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DIABETES SERIES · ARTICLE 13 OF 17
Children and teenagers
Diabetes when you start younger than the textbooks describe.
A child diagnosed with diabetes isn't a smaller adult with the same condition. The biology runs differently, the social pressures run differently, the school days run differently, and the parents become part of the medical team in a way no adult patient ever requires.
This article is for parents whose child has just been diagnosed, teenagers reading this for themselves, teachers who have a diabetic learner in class, and anyone supporting a young person with diabetes through years that are already complicated without it.
There is good news here: with proper care, a child with diabetes today can grow up to have a full, long, healthy adult life. That wasn't true a generation ago. It is true now, and South African children are part of that success story.
Before you read on
Most of the medical content from earlier articles in the series still applies to children — what diabetes is, how to test, what hypos look like. This article focuses on what is different when the patient is young.
Which kind of diabetes?
Most diabetes in children and teens is Type 1 — about 90% of cases under age 18. The immune system attacks the insulin-producing cells of the pancreas, often suddenly, often in someone who was healthy weeks earlier. The most common ages for diagnosis are 5–7 and 10–14, though it can happen at any age, including under one year.
Type 2 in young people used to be rare. It isn't anymore. South African paediatric clinics now regularly see Type 2 in teenagers — almost always linked to weight, family history, and inactivity. The youngest published South African Type 2 cases are in 10-year-olds. This is a trend, not a rare event.
There are also a few rare forms (MODY — maturity-onset diabetes of the young) where children develop diabetes through inherited gene defects. These are sometimes mistaken for Type 1 initially. If a family has several relatives with diabetes diagnosed young, it's worth asking about MODY testing.
Recognising diabetes in a child
The four classic signs of Type 1 diabetes in a child are easy to remember:
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Constant thirst — the child drinks everything in sight.
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Frequent urination — including waking at night, or bed-wetting in a previously dry child.
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Rapid weight loss — even with good appetite.
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Exhaustion — far beyond normal tiredness.
This is an emergency
If a child has these symptoms, especially the rapid weight loss and the constant thirst, get to a hospital that day. Children can go from these symptoms to a life-threatening complication called diabetic ketoacidosis (DKA) within days. Other signs that mean go faster: fruity-smelling breath, vomiting, abdominal pain, fast breathing, drowsiness, confusion.
The first weeks after diagnosis
The first weeks are intense. The child needs insulin from day one — usually multiple injections a day or an insulin pump. Parents need to learn carb counting, insulin dosing, ketone testing, and how to spot a hypo. Most families spend a few days in hospital initially while the basics are taught.
What helps:
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Take notes — there will be a flood of information and you will forget most of it
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Both parents (or both primary caregivers) should attend the teaching sessions
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Ask the team to write down the meal-time insulin plan in simple form
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Ask for written sick-day rules before you leave the hospital
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Get the contact number of the paediatric diabetes team for after-hours questions
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Connect with a parent support group — Type 1 Diabetes South Africa has active community pages
School and diabetes
Going back to school is one of the hardest transitions. The child can no longer just "be a child at school" — there is testing, medication, hypos to spot, lunchtime carb counting. This is normal and it becomes routine, but it takes work in the beginning.
What schools should know
Brief the school formally. Ideally meet with the principal, the class teacher, the school nurse if there is one, and the sports coach. Bring:
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A written diabetes management plan from the clinic
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Insulin and supplies labelled with the child's name
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Fast sugar (glucose tablets, juice) kept in a known place
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Ketone strips if relevant
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Emergency contact numbers including the diabetes clinic
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A simple description of what a hypo looks like and what to do
The child's rights at school
Under South African law and Department of Basic Education guidelines:
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Schools cannot refuse to enrol a child because they have diabetes
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A child with diabetes must be allowed to test blood sugar and administer insulin during the school day
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Reasonable accommodations must be made — including water access, bathroom breaks, and food at appropriate times
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The school cannot withhold care during an emergency
If a school is being unreasonable, contact Diabetes South Africa for advocacy support.
The adolescent storm
Diabetes in childhood can be hard. Diabetes in adolescence can be much harder. The teenage years bring hormones that make blood sugar harder to control, growing independence that makes supervision harder, social pressure that makes being different unbearable, and a developing brain that is wired for present-focused decisions.
Things commonly go off the rails between ages 13 and 17:
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HbA1c drifts up as the teen takes over their own care
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Insulin doses get skipped — sometimes regularly
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Testing becomes erratic
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Diet falls apart
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Clinic visits get missed
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Risk-taking behaviours (alcohol, drugs) layer on diabetes risk
This is a stage, not a personality
Almost every teenager with diabetes goes through a period of rebellion against the routine. It is partly developmental — teenagers are wired to resist authority — and partly a response to the unfairness of having a condition their friends don't.
