Preston and Chorley Junior Diabetes Group

Diabetes comes from Greek, and it means a siphon. Aretus the Cappadocian, a Greek physician during the second century A.D., named the condition diabainein. He described patients who were passing too much water (polyuria) - like a siphon. The word became "diabetes" from the English adoption of the Medieval Latin diabetes.

In 1675 Thomas Willis added mellitus to the term, although it is commonly referred to simply as diabetes. Mel in Latin means honey; the urine and blood of people with diabetes has excess glucose, and glucose is sweet like honey. Diabetes mellitus could literally mean "siphoning off sweet water".

Diabetes, or to give it its full name, diabetes mellitus, is a condition in which the amount of glucose (sugar) in the blood is too high because the body is unable to use it properly. This is because the body's method of converting glucose into energy is not working as it should. Normally the amount of glucose in our blood is carefully controlled by the hormone insulin. Insulin is made by a gland called the pancreas which lies just behind the stomach. Insulin helps the glucose to enter the cells where it is used as fuel by the body. We obtain glucose from the food that we eat, either from sweet foods or from the digestion of starchy foods such as bread, potatoes, pasta, cereals and rice. Glucose is also made by the liver.  After a meal including these starchy foods, the blood glucose level rises and insulin is released into the blood. When the blood glucose level falls (for example during exercise), the level of insulin falls. Insulin, therefore, plays a vital role in regulating the level of blood glucose and, in particular, in stopping the blood glucose from rising too high.

Children with diabetes have lost the ability to produce insulin because the cells in the pancreas that produce it have been destroyed. Without insulin, the child's body cannot use glucose and the blood glucose level will rise. When this happens, the excess glucose will leak into the urine causing frequent passing of urine and increased thirst. Because the body cannot use glucose, fat is broken down instead, leading to weight loss. Therefore, a child with undiagnosed and untreated diabetes will show symptoms of thirst, frequent trips to the loo, weight loss and tiredness.

Diabetes cannot be cured, but it can be treated. Children with diabetes will have treatment consisting of insulin injections and appropriate diet. The aim of this treatment is to keep the blood glucose level close to the normal range so that the blood glucose is neither too high (hyperglycaemia) nor too low (hypoglycaemia).

All children with diabetes will need injections of insulin. In most cases, children will be on 2 or 4 injections of insulin a day. The injections will be taken at home and or school, before breakfast and other main meals. Injections of insulin are given by means of a pen type device. The injections of insulin will lower the blood glucose level and they need to be balanced with food intake.

Hypoglycaemia means low blood glucose. The possibility of a child having a hypoglycaemia episode (a hypo) is a worry to many people and needs to be treated immediately.

It is important to know what causes hypoglycaemia, how to recognise it and what action to take. The common causes of hypoglycaemia are:

• a missed or delayed meal or snack
• extra exercise (above that normal anticipated)
• too much insulin

It has been noticed that hypoglycaemia may occur more frequently when the weather is very hot or very cold.  Symptoms can include hunger, sweating, drowsiness, pallor, glazed eyes, shaking, mood changes or lack of concentration. How to recognise hypoglycaemia:

• hunger      sweating      drowsiness      pallor/gloomy      glazed eyes      shaking
• mood changes/lack of concentration

Fast acting sugar should be given immediately. This will raise the blood glucose level. It is most important that you do not send a child who is hypo unaccompanied to get sugary food. Always make sure that they are accompanied.

Examples of fast acting sugars are:

• Lucozade      Sugary drink, eg Coke, Fanta (not diet drinks)
• Mini chocolate bar, eg Mars, Milky Way           Fresh fruit juice
• Glucose tablets        Honey or jam                  'Hypo-Stop' - a glucose gel which is available from the medical team.

Hyperglycaemia

Hyperglycaemia – (hyper) - happens when blood glucose levels rise too high. Some of the reasons “hypers” happen are:

• missing an insulin dose or taking too little insulin
• eating more sugary or starchy food than usual
• over-treating a hypo
• stress
• being unwell with an infection.

The symptoms include:

• increased thirst and urination
• headaches
• lethargy/ lack of energy 
• stomach pain.

Children will need to drink lots of sugar-free fluids and may need extra insulin. Tests for ketoacidosis will also need to be completed.

Diabetic ketoacidosis (DKA)

In the short term, consistent high blood glucose levels can lead to a condition called diabetic ketoacidosis (DKA).This happens because there's not enough insulin to allow glucose to enter the cells where it can be used as energy.

The body begins to use stores of fat as an alternative source of energy, and this in turn produces an acidic by-product known as ketones.

Ketones are very harmful and the body will immediately try to get rid of them by excreting them in urine. Consequently, when ketones are present and blood glucose levels are rising, people often become increasingly thirsty as the body tries to flush them out. If the level of ketones in the body continues to rise, ketoacidosis develops (ketoacidosis means acidity of the blood, due to an excess of ketones in the body).

Their harmful effect becomes more apparent, and nausea or vomiting may start. In addition, the skin may become dry, eyesight blurred and breathing deep and rapid.

Unfortunately, because of vomiting, the body becomes even more dehydrated and less efficient at flushing out the ketones, allowing levels to rise even faster. As the level of ketones rise, it may be possible to smell them on the breath - often described as smelling like pear drops or nail varnish. Eventually, if untreated, the level of ketones will continue to rise and, combined with high blood glucose levels, a coma will develop which can be fatal. However, at any of these intermediate stages, ketoacidosis can be treated and damage usually limited. Obviously, the sooner, the better.

Anyone with Type 1 diabetes could develop ketoacidosis.

The high-risk time for developing ketoacidosis is when a person is unwell, as part of the body's response to illness and infection is to release more glucose into the bloodstream, and to stop insulin from working properly. This happens even if the person loses their appetite or goes off food altogether.

During periods of illness, even if you are not eating, insulin is still needed and it is important never to stop taking your insulin. You should do more frequent blood glucose testing. Diabetes UK recommends that you test at least four times a day during periods of illness. Ask your care team for help if you are worried.

Ketones are easily detected by a simple urine or blood test, using strips available on prescription. People with diabetes should test their urine for ketones if their blood glucose is high (usually over 15mmol/l) or if they have any symptoms of ketoacidosis. If an individual discovers high levels of ketones in their urine (the test strips will tell you if levels are high), and especially if their blood glucose levels are high, they should call their doctor or diabetes specialist nurse immediately, or go to their nearest casualty department.

If you need further advice, speak to staff at your local clinic or directly to specialist diabetes staff at your local hospital.