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Diagnosis of diabetes mellitus in children
Last reviewed: 03.07.2025
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Almost all children with newly diagnosed disease have some clinical symptoms. Hyperglycemia and glucosuria confirm the diagnosis of diabetes mellitus. The glucose level in venous blood plasma above 11.1 mmol/l is diagnostically significant. In addition, ketonuria is noted in most children when the diagnosis is established. Sometimes a child is found to have an increase in glucose concentration above 8 mmol/l in the absence of symptoms of diabetes mellitus. If the postprandial glucose level (two hours after eating) is repeatedly higher than 11.0 mmol/l, the diagnosis of diabetes mellitus is beyond doubt and does not require additional studies. A convincing criterion for confirming the diagnosis of type 1 diabetes mellitus is autoantibodies to islet cells (IA) and to the islet cell protein - glutamate decarboxylase in the blood serum.
A standard glucose tolerance test is used to diagnose pre-manifest stages of diabetes mellitus. Glucose tolerance is impaired if its level in whole capillary blood 2 hours after an oral glucose load (1.75 g/kg body weight) is within 7.8-11.1 mmol/l. In this case, the diagnosis of type 1 diabetes mellitus can be confirmed by detecting autoantibodies in the blood serum.
Despite the fact that the symptoms of the disease are well known, diabetes mellitus 1 is often diagnosed late. The condition of young children is difficult to assess for both parents and doctors, and ketoacidosis in young children can develop much faster than in older children. Abdominal pain in older children can be mistakenly assessed as a manifestation of acute appendicitis. Frequent and deep breathing observed in ketoacidosis can be mistakenly assessed as pneumonia, and polyuria - as a manifestation of a urinary tract infection. In this case, hyperglycemia and glucosuria are decisive for making a diagnosis.
[ Diagnostic criteria for diabetic ketoacidosis
- ketosis - hyperglycemia 11.1-20 mmol/l; glucosuria, ketonuria; blood pH not lower than 7.3; BE up to -10;
- precoma - hyperglycemia 20-40 mmol/l; glucosuria, ketonuria; Blood pH 7.3-7.1; BE -10...-20; K+ Na+ of erythrocytes is reduced; hemoglobin and hematocrit are increased;
- coma - hyperglycemia 20-40 mmol/l; glucosuria, ketonuria; blood pH below 7.1; BE below -20; K and Na of erythrocytes and blood serum are decreased, blood urea is increased; hemoglobin and hematocrit are increased, serum osmolality is 310-320 mosm/l.
Differential diagnosis of diabetes mellitus in children
Differential diagnosis should be carried out with diabetes insipidus accompanied by normoglycemia, aglucosuria and low relative density of urine, neurogenic polydipsia and polyuria, acetonemic vomiting in children with neuroarthritic diathesis.