Published on Oct. 20, 2026
In my 25 years of practice, I have taken care of many patients with type 1 diabetes, including a few that have walked into my office with no known diagnosis, and walked out with this new lifelong condition.
In fact, while writing this article, I met a sweet 11-year-old boy, who had been "very sick for months," and I ended up rushing him to the ER for what turned out to be type 1 diabetes in the early stages of getting very sick. In a flash, his life changed dramatically. Thus, I want to share the importance of understanding the warning signs of type 1 diabetes.
Parents know childhood changes can happen quickly, but persistent fatigue, excessive thirst, or unexplained weight loss should never be ignored. These can be early warning signs of type 1 diabetes, a condition that requires prompt medical attention.
What Is Type 1 Diabetes?
Type 1 diabetes is an autoimmune condition, and like other autoimmune conditions, is on the rise. Type 1 diabetes occurs when the body's immune system attacks the insulin-producing cells in the pancreas. Unlike type 2 diabetes, it is not caused by diet, lifestyle, or too much sugar. It can develop in children of any age, often with no family history of diabetes. As November marks Diabetes Awareness Month, understanding the warning signs can help families seek care before a medical emergency occurs.
The Four Ts of Type 1 Diabetes
A simple way to remember the symptoms of type 1 diabetes is the "Four Ts": Tired, Thirsty, Toilet and Thinner.
Tired
Children with Type 1 diabetes may become unusually tired because their bodies are unable to properly use sugar for energy. They may feel fatigued, have difficulty concentrating or seem less interested in their usual activities.
Thirsty
Many children also become excessively thirsty, drinking more fluids than normal and frequently asking for water.
Toilet
Increased thirst is often accompanied by more trips to the toilet, including frequent urination during the day, waking from sleep to pee, or even bedwetting in a child who previously stayed dry through the night.
Thinner
The final "T" is thinner. Despite eating normally or sometimes more than normal, children with type 1 diabetes may begin losing weight because their bodies cannot effectively use glucose, the primary source of energy in the body.
When to Call Your Child's Pediatrician
If you notice one or more of these warning signs, contact your child's pediatrician as soon as possible. A simple blood glucose test can help determine whether diabetes is the cause. Early diagnosis is important because untreated type 1 diabetes can lead to diabetic ketoacidosis, a serious condition that requires emergency medical care. Symptoms of diabetic ketoacidosis include vomiting, abdominal pain, rapid breathing, and dehydration, and require an immediate trip to the ER.
Recognizing the Four Ts can help families take action early and get the care their child needs at a critical time. Together, they can learn how to confidently manage the condition and thrive. Fortunately, in the last 2+ decades, I have seen, firsthand, the care of diabetes advance in many ways. With early diagnosis, education and ongoing support, children with type 1 diabetes can thrive, leading active, healthy lives.
Medically Reviewed By:
Stacey Epstein, M.D., pediatrician, Miller Children’s Care Network
About the Author:
Stacey E. Epstein, M.D., is a pediatrician with The Children’s Clinic in Long Beach who provides comprehensive primary care for children and adolescents and is affiliated with Miller Children’s & Women’s Hospital through the Miller Children's Care Network.
