Juvenile Diabetes: Treatment Methods, Coping Tips, Nutrition, and Essential Medical Information

The term "diabetes" is a well-known and common term, but few differentiate between the different types of diabetes. The more common and familiar diabetes is Type 2 diabetes, sometimes mistakenly called "adult diabetes". However, juvenile diabetes is a completely different disease, even though their symptoms and some of their treatment methods are similar.

Currently, in Israel, there are about 50,000 people with juvenile diabetes, about 5,000 of whom are children. Juvenile diabetes accounts for about 10-15 percent of all diabetes cases.

(Not) Pleased to Meet: What is Juvenile Diabetes?

Juvenile diabetes, also known as "Type 1 diabetes" or "insulin-dependent diabetes" is an autoimmune disease, where the body's immune system attacks the beta cells in the pancreas, which are responsible for producing insulin in the body, rendering them useless. This means that the body of a Type 1 diabetic has no insulin at all.

What is insulin, and why is it important? Let's start one step back. To function, the body needs energy. This energy is produced from the carbohydrates and sugars that enter the body. When we eat carbohydrates, they turn into sugars present in the bloodstream. Insulin is the hormone that takes these sugars, turns them into energy, and brings them into the body's cells.

Without insulin, the sugars remain in the bloodstream. When such a condition persists for a long time, two problems arise. First, the high sugar levels in the blood vessels cause various damage to those blood vessels, and at the same time, the body does not receive energy. This is what happens when juvenile diabetes breaks out.

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Why does this happen? The exact cause of the onset of juvenile diabetes is not completely understood. There are various genetic factors that may predict the outbreak of the disease, but these are not the only factors that influence its appearance. For example, people with a close family member who has juvenile diabetes have a higher chance of developing the disease compared to others, but even for identical twins, the probability is no more than 50%. Meanwhile, most people with juvenile diabetes today are the only ones in their family with the condition. In many cases, a trigger is responsible for the actual outbreak of the disease, such as an illness or emotional stress. However, there is still no sure way to predict or prevent the appearance of juvenile diabetes.

Diagnosis: How Do I Know I Have Juvenile Diabetes?

There are several symptoms that may indicate the development of juvenile diabetes. The first symptoms include increased thirst, drinking a lot, and at the same time frequent urination; fatigue and weakness, significant weight loss, nausea, and abdominal pain—but also an increase in appetite, blurred vision, and a fruity odor from the mouth.

About 40% of juvenile diabetes cases are discovered following a condition called "diabetic ketoacidosis" (DKA). This is a situation where blood sugar levels are high for a long time, and the body does not receive enough energy. To produce the necessary energy, the body breaks down fats instead of carbohydrates. The first result is rapid weight loss, but at the same time, a condition is created where the blood becomes acidic, and conduction disturbances develop in the body. In this state, the described symptoms worsen, and additional symptoms like extreme weakness, reddening of the skin, breathing difficulties, vomiting, and sometimes confusion and disorientation are added. This is a life-threatening situation.

The tests conducted to diagnose juvenile diabetes are simple blood and urine tests. High blood glucose levels will be found in the blood, and in cases of ketoacidosis, there will also be disturbances in blood electrolytes. In the urine test, ketones will be found, created due to the prolonged condition of the high sugar levels in the blood.

Contrary to common belief, juvenile diabetes does not appear only during adolescence. The most common ages for the onset of the disease are around ages 4-7 and around adolescence, but the disease can appear at younger or older ages as well.

So I Have Juvenile Diabetes. What Next?

Unlike Type 2 diabetes, which can be treated with diet and various medications, for juvenile diabetes, there is only one treatment: insulin. Because the body produces no insulin at all, it must be introduced into the body artificially.

In fact, until about 100 years ago, Type 1 diabetics would die within weeks to months from the onset of the disease because of diabetic ketoacidosis effects. About 100 years ago, artificial insulin was developed, allowing diabetics to live long and healthy lives.

Insulin is given to the body with a simple subcutaneous injection. There are two main methods of insulin treatment. One is through injections throughout the day, and the other is using an insulin pump.

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With injections, usually, two types of insulin are used. One is short-term, which acts for about two hours after injection. It is used to balance sugar after meals, especially when eating carbohydrates. The second type is long-term, usually given once a day to maintain normal sugar levels throughout the day, as even without eating, the liver produces sugar during the day that needs to be balanced.

