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Symptoms of type 1 diabetes

Author: Dr Sorin Ioacara, MD, PhD
Last Updated on
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Discover here: List of symptoms of diabetes | The order of onset of symptoms | Frequent urination | Increased consumption of water | Constant hunger | Intense thirst | Dizziness and dehydration | Frequent urination during the night | Bedwetting | Weight loss | Nausea and decreased appetite | Fatigue | Decreased school performance | Visual disturbances | The importance of knowing the symptoms of type 1 diabetes

The signs and symptoms of type 1 diabetes appear and worsen at a much faster rate compared to type 2 diabetes. Type 1 diabetes in children can evolve undiagnosed for some time. The longer the delay of the correct diagnosis, the higher the chances of an onset with diabetic ketoacidosis.

Diabetic ketoacidosis is a formidable complication of diabetes. It can lead to coma and even the death of the patient. Hence how important it is to know the signs and symptoms of diabetes in making an early diagnosis.

List of symptoms of type 1 diabetes

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We will start with a list of the main signs and symptoms of type 1 diabetes. We’ll present them in descending order of importance. Later, we will discuss them in detail, in separate subchapters. The evolution usually spreads over 1-3 weeks, but sometimes it can be extremely fast, in just a few days.

The list of symptoms of type 1 diabetes includes the following:

  1. Frequent and extensive urination
  2. Increased water consumption
  3. Hunger (initially)
  4. Intense thirst
  5. Dizziness and dehydration
  6. Urinating at night
  7. Bed-wetting (enuresis)
  8. Weight loss
  9. Decreased appetite (late)
  10. Fatigue
  11. Decreased school performance
  12. Visual disturbances
  13. Reduced speed of growth in height
  14. Increased suspicion of respiratory and other infections
  15. Nausea
  16. Vomiting
  17. Abdominal pain
  18. Increased frequency and amplitude of breathing
  19. The acetone smell of breath
  20. Marked drowsiness
  21. Coma

The onset order of type 1 diabetes symptoms

"This is the sign you've been looking for" written with neons on a black background.

The main signs and symptoms of type 1 diabetes will be presented in detail in dedicated sections, presented below. In short, it usually starts with noticing that more and more often, the child asks for a drink. Although the focus here is on children, most things are similar in adults.

Although he consumes an increasing amount of water and juices, the child does not seem to get tired. After drinking so much fluid, it looks reasonable to need to go to the bathroom more often. But he also starts going to the toilet during the night. Sometimes, if he sleeps deeper, he can even pee on himself at night.

The appetite initially increases in most cases, which generally pleases the parents. The feeling of hunger reappears surprisingly quickly after the meal. The child, instead of gaining weight from so much food, on the contrary, seems to lose weight.

The addition of ketone bodies to the already excess glucose present in the blood causes nausea. Consequently, there is a significant decrease in appetite. This decrease in appetite is a first sign of gravity, which, ignored, can later lead to vomiting. From this moment on, the onset of diabetic ketoacidosis is imminent and extremely dangerous.

Frequent and extensive urination, including at night

A teenager sits on the floor in the bathroom, next to a toilet with the lid down, with her head resting on the arm.

Increased blood sugar above 180 mg/dl (10 mmol/l) is responsible for the appearance of glucose in the urine (glycosuria). Each molecule of glucose can draw a relatively large amount of water after it. As the concentration of glucose in the urine increases, there is a consecutive phenomenon of acceleration of urinary water loss. As urine production by the kidneys increases, a faster filling of the bladder ensues. The fact that the bladder fills up very quickly will significantly reduce the time between two urinations.

In addition to frequent urination, the patient will also have a much increased 24-hour urine volume. It often exceeds three litres.

What to do about excessive urination?

The first thing to do when you notice an increase in the volume and frequency of urination in your child is to give him enough water to drink. Dehydration that can occur as a result of massive water loss through urine can be extremely dangerous.

If the 24-hour urine volume is high for two consecutive days or if other symptoms suggestive of diabetes are present, you should see your paediatrician immediately for a consultation. This consultation should include the determination of blood glucose (often from the finger) or at least the evaluation of glucose presence in the urine.

Under frequent urination conditions, glucose can be detected in the urine particularly easy. You can use strips readily available at the pharmacy. They change their colour in the presence of glucose. Often, these strips can simultaneously detect other substances in the urine, such as ketone bodies. However, everything might be explained by different situations or conditions, except diabetes.

What are the consequences of these frequent urinations?

The younger the child’s age, the faster he dehydrates in conditions of substantial urinary losses without proper water intake. If dehydration is significant, use rehydration salts (from the pharmacy). You should not use sweet drinks (juices) for rehydration. The reason is that sweetened fluids increase blood sugar and thus increase the passing of glucose into the urine.