Yelling, ultimatums, and removing privileges almost never work. What helps: connection, non-judgemental conversations, peer groups of other diabetic teens, and a clinic team that the teenager actually likes. The years pass. Most teens come out the other side with their diabetes intact, especially when the family stayed in their corner.
Eating disorders and diabetes — a serious risk
Young women with Type 1 diabetes have a higher rate of eating disorders than the general population. The specific danger is "diabulimia" — deliberately taking less insulin than needed to lose weight. It works for weight loss in the short term and causes catastrophic long-term damage.
Warning signs to watch for:
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Sudden, unexplained weight loss in someone whose diabetes seemed under control
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Refusal to eat, or strange rituals around food
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HbA1c much higher than the daily readings would suggest
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Frequent unexplained DKA episodes
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Anxiety around carbohydrates or insulin doses
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Hiding insulin pens, syringes, or test results
Speak to your diabetes team or a clinical psychologist. This is treatable but specialised — paediatric diabetes teams in major SA hospitals have access to the right support.
Sports and exercise
Children with diabetes can do any sport other children do — including high-performance sport. Many international athletes have Type 1. The general rules:
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Test blood sugar before exercise — if under 5.5 mmol/L, eat a small snack first
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If over 14 mmol/L, check for ketones; only exercise if ketones are negative
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Take fast sugar to every practice, every match
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Tell the coach about diabetes
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Reduce insulin for prolonged exercise (the clinic will help work out doses)
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Watch for delayed hypoglycaemia — blood sugar can drop hours after exercise, including overnight
Diet for growing bodies
A child or teenager with diabetes still needs the nutrition of a growing person — enough kilojoules, enough protein, enough calcium, enough iron. This is not a weight-loss diet. The adjustments are about HOW carbohydrates are matched with insulin, not about restriction.
The main principles:
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Three meals plus 1–2 snacks across the day
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Whole grains, beans, eggs, dairy, vegetables, fruit, meat or fish
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Smaller portions of refined starch, larger portions of vegetables and protein
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Counted carbs at meals if on mealtime insulin (the dietitian will teach this)
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Sugary drinks only for treating hypos
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Occasional treats are fine — paired with the right insulin dose
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Calcium and vitamin D are essential during growth — encourage milk, maas, yoghurt
The transition to adult care
Somewhere between ages 16 and 21, the young person moves from paediatric diabetes care to adult clinics. This is a vulnerable time — many people drop out of the health system here and resurface years later with complications.
What helps the transition:
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Start preparing 1–2 years before — let the teenager take over phoning the clinic, ordering medication, attending visits alone
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Have a structured handover from the paediatric team to the adult team
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Find an adult clinician who is comfortable with young adults
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Keep parents in the loop without making them the primary contact
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Use peer groups for young adults with diabetes — Type 1 South Africa has events
The mental load on the parents
Parents of children with diabetes carry an enormous weight. The constant low-level fear of a hypo overnight, the daily medical decisions, the worry about long-term complications, the management of a condition that doesn't take holidays. This is real, it is exhausting, and it deserves attention.
Things that help:
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Both parents (or other adult carers) sharing the load actively — not one parent doing everything
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Trusted babysitters or family members who can manage a sleepover or evening out
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A diabetes parent support group — online or in person
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Counselling specifically for parents of chronically ill children
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Periodic breaks — even a few hours of not being the responsible one
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Permission to grieve the diagnosis. Many parents feel guilty for grieving when their child is alive and being treated. Grief is normal and processing it is healthy.
The bigger picture
Childhood and teenage diabetes is a marathon for the whole family — but it is a marathon that can be completed well. The child who tests their blood sugar at age 7 grows into the teenager who counts carbs at age 14 and the adult who manages their own clinic visits at age 22. Each stage builds on the last. The work isn't easy, but it pays off in a child who reaches adulthood with their body intact, their education complete, and the skills to live independently with a chronic condition.
The next article in the series focuses on diabetes and pregnancy — planning before conception, glucose targets in pregnancy, gestational diabetes, and what to expect during delivery and after.
Where to get more help
Diabetes South Africa — diabetessa.org.za · 011 792 9888
Type 1 Diabetes South Africa — active parent and patient community
Your nearest paediatric clinic — for diagnosis and ongoing care
Phila Today Mental Health tab — for parents and teens both
Phila Today Diabetes Series — next: diabetes and pregnancy
Phila Today · Article 13 of 17 in the Diabetes Series