Endocronologist (Pediatric) Questions Diabetes

Is diabetic kidney disease common in children?

My daughter has type 1 diabetes, and was diagnosed with it when she was pretty young, like 6 years old. After several years, I finally feel comfortable with her management in treatment. But I'm still nervous about any complications that can happen as a result of her diabetes. Especially with her kidneys because she already had issues with them. Is diabetic kidney disease possible in children?

3 Answers

Any complication is possible at young age if the diabetes is uncontrolled.
Yes, there is an early test to see if kidneys are affected, called microalbumin. If this is up, she needs to be monitored for kidney problems and needs to be on altace which has a protective effect on the kidneys.
Diabetes is the most common metabolic disease. It is characterized by high blood glucose, excessive thirsty, excessive urination, nocturia (waking up at night to urinate or bedwetting) and weight loss. There are two major categories though there are other classes too. The major classes are type 1 and 2. Children have mostly type 1 diabetes, though type 2 diabetes is also catching up. Type type 2 is more common in adults.
Type 1 is an absolute insulin deficiency state. Insulin is important not only to control the blood glucose but also for survival. Type 2 can respond to weight loss, diet, regular physical activity and oral medications. However most type 2 diabetic patients may require Insulin in the long run in order to control the diabetes well.
Your daughter has type 1 diabetes. She needs to be on insulin using different insulin regiments suitable for her in order to control her blood glucose at a disirable range. Reasonable blood glucose range would be 70-140 mg/dl above 50%of the time. That is if you have 10 blood glucose results at least 5 of them should be in range. Good diabetes control would be getting HA1c <8%, ideally <7.5% with out causing frequent low blood glucose.
Insulin management can achieved using Insulin infusion pumps, basal bollus injections, long acting or intermediate acting insulin with Short or fast acting insulin algarythms for food or other combinations.
Any form of insulin combinations would work as long as the patient or the care taker of the diabetes understands the dynamics of insulin action and have reasonable understanding of diabetes.
If diabetes is well controlled complications are less likely to happen. However when diabetes is uncontrolled acute and chronic complications are possible. Acute complications can be due to high or low blood glucose. Diabetic ketoacidosis and seizure are the extreme manifestation of acute complications. Before ketoacidosis one will have the signs of high blood glucose such as excessive urination, thirsty, nocturia etc. And before sizure one would have the signs of low blood glucose such as shaking, hunger, dizziness, lightheadedness, etc.
Chronic complications are mostly eye disease, kidney disease, nerve disease and cardiovascular disease. In uncontrolled diabetes,chronic complications can develope in few years to decades after diagnosis. Those are determined by genetic susceptibility. Some will get it early some late. The key issue is to control the diabetes well. Controlling blood glucose well will prevent the chronic complications of diabetes. Kidney disease, like all chronic complications of diabetes, can start early in the course of diabetes or many years after having uncontrolled diabetes.
Uncontrolled diabetes starts with spilling albumin in the urine called microabuminuria. This will lead to proteinuria. Eventually this may lead to renal insufficiency and renal failure.
If your child is spilling albumin in the urine, you need to control diabetes well (reasonably). And she may need to be on medications called ACE inhibitors, such as Lisinopril and enalpril. She can start small dose of Lisinopril 2.5 mg daily.
Make sure the urine collection is done correctly. No competitive sports for 3 day before the test and repeat the test three times at least one month apart for each test before one establishes the diagnosis of microabuminuria. Once the diagnosis is established correctly you can either work on controlling the diabetes well and repeat the test in three months or start her on medication or you can do both. You should work with your doctor closely. Your doctor's advice is very important.
Good luck