Childhood diabetes is no longer a condition that can be overlooked as rare or distant. From increasingly younger children being diagnosed to the growing presence of Type 2 diabetes alongside Type 1, doctors are witnessing a significant shift in the way the disease is affecting children and adolescents.
According to UNICEF, diabetes is among the major non-communicable diseases affecting children and adolescents. In India, the challenge is compounded by changing lifestyles, rising obesity, and the emotional burden that often comes with managing a lifelong condition. Yet, early detection, regular monitoring, physical activity, a healthy diet and timely medical intervention can play a crucial role in preventing long-term complications.
To understand how childhood diabetes is changing, the warning signs parents often miss, and the impact of lifestyle and hormonal changes, we spoke to Dr. (Prof.) I.P.S. Kochar, a Senior Consultant Paediatric and Adolescent Endocrinologist and Diabetologist. With expertise in growth disorders, diabetes and premature sexual maturation, he is currently affiliated with Indraprastha Apollo Hospital, New Delhi, and Pushpanjali Medical Centre, Delhi.
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Excerpts from the interview with Dr Kochar
Q1. How is childhood diabetes different from diabetes in adults?
Dr Kochar: There are several differences between childhood and adult diabetes. Childhood diabetes is mainly of three types: Type 1 diabetes, Type 2 diabetes and monogenic diabetes.
Type 2 diabetes in children is somewhat similar to Type 2 diabetes in adults. It can often be managed with medications, and sometimes insulin may also be required. However, Type 1 diabetes requires insulin from the beginning. Children with Type 1 diabetes need insulin injections. Many use a basal-bolus regimen, which involves insulin before meals and longer-acting insulin to maintain blood sugar levels throughout the day and night.
Adults are more commonly managed with oral medications, particularly in Type 2 diabetes. Complications are generally seen more commonly in adults because they may have had diabetes for a longer period. However, when children develop Type 2 diabetes at an early age, complications can also appear earlier.
Then there is monogenic diabetes, which is caused by specific genetic changes. Some babies can develop diabetes within the first six months of life. Another form is called MODY, or Maturity-Onset Diabetes of the Young. These forms involve specific genes, and treatment may involve medication or insulin, depending on the type.
Q2. Are you seeing more cases of diabetes among children today than before?
Doctor: Yes, definitely.
I came back from the UK in 2008. When I initially started practising here, I would see around eight to ten cases in a year. Now, the situation is very different.
Earlier, we would commonly see children between the ages of 10 and 14. Now, I am seeing more toddlers and very young children, two-year-olds, three-year-olds, and four-year-olds. What used to be around 10 or 12 patients a year has now increased to perhaps 80 or 90 patients a year in my practice. Sometimes, I see around 10 newly diagnosed Type 1 diabetes patients in a single month.
One reason could be increased awareness. Parents now understand that if their child is passing a lot of urine, they should consider getting their blood sugar checked. There has also been some improvement in awareness in rural areas, with government initiatives helping people recognise symptoms at the ground and village levels.
We often talk about the four Ts: Toilet, passing urine frequently; Thirst, excessive thirst; Thinness, unexplained weight loss; and Tiredness, unusual fatigue. These symptoms can be warning signs of diabetes.
Q3. What are some early signs of diabetes that parents may be missing?
Doctor: Frequent urination is one of the important signs. Sometimes, parents may dismiss it, thinking the child is passing more urine because of the use of air conditioners or coolers. But an increase in the frequency of urination can occur in both Type 1 and Type 2 diabetes.
The second important sign is increased thirst. The child may want to drink significantly more water than usual.
The third sign is weight loss. Many children with newly diagnosed diabetes begin losing weight.
Another common complaint is unusual tiredness. A child who previously played games without difficulty may suddenly start getting tired very quickly. Parents may attribute this to the heat, weather or some other factor and may not immediately think of diabetes.
These are some of the signs that parents need to be more aware of.
Q4. Can a child look healthy but still be developing insulin resistance or diabetes?
Doctor: Yes. This is more commonly associated with Type 2 diabetes, rather than Type 1.
You may have an overweight or obese child who appears healthy, walks around normally, plays and eats well. However, there may be certain warning signs.
One important sign is dark pigmentation around the neck, under the arms or in other skin folds called acanthosis nigricans. This can be a sign of insulin resistance.
The child may also eat more than usual, drink more than usual, pass urine frequently or get tired more easily. However, these signs may be ignored because the child appears otherwise healthy and active.
Q5. How do puberty and hormonal changes affect insulin resistance?
Doctor: When puberty begins, there is a natural increase in insulin resistance in the body.
The body's insulin may not work as effectively, while the liver may release more glucose into the bloodstream, leading to higher blood sugar levels. This is more commonly associated with Type 2 diabetes, rather than Type 1 diabetes.
In Type 2 diabetes, the pancreas may still produce insulin, sometimes even in higher amounts, but the body's cells do not respond to it effectively. This is known as insulin resistance. There may also be increased glucose production by the liver.
These children may develop signs such as acanthosis nigricans, increased thirst and frequent urination, but these symptoms can be ignored because the child appears healthy. Sometimes, a teacher or family member notices these changes and encourages the parents to consult a doctor.
Q6. If a child is diagnosed with prediabetes, can diabetes still be prevented or reversed?
Doctor: Yes, that is an important question.
A child with signs of insulin resistance, such as a dark, thickened or velvety appearance around the neck, may be at risk of prediabetes. Prediabetes means that the child is not yet diabetic, but their blood sugar levels are higher than normal.
At this stage, lifestyle changes can make a significant difference. The child's weight needs to be managed, and excessive sugar intake should be reduced. However, a child still needs a balanced diet containing carbohydrates, fats, proteins and minerals.
We should reduce excessive sweets and junk food and avoid unhealthy beverages, including sugary and cold drinks. Excessive consumption of packaged juices should also be avoided.
With healthy lifestyle changes, it is possible to improve insulin resistance and prevent progression towards diabetes.
Q7. Beyond diet and obesity, how do sleep, screen time and physical inactivity affect a child's risk of developing diabetes?
Doctor: There are several important lifestyle factors.
First is physical activity. A child should ideally get around 30 to 45 minutes of physical activity or exercise every day. This helps maintain a healthy weight and supports overall health.
Second is nutrition. Children need a balanced diet. There is no need to completely eliminate one particular food group. They need carbohydrates, proteins and fats, but in appropriate proportions.
Third is sleep. A proper sleep pattern is extremely important. If a child stays awake late watching television or using a mobile phone and their sleep routine is disturbed, it can negatively affect their health. Poor sleep can increase the risk of obesity and metabolic problems, including prediabetes.
Fourth is screen time. When children are absorbed in a screen, they may eat more without realising how much they are consuming. Increased screen time is associated with a higher risk of obesity and, consequently, diabetes.