Juices, even natural ones (fresh) will significantly increase water loss through frequent urination, in the context of unbalanced diabetes. This will increase dehydration. If the child’s thirst is very high, he should be allowed to drink any amount of water, as needed.

In addition to diabetes, several other conditions could be responsible for frequent urination:

  • urinary tract infection
  • some medicines (diuretics)
  • psychogenic polydipsia
  • pregnancy
  • diabetes insipidus

Urinary tract infection

Urination often associated with urinary tract infection leads to the elimination of a generally small amount of urine, but often. Frequent urination from diabetes differs from urinary tract infection in that a large amount of urine passes each time. Urinary tract infection is additionally associated with burning sensations when urinating, which is not the case with diabetes mellitus alone.

The colour of urine in the case of a urinary tract infection is generally darker compared to that of diabetes. Also, unclear (turbid) urine suggests a urinary tract infection. In unbalanced diabetes, the urine is clear and often diluted. The presence of glucose in the urine dramatically increases the risk of a urinary tract infection. Therefore, the situation must be taken into account when, after a few days of frequent urination, some stinging or burning sensations develop. In this context, the addition of a urinary tract infection is very likely.

Given the generally rapid evolution of symptoms, the child with the onset of diabetes does not usually have a urinary tract infection associated with excess glucose in the urine. If it occurs, however, you should look for risk factors for urinary tract infection in children. There are often various anatomical variants predisposing to urinary tract infection. Many of them are apparent right from the birth.

Medicines

Diuretics help the body eliminate water when needed. This medicines can lead to frequent urination, and in some cases to dehydration. Their use in children is sporadic, for example, in some chronic lung diseases, nephrotic syndrome or heart failure.

If there are no medications that your child takes regularly, then most likely urinating often and a lot is due to diabetes.

Psychogenic polydipsia

Children drink a lot of water compared to adults. At the same time, they eliminate a more substantial amount of water through respiration and perspiration. Sometimes when encouraged by parents or under conditions of unusually persistent stress for several weeks, children may begin to consume a lot of water “on a nervous background.”

Under these conditions, it is reasonable to urinate more often and in larger quantities. Urine will be light in colour, as in the case of diabetes. Restricting access to water for several hours will lead to a significant reduction in urine volume and staining of urine to yellow (initially being discoloured).

However, it is a good idea to take a blood glucose from the finger first to rule out diabetes. In this case, the child will continue to urinate a large volume which can quickly lead to dehydration.

Pregnancy

Although rare, teenage pregnancies are a reality, especially in disadvantaged areas in terms of general education. In the 3rd trimester of pregnancy, the woman will need to go to the bathroom more often because there is a significant external pressure on the bladder. However, the urinary volume is small in this case, and the pregnancy diagnosis is visible.

Increased water consumption

A tiger drinks water from a river

Increased water consumption in a child is most often healthy. It may look too much from an adult’s point of view, but in reality, it is suitable for the child’s particularities. The percentage of water in the body of children is much higher compared to that of adults. At the same time, this percentage of water changes at a very high rate in children. Multiple factors cause either dehydration or hyperhydration. Children become relatively easily dehydrated when they perform a sustained physical effort for several hours. This is especially true if done in high-temperature conditions.

Another common cause of dehydration in children is diarrhoea or vomiting. Rehydration of the child accelerates when using rehydration salts. You may find them in any pharmacy.

What to do when thirst does not pass

A value of over 200 mg/dl (11.1 mmol/l) at any time during the day, accompanied by thirst, dry mouth, high water intake, and frequent urination is highly suggestive for the onset of diabetes. In this situation, You should pay a visit to the emergency room of the nearest hospital. Here the diagnosis is confirmed by collecting a blood glucose from a vein.

The blood glucose meter cannot be used to diagnose diabetes. It is used only for the follow-up of the response to treatment.

In addition to diabetes, high water intake is a common feature of several conditions:

  • diabetes insipidus
  • psychogenic polydipsia
  • diarrhoea or vomiting
  • renal insufficiency
  • heart failure

Diabetes insipidus

Regarding diabetes insipidus, we must first understand that the term diabetes does not mean high blood sugar. Diabetes means urinating often and a lot, especially a lot. The term “mellitus” can be used only in those situations where this urination often and much is due to high blood sugar.

There is a form of diabetes that is not accompanied by high blood sugar. The problem, in this case, is the inability of the body to maintain water in the body. In this case there is a malfunction of the water pipes in the kidneys. In this form of diabetes, the urine is light in colour. Its density is almost similar to that of water.

The fact that urine does not contain glucose has led to the naming of tasteless diabetes (urine related). A term synonymous with lack of taste is “insipid” and hence the name diabetes insipidus. Stopping water intake in a patient with diabetes insipidus will not be followed by a reduction in the amount of urine excreted. Also, there will not be a gradual recolouration of the urine to yellow (its concentration).

