The first T (toilet) is a biggie: When a kid has type 1 diabetes, they’ll usually go to the bathroom a lot because their body will try to get rid of extra glucose by way of pee. The kidneys can filter out some glucose from the bloodstream, Dr. Marks says—but at some point, the excess begins to spill over into the urine, pulling water out of the body’s tissues along with it. Peeing all the time tends to be especially overlooked in babies and toddlers, Dr. Marks says: “When you have a kid in diapers, it’s harder to notice that they’re urinating more often.” Some caregivers of kids with type 1 diabetes tell Dr. Mucci that they encounter extremely heavy, soaked, or leaking diapers that need to be changed nonstop.
If you have kids who can use the toilet on their own, you might hear them shuffling to the bathroom more than usual throughout the night, or they might wet their bed (every kid is different, but in general, children shouldn’t be regularly having this kind of accident beyond age six).2 As Dr. Mucci points out, any seemingly inexplicable shift in pee habits could signal trouble. Teachers tend to notice more frequent bathroom trips too, so ask your kid’s school if they’ve noticed changes.
2. They’re insatiably thirsty.
If your kid is urinating a lot, they might also be dehydrated and thirsty (the second T), Dr. Marks says. (The increased drinking, in turn, leads to even more peeing.) In addition, extra sugar can move into a person’s urine with type 1 diabetes, which can make them crave fluids.
Gulping down water or juice might seem harmless—and knowing when it’s a problem can be tricky. “Sometimes [parents and caregivers] will mistake being thirsty [from type 1 diabetes] for it being the summer, or the child being active and sweating a lot,” she explains. (For a rough baseline, kids ages one to three should drink about four cups of fluids a day, including milk; kids ages four to eight, about five cups; and older children, seven to eight cups, according to the American Academy of Pediatrics—though these amounts can vary, so ask a pediatrician if you’re not sure.)
Drinking more than this doesn’t necessarily mean a kid has type 1 diabetes, so Dr. Mucci says to look for an “insatiable urge” to hydrate instead. She notes that caregivers who look after infants with type 1 diabetes report constant crying for milk day and night. In older kids, you might notice them filling up a water bottle way more than they used to, Dr. Mucci says. Teachers may also find a kid asking to use the water fountain frequently (another reason to check in with the school), she adds. Again, if a child is extra thirsty at night, that could be a telltale hint that something is off, Dr. Mucci adds: “Taking sips is one thing, but drinking two glasses of water overnight is probably too much.”
3. They’re looking particularly thin, despite eating plenty or more than usual.
Weight loss is common in kids with type 1 diabetes—even when they’re eating as much or more than usual. That’s because the disease makes it hard for the body to break down food into fuel and for storage, Dr. Marks says. Increased appetite is also a symptom that kids tend to show in untreated type 1 diabetes, but caregivers don’t always bring it up to pediatricians—they might simply chalk it up to kids’ growing, hungry bodies.