Type 1 diabetes in children
Type 1 diabetes in children
Type 1 diabetes in children is a condition in which your child's pancreas no longer produces the insulin your child needs to survive, and you'll need to replace the missing insulin. Type 1 diabetes in children used to be known as juvenile diabetes or insulin-dependent diabetes.
The diagnosis of type 1 diabetes in children can be overwhelming at first. Suddenly, you and your child — depending on his or her age — must learn how to give injections, count carbohydrates and monitor blood sugar.
Although type 1 diabetes in children requires consistent care, advances in blood sugar monitoring and insulin delivery have improved the daily management of type 1 diabetes in children.
The signs and symptoms of type 1 diabetes in children usually develop quickly, over a period of weeks. Look for:
When to see a doctor
The exact cause of type 1 diabetes is unknown. Scientists do know that in most people with type 1 diabetes, the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas. Genetics may play a role in this process, and exposure to certain viruses may trigger the disease.
Insulin key to sugar entering cells
The liver acts as a glucose storage and manufacturing center. When insulin levels are low — when you haven't eaten in a while, for example — the liver releases stored glycogen, which is then converted to glucose to keep your blood glucose level within a normal range.
Dangerous sugar level in bloodstream
The cause of type 1 diabetes is different from the more common type 2 diabetes. In type 2, the islet cells are still functioning, but the body becomes resistant to insulin or the pancreas doesn't produce enough insulin.
There aren't many known risk factors for type 1 diabetes, though researchers continue to find new possibilities.
Known risk factors
Possible risk factors
Type 1 diabetes can affect nearly every major organ in your child's body, including the heart, blood vessels, nerves, eyes and kidneys. The good news is that keeping your child's blood sugar level close to normal most of the time can dramatically reduce the risk of these complications.
Long-term complications of type 1 diabetes develop gradually. Eventually, if blood sugar levels aren't well controlled, diabetes complications may be disabling or even life-threatening.
Preparing for your appointment
Your child's family doctor or pediatrician will probably make the initial diagnosis of diabetes, and possibly send your child straight to the hospital. There, the staff will stabilize his or her blood sugar levels, and you and your child will learn about insulin delivery, carbohydrate counting and more. Diabetes education may also be done on an outpatient basis if your child's condition is stable.
Once your child is discharged from the hospital, his or her diabetes care will likely be handled by a doctor who specializes in metabolic disorders in children (pediatric endocrinologist). Your child's health care team will also generally include a dietitian, a certified diabetes educator, and a doctor who specializes in eye care (ophthalmologist).
Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for any appointments you have with your child's health care team. Here's some information to help you get ready for your appointment, and what you can expect from your doctor.
What you can do
Your time with your doctor is limited, so preparing a list of questions that can help you clarify aspects of your child's care can be useful. Some of your concerns may be best addressed by a dietitian or a diabetes nurse educator. Ask your doctor for a referral. For type 1 diabetes in children, some topics you may want to address with your doctor, dietitian or diabetes educator include:
What to expect from your doctor
What you can do in the meantime
Tests and diagnosis
If your child's doctor suspects diabetes, he or she will recommend a screening test. The primary test used to diagnose type 1 diabetes in children is the:
If your child's random blood sugar test results don't suggest diabetes, but your doctor still suspects it because of your child's symptoms, you doctor may do a:
Another test your doctor might use is a fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, your child will be diagnosed with diabetes.
If your child is diagnosed with diabetes, your doctor will also run blood tests to check for autoantibodies that are common in type 1 diabetes and help doctors distinguish between type 1 and type 2 diabetes. The presence of ketones — byproducts from the breakdown of fat — in your child's urine also suggests type 1 diabetes, rather than type 2.
After the diagnosis
During these visits, the doctor will also check your child's A1C levels. Your child's target A1C goal may vary depending on his or her age and various other factors. The American Diabetes Association (ADA) generally recommends slightly higher A1C levels for children and teens than for adults, because children are less likely to notice the symptoms of low blood sugar levels. For children younger than age 6, the ADA recommends an A1C of less than 8.5 percent. In children between ages 6 and 12, the recommendation is for an A1C under 8 percent, and teenagers are advised to try to keep their A1C under 7.5 percent.
Compared with repeated daily blood sugar tests, A1C testing better indicates how well your child's diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your child's insulin regimen or meal plan.
In addition to the A1C test, the doctor will also periodically check your child's cholesterol levels, thyroid function, liver function and kidney function using blood and urine samples, as well as periodically test for celiac disease. The doctor will also examine your child to assess his or her blood pressure and growth, and will check the sites where your child tests his or her blood sugar and delivers insulin.