The ensuing dehydration is severe and can even be life-threatening. In this case, an emergency presentation to the endocrinologist is required to establish the correct diagnosis and start treatment.

Insufficiency of some organs

Kidney and heart failure are severe conditions. They generally evolve long before increased water consumption occurs. They are usually not suspected in a child who is not already familiar with these conditions.

Increased appetite and constant hunger

A child in a wooden barrel eats an apple with a great pleasure

Hunger is a normal sensation, which occurs in children spontaneously after about 3 hours in preschoolers, 4 hours in the age group 7-10 years and 5-6 hours after reaching the age of 11 years. Appetite can increase under conditions of unusual effort or stress. Hunger becomes pathological when it always reappears after only two hours or does not pass entirely after eating. Polyphagia means the consumption of large amounts of food at short intervals. Another word used in this context is hyperphagia.

The appetite in undiagnosed diabetes

In the presence of diabetes, increased appetite doesn’t correlate with weight gain. On the contrary, weight loss accompanies this increased food intake. Also, there is a feeling of intense thirst, consuming a large amount of water, followed by frequent and high amount urination. This combination of signs and symptoms is highly suggestive for a diagnosis of diabetes.

In the presence of diabetes, the glucose available in the blood cannot enter those cells where the transport is insulin-dependent. Instead, glucose will enter in excess into those cells that can carry glucose without the need for insulin.

The lack of sufficient intracellular glucose fools the centres that control the feeling of hunger and satiety. They will believe that the whole body suffers from the lack of glucose and implicitly from other nutrients. This intensifies the feeling of hunger, aiming to bring more glucose to these centres.

The body’s cells that cannot protect themselves from excessive glucose entry will suffer damages. These lesions will ultimately be responsible for the onset of chronic complications of diabetes.

Among the most common diseases in children, which could be associated with an increase in appetite, we mention:

  • depression
  • unusual stress
  • bulimia
  • hyperthyroidism
  • genetic diseases

Depression

Depression can also occur in children, not just some adults. Family problems can affect the child in totally unexpected ways. This happens even if the parents believe that they have hidden the unpleasant things from the child entirely.

The main symptoms that may suggest the onset of depression in your child are apathy, withdrawal from the group, preferring to be alone. Besides, he can’t decide, and he’s sadder. If there are “dark” thoughts about the calamities that will come, the problem is already severe. A consultation with a psychologist is beneficial in this case.

Most children with mild depression have difficulty concentrating and memorising. In general, they no longer like the things and activities they liked before. On this background, there may be an increase in appetite. Still, occasionally there may be a decrease in appetite. The same can happen under conditions of unusually high stress.

Bulimia

Bulimia is a condition characterized by ingesting large amounts of food without proper physical activity. This does not explain the increased need for calories. Most often, bulimia is a psychological disorder. It mainly affects adolescents, in the context of family and social stress over their usual level of accommodation.

Children affected by bulimia generally have meals at irregular hours and do not want to discuss the topic of food. They cannot control the amount swallowed at a meal. Often these children also associate episodes of induced vomiting after a plentiful meal. Some of them may use laxatives and diuretics. More usually, they try to make amends by temporarily increasing the physical effort.

However, the amount of urine excreted in 24 hours is typical. Children with bulimia tend to gain weight compared to diabetes, where the tendency is to lose weight. Psychological consultation is mandatory, with the participation of the whole family. This is the only way to solve the complex problems that led to this phenomenon.

Thyroid

Hyperthyroidism is a condition of the thyroid gland characterized by an increased production of thyroid hormones. That production may be reasonable for another person, but abnormal compared to the child’s needs at that time. Fortunately, it rarely occurs in children compared to adults. However, when it happens, it must be diagnosed and treated promptly.

Hyperthyroidism is mostly due to Graves’ or Basedow-Graves’ disease. In children it can have some significant negative consequences.

The main symptoms of hyperthyroidism in children are:

  • hyperactivity
  • restless agitation
  • nervousness
  • decreased school performance
  • emotional lability

They appear gradually and ignored for several months. Sometimes the child with hyperthyroidism receives a misdiagnosis of ADHD. The term ADHD means attention deficit hyperactivity disorder.

Undiagnosed, hyperthyroidism can progress to mild weight loss. This weight loss is associated with an increased appetite. Affected patients also describe profuse sweating, hot intolerance and decreased ability to write and draw correctly. Fatigue and frequent stools follow.

In more advanced forms there is difficulty in sustaining physical exertion, especially on the hill (e.g. climbing stairs) and insomnia. Girls have irregular periods. Some children may experience eye pain and double vision. Finger blood sugar is generally normal or at the upper limit of normal.

Hyperthyroidism is not associated with frequent and high amount of urination. Blood TSH and fT4 are initially necessary for diagnosis, followed by an endocrinology consultation.

