes in children and is caused by lack of insulin due to destruction of the cells in the pancreas that make insulin. In the past this type of diabetes was called Insulin Dependent Diabetes Mellitus (IDDM). Daily treatment with insulin is required to prevent hyperglycaemia in the short term and in the long term the known complications of diabetes related to poor blood sugar or ‘glycaemic’ control. Insulin cannot be taken by mouth because digestive enzymes would break it down before it had a chance to work. Insulin must be given by injection.

Type 2 diabetes

This is the second type of diabetes and was formerly called Non insulin dependent diabetes (NIDDM). It is not caused by a lack of insulin but by resistance of body cells to insulin. Normal or sometimes raised levels of insulin in the body do not control blood sugar levels in the usual way and blood sugar levels will be higher than normal for much of the time, this is called ‘insulin resistance’. Without treatment this condition leads to rapid onset of the longer term complications of diabetes but is less likely to result in hyperglycaemic coma and death. This condition was unknown in children until recent years but is becoming more common, particularly related to obesity in teenagers. This type of diabetes can be treated with oral medication and or insulin injections. Another name that might be used for Type 2 diabetes in children is Maturity-onset diabetes of the young (MODY).

What is the incidence of diabetes in children?

Diabetes is a rare condition in the UK. Type 1 diabetes is the most common type. This has an incidence rate of 13.5 children per 100 000 per year. 25% of children with new onset diabetes are under 5 years old. Diabetes is treatable but not curable and so more children in older age groups have diabetes than children in younger age groups. The UK prevalence of type 2 diabetes is much lower than type1. Children with type 2 diabetes are likely to be overweight, female and from an ethnic minority group.