Treatments and drugs
Treatment for type 1 diabetes is a lifelong commitment of blood sugar monitoring, insulin, healthy eating and regular exercise — even for kids. And as your child grows and changes, so will his or her diabetes treatment plan. Over the years, your child may need different doses or types of insulin, a new meal plan or other treatment changes.
If managing your child's diabetes seems overwhelming, take it one day at a time. Some days you'll manage your child's blood sugar perfectly. Other days, it may seem as if nothing works well. Don't forget that you're not alone. You'll work closely with your child's diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your child's blood sugar level as close to normal as possible.
Blood sugar monitoring
Continuous glucose monitoring (CGM)
Insulin and other medications
Many types of insulin are available, including:
Depending on your child's age and needs, the doctor may prescribe a mixture of insulin types to use throughout the day and night.
Insulin delivery options
An insulin pump also may be an option for some children. The pump is a device about the size of a cell phone worn on the outside of the body. In most cases, a tube connects the reservoir of insulin to a catheter that's inserted under the skin of the abdomen. A wireless pump that uses small pods filled with insulin is another option that's now available. The pump is programmed to dispense specific amounts of insulin automatically. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.
Yet understanding what and how much to feed your child can be a challenge. A registered dietitian can help you create a meal plan that fits your child's health goals, food preferences and lifestyle. Certain foods, such as those with a high sugar or fat content, may be more difficult to incorporate into your child's meal plan than healthier choices. For example, high-fat foods — because fat slows digestion — may cause a spike in blood sugar several hours after your child has eaten. Unfortunately, there's no set formula to tell you how your child's body will process different foods. But, as time passes, you'll learn more about how your child's favorites affect his or her blood sugar, and then you can learn to compensate for them.
But remember that physical activity usually lowers blood sugar, and it can affect blood sugar levels for up to 12 hours after exercise. If your child begins a new activity, check your child's blood sugar more often than usual until you learn how his or her body reacts to the activity. You might need to adjust your child's meal plan or insulin doses to compensate for the increased activity.
Signs of trouble
Low blood sugar (hypoglycemia). If your child's blood sugar level drops below his or her target range, it's known as low blood sugar. Ask your doctor what's considered a low blood sugar level for your child. Blood sugar levels can drop for many reasons, including skipping a meal, getting more physical activity than normal or injecting too much insulin. Hypoglycemia occurs more frequently with intermediate-acting insulin, such as NPH.
Teach your child the symptoms of low blood sugar, and that when in doubt, he or she should always do a blood sugar test. Early signs and symptoms of low blood sugar include:
Later signs and symptoms of low blood sugar, which are sometimes mistaken for alcohol intoxication in teens and adults, include:
If your child develops hypoglycemia during the night, he or she might wake with sweat-soaked pajamas or a headache. Thanks to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning.
If your child has a low blood sugar reading, give him or her fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Then retest his or her blood sugar in about 15 minutes to make sure it has gone up into the normal range. If it's not in the normal range, re-treat with more sugar (juice, candy, glucose tablets or another source of sugar) and then retest in another 15 minutes. Keep doing this until you get a normal reading. It's a good idea to have your child eat another snack, this one containing a mixed food source, such as peanut butter and crackers, to help stabilize the blood sugar.
If a blood glucose meter isn't readily available, treat for low blood sugar anyway if your child has symptoms of hypoglycemia, and then test as soon as possible.
Make sure your child always carries a source of fast-acting sugar with him or her.
Left untreated, low blood sugar will cause your child to lose consciousness. If this occurs, he or she may need an emergency injection of glucagon — a hormone that stimulates the release of sugar into the blood. Be sure your child always has a glucagon emergency kit available — at home, at school, during sports, on sleepovers — and make sure it hasn't expired.
High blood sugar (hyperglycemia). As with low blood sugar, your child's blood sugar can rise for many reasons, including eating too much, eating the wrong types of foods, not taking enough insulin or illness.
If you suspect hyperglycemia, check your child's blood sugar. You might need to adjust your child's meal plan or medications. If your child's blood sugar is higher than his or her target range, you'll likely need to administer a "correction" using an insulin shot or through an insulin pump. A correction is an additional dose of insulin that should bring your child's blood sugar back into the normal range. High blood sugar levels don't come down as quickly as they go up. Ask your doctor how long to wait until you recheck. If your child uses an insulin pump, you may need to change the pump site if blood sugar levels don't come down.
If your child has two consecutive blood sugar readings above 250 mg/dL (13.9 mmol/L), have your child test for ketones using a urine test stick. Don't allow your child to exercise if his or her blood sugar level is high or anytime ketones are present. If only a trace or small amount of ketones are present, have your child drink extra fluids to flush out the ketones.