Thirst does not pass despite increased water consumption

A thirsty girl drinking water from a glass

The feeling of intense thirst is most often normal in children, especially in conditions where they play a lot outside, in a hot environment. Thirst becomes a problem when it cannot be satisfied by increased water intake. If you notice an unusual increase in your child’s need to drink water, beyond a glass every 30-60 minutes, this may be an alarm signal that something is wrong. Diabetes leads to a feeling of thirst through a mechanism common to other conditions, called dehydration.

Why doesn’t thirst pass?

The decrease in the concentration of water in the body stimulates the centre of thirst in the hypothalamus. Consequently, there is an increased desire to drink water. The reason for the decrease in the concentration of water in the body in diabetes is the considerable increase in water loss through urine.

When the child asks for water because he ran and sweated a lot, the amount of urine produced is generally small. This is different from the situation in diabetes, where the urine volume is very high.

The main conditions that can be accompanied by intense thirst in children (in addition to diabetes) are the following:

  • diarrhoea
  • diabetes insipidus
  • Sjögren’s syndrome
  • cystic fibrosis
  • mumps
  • side effect of some drugs
  • smoking

Diarrhoea

Diarrhoea is a mild condition, usually affecting a child 2-3 times a year, but only for 2-3 days. Most often, diarrhoea is due to an intestinal virus. However, there may be other causes, such as bacterial infections, spoiled food, food allergies, hyperthyroidism or even some medications.

Diarrhoea becomes alarming when accompanied by fever, weight loss, stools with a lot of mucus or blood. Fluid loss through the stool can be significant enough sometimes to lead to dehydration, especially in a young child. Stomach pain and nausea that can sometimes accompany more severe diarrhoea can temporarily mask the feeling of thirst or at least temporarily prevent water intake.

The amount of urine excreted cannot be quantified in this situation, which makes it very difficult to suspect the onset of diabetes mellitus associated with diarrhoea. The other signs and symptoms of diabetes will be alarming in this case. Still, a blood sugar from the finger will solve the mystery.

Sjögren’s syndrome

Sjögren’s syndrome is an autoimmune disease in which the immune system recognizes the salivary and tear glands as an infection. Therefore, it decides to destroy them using antibodies. If needed, you can measure the blood concentration of these antibodies. The consequence will be a marked decrease in the function of the salivary and tear glands, leading to dry mouth and lack of tears (dry eyes). Often, the affected child asks for water due to the dry mouth and cries without tears.

Dry mouth and lack of tears occur much less often in Sjögren’s syndrome affecting children than in adults. The child usually has an impairment of sweat secretion, but only on limited areas of the skin. Affected skin areas appear dry, with local lack of sweat. Besides, the child with Sjögren’s syndrome complains of fatigue and does not feel like running.

The amount of urine excreted is high when the child drinks a lot of water. However, the amount of urine becomes small when water is restricted, and the urine does not contain glucose. In diabetes, the amount of urine excreted continues to be high when water is temporarily restricted, and it contains glucose.

Cystic fibrosis

Cystic fibrosis is a doubtful differential diagnosis in a child who complains of intense thirst. The reason is relatively simple. The condition most likely has been known for a long time in those who have it. Cystic fibrosis is a genetic disease, i.e. it is present from birth. In this condition, most of the body’s liquid secretions will contain a minimal amount of water. These secretions become viscous and sticky.

In cystic fibrosis, the mucus produced in the lungs cannot be eliminated and will retain bacteria locally. Chronic cough and repeated lung infections occur. Digestive enzymes can become ineffective, and sweat will contain a lot of salt. The affected child becomes dehydrated more quickly and may ask for more water as a result.

Unfortunately, the lesions that appear on the pancreas can lead to diabetes. Diabetes is associated with cystic fibrosis in up to 50% of cases.

Dizziness and dehydration

A caravan of camels goes through the desert

By dehydration, we mean an abnormal situation in which there is a significant reduction in the water content of the body. It accompanies a lot of diseases, including the onset of type 1 diabetes. Some of them are mild, but unfortunately, some may be severe. Untreated on time, dehydration can become dangerous, especially in young children. Dizziness that accompanies dehydration is an alarm signal. Dehydration can be so advanced that it becomes more dangerous than the disease that led to it.

In most cases, dehydration quickly resolves by increasing the intake of water by mouth. The child should be encouraged to drink plenty of water. It is best to use rehydration salts for children. Sometimes it is necessary to administer water in the form of a saline i.v. infusion. This is essential when oral administration is no longer possible. The feeling of dizziness shows the need for quick hydration, which sometimes implies a saline perfusion.

About 65% of a child’s body is water. The percentage is 70% in infants and 60% in adults. The amount of water that is lost every day and must be replaced by external intake is proportionally higher in children than in adults. Inside the body, water is mostly in the cells. Water located outside the cells represents about 25% of body weight. The higher the muscle mass, the higher the percentage of water found inside the cells.

