From the Guidelines
New onset diabetes in a toddler requires immediate medical attention as it is likely Type 1 diabetes, an autoimmune condition where the pancreas fails to produce insulin. The child should be taken to the emergency room or pediatrician immediately for diagnosis and treatment. Initial management typically involves insulin therapy, with multiple daily injections or an insulin pump. The regimen usually includes a long-acting insulin like glargine (0.2-0.4 units/kg/day) and rapid-acting insulin like lispro or aspart (0.1-0.3 units/kg per meal) adjusted based on blood glucose levels 1. Parents must learn blood glucose monitoring (target range 100-180 mg/dL for toddlers and preschoolers), carbohydrate counting, insulin administration, and recognition of hypoglycemia symptoms (shakiness, confusion, sweating) 1. Treatment for hypoglycemia involves giving 15 grams of fast-acting carbohydrates like juice or glucose tablets. The family will need comprehensive diabetes education and regular follow-up with a pediatric endocrinologist. Unlike Type 2 diabetes, Type 1 cannot be managed with oral medications or lifestyle changes alone, as the child's body cannot produce insulin, which is essential for glucose metabolism and cellular energy production. It is essential to note that the management of Type 1 diabetes in toddlers requires careful consideration of their unique needs, including higher blood glucose goals to minimize the risk of hypoglycemia 1. The American Academy of Pediatrics and other organizations emphasize the importance of a team approach to managing Type 1 diabetes in children, including collaboration between pediatricians, pediatric endocrinologists, and other healthcare professionals 1.
From the Research
New Onset Diabetes in Toddlers
- New onset diabetes in toddlers can be a challenging diagnosis, as the symptoms may be nonspecific and similar to those of other illnesses 2, 3, 4, 5, 6.
- Diabetic ketoacidosis (DKA) is a common complication of new onset diabetes in children, and can be life-threatening if not recognized and treated promptly 3, 4, 5, 6.
- The symptoms of DKA include polyuria, polydipsia, nausea, vomiting, abdominal pain, weight loss, severe fatigue, dyspnea, and preceding febrile illness 3, 4, 5.
- The diagnosis of DKA is typically made based on the presence of hyperglycemia, metabolic acidosis, and elevated serum or urine ketones 3, 4, 5.
- Treatment of DKA involves fluid and electrolyte replacement, insulin, treatment of precipitating causes, and close monitoring to adjust therapy and identify complications 3, 4, 5.
Risk of DKA in New Onset Diabetes
- Fifteen to sixty-seven percent of patients with new onset type 1 diabetes mellitus (T1DM) present in DKA 6.
- DKA is the most common cause of diabetes-related deaths in children, mainly due to cerebral edema 6.
- Early recognition of DKA is critical to prevent serious complications and fatal outcomes 6.
- Urgent referral to specialist centers for suspected new onset T1DM/DKA is required 6.
Management of New Onset Diabetes in Toddlers
- The management of new onset diabetes in toddlers requires careful attention to blood glucose levels, insulin replacement therapy, and dietary management 2.
- Regular and ongoing monitoring of blood glucose levels, quarterly measurement of glycated hemoglobin, and management of hyperglycemia and hypoglycemia are essential to prevent long-term complications 2.
- Education and support for families of children with new onset diabetes are critical to ensure successful management of the condition 2.