儿童也有糖尿病？

在很多人的印象里，糖尿病是“成年人的病”。但现实是，儿童糖尿病并不少见，而且发病率还在逐年上升。更令人担忧的是，约20-40%的1型糖尿病患儿在首次就诊时，已经出现了危及生命的酮症酸中毒。孩子不是大人的“缩小版”，他们的糖尿病有着独特的面貌，需要家长用全新的视角来认识和防范。

Many people assume diabetes is an “adult disease.” However, childhood diabetes is not rare, and its prevalence is rising. Alarmingly, about 20-40% of children with type 1 diabetes already present with life-threatening diabetic ketoacidosis (DKA) at first diagnosis. Children are not just “miniature adults”; their diabetes has unique features that require a fresh perspective from parents.

1型糖尿病是儿童糖尿病最常见的类型，占到了90%以上。它的本质是免疫系统出现了“识别错误”——本该攻击病菌的“防御部队”，却错误地攻击了胰腺中负责生产胰岛素的胰岛β细胞，导致胰岛素绝对缺乏。

这种类型通常起病急骤，

典型症状是“三多一少”：多饮、多食、多尿、体重骤降。

由于身体无法利用血糖作为能量，只能分解脂肪来供能，分解过程中会产生大量酮体，在血液中堆积就会引发酮症酸中毒，表现为恶心、呕吐、腹痛、呼吸有烂苹果味、精神萎靡甚至昏迷。

一旦孩子出现不明原因的呕吐、腹痛伴精神差，不要只想到肠胃炎，务必警惕糖尿病的可能，立即就医。

Type 1 Diabetes

Type 1 diabetes is the most common type in children, accounting for over 90% of cases. It is an autoimmune condition where the body’s immune system mistakenly attacks the insulin-producing beta cells in the pancreas, leading to absolute insulin deficiency.

Onset is often acute, with classic symptoms of polydipsia, polyphagia, polyuria, and weight loss. Since the body cannot use glucose for energy, it breaks down fat instead, producing ketones that can lead to diabetic ketoacidosis (DKA)—manifested by nausea, vomiting, abdominal pain, fruity-smelling breath, lethargy, and coma.

If a child presents with unexplained vomiting and abdominal pain along with poor mental status, don’t just assume it’s gastroenteritis—consider diabetes and seek immediate care.

2型糖尿病

曾被认为只有成人才会得的2型糖尿病，如今正悄然影响着越来越多的肥胖儿童。与1型不同，2型糖尿病的主要问题是胰岛素抵抗——身体细胞对胰岛素不敏感，胰腺需要拼命分泌更多胰岛素才能把血糖“塞”进细胞。久而久之，胰腺不堪重负，功能逐渐衰退。

这类孩子通常

有明确的肥胖史，颈部、腋下、腹股沟等皮肤褶皱处常出现黑棘皮样改变

（皮肤颜色加深、增厚、呈天鹅绒样），这是胰岛素抵抗的典型皮肤标志。起病隐匿，早期可能没有明显症状，往往在体检时偶然发现血糖升高。对于超重或肥胖、有糖尿病家族史的孩子，建议在青春期开始后每1-2年进行一次血糖筛查。

Type 2 Diabetes

Type 2 diabetes, once considered an adult-only disease, is now affecting a growing number of children with obesity. Unlike type 1, type 2 is primarily characterized by insulin resistance—body cells become less sensitive to insulin, and the pancreas must work harder to compensate. Eventually, pancreatic function declines.

These children often have a history of obesity and may present with acanthosis nigricans on the neck, armpits, or groin—a typical skin marker of insulin resistance. Onset is insidious, often detected incidentally on routine check-ups. For children who are overweight or have a family history of diabetes, blood glucose screening every 1-2 years after puberty is recommended.

还有一类特殊的儿童糖尿病，叫做青少年起病的成人型糖尿病（MODY），它是由于单个基因突变导致的单基因糖尿病。如果家族中有多位成员在25岁前被诊断为糖尿病，且不典型（无肥胖、无自身免疫抗体阳性），就要高度警惕MODY的可能。

这类糖尿病起病隐匿，症状较轻，有时仅表现为轻度空腹血糖升高。诊断依赖于基因检测，一旦确诊，治疗方案高度个体化——有些患者仅需饮食运动控制，有些需要用磺脲类药物，而不一定需要使用胰岛素。

Maturity-Onset Diabetes of the Young (MODY)

Maturity-Onset Diabetes of the Young (MODY) is a monogenic form of diabetes caused by single gene mutations. If multiple family members were diagnosed with diabetes before age 25, especially without obesity or positive autoantibodies, consider MODY.

Diagnosis relies on genetic testing. Treatment is highly individualized—some patients respond to lifestyle modifications or sulfonylureas rather than insulin.

儿童糖尿病并非无迹可寻。当孩子出现以下表现时，家长应提高警惕：

突然开始尿床或夜尿增多（孩子可能因口渴而大量饮水，夜间频繁起夜）老师反映孩子比同龄人喝水更频繁体检发现血糖异常（空腹血糖≥7.0mmol/L）视力模糊（血糖波动影响晶状体渗透压）；伤口愈合缓慢皮肤反复感染（如疖肿、念珠菌感染）

一旦怀疑，应立即到儿童内分泌专科就诊。早期识别是避免严重并发症的关键一步。

Warning Signs Parents Should Watch For

Childhood diabetes is not invisible. Watch for these signs: sudden bedwetting or increased nighttime urination; teacher reports that the child drinks more water than peers; abnormal blood glucose on check-ups (fasting glucose ≥7.0mmol/L); blurred vision; slow wound healing; recurrent skin infections. Seek pediatric endocrinology care immediately if suspected. Early recognition is the key to preventing severe complications.

儿童糖尿病不是“成人病的缩小版”。1型常来势汹汹，2型悄然扎根，MODY则带着家族印记。请记住：当孩子突然出现“三多一少”（多饮、多食、多尿、体重下降），或反复不明原因的呕吐腹痛时，不妨多留一个心眼——测一下指尖血糖。这一个小小的动作，或许就能避免一次危及生命的酮症酸中毒。

Childhood diabetes is not a miniature version of adult disease. Type 1 strikes suddenly, type 2 creeps in silently, and MODY carries a family imprint. Remember: if a child suddenly develops the “three polys and one less” (polydipsia, polyphagia, polyuria, and weight loss), or recurrent unexplained vomiting with abdominal pain, take a moment to check their blood glucose. This small act could prevent a life-threatening episode of DKA.