The Four T’s of Type 1 Diabetes

The first symptoms of Type 1 diabetes in children are easy to ignore or explain away. A child who lacks the energy he or she once had and who falls asleep during the day might be growing or not getting enough sleep at night. Constant thirst might mean they are dehydrated, and then, naturally, they’re wetting diapers or using the toilet more often.

It’s not uncommon for a child to be seriously ill at the time of diagnosis, presenting in the ER with cramps, vomiting, and fruity or acetone-smelling breath. Still, this can look like a stomach virus or flu. These more dramatic symptoms can quickly progress to confusion, breathing difficulty, loss of consciousness, and death.

No parent wants to imagine their child could have a life-threatening, incurable disease like Type 1 diabetes. Because only five percent of patients with diabetes have Type 1 diabetes, originally known as juvenile diabetes, most people are unfamiliar with early symptoms.

Type 1 diabetes is not related to the poor dietary choices or weight issues often associated with Type 2 diabetes. Unless a parent or caregiver has experience with Type 1 diabetes, they might never consider it a possibility that it could affect their child.  However, according to the American Diabetes Association, there are an estimated 40,000 children and adults diagnosed every year in the United States.

Diabetes occurs when the body is unable to create or use the hormone insulin. Insulin ushers glucose (sugar from the carbohydrates in food) into the body’s cells for energy. A patient with Type 2 diabetes can create insulin, but his or her body is resistant to it. The pancreas must produce much more insulin than normal to get glucose into the cells.

In Type 1 diabetes, the patient’s own immune system attacks the insulin-producing beta cells in the pancreas. Eventually, the body is unable to produce any insulin, and patients must inject insulin or use an insulin pump in order to process glucose.

When the body stops producing insulin, it must use its own reserves (fat) for nourishment. The process results in ketones, an acid that builds up in the body as an unusable waste product. When sufficient insulin is unavailable (before diagnosis), the child will experience increased thirst and need to urinate – the body’s first attempt at flushing out ketones. Fat will quickly metabolize, causing marked weight loss, and the illness will progress as the blood becomes more acidic and damaging to the body.

These are the four classic early-warning signs of Type 1 Diabetes – easily remembered as the Four Ts:
•    Thirst
•    Toilet
•    Tired
•    Thinner

Thirst – Drinking much more than usual, complaining of extreme thirst, gulping drinks, needing to drink throughout the day and night.

Toilet – Going to the bathroom frequently, bedwetting or daytime wetting accidents after toilet training.

Tired – Greatly reduced energy, laying around, napping more than usual, difficulty waking, behavioral changes, dark circles under the eyes.

Thinner – Clothing fitting loosely, hollow cheeks, ribs and backbones visible beneath the skin as the body depletes fat stores for energy.

Type 1 diabetes can strike anyone at any age. However, a genetic history of Type 1, recent illnesses, or other factors can increase a child’s risk.

Pediatricians can perform simple urine and blood tests to measure blood glucose levels and ketones. They are minimally invasive and relatively inexpensive. An early diagnosis of Type 1 diabetes can prevent lasting health repercussions. With proper care and support from a medical team, children with diabetes can live long, active, healthy lives.

Lynn van Lier is a teacher, writer, and mother from Milwaukee, Wisconsin. She has two children, one with Type 1 Diabetes, and she is passionate about diabetes education and advocacy.