There are three stages of dehydration:

  1. Mild
  2. Medium
  3. Severe

The symptoms of dehydration depend on how much water has been lost from the body. In a slight dehydration, the loss of fluids leads to a weight loss of less than 5% of the initial weight. It is associated with moderate or rarely severe thirst. The child has a playful mood, a standard heart rate and a pulse that feels strong.

He breathes normally, has bright eyes and tears profusely when he cries. Of course, you shouldn’t do a crying test to find this out. In mild dehydration, the skin fold resulting from squeezing the skin on the abdomen between two fingers returns to normal as soon as the skin is released from the grip. The skin should become stretched again in less than two seconds.

When you press a nail, the white colour that usually appears under it turns red immediately or in less than 2 seconds after you stop applying pressure.

Medium dehydration

Medium dehydration is defined as a fluid loss of 5-10% of body weight. This dehydration is almost invariably associated with intense thirst, dry mouth and fatigue. Besides, there is often a lack of desire for regular activities, including playing. At this stage of dehydration, the child is easily upset by almost anything. Initially, the child doesn’t stand still, always looking for water or juices.

Quite quickly, however, the child becomes apathetic, soft. Young children ask to be taken in their arms if they are walking. The heart starts beating faster and faster, but the pulse feels weaker and weaker at the wrist level. In medium dehydration, there is a slightly increased frequency of breathing, and the eyes slightly deepens in the orbits, without shining. The general look suggests fatigue and drowsiness.

In infants, the fontanelle slightly deepens when you press on the head. In a medium dehydration, the skin fold still takes less than two seconds to return to normal. However, the return is not instantaneous, as usual. The time of capillary recolouration after pressing on a nail takes more than two seconds to return to the original colour. In medium dehydration, the temperature of the skin on the hands and feet begins to drop.

Severe dehydration

In severe dehydration, the child will have a significant fluid loss of over 10% of the initial weight. Weight loss can be quite substantial. The child with severe dehydration has a dry mouth, with whitish deposits on the tongue (fried tongue). There is an intense thirst, he is sleepy, grumpy, whimpering and wants to be left alone. The pulse is speedy, but at the same time very perceptible on palpation.

A sign of high severity is a decrease in heart rate, sometimes below 60-70 beats per minute. This is especially dangerous when the child has been initially tachycardic for some time. In this situation, bradycardia (lowering of the heart rate below normal) signals the imminent loss of consciousness and entry into a coma. In severe dehydration, the respiratory rate increases, and the eyes become deeply clogged in the orbits. Crying, often for no reason, will be without tears.

Mineral losses

Dehydration is not just a waste of water. Significant changes in the level of sodium, potassium, bicarbonate and blood acids accompanies it. Ion imbalance contributes significantly to the severity of the problem. The level of sodium in the blood can drop a lot if the rehydration of the child with diarrhoea comprises only water. This massive decrease in sodium levels can give intense dizziness, which does not go away with anything.

The child can lose a lot of sodium through diarrhoea. Usually, only plain water will enter the mouth in this situation. If the diarrhoea persists long enough, rehydration with water alone will lower the level of sodium in the blood. It does that by diluting it. Dangerously low levels of sodium can lead to cerebral oedema and seizures. Rehydration of the child with diarrhoea should include rehydration salts. These can be easily purchased from any pharmacy. The feeling of dizziness will gradually improve, as the deficiency of water and minerals also resolves.

Dehydration that occurs in diabetes comes along with massive losses of sodium and potassium in the urine. The presence of glucose forces urinary excretion of water and electrolytes (sodium, potassium, chlorine). This phenomenon is called osmotic diuresis. Osmotic means forced by the many particles of a substance that attracts water. The osmotic element in our case is glucose. Diuresis means the production and passes of the urine.

The appearance of ketone bodies

Lack of a minimum amount of insulin will lead to the appearance in the blood of organic acids called ketone bodies. They will consume the bicarbonate (baking soda) from the blood. Consequently, the bicarbonate will gradually have a lower concentration.

Dehydration in diabetes is complex, with multiple changes in blood and cell contents. Therefore, the treatment of severe dehydration that accompanies diabetic ketoacidosis should be done carefully, under medical supervision. This is especially true if the child has started to vomit.

What other causes could explain dehydration?

Dehydration generally occurs through a combination of varying proportions of water loss and decreased water intake. Water loss can increase not only in the urine and digestive tract, but also at the skin level (e.g. fever) or by breathing.

