Diabetes is a disorder in the body’s ability to break down glucose (blood sugar). It is one of the most common chronic diseases affecting children in developed nations. According to U.S. government health agencies:

• 176,000 Americans under age 21, or 0.22 percent of that age group, have diabetes.
  
  
• One in every 400 to 600 American children and adolescents has type 1 diabetes.
  
  
• About 2 million American adolescents have prediabetes.
  
  
• More than a third of Americans born in 2000 will eventually develop diabetes.

The National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) cautions that data on pediatric diabetes are inadequate. Although authorities generally agree that the prevalence of diabetes in childhood is growing, federal estimates were slightly reduced in 2005 because they were based on five years of data instead of the most recent three years, as was previously done. Improved reliability is expected upon completion of a major five-year project, SEARCH for Diabetes in Youth.

Children can develop both major kinds of diabetes:

• Type 1 diabetes. An autoimmune disease in which the body attacks the beta cells in the pancreas that make insulin. Insulin is a hormone the body needs to use glucose for energy. Type 1 was once called juvenile diabetes because it is often diagnosed at an early age. After diagnosis, several weeks or months may pass before the child requires regular insulin injections. This period of time is called the honeymoon period. After this period the person needs to take insulin regularly.
  
  
• Type 2 diabetes. A metabolic disorder in which the body develops insulin resistance and can no longer use insulin correctly. Over time, the pancreas may become unable to make enough insulin to regulate glucose. Type 2, which accounts for about 90 to 95 percent of diabetes cases, was formerly called adult–onset diabetes because it is often diagnosed in middle age.

Childhood obesity is strongly linked to pediatric type 2 diabetes. Children with type 2 diabetes, especially those who are overweight, can also have high blood pressure and unhealthy levels of cholesterol. Prediabetes generally develops before type 2 diabetes, but diagnosis and treatment of prediabetes can delay or prevent this escalation.

Other pediatric diabetes conditions include:

• Double diabetes. A condition in which people with type 1 diabetes develop insulin resistance, typically because of obesity due to physical inactivity and overeating.
  
  
• Maturity-onset diabetes of the young (MODY). An uncommon hereditary condition that is usually diagnosed in adolescents or young adults.
  
  
• Secondary diabetes. Diabetes caused by another condition or a medical treatment. Causes of secondary diabetes in children can include cystic fibrosis, celiac disease, growth hormone disorders, inherited neuromuscular diseases, insulin resistance syndromes such as ataxia-telangiectasia and leprechaunism, and chromosomal disorders such as Down syndrome, Klinefelter syndrome and Turner syndrome.
  
  
• Autoimmune polyglandular syndrome. A rare group of autoimmune endocrine conditions, often including type 1 diabetes.
  
  
• Wolfram syndrome. A rare hereditary condition that includes insulin-dependent diabetes, problems with vision and hearing, and diabetes insipidus.
  
  
• Persistent hyperinsulinemic hypoglycemia of infancy (PHHI, also called congenital hyperinsulinemia). A genetic disorder involving overproduction of insulin by the pancreas. Though rare, PHHI is nonetheless the leading cause of hypoglycemia in early infancy. Treatment typically includes drugs such as diazoxide and somatostatin and may require a partial pancreatectomy. 
  
  
• Mauriac syndrome (diabetic dwarfism). A rare complication of childhood diabetes that enlarges the liver, delays puberty and limits height.

• Damage to blood vessels (diabetic angiopathy and atherosclerosis)
  
  
• Eye diseases including diabetic retinopathy, glaucoma and cataracts

• Nerve damage (diabetic neuropathy)
  
  
• Kidney disease (diabetic nephropathy)
  
  
• Slow healing of wounds
  
  
• Dehydration, which is especially dangerous in children

These problems can lead to the most traumatic consequences of diabetes, including foot or leg amputation, blindness, chronic kidney failure, heart disease and stroke. Physicians are already noting chronic diabetic complications in some teens with type 2 diabetes.

Research has suggested a high prevalence of microvascular and macrovascular complications (problems with the small and large blood vessels) in young adults who developed type 2 diabetes as children, according to the National Institutes of Health (NIH). The rise of childhood obesity, insulin resistance and diabetes also raises the risk of heart disease.

Recent studies have also linked childhood diabetes to periodontal disease, childhood type 2 diabetes to behavioral and psychiatric disorders, and childhood glucose irregularities to impaired learning and memory.

Pediatric type 2 diabetes was first noted in significant numbers in the 1980s. Studies have found the incidence of type 2 diabetes in children is increasing in the U.S. with the highest rates among members of racial or ethnic minorities. American children with type 2 diabetes typically are overweight or obese, have a family history of the disease and tend to be Hispanic, Native American, black or Asian. Type 1 diabetes, in contrast, is more common in white children, particularly those of Northern European ancestry.

When children are diagnosed with diabetes, it is common for parents to feel overwhelmed or helpless. Children with type 1 diabetes must take insulin by syringe injection or other means several times every day, and children who develop type 2 diabetes must improve their diet and exercise habits. They may also need to take insulin or other medication.

A child’s attitude toward the condition will, to a large extent, reflect the parents’. It is important for parents to approach diabetes management in a matter-of-fact way, so their children do not develop feelings of being inferior or handicapped. Properly managed, diabetes does not have to prevent children from growing, learning, playing and achieving.

For instance, there may be a temptation to be overprotective or overindulgent with a child who has diabetes. As with all children, this can lead to discipline problems, feelings of incompetence and other issues. Many experts suggest that parents love, teach and discipline their children as if diabetes were not a factor.

Learning about diabetes is a crucial factor in being able to control anxiety for parent and child. Both should learn as much as possible by working closely with a certified diabetes educator.