Possible Complications In Children With Diabetes

Key points to remember about diabetes complications

• the risk of diabetes complications may be reduced by maximising the time your glucose levels are in the target range (3.9 to 10 mmol/L)
• screening is important to allow for early detection of possible developing complications
• smoking increases the risk of complications

What diabetes complications are possible?

Eye problems

Retinopathy occurs when there is damage to the retina. The retina is the thin layer of tissue at the back of the eye. It contains small blood vessels and nerve endings for vision. Other diabetes related eye conditions which can occur are cataracts and blurred vision. Regular screening will help to minimise any damage.

The current recommendation for screening for retinopathy is:

• start screening from the age of 11 years with 2 to 5 years diabetes duration 
• ongoing screening every 1 to 2 years depending on what is seen during screening

Kidney problems

The kidneys act as a filter for our bodies, passing waste into the urine to be removed from the body. Nephropathy refers to kidney damage associated with diabetes. Most at risk are people who have consistently high blood glucose levels or very erratic blood glucose levels over a long period of time. Regular screening to look for protein in the urine (microalbuminuria) will help to identify any early changes with the kidneys and minimise any damage that this condition may cause. The screening test for nephropathy is a urine sample, and blood pressure also needs to be checked regularly.

The current recommendation for screening for nephropathy is:

• start screening from the age of 11 years with 2 to 5 years diabetes duration
• ongoing screening every year

Nerve problems

Neuropathy refers to nerve damage associated with diabetes. Again, most at risk are people who have consistently high blood glucose levels over a long period of time.

Foot problems

Foot problems, due to decreased blood flow or nerve problems, are unlikely to occur in children or young people. But, feet need to be well cared to prevent problems in later life. Podiatrists (people who treat foot disorders) can help.

Vascular (blood vessel) disease

This increases the risk of heart attacks and strokes. People with diabetes have an increased risk of getting vascular disease at an early age.

High blood pressure (hypertension)

This increases the risk of heart attacks and strokes. Blood pressure should be checked at time of diagnosis and at least once a year.

Cholesterol or lipids

Cholesterol is a fat substance that is naturally present in blood and cells. High cholesterol increases the risk of heart attacks and strokes. The current recommendation for lipid screening is:

• start screening soon after diagnosis (when diabetes has stabilised) in all children with type 1 diabetes from the age of 11 years
• ongoing screening depends on the results - if the first screen is normal, a fasting lipid profile should occur every 5 years
• if there is a family history of high cholesterol or early cardiovascular disease, screening should commence as early as the age of 2 years

Auto-immune conditions (thyroid disease and coeliac disease)

People with type 1 diabetes have a higher risk of developing other auto-immune conditions. Screening blood tests are at diagnosis then every year for the first 5 years, then every 2 years.

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