Dr. Greene, with a new diabetic child, I wonder why yeast infections are not
included in the symptoms of onset -- especially in young infants and children?
Parents I speak with (and my own daughter) first presented with yeast that
was not resolving. She was 3 and potty trained and no one ruled out DM. Most
parents I talk with had yeast, even boys. I was alarmed that my pediatric team
did not consider this and it is not mentioned anywhere in public info pamphlets
in what you should know about diabetes, because most kids are going into diabetic
crisis before intervention. What do you think?
DR. ALAN GREENE:
Timbo, I'm so glad you have raised this issue. There are indeed early ways
to detect diabetes, but most children with type 1 diabetes are not diagnosed
until the situation has become desperate. The diabetes symptoms that most people
are familiar with (increased thirst and increased urination) are very late
warning signs. By then, the child is dangerously close to the end, unless she
receives prompt treatment.
Diabetes develops slowly
Diabetes is a slow process that may have begun as long as nine years earlier
- with no one suspecting.
People who get type 1 diabetes were born with a genetic predisposition to
it. Not everyone born with this predisposition gets diabetes, however. In fact,
if an identical twin has diabetes, the other twin gets it only about half the
time. Along the way, some of the predisposed individuals are exposed to something
in the environment that triggers the diabetes. This is usually a viral infection.
The virus misleads the body's immune system into making antibodies against
its own pancreas cells that make insulin. (This is why type 1 diabetes is now
also called immune-mediated diabetes.)
Type 1 diabetes most often strikes young people, especially between the ages
of 5 and 7 (when viruses run through the schools), or at the time of puberty
(when so many hormones change). For this reason, it used to be called juvenile-onset
diabetes. This term has now been eliminated, since we now know that it can
appear at any age.
Normally, a hormone called insulin pushes sugar from the blood into the body's
cells where it can be used for fuel. This insulin is produced in the pancreas.
Diabetes is an attack on the pancreas.
When diabetes first begins, the insulin-producing cells of the pancreas are
destroyed gradually over months or years. The remaining cells are able to compensate
for this by increasing their insulin production. The body can still make enough
insulin to keep the concentration of sugar in the blood within a fairly narrow
Diabetes is usually diagnosed soon
after symptoms appear
When 90% of the insulin-producing cells have been destroyed, the person suddenly
begins to develop symptoms. Thus, type 1 diabetes generally brews for years,
but appears abruptly. Once symptoms appear, it rarely goes undiagnosed for
more than a few weeks.
The classic symptoms of type 1 diabetes are increased urination (polyuria),
increased thirst (polydipsia), increased eating (polyphagia) and weight loss.
Anyone with the classic symptoms should have a blood sugar test as well as
a urine test. Occasionally people also report fatigue, blurred vision, vomiting,
abdominal pain, or frequent skin infections. If the disease remains undiagnosed,
symptoms progress to include labored breathing, coma, and death.
How much better it would be to diagnose diabetes long before everything is
out of control! As you have pointed out, Timbo, chronic yeast infections (or
other skin infections) can be an early warning sign. Healthy kids in diapers
commonly get yeast diaper rashes. But if these infections are very frequent,
or not easy to clear up with appropriate treatment, I get concerned. If a child
is out of diapers, I prefer checking a fasting blood sugar after only one yeast
infection, especially if there is a family history of diabetes.
Other tests are available for even earlier detection of the diabetes process.
People with type 1 diabetes have measurable antibodies in their blood that
reveal their autoimmune condition. One autoantibody found in people with type
1 diabetes is the islet cell antibody. This antibody is often detectable months
or years before symptoms appear. Other antibodies include the ICA 512 antibody
and the GAD (or 64-K) antibody. The presence of these antibodies is a sign
that the body is attacking its own insulin-producing cells. I expect that testing
for autoantibodies will get less expensive and more common over the next several
An intriguing study released in October 1999 showed that by measuring the
number of autoantibodies in siblings of children with diabetes, they were able
to predict the risk each of these siblings had for going on to develop diabetes.
They were even able to predict how long it would be likely to take.
Clearly this is useful information. It will become especially powerful when
we find ways to prevent the autoantibodies from completing their destructive
My hope is that in this next century, most diseases -- from cancer to diabetes
to the common cold -- will no longer be thought of as beginning when we first
notice the symptoms. As we are able to detect the true beginnings of these
processes, we will be far more able to prevent and treat diseases before they
wreak mayhem and destruction in our bodies.
Alan Greene, M.D. earned a Bachelor's degree from Princeton University
and graduated from medical school at University of California at San Francisco.
Upon completion of his pediatric residency program at Children's Hospital
Medical Center of Northern California in 1993, he served as Chief Resident.
During his Chief year, Dr. Greene passed the pediatric boards in the top
5% of the nation.
Dr. Greene entered primary care pediatrics in January 1993. He is on the
Clinical Faculty at Stanford University School of Medicine where he sees
patients and teaches Residents. He serves as the Chief Medical Officer of
A.D.A.M., Inc., a leading provider of consumer health information, and helps
direct A.D.AM.'s editorial process. As A.D.A.M.'s CMO, he served as a founding
member of Hi-Ethics (Health Internet Ethics) and helped URAC develop its
standards for eHealth accreditation. He is also the Founder & CEO of
DrGreene.com. Dr. Greene was also named Intel's Internet Health Hero for
children's health. He is an author, medical expert, and a media personality.
He is the author of The Parent's Complete Guide to Ear Infections (People's
Medical Society, 1997). Dr. Greene has appeared in numerous publications
including the Wall Street Journal, Parenting, Parent, Child, American Baby,
Baby Talk, Working Mother, Better Home's & Gardens, and Reader's Digest.
He also appears frequently on television and radio shows as a medical expert.
Eisenbarth GS. Immunogenetics/immunopathogenesis of type 1a diabetes. Ann
N Y AcadSciences Online. November 2004:109-118.
Ludvigsson J. Why diabetes incidence increases -- a unifying theory. Ann
N Y Acad Sciences Online. October 2006:374-382.
Review Date: 5/10/2007
Reviewed By: Robert Hurd, MD, Professor of Endocrinology, Department of Biology, Xavier University, Cincinnati, OH. Review provided by VeriMed Healthcare Network.
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