American Medical Association Family Medical Guide - American Medical Association [604]
Children and Diabetes
Having a chronic illness such as diabetes can be especially difficult for children and can present challenges to their parents and caregivers. Young children may not understand why they must stick to a special diet and can’t have candy and soft drinks like other kids. But parents and caregivers need to be firm and consistent in enforcing the child’s diet. Many teenagers go through periods of rebellion, and teenagers with diabetes may react against the restrictions the disease imposes on them. In this case, it is essential to consult a psychiatrist or counselor who can work with the teen to help him or her cope with the emotional and social ramifications of having a chronic disease and to encourage him or her to regain control over it.
Symptoms
The symptoms of type 1 diabetes usually develop rapidly, within weeks or months. See your doctor right away if you have any of the following symptoms:
• Unusually frequent urination, sometimes as often as every hour or so, throughout the day and night.
• Unusual thirst from excessive loss of fluid; drinking sweetened beverages increases urination and makes the thirst worse.
• Fatigue, weakness, and apathy that can make it hard to get up in the morning.
• Significant weight loss, especially in children and young adults, because fat and muscle are burned for energy, and the glucose lost in urine is a major source of calories.
• Tingling in the hands and feet.
• Reduced resistance to infections, especially boils and vaginal yeast infections (see page 880). Bladder infections and other urinary tract problems can develop from bacteria that are attracted to the glucose in the urine.
• Blurred vision resulting from excess glucose in the fluid of the eye.
• Erection problems (see page 486) in men and absence of menstrual periods (see page 846) in women.
Diagnosis
If you have symptoms of diabetes, your doctor will ask you for a urine sample to test for glucose and ketones; their presence in the urine indicates that you probably have diabetes. If only glucose is present in your urine, your doctor will ask for a blood sample to measure the amount of glucose in your bloodstream. A blood glucose test (see page 895) is necessary for a diagnosis because you can have some glucose in your urine without having diabetes. A diagnosis of diabetes is made if the blood glucose level is 126 milligrams per deciliter (mg/dL) or higher.
Long-Term Complications of Diabetes
When uncontrolled, both forms of diabetes can have long-term consequences, damaging blood vessels, kidneys, and nerves. The best ways to avoid the following serious complications are to keep your blood glucose level in a healthy range and to see your doctor regularly—even when you feel fine.
• Heart disease The changes in the body’s chemistry brought on by an elevated glucose or insulin level can lead to the buildup of fatty deposits inside the arteries (atherosclerosis; see page 557). These changes can also make the blood clot more easily, leading to the formation of blood clots that can block blood flow and cause a heart attack or stroke. High blood pressure linked to diabetes can also lead to heart disease and stroke.
• Nerve damage An elevated level of glucose reduces the ability of nerves to carry messages to various parts of the body, including the feet and legs, bladder, digestive system, and reproductive system. Depending on the tissues affected, nerve damage (neuropathy) can cause symptoms that include loss of feeling; muscle weakness; tingling, burning, or jabbing sensations; vomiting; frequent bladder infections; and sexual problems.
• Peripheral vascular disease An elevated glucose level can cause narrowing of the blood vessels that deliver blood to the feet