The main causes of dehydration are the following:

  1. Vomiting
    • central nervous system damage (infections, increased intracranial pressure)
    • digestive tract damage (enterocolitis, appendicitis, peritonitis, obstruction, volvulus, hepatitis)
    • endocrine gland damage (diabetic ketoacidosis, congenital small adrenal glands, Addisonian crisis)
    • kidney damage (infections, kidney failure)
  2. Diarrhoea
    • digestive tract damage (gastroenteritis, food intolerance, irritable bowel syndrome, inflammatory bowel disease)
    • endocrine gland damage (excess thyroid hormones, small congenital adrenal glands, Addisonian crisis)
  3. Diabetes
  4. Kidney loss
  5. Extrarenal losses
    • bleeding
    • peritonitis

Repeated urination during the night

A teenager stands in the doorway of his room at night

Plenty of fluid intake before bed is often associated with waking at night and going to the bathroom. Waking up at night to go to the toilet becomes a problem if it happens twice a night, every night. This situation is called nocturia. It differs radically from urinary incontinence during the night. In the case of urinary incontinence, the child wets the bed at night without waking up. The medical term for this problem is enuresis (bedwetting). The reason why diabetes leads to urination at night is due to the filling of the bladder at a very high speed.

Why we urinate at night in diabetes?

During the night, the production of urine decreases a lot, which allows a sleep of 6-9 hours, sometimes even longer. The passage of glucose from the blood into the urine attracts an unusually large amount of water towards urine. This dramatically increases urine flow throughout the day.

In other words, diabetes is a state of constant hyperproduction of urine, regardless of the time of day or night. This is especially noticeable at night, when we are supposed to be able to resist until the morning without going to the bathroom. However, frequent and high amount urination is also present during the day.

Loss of urine fluid in unbalanced diabetes can lead to dehydration. The child begins to drink a lot of water, but this is not enough to quench his intense thirst. These specific symptoms of diabetes should not go unnoticed. Any child with these symptoms should see a doctor immediately.

The main conditions associated with nighttime urination (nocturia) are the following:

  • urinary tract infections
  • renal insufficiency
  • heart failure
  • diabetes insipidus
  • obstructive sleep apnea syndrome

The child urinates on himself (bedwetting)

An upset child is staying upwards in his bed in the morning

The child who learned to ask to go to the bathroom has control over urination. This child has urinary continence. The child who doesn’t feel when he needs to urinate or doesn’t pay attention to this need may urinate on himself. Therefore, he has urinary incontinence, also called enuresis. In a broad sense, bedwetting means that a child pees on himself, whether it happens during the day or night. The trend nowadays is to use this term only for urinary incontinence that occurs during the night.

From now on, the term enuresis means a child who gained control of urination and then lost it at night. Such episodes of enuresis are reasonable if they occur occasionally and do not persist after the age of four years. If the child wakes up at night and goes to the bathroom, the correct medical term is nocturia.

Why does the child pees on himself?

Elevated blood sugar in diabetes is associated with the passage of sugar (glucose) in the urine. Consequently, there is an increase in urine production. During the night, the physiological decrease in urine production can no longer occur as in children without diabetes. The bladder will fill before morning, waking the child to go to the bathroom, a phenomenon called nocturia.

If the sleep is deep or in other particular situations, the child may not wake up to go to the toilet and will pee on himself. This phenomenon is called enuresis. The term nocturnal enuresis is not wrong. It shows that the episode of enuresis occurred at night. Nowadays the term suggests a possible pleonasm because its use tends to restrict to the incidents of nocturnal urinary incontinence.

What other causes of bedwetting could be?

If a child who does not pee on himself at night begins to have such episodes, it does not necessarily mean that it is something disastrous. Sometimes, before taking a significant step forward neurologically and intellectually, some children take a small step back for a few days. Having a little developmental setback is not abnormal, but neither can it be explained. What is certain is that we need to worry if it persists for more than a week. Another indication of severity will be the addition of other signs of diabetes. In the absence of diabetes, enuresis in a child who until then had control of urination at night can be a sign of other diseases such as:

  • urinary infection
  • constipation
  • psychological problems
  • sleep awakening disorder
  • reduced bladder capacity
  • hyperfunctional bladder
  • sleep apnea syndrome

The child loses weight even though he eats a lot

A black and white picture of a skinny child in an open field

Usually, the child’s weight is continuously growing. Weight stagnation is generally healthy if it does not persist for more than 1-2 months. This is only valid until the age of 16-18 years, when the growth ends. Unintentional weight loss is most often pathological. In the particular case of type 1 diabetes in children, weight loss is generally rapid, over 1-2 weeks, and unintentional. Increased appetite and food intake paradoxically accompanies it.

Any unintentional weight loss, accompanied by increased consumption of water, urinating frequently and extensively, including at night, should arouse a very high suspicion of diabetes onset.

Why does the child lose weight in diabetes?

Increasing blood sugar beyond the so-called renal threshold causes glucose to pass into the urine and from there to be eliminated naturally from the body. Each gram of glucose lost in urine is associated with about four calories lost. During the onset of diabetes, a child losses about 400-600 calories per day. He does that through glucose excreted in the urine.