With a pump, only short-term insulin is used, and the pump—permanently attached to the body—releases small amounts of insulin throughout the day.

The choice between injections and a pump depends on the patient's balance abilities as well as personal preferences.

The amount of insulin required during the day varies from person to person, necessitating a personal medical prescription. Amounts change according to the patient's age, general medical condition, carbohydrate and fat intake throughout the day, and frequency of physical activity.

The insulin treatment is meant to prevent—or treat—high blood sugar levels (hyperglycemia). However, there is one significant risk: Since insulin is given externally and not produced naturally by the body, there can be too much insulin in the body. This leads to a drop in blood sugar levels (hypoglycemia). Hypoglycemia can be life-threatening immediately because the body needs a basic level of sugar in the blood to function. Symptoms of hypoglycemia include weakness, hand tremors, sudden increased hunger, confusion and disorientation, cold sweat, numbness, etc.

Treatment for juvenile diabetes focuses on maintaining balance—that is, normal blood sugar levels between 70-100 mg/dL. A rise in sugar over 180 mg/dL is considered hyperglycemia and should be treated promptly with additional insulin. However, mild or short-term hyperglycemia is not immediately life-threatening, but in the long term, sustained high blood sugar can cause damage. In contrast, blood sugar levels below 70 mg/dL are considered mild hypoglycemia, and below 50 mg/dL—severe hypoglycemia. A sugar drop can pose an immediate life threat. Therefore, it is crucial for every diabetic to carry sweet drinks, available sugar, or tablets/gels sold in pharmacies, intended to quickly raise blood sugar levels in case of hypoglycemia.

To maintain balance, diabetics need to measure their blood sugar levels throughout the day. The basic test is done by a light prick of the finger to release a small drop of blood, measured by a small manual device that assesses blood sugar levels. Today, more advanced technologies allow continuous sugar monitoring without pricking throughout the day. It involves a sensor attached to the body, similar to a pump, which can be scanned to get the blood sugar level (Flash technology) or provide continuous information to a suitable device or personal phone, with sugar levels measured and updated every minute (CGM). Again, the choice of sugar measurement technology depends on the patient's personal preferences and medical needs. The most advanced technologies today allow the sugar monitor to communicate with the insulin pump, adjusting the insulin levels injected into the body according to blood sugar levels. This technology is called "artificial pancreas," as it mimics the pancreas's activity as closely as possible.

Diabetic women can conceive, give birth, and breastfeed. Insulin treatment has no impact on the fetus. However, maintaining sugar balance is particularly important during pregnancy. High sugars during pregnancy can affect the fetus and cause complications like excessively large fetus (macrosomia) and shoulder dystocia; impaired fetal development and too small a fetus, etc. Many babies of diabetic mothers require sugar infusion or additional nutrition shortly after birth because their bodies, accustomed to high sugar levels, release too much insulin until a new balance is achieved after a few days. However, if the mother is well-balanced, the pregnancy can proceed healthily and without complications.

Nutrition: What Should I Eat If I Have Juvenile Diabetes?

Aside from insulin treatment, diabetics are particularly recommended to maintain a healthy and balanced diet and regular physical activity that helps balance sugar over time. It is especially important to avoid sweet drinks, which quickly raise blood sugar and should be used only in hypoglycemia situations.

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Some recommend diabetics adhere to a low-carb diet (ketogenic diet) that helps balance blood sugar levels and reduce the insulin amounts required throughout the day. High insulin amounts (natural and artificial) are directly linked to weight gain, so it is recommended to reduce carbohydrates throughout the day and prefer a diet composed of whole carbohydrates rather than white flour and the like, and overall—foods with a low glycemic index. The glycemic index indicates the breakdown speed of carbohydrates in the body—low index carbohydrates break down slowly, like whole grain products, fruits (with their dietary fibers), etc., as opposed to high index carbohydrates that break down quickly, like white sugar, white flour, pasta, potatoes, white rice, and more.

It is highly recommended to consult with a dietitian to tailor an accurate personal menu. It is also important to consult with a diabetes specialist about physical activity to adjust the needed insulin levels and prevent sugar drops—or spikes during exertion.

It is important to know that although juvenile diabetes requires a lot of attention every day and throughout the day, by maintaining balance, it is possible to live full and healthy lives and enjoy sports, travels, and almost all activities without restrictions.