Pediatric Type 1 Diabetes

Type 1 diabetes is an autoimmune disease in which pancreatic beta cells are destroyed. The child therefore has an absolute insulin deficiency: glucose remains in the bloodstream but cannot enter insulin-dependent cells effectively for energy. The body responds as though it is starving despite high blood glucose. It breaks down fat and muscle, causing weight loss and producing ketones. At the same time, excess glucose pulls water into the urine. Polyuria, dehydration, thirst, fatigue, and blurred vision all follow from that osmotic diuresis. Basal insulin prevents ketone production between meals and overnight. Prandial insulin manages the glucose rise from food. A child with type 1 diabetes needs both; giving only meal insulin leaves a gap in insulin coverage that can permit ketosis even when the child is not eating. Type 1 diabetes can occur at any body size. Obesity or acanthosis nigricans may suggest insulin resistance and type 2 diabetes, but neither finding excludes type 1 diabetes. In a child with weight loss, polyuria, thirst, and ketones, presume insulin deficiency until assessment proves otherwise.