Insulin is an anabolic hormone, merely said it helps to gain weight. Insulin deficiency induces a catabolic state in the body. Very simplistically said it leads to weight loss. Unfortunately, this weight loss is caused by a massive loss of muscle mass, vitamins, minerals and other substances essential for survival.

Unintentional weight loss in a child may suggest many other situations besides diabetes:

  • intestinal parasites
  • celiac disease
  • various infections
  • malnutrition
  • psychological problems
  • exocrine pancreatic insufficiency
  • hyperthyroidism
  • cancer

Decreased appetite accompanied by nausea

An empty white plate with cutlery on it on a pink background

From the beginning, we must mention that the onset of diabetes in children is associated with an initial increase in appetite. It is associated with an increased desire to drink water. Decreased appetite in a child with the onset of diabetes is a sign of seriousness. This is especially true if accompanied by nausea. The appearance of vomiting announces the installation of metabolic ketoacidosis. This is a severe pathological condition given by the presence of excessive amounts of ketone bodies.

Ketone bodies can cause nausea

Ketone bodies appear in the blood of a child who no longer has enough insulin to block their production from fat. The accumulation of ketone bodies in the blood initially leads to cessation of appetite and satiety. Afterwards, a feeling of nausea ensues.

This feeling of nausea does not resolve with the parents’ attempt to offer the child “something good”, sweet. Besides, sweets make the situation even worse. Decreased appetite occurs in diabetes only in the case of a severe metabolic imbalance, usually associated with the onset of diabetic ketoacidosis.

Other pathological conditions other than diabetes in which there is a decrease in appetite are:

  • sore throat
  • fever
  • abdominal pain
  • selective appetite (children want sweets)
  • any acute infection
  • psychological problems

Fatigue, asthenia, not “in the mood”

A teenager rubs his eyes with his hands because of tiredness

Children need at least eight hours of sleep during the night. The physical exertion during the day does not tire the child as much as it exhausts an adult. Children draw energy from play, and systematically preventing a child from spending a lot of time outdoors playing will decrease their ability to exercise. The time allotted for lessons is crucial for the child’s intellectual development. However, his need to move is also essential. A child should spend at least 1.5 hours a day outdoors, playing, where he should perform a medium to vigorous physical effort.

Insulin and lack of energy

Glucose is the primary source of energy in the body. Insulin is the only hormone that helps glucose enter the cells. All other hormones have the effect of decreasing the uptake and use of glucose in the cells and consequently, increasing the blood sugar level.

The appearance of glucose in the urine causes its volume to increase significantly. Decreased insulin availability causes large quantities of glucose to pass in the urine. In fact, besides glucose, a high amount of vitamins, minerals and oligominerals (rare minerals) are also lost. The patient feels how “life is swept away” through the urine.

Gradually, the high blood sugar levels will make regular activities more and more difficult. The child generally remains interested in playing, but it becomes increasingly difficult to persuade him to do other (i.e. household) tasks. The onset of ketoacidosis in conditions of very high insulin deficiency is associated with a marked reduction in exercise capacity, apathy, and lack of interest in the things he liked before. These symptoms are in addition to the traditional ones (intense thirst, excessive consumption of water, frequent and high amount urination) and signal the onset of diabetes (or its severe imbalance).

Chronic fatigue can occur in several conditions, in addition to diabetes, such as:

  • common cold
  • anemia
  • fever
  • celiac disease
  • psychological problems

Decreased school performance

A little girl is doing homework at a table

Attention and concentration are maximal when blood glucose ranges from 90 to 150 mg/dl (5-8.3 mmol/l). For values below 80 mg/dl (4.4 mmol/l) and above 180 mg/dl (10 mmol/l), intellectual performance begins to decline sharply, with an evident collapse at values below 70 mg/dl (3.9 mmol/l) or above 250 mg/dl (13.9 mmol/l). The child’s mood is also sensitive to blood sugar fluctuations. Blood glucose values exceeding 250 mg/dl (13.9 mmol/l) may initially induce a state of “lack of mood” associated with irritability, nervousness, and later apathy. The disorders associated with hyperglycemia may also contribute to this situation.

Teachers notice when a student loses interest in class and tend to “correct” them. The child with unbalanced diabetes (e.g. at onset) does not raise his hand in class as often as he did before. Subsequent indulgence of teachers when they will make usual mistakes will inevitably decrease.

Causes of inattention in diabetes

Sometimes the child may not pay attention to the class because he needs to go to the bathroom and count the minutes until he can do that. In general, the child will not ask for permission to go to the toilet during class. Most often he is afraid to repeat this demand, but sometimes he is just “lazy”, apathetic.

The loss of vitamins in the urine is very high in these children and must be carefully corrected. Among the symptoms of diabetes, a vital contributor can be the dehydration. Still, increased water intake does not usually improve the situation.

