Type 1 diabetes is an autoimmune disease in which the immune system destroys insulin-producing beta cells of the pancreas. (The more common Type 2 diabetes occurs when the body fails to use insulin properly, eventually driving up glucose levels.)
The uptick in Type 1 diabetes for young children is not limited to Philadelphia. A study tracking European cases of diabetes among children notes that if "present trends continue, doubling of new cases of Type 1 diabetes in European children younger than 5 years is predicted between 2005 and 2020."
"The older data is consistent with the increases shown with the . . . study about the increased incidence of Type 1 diabetes across the United States," says Jessica Dunne, senior program scientist for cure therapies at the JDRF (formerly the Juvenile Diabetes Research Foundation).
"The big question," says Lipman, "is why very young children are developing Type 1 diabetes much more frequently than in the past." Although there are several hypotheses, many having to do with environmental factors, no theory has been substantiated.
Obesity may be to blame, says Lipman, because in overweight children there is an acceleration of beta cell dysfunction, which puts greater stress on cells in the pancreas that manufacture insulin.
"While these children might have developed diabetes at 10, obesity may possibly accelerate the process," Lipman says.
Another possible cause is the "hygiene hypothesis," which blames children's decreased exposure to infectious agents such as viruses and bacteria for short-circuiting their immune response, causing the body to destroy its own insulin-producing cells.
"The question is how this could happen so quickly over the past 10 to 15 years," says Lipman. "There are more antibiotics and vaccines today, but why would there be such a marked increase in five years?"
Other possibilities include increases in vitamin D deficiency and an earlier exposure to cow's milk.
While researchers seek answers, Lipman says providers and parents need to be better informed so they can spot and diagnose Type 1 diabetes.
The signs in very young children can include extreme thirst, frequent and copious urination, sudden bedwetting, intense hunger, and unexplained weight loss.
"Diagnosing diabetes in young children can prove difficult," Lipman says. "Very young children can't articulate their symptoms in the way older children can. With an older child, it is easier to quantify excessive urination if a child is complaining about running to the bathroom frequently or suddenly wetting the bed."
Health care providers can miss these symptoms, leaving some children to become increasingly sick, and, in extreme cases, to be near death by the time of diagnosis.
Such was the case for Claire Freed of Philadelphia. Two days after her second birthday party last fall, Claire turned tired and clingy, drinking up to two cups of water an hour and soaking through her diapers. When her breathing grew labored, her mother, Jennifer, 32, took her to an emergency care center, where she was diagnosed with a double ear infection and given a breathing treatment, nose spray, and Tylenol.
That night, her condition worsened. The next morning, her parents rushed her to Children's Hospital of Philadelphia, where she was immediately diagnosed with Type 1 diabetes and diabetic acidosis, a potentially life-threatening condition.
"We were shocked," says Freed. "We weren't aware of the symptoms of Type 1." After two days in the ICU and three days in the hospital, Claire was stabilized.
A luckier case was Kayla Kretschman, 8, of Jenkintown, who was diagnosed with diabetes after her mother - worried because Kayla's father had Type 1 diabetes - asked her nurse practitioner to run a urinalysis and blood sugar test at the end of Kayla's three-year checkup. The blood sugar test showed a reading of 230 mg/dL - 70 to 120 is normal - confirming that Kayla had Type 1 diabetes. Nine months later, her 14-month-old brother, Kyle, was "super thirsty," leading his parents to test his sugars. When the numbers read high, they rushed to Children's, where Kyle's sugars registered in the 600s.
Kyle's father, Kurt, 34, says seeing his 14-month-old son with the disease was very hard.
"I mean," he says, "how are you going to carb-count for a little baby?"
These youngest patients may also have special issues, ranging from toddlers who are picky eaters and who may not consume enough to balance out their dosage of insulin to an inability to articulate the symptoms of low blood sugars.
"They also have an inability to reason in terms of doing a painful procedure such as a finger stick for a blood sugar test," says Lipman. "Finding qualified caregivers can also pose problems. You need someone who is willing and ready to care for a child with diabetes."