Severe Cases of Pediatric Type 1 Diabetes on the Rise

Diabetes written on a chaulkboard

It wasn’t long ago when it was fairly uncommon for pediatric providers at the Children’s Hospital at Dartmouth-Hitchcock’s (CHaD) in Lebanon and Manchester, NH, to diagnose severe cases of new onset Type 1 diabetes. But these cases have noticeably become more frequent during the COVID-19 pandemic.

“Normally we would see a few children each year with severe new onset Type 1 diabetes, and we would take pause,” says Frances Lim-Liberty, MD, Pediatric Endocrinology, CHaD. “These cases have significantly increased during the pandemic and, unfortunately, it’s no longer a surprise.”

Type 1 diabetes is an autoimmune disease, and while still unclear, it’s possibly triggered by a viral infection. More cases of Type 1 diabetes are diagnosed during the fall and winter seasons, when people get sick with colds and the flu. While COVID-19 is also a virus most of the children being diagnosed with Type 1 diabetes are not COVID-19-positive. So, what’s causing the recent increase in cases?

“Parents are keeping their kids away from the hospital and health care appointments because they don’t want the added exposure to COVID-19,” explains Lim-Liberty. “When parents notice symptoms they treat them supportively and wait for them to resolve. When they don’t, they seek medical care but the new onset diabetes cases are more severe when we see them.”

When children have Type 1 diabetes, their pancreatic islet cells—which contain cells that help make the insulin hormone—are actively being destroyed. This insulin attack may be triggered by something like the flu, and it’s unnoticeable until the child is symptomatic. By then, the body doesn’t have enough insulin reserve and the child may need emergency hospitalization to achieve insulin regulation. 

What you need to know

Lim-Liberty stresses the importance of proactively recognizing the most common symptoms of Type 1 diabetes: being thirsty and drinking more, going to the bathroom several times during the night and/or having bedwetting accidents. Other noticeable symptoms may include: increased hunger with weight loss (despite eating more); fatigue; blurry vision and/or yeast infections, diaper rashes and/or thrush.

Emergency care is required if children have rapid breathing, fruity smelling breath, abdominal pain, vomiting and/or confusion. However, most cases of Type 1 diabetes are diagnosed before symptoms become this serious. 

Children are diagnosed through clinical presentation and checking for blood sugar levels or glucose in urine. Providers then determine whether the child requires hospitalization. Families receive teaching to manage insulin and diet requirements when the child goes home.

“It’s important for every kid to eat in a healthy way, but kids with Type 1 diabetes still get to enjoy a cupcake at a birthday party,” says Lim-Liberty. “We ask a lot from them in managing their diabetes, and we really want to make their lives as normal as possible.”

In this video, Lim-Liberty discusses the symptoms of Type 1 diabetes.

Frances Lim-Liberty MD, CHaD pediatric endocrinologist, also serves as co-director, Pediatric Clerkship, director, Medical Student Education in Pediatrics and clinical assistant professor of Pediatrics, Geisel School of Medicine at Dartmouth.