By Dr. David Repaske

Most people are well aware that diagnoses of type 2 diabetes are on the rise. But just as concerning, yet less often publicized, is the fact that type 1, or juvenile, diabetes is also becoming more common. Today, it’s estimated that 4 out of every 1,000 children will have type 1 diabetes by the age of 18. That’s 300,000 children — double the number of kids diagnosed 20 years ago.

Unfortunately, many people aren’t aware of the risk factors and subtle warning signs of type 1. As a result, approximately half of children go undiagnosed until they experience a serious complication of diabetes called diabetic ketoacidosis (DKA). This causes blood sugar levels to skyrocket and, in rare cases, can lead to coma or even death.

To help identify type 1 diabetes sooner — before it reaches this dangerous stage — it’s important for parents to gain a better understanding of the disease. And it’s important for the medical community to consider the possibility of universal type 1 diabetes screening, now being studied at UVa Children’s.

Diabetes 101: Type 1 vs. type 2

Type 1 diabetes is a chronic autoimmune disorder. That is, rather than fighting off harmful germs, the immune system attacks parts of the body. More specifically, it destroys the insulin-producing beta cells created in the pancreas. Without enough insulin to help the body process glucose and turn it into an energy source, glucose remains in the bloodstream. As blood sugar levels rise and remain elevated over time, life-threatening complications can occur.

Of course, elevated blood glucose is a hallmark of type 2 diabetes as well; however, this is the only real similarity between the two types. In people with type 2, the body’s need for insulin surpasses what the pancreas can make. That is, “normal” insulin production just isn’t adequate to help fuel the body, often because of excess weight gain.

Recognizing the warning signs of type 1

Type 1 diabetes, or juvenile diabetes, is most often diagnosed in children between the ages of 2 and 18. The symptoms are easy to dismiss, especially if parents have no reason to suspect their children may be at increased risk for the disease. Some of the warning signs include:

• Frequent urination

• Excessive thirst

•  Weight loss

Should a child’s blood sugar levels become extremely high, they may experience DKA, as mentioned above. This is a serious emergency and requires immediate medical attention. Signs of DKA include:

•  Extreme flu-like symptoms

•  Rapid breathing

•  Confusion

•  Abdominal pain

Staying one step ahead with genetic testing

We now know the cause of type 1 diabetes is 50% genetic. If your child has specific genetic markers, he or she is 10 times more likely to be diagnosed with type 1 diabetes than a child without those genetic markers.

UVa has enrolled thousands of children in a study that is using a genetic test to identify children who have the gene variants that make them more susceptible to type 1. But that’s only the first step.

Unfortunately, although we’ve identified the genetic components that make some kids susceptible, we don’t know what ultimately triggers the disease. The risk factors that make up the remaining 50% are still a mystery. Some believe environmental factors or even a virus may be the cause, but research is ongoing.

Until we solve that missing piece of the puzzle, our best bet is first to identify those at elevated genetic risk and then screen these children regularly. A blood test is used to check for the presence of antibodies that drive the disease and signal that the beta cells are under attack. By identifying the antibodies, we can diagnose the disease in its earliest stages before complications set in.

Improving our approach to type 1 treatment

We’ve made great strides in treating type 1 diabetes over the past decade thanks to advanced technology — the continuous glucose monitor, insulin pump and UVa-developed artificial pancreas — that is changing the way the disease is managed. Type 1 diabetes screening is one more positive step forward in our efforts to improve the lives of patients with this disease.

With early diagnosis, we have the potential to avoid serious side effects of elevated blood sugar, including DKA. There’s also a greater opportunity to prepare and educate families on how to properly manage the disease before symptoms begin. And eventually, based on promising new studies, we may even be able to initiate a treatment that can postpone the onset of disease. That’s why UVa doctors are hoping to make type 1 diabetes screening standard practice across the state.

To learn more about juvenile diabetes treatments available at UVa, visit

Dr. David Repaske is chief of the Division of Pediatric Endocrinology at UVa, ranked among the top 50 endocrinology programs in the nation by US News and World Report. 
This column, which promotes community health, is sponsored by Sentara Martha Jefferson Hospital, Region Ten Community Services Board, Thomas Jefferson Health District and the University of Virginia Heath System.

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This column, which promotes community health, is sponsored by Sentara Martha Jefferson Hospital, Region Ten Community Services Board, Thomas Jefferson Health District and the University of Virginia Heath System.
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