From the Guidelines
Type 1 diabetes in toddlers typically manifests with several distinct symptoms that parents and caregivers should recognize, including polyuria, polydipsia, and polyphagia, often accompanied by unexplained weight loss, irritability, fatigue, and behavioral changes due to fluctuating blood glucose levels, as noted in the most recent guidelines 1. The classic triad of symptoms includes:
- Polyuria (frequent urination)
- Polydipsia (increased thirst)
- Polyphagia (increased hunger) Toddlers may also show signs of dehydration, such as dry mouth, sunken eyes, and decreased tear production. In severe cases, diabetic ketoacidosis can develop, presenting with fruity-smelling breath, vomiting, abdominal pain, rapid breathing, confusion, and potentially life-threatening coma. The symptoms of Type 1 diabetes in toddlers can develop rapidly over days to weeks, though some children show a more gradual onset, and immediate medical attention is essential if these symptoms appear, as prompt diagnosis and insulin therapy are critical to prevent serious complications in this age group, as emphasized in recent standards of care 1. It is essential to consider the unique aspects of care and management of children and adolescents with type 1 diabetes, such as changes in insulin sensitivity related to physical growth and sexual maturation, ability to provide self-care, supervision in the childcare and school environment, neurological vulnerability to hypoglycemia and hyperglycemia in young children, and possible adverse neurocognitive effects of diabetic ketoacidosis (DKA) 1. An interprofessional team trained in pediatric diabetes management and sensitive to the challenges of children and adolescents with type 1 diabetes and their families should provide diabetes-specific care for this population, including diabetes self-management education and support, medical nutrition therapy, and psychosocial/behavioral support, as recommended in the latest guidelines 1.
From the Research
Clinical Manifestations of Type 1 Diabetes Mellitus (T1DM) in Toddlers
- The clinical manifestations of T1DM in toddlers can vary, but common symptoms include polyuria, thirst, and weight loss 2.
- In some cases, toddlers with T1DM may present with diabetic ketoacidosis (DKA), which can be a life-threatening condition if not treated promptly 3.
- Other symptoms that may be observed in toddlers with T1DM include lethargy, dehydration, and abdominal pain 3.
- The diagnosis of T1DM in toddlers can be challenging, and a high index of suspicion is required to make an early diagnosis 3.
Neurological and Behavioral Manifestations
- T1DM can also have neurological and behavioral manifestations, including neurocognitive and behavioral complications, which may present soon after disease onset 4.
- These manifestations may be prominent, but at times subtle, and may not be reported by patients or physicians as related to the diabetes 4.
- The metabolic mechanism for such manifestations has been inconsistent and difficult to interpret in practical clinical care 4.
Laboratory and Instrumental Characteristics
- Laboratory and instrumental characteristics of T1DM in toddlers may include high blood glucose levels, metabolic acidosis, and hyperuricemia 3.
- In some cases, toddlers with T1DM may have evidence of pre-renal azotemia and leukocytosis 3.
- The presence of microalbuminuria and increased serum creatinine levels may indicate early stage diabetic nephropathy 5.
Treatment and Management
- The treatment and management of T1DM in toddlers typically involves insulin therapy, which can be administered via continuous subcutaneous insulin infusion (CSII) or multiple daily injections 6.
- CSII has been shown to be safe and effective in toddlers and children with T1DM, with improvements in glycemic control and reduced frequency of hypoglycemic episodes 6.