Decreased school performance may also occur in other situations such as:

  • psychological problems
  • inappropriate surroundings
  • celiac disease
  • anemia

Visual disturbances

A pair of eyeglasses held in the air on the street, looking through them, on a blurred background

Visual disturbances refer to blurred, foggy vision. It manifests most often by difficulties in reading a book written with relatively small font. Vision disorders in the child can induce a feeling of dizziness and rapid fatigue when the child begins to read a book. The parent can misinterpret this as a deliberate avoidance of the child’s reading activity. Sometimes the child may say that he does not want to read because reading gives him “headaches”. These symptoms should not go unnoticed by the parent.

An ophthalmological consultation is relatively simple to perform. It can quickly solve a simple problem or highlight a more complex issue.

The eye crystalline lens

The eye crystalline lens is essentially a magnifying glass with the ability to change its magnifying power. It is located in the middle of the eye. The role of the lens is to ensure precise image formation on the retina. The increase in blood sugar is associated with a significant increase in the concentration of glucose in the crystalline lens. Glucose draws water after it into the lens, which will swell, becoming more bulging.

Its ability to change its magnification (curvature) decreases significantly. As a result, the clarity of the image that forms on the retina drops and blurred vision occurs.

Insulin therapy and visual disturbances

The start of insulin treatment after the diagnosis of type 1 diabetes in children is associated with a significant decrease in glycemic values. Excess glucose in the lens will come out of it along with a certain amount of water, which can no longer stay in the lens.

The curvature of the decreases. Consequently, there is a significant change in its diopters. When hyperglycemia persists for a longer time (i.e. one month), the eye partially readjusts to the new situation. The vision becomes somewhat clearer, even in the conditions of an excessively convex lens.

The outflow of water from the lens (it runs after glucose) will quickly change the curvature of the crystalline lens. The vision may become blurred for this reason. After 1-4 weeks, the eye readjusts to the new blood glucose, obtained under insulin therapy. The eyesight thus becomes clear again.

Do not consult an ophthalmologist to determine the diopters of the glasses during a period of sudden increase or decrease in blood sugar. The reason is that those diopters will only be valid for a few days.

After a few days of clear vision using glasses with the diopters set during this period, the eyesight will become blurred again because the diopters have changed. Wait at least four weeks after starting insulin therapy to see if vision correction needs glasses. After a period of glycemic stability, you may consult an ophthalmologist to set the correction diopters eventually.

When should we worry about blurred vision?

If the child is not very tired, any difficulty reported by him in the reading activity must be taken seriously by the parent. Ophthalmological examination is relatively easy to access. It can quickly reassure you that there is no problem or on the contrary, it can highlight an eye problem.

The vast majority of eye problems in children relate to simple refractive errors. The only consequence, in this case, is the need to wear glasses. Children should not use contact lenses. Other symptoms of diabetes almost always accompany a foggy vision associated with hyperglycemia.

The main conditions, other than diabetes, that could cause vision problems are the following:

  • diabetic retinopathy
  • hypoglycemia
  • glaucoma
  • cataract
  • some drugs
  • migraine

Vision disorders from the onset of diabetes in children are not a consequence of diabetic retinopathy, which is a chronic complication. It takes at least three years for diabetic retinopathy to appear. After retinopathy develops, it goes for decades without any symptoms.

Vision disorders can also occur in diabetes due to hypoglycemia. At the time of onset, this is not the case because the child doesn’t have a hypoglycaemic treatment yet.

The importance of knowing the symptoms of type 1 diabetes

Ignoring the signs and symptoms of diabetes can significantly delay the correct diagnosis. Consequently, the start of a specific treatment is also postponed. In some cases, the child ends up feeling so bad that he loses consciousness. Parents will call for an ambulance seeking urgent medical attention. At the hospital, the parents will discuss the symptoms of diabetes with the diabetologist. On this occasion, they will describe the presence of symptoms and acknowledge that they ignored them for more than two weeks. Then follows the usual discussions on the topic “if I had known …”, immediately followed by “Is this our fault?”.

It’s no one’s fault. It’s just a chain of consequences that started a long time ago, maybe even years. However, knowing the signs and symptoms of diabetes is of great value to avoid the ketoacidosis at diabetes onset in children. Parents who know the signs of diabetes will use this knowledge not only for their own family, but also to signal a possible problem to others, outside the family. When they notice something “suspicious” for them, but overlooked by those affected, a knowledgeable person can make the difference.

The symptoms of type 1 diabetes appear not only at the onset of diabetes, but also whenever the diabetes becomes significantly uncontrolled. However, the roots of type 1 diabetes differ from the causes of the symptoms. Persistence of high blood sugar for several hours can lead to almost any combination of signs and symptoms of diabetes.

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