If your child's blood sugar is persistently above 300 mg/dL (16.7 mmol/L), call your child's doctor or seek emergency care.
Increased ketones in your child's urine (diabetic ketoacidosis). If your child's cells are starved for energy, your child's body may begin to break down fat — producing toxic acids known as ketones.
Signs and symptoms of this serious condition include:
If you suspect diabetic ketoacidosis, check your child's urine for excess ketones with an over-the-counter ketones test kit. If your child has a large amount of ketones in his or her urine, call your child's doctor right away or seek emergency care. Also, call your doctor if your child has vomited more than once in a four-hour period and has ketones in his or her urine.
Lifestyle and home remedies
Type 1 diabetes is a serious disease. Helping your child follow his or her diabetes treatment plan takes round-the-clock commitment and will initially require some significant lifestyle changes. But your efforts are worthwhile. Careful management of type 1 diabetes can reduce your child's risk of serious — even life-threatening — complications.
As your child gets older:
Above all, stay positive. The habits you teach your child today will help him or her enjoy an active and healthy life with type 1 diabetes.
School and diabetes
Coping and support
Living with type 1 diabetes isn't easy — for you or for your child. Good diabetes management requires a lot of time and effort, especially in the beginning.
Your child's emotions
Another way diabetes can take a toll on your child's emotions is by making him or her feel different from other kids. Most of the time, children don't want to be different, and having to draw blood and give themselves shots definitely sets kids with diabetes apart from their peers. Getting your child together with other children who have diabetes may help make your child feel less alone.
Mental health and substance abuse
Teenagers, in particular, may have a particularly hard time dealing with diabetes. A child who has been very good about sticking to his or her diabetes regimen may rebel in the teen years by ignoring his or her diabetes care. Teens may also have a harder time telling friends or boyfriends or girlfriends that they have diabetes because they want to fit in. They may also experiment with drugs or alcohol, behaviors that can be even more dangerous for someone with diabetes. Eating disorders and forgoing insulin to lose weight are other problems that can occur more often in the teen years.
Talk to your teen, or ask your teen's doctor to talk to your teen, about the effects of drugs and alcohol on someone with diabetes. If you notice that your child or adolescent is persistently sad or pessimistic, or if you notice dramatic changes in his or her sleeping habits, friends or school performance, talk to your doctor or a therapist to have your teen assessed for depression. Additionally, let your child's doctor know if you notice that your son or daughter is losing weight or doesn't seem to be eating well.
Or, you can visit the websites of the American Diabetes Association, the Juvenile Diabetes Research Foundation or Children with Diabetes to find support and regional activities for people with type 1 diabetes and their families. The American Diabetes Association also offers diabetes camp programs that provide children and teens with diabetes education and support. And, these groups offer online information and forums for children and teens.
Putting information in context
There is no treatment that can replace insulin for anyone with type 1 diabetes. People who have type 1 diabetes must use injected insulin (exogenous insulin) every day to survive.
It's been suggested that some substances may help with blood sugar control, but none have been proved to effectively manage or prevent type 1 diabetes. Some of the substances that have been tested and found ineffective for blood sugar control include nicotinamide, vitamin D, cinnamon, zinc and alpha-lipoic acid.
There isn't yet enough evidence on vitamin E or chromium to assess whether or not these substances might be helpful in lowering blood sugar levels.
There's nothing you or your child could have done to prevent type 1 diabetes; there is currently no known way to prevent type 1 diabetes.
Tests can be done in children who have a high risk of developing type 1 diabetes to see if they have any of the antibodies associated with type 1. However, the presence of these antibodies doesn't mean that diabetes is a certainty, and there's currently no known way to prevent type 1 diabetes if the antibodies are found.
Researchers are working on preventing type 1 diabetes in people who have a high risk of developing the disease, such as those who have the type 1 antibodies, and others are working on preventing further destruction of the islet cells in people who are newly diagnosed.
Some children with type 1 diabetes may be eligible for clinical trials, but carefully weigh the risks and benefits of any treatment available in a clinical trial with your doctor.
While there's nothing you could have done to prevent your child's diabetes, you can help your child prevent complications due to type 1 diabetes by helping him or her maintain good blood sugar control as much as possible.
In addition, be sure to schedule regular visits with your child's diabetes doctor and a yearly eye exam beginning no more than five years after the initial diabetes diagnosis.
And, like everyone else, people with type 1 diabetes should eat a healthy diet full of fruits, vegetables and whole grains, and participate in regular physical activity to help keep their hearts healthy.
Last Updated: 2011-03-03
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