Medicosnext
Dr. Subhana Thapa Karki
She is senior consultant pediatrician and pediatric endocrinologist(Kanti Children Hospital), Associate Professor of Pediatrics (NAMS) and also the Chair of Endocrine Chapter of NEPAS.
In recent years, diabetes in children has emerged as a rising health concern worldwide, including in Nepal. We don’t have published data on the prevalence of diabetes in children. Once thought to be a condition primarily affecting adults, diabetes, especially Type 1, now increasingly affects children and adolescents. Being a chronic illness, diabetes in early life increases the risk of morbidity thereby impairing physical, mental as well as social development. Early diagnosis, awareness, and appropriate management of Type 1 Diabetes can help to prevent complications associated with diabetes and live healthy and fulfilling lives. Findings of the current 11th edition 2025 Diabetes Atlas confirm that diabetes is one of the fastest-growing global health challenges of the 21st century. It is estimated that over 9.5 million people had type 1 diabetes in 2024, of which 1.9 million were children and adolescents under the age of 20. The total number of people living with diabetes is projected to reach 853 million by 2050.
Type 1 Diabetes (T1D) has become more common in the younger age group in recent times, specifically in the pre-school group. Managing young child with diabetes has a unique set of challenges. The diagnosis of Type 1 Diabetes (T1D) is very distressing for the children with diabetes and the family.
Types of Childhood Diabetes
There are two main types of diabetes seen in children:
1. Type 1 Diabetes Mellitus (T1DM)
This is an autoimmune condition in which the child’s immune system mistakenly attacks the insulin-producing beta cells in the pancreas. As a result, the body produces little or no insulin, a hormone essential for glucose regulation. Type 1 Diabetes is the most common form in children. So, the treatment is insulin, with no role for oral medicines. Dieting and/ or exercise by themselves cannot control Type 1 DM.
2. Type 2 Diabetes Mellitus (T2DM)
Traditionally an adult-onset disease, Type 2 diabetes is now seen in children, especially adolescents with obesity, sedentary lifestyles, and a family history of diabetes. In T2D, insulin production is normal or even supra-normal, at least initially. In genetically susceptible individuals, excess weight, and/ or insufficient physical activity leads to insulin RESISTANCE (IR). This results in increased insulin production, which over time overburdens the β cells and causes β cell loss. In this situation, reducing the burden on the β cells with a healthy diet and regular physical activity, and reducing IR with drugs like metformin, help control BG. Insulin may be needed initially during the phase of glucotoxicity, but the attempt is to discontinue its use as soon as possible.
3. MODY (Maturity onset of Diabetes in Young) is typically detected in adolescents or young adults (< 35y of age), usually with 3 generation history of diabetes, normal C-peptide, negative antibodies, no ketoacidosis, and no signs of insulin resistance
4. Diseases of the pancreas like cystic fibrosis, fibrocalcific pancreatitis
5. Medication induced diabetes, e.g. by steroids, L-Asparaginase, etc.
6. Systemic illnesses: thalassemia major, hemochromatosis
Clinical features of Type 1 Diabetes Mellitus
Early signs of diabetes in children are often subtle and may be overlooked. The classic symptoms include:
– Excessive thirst and frequent urination
– Sudden weight loss despite normal or increased appetite
– Fatigue and weakness
– Blurred vision
– Bedwetting in a previously dry child
– Recurrent infections, including skin or fungal infections
Diabetic ketoacidosis (DKA)
In some cases, children may present with a life-threatening emergency due to severe insulin deficiency, marked by vomiting, abdominal pain, rapid breathing, and altered consciousness. Ketosis causes abdominal pain, vomiting, deep sighing respiration (Kussmaul breathing), drowsiness, and eventually coma and death.
Diagnosis and Treatment
A child suspected of diabetes should be evaluated with blood glucose testing, urine sugar and ketones, and HbA1c. In T1DM, autoantibody testing can help confirm the diagnosis.
Treatment for Type 1 diabetes includes: Daily insulin injections or insulin pump therapy are required for survival. A balanced diet and regular physical activity are essential components.
Treatment For Type 2 diabetes: Lifestyle modifications, Oral medications like metformin, sometimes insulin may be used, depending on severity
The Psychosocial Dimension of Type 1 Diabetes Mellitus
Diabetes affects not just the child but the entire family. Adjusting to insulin regimens, dietary restrictions, and the fear of hypoglycemia can be overwhelming. Children with diabetes may feel “different” or stigmatized. This is where support groups, diabetes education, and counseling play vital roles. Encouraging schools to be diabetes-friendly environments is also essential.
Challenges of Type 1 Diabetes Mellitus in the Nepalese Context
– Limited awareness about diabetes Type 1 among the general public and even healthcare providers can delay diagnosis.
– Lack of access to insulin, glucose monitoring tools, and pediatric endocrinologists in rural areas.
– Cost of care, often out-of-pocket, becomes a barrier for many families.
Despite these challenges, growing advocacy and partnerships—both local and international—are improving access to care and education for diabetic children in Nepal. Recent years have brought significant advances in pediatric diabetes care like Insulin pumps and CGMs (continuous glucose monitoring systems), artificial pancreas systems and emerging research into immunotherapy offer hope for the future.
Diabetes in children, though a lifelong condition, can be effectively managed. With timely diagnosis, proper treatment, family and school support, and broader awareness in society, children with diabetes can thrive just like any other child. As we step into a future of better technology and knowledge, it is our shared responsibility to ensure that no child is left behind in the fight against diabetes. Currently, there is no known way to prevent type 1 diabetes in children. However, research is actively exploring potential strategies to prevent or delay the onset of the disease, particularly in individuals identified as being at high risk.
