Every year in France, nearly 2,300 children “suddenly” become type 1 diabetics before the age of 14, half of whom arrive at the hospital in an emergency. There are, however, symptoms that can be spotted.
It is rare for a newborn child to develop type 1 diabetes in the first weeks of life, i.e. insulin-dependent diabetes requiring daily injections of insulin. In Europe, it is estimated that this happens less than once in every 300,000 births.
Nevertheless, every year in France, nearly 2,300 children “become” suddenly diabetic before the age of 14, according to a study by Public Health France, presented at the annual congress of the French-speaking Society of Diabetology. Above all, half of them arrive at the hospital in an emergency situation due to a lack of earlier diagnosis, according to a survey of 150 paediatric services carried out in 2010 by the association AJD (Aide aux jeunes diabétiques).
There are, however, symptoms that can be spotted, particularly by parents, before it gets to that point. And perhaps to avoid the deaths that still occur every year (from one to six per year!). In reality, the disease has already started long before the child’s condition suddenly worsens.
For several months or years, the child’s own immune system attacked, and destroyed, for no clear reason, the beta cells of the pancreas, which naturally produce insulin. A hormone that our body needs every day to bring sugar (carbohydrate) from food into the cells and store what we need throughout the day.
Urinating and drinking a lot,
a sign that should alert parents to the fact that insulin is a natural part of the diet.
However, this precious source of energy for the body must not remain in excess (hyperglycemia) in the bloodstream for too long, as this can damage arteries, nerves and the retina in particular. This risk is also found with type 2 diabetes (formerly known as adult-onset diabetes), except that in type 2, insulin is present in the body and hyperglycemia results from resistance to its action.
In type 1 diabetes, multiple daily injections of insulin are vital. Otherwise, it is ketoacidosis, where the body draws on fat cells (fat) for energy, leading to weight loss, coma and even death. A well-known symptom for 95% of doctors, according to a 2009 AJD survey of 1,467 general practitioners in seven French cities.
“General practitioners attach a lot of importance to weight loss in the diagnosis of type 1 diabetes, but it is a sign that appears late,” noted the president of the AJD, Prof. Jean-Jacques Robert (Necker Hospital, APHP), who was speaking at the Lille congress. On the other hand, “only 17% of them think of type 1 diabetes in front of a dyspnea of the child (accelerated breathing, editor’s note), whereas it is the sign of a severe ketoacidosis”, he regretted.
One out of four general practitioners is unaware that type 1 diabetes can appear before the age of 2 years.
And while doctors are familiar with the first sign of early onset type 1 diabetes that is polyuro-polydipsia (urinating a lot, drinking a lot), unfortunately it is the parents who do not. In retrospect, however, after the discovery of diabetes, nine out of ten say that they had indeed noticed it, without understanding what was happening. In practice, hyperglycemia leads to intense thirst, while blood sugar, eliminated by the kidneys, takes more water molecules with it, resulting in dehydration that intensifies thirst.
If you have enuresis (bed-wetting), you should always ask yourself if you are starting to develop diabetes. This is true at any age. According to the AJD survey, one in four general practitioners are unaware that type 1 diabetes can develop before the age of two. It is rare, but it is better to check, especially since you only have to dip a strip in the urine to suspect the diagnosis. “Enuresis is a sign that is often present,” says Prof. Robert. From 25% of cases for 10-15 year olds to 70% for those under 5 years old.”
Another trap that complicates the early detection of early onset diabetes is the fact that “in nine out of ten cases, there is no family history of diabetes,” notes Prof. Robert. The child is the first case in the family. This makes it harder to talk about the diagnosis of diabetes when no one else has it.
In presenting the French Public Health study, which shows an incidence (new cases) of 19.1 per 100,000 between 6 months and 14 years (18.7 in girls, 19.6 in boys), Clara Piffaretti highlighted the increase in this crude rate with age groups: “We observe a rate that ranges from 14.2, in 6 months to 4 years, to 23.1 in 10-14 years. And the increase in incidence, calculated between 2010 and 2015 is 3.7% per year, regardless of age and gender.” Figures in line with European data. “On the other hand, we have not found a faster increase in incidence in the 6 month-4 year age group,” she explains.