LISA BUSER
Kathryn Sumpter was diagnosed with type 1 diabetes as a junior in college. “I was really thirsty all the time, having to go to the bathroom all the time,” she says. “I didn’t know anything about diabetes.” She first thought that maybe the Houston, Texas, heat was causing dehydration. But then she lost a lot of weight.
“I came home for a weekend, and my mom said, ‘You need to go to the doctor.’ I did not have to be hospitalized, but it was a huge shock,” she says. “I had nobody in my family with type 1, and I’d always been a really healthy person. So it was a big upheaval for me to figure that all out and come to terms with having a condition that, at least so far, we can’t get rid of — there’s no cure.”
The process Sumpter went through after her diagnosis led her to where she is today, working as a pediatric endocrinologist at Le Bonheur Children’s Hospital. “I had amazing medical care, doctors, diabetes educators,” she says. “Everybody took such great care of me, and I realized what a difference a physician can make in someone’s life. That, for me, was the inspiration to pursue the career I did.”
Today, Sumpter specializes in type 1 diabetes, formerly known as juvenile diabetes, but sees pediatric patients with both type 1 and type 2. Here, she shares some valuable information about both.
Memphis Parent: At what age is a child with diabetes typically diagnosed?
Dr. Kathryn Sumpter: Type 1 can be any age range in pediatrics. The earliest I’ve heard of is about 7 months of age, but for the most part, diagnosis in infancy is uncommon. They can still be very young, toddlers, with the peak being around puberty, age 12 or 13.
Most patients with type 2 are 10 and older, on average. We have a few who are younger, but that is uncommon. It’s much more commonly seen in tweens and teens.
What are signs that a child might have diabetes?
The most common thing we see is increased thirst and increased urination; going to the bathroom over and over again and still being thirsty. Weight loss, we see that a lot with type 1. Some people, if it gets more severe before they’re diagnosed, can develop vomiting, have trouble breathing. Those are signs of something called diabetic ketoacidosis.
What are some of the risk factors for type 1 diabetes?
Some of it is genetic, so we know that people who have family members with type 1 have a higher risk. That being said, most of our patients don’t have anyone in their family with it. So people will say, ‘Well, it doesn’t run in my family,’ but you may still have the genes that predisposed you to it. There’s not one gene, it’s a bunch of different genes.
Take identical twins: If one of them has type 1 diabetes, the other one will develop it, on average, 50 to 60 percent of the time. So the genes are important, but they’re not the only factor. Then there’s the question of, beyond the genes, what is it that makes one twin get it and the other not? That’s the billion-dollar question. We still don’t completely know.
There are a lot of things that we think are risk factors. It could be certain viruses. People are infected with certain viruses, and they seem to increase the risk. Not COVID, as far as we know at this time. There are also some studies that suggest that certain stressful life experiences for kids might increase the risk. There are also theories that as kids become heavier, that increases the risk of even type 1 diabetes, even though we think of that as usually type 2.
How does obesity factor in?
For type 1, it’s what we call an accelerating factor, meaning people who might have developed type 1 anyway might get it at an earlier age because of obesity. As for type 2, it’s exceedingly uncommon for a person under the age of 18 to get type 2 diabetes without obesity. It seems to be a much bigger player in type 2 where, with obesity, the body has to work harder to keep the blood sugars normal.
There are also genetic factors in type 2 as well. There are lots of obese patients who don’t have type 2 diabetes, but in the genetically predisposed person — type 2 may be even more genetic than type 1 — obesity can lead to type 2.
How is diabetes managed?
Type 1 always requires insulin to be managed. Since with type 1 you lose the ability to make insulin, it requires insulin injections. Most of our patients take at least four injections of insulin a day. Our goal is to, as close as possible, match what the body would do in response to food and the normal ins and outs of your daily routine. We want to do as good of a job at making insulin as the pancreas would.
Part of that is, with type 1, the insulin you take for food needs to match the amount of food you’re eating. We don’t need our patients to be on a very restricted diet. It’s OK for them to have a chocolate chip cookie with lunch, but it’s crucial that the amount of insulin we give is enough to take care of that amount of food. That’s one of the biggest challenges.
With type 2 diabetes, there are more options. We find that our pediatric patients often need insulin much more quickly than adults do with type 2 diabetes, which is one of the scary parts of it. We find that kids with type 2 diabetes often progress to needing insulin in a relatively short period of time, one to two years — or sometimes even less — compared to an adult who may go many years on just oral medications. They also seem to be developing the complications of diabetes much more quickly than adults; things like kidney problems, eye disease related to diabetes, nerve damage.
Many of our patients need insulin, but some can be managed solely with oral medications. Just like type 1, the relationship between the food and the medicine is important. For type 2, if they also take insulin, we always have to make sure the food and the insulin are balanced. Too much of one or the other can cause high or low blood sugars.
What advice do you have for parents who think their child may have diabetes?
It’s often in times where people are close together that they’ll recognize the types of changes you’ll want to look for. On a road trip, for example. COVID has actually been a time where people are noticing what their kids are doing more because they’re home together all the time.
If you’re noticing that your kid’s pattern of using the restroom or their drinking is very different than it was before, or another big sign is if they’re waking up in the middle of the night needing a drink when they didn’t need that before, or you’re hearing them wake up multiple times at night to go to the bathroom — those are signs that deserve investigation.
Usually it’ll be pretty easy. Often a physician will start by checking their urine. Get a urine test and look to see if there are any signs of diabetes. Sometimes parents will think, ‘Maybe it’s just a urinary tract infection or kidney or bladder infection,’ and that urine test can work for that, too.
What is type 1 diabetes?
If you have type 1 diabetes, your pancreas doesn’t make insulin or makes very little insulin. Insulin is a hormone that helps blood sugar enter the cells in your body where it can be used for energy. Without insulin, blood sugar can’t get into cells and builds up in the bloodstream. High blood sugar is damaging to the body and causes many of the symptoms and complications of diabetes. Type 1 diabetes (previously called insulin-dependent or juvenile diabetes) is usually diagnosed in children, teens, and young adults, but it can develop at any age.
What is type 2 diabetes?
Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy. If you have type 2 diabetes, cells don’t respond normally to insulin; this is called insulin resistance. Your pancreas makes more insulin to try to get cells to respond. Eventually your pancreas can’t keep up, and your blood sugar rises, setting the stage for prediabetes and type 2 diabetes. High blood sugar is damaging to the body and can cause other serious health problems, such as heart disease, vision loss, and kidney disease.
Source: Centers for Disease Control, cdc.gov