This topic covers type 1 diabetes in children. For information about type 1 diabetes in adults and about preventing complications from type 1 diabetes, see the topic Type 1 Diabetes.
Type 1 diabetes develops when the pancreas stops making insulin. Your body needs insulin to let sugar (glucose) move from the blood into the body's cells, where it can be used for energy or stored for later use.
Without insulin, the sugar cannot get into the cells to do its work. It stays in the blood instead. This can cause high blood sugar levels. A person has diabetes when the blood sugar is too high.
Your child can live a long, healthy life by learning to manage his or her diabetes. It will become a big part of your and your child's life.
You play a major role in helping your child take charge of his or her diabetes care. Let your child do as much of the care as possible. At the same time, give your child the support and guidance he or she needs.
The key to managing diabetes is to keep blood sugar levels in a target range. To do this, your child needs to take insulin, eat about the same amount of carbohydrate at each meal, and exercise. Part of your child's daily routine also includes checking his or her blood sugar levels at certain times, as advised by your doctor.
The longer a person has diabetes, the more likely he or she is to have problems, such as diseases of the eyes, heart, blood vessels, nerves, and kidneys. For some reason, children seem protected from these problems during childhood. But if your child can control his or her blood sugar levels every day, it may help prevent problems later on.
Even when you are careful and do all the right things, your child can have problems with low or high blood sugar. Teach your child to look for signs of low and high blood sugar and to know what to do if this happens.
Young children can't tell if they have low blood sugar as well as adults can. Also, after your child has had diabetes for a long time, he or she may not notice low blood sugar symptoms anymore. This raises the chance that your child could have low blood sugar emergencies. If you are worried about your child's blood sugar, do a home blood sugar test. Don't rely on symptoms alone.
Both low and high blood sugar can cause problems and need to be treated. Your doctor will suggest how often your child's blood sugar should be checked.
See your child's doctor at least every 3 to 6 months to check how well the treatment is working. During these visits, the doctor will do some tests to see if your child's blood sugar is under control. Based on these results, the doctor may change your child's treatment plan.
When your child is 10 years old or starts puberty, he or she will start having exams and tests to look for any problems from diabetes.
Your child's insulin dose and possibly the types of insulin may change over time. The way your child takes insulin (with shots or an insulin pump) also may change. This is especially true during the teen years when your child grows and changes a lot.
What and how much food your child needs will also change over the years. But it will always be important to eat about the same amount of carbohydrate at each meal. Carbohydrate is the nutrient that most affects blood sugar.
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Type 1 diabetes develops because the body's immune system destroys beta cells in a part of the pancreas called the islet tissue. Beta cells produce insulin. So children with type 1 diabetes can't make their own insulin. Experts do not know what causes this to happen. But the cause may involve family history and maybe environmental factors like diet or infections.
Type 1 diabetes develops when your child's pancreas stops producing enough insulin. Insulin lets blood sugar—also called glucose—enter the body's cells, where it is used for energy. Without insulin, the amount of sugar in the blood rises above a safe level. As a result, your child experiences high and low blood sugar levels from time to time. High blood sugar can damage blood vessels and nerves throughout the body and increases your child's risk of eye, kidney, heart, blood vessel, and nerve diseases.
Because your child has type 1 diabetes, he or she will experience high and low blood sugar levels from time to time. High blood sugar usually develops slowly over hours or days, so you can treat the symptoms before they become severe and require medical attention. On the other hand, your child's blood sugar level can drop to dangerously low levels in minutes.
Be alert for:
Sometimes it's hard to distinguish between high and low blood sugar symptoms, especially if your child is very young. Test your child's blood sugar whenever you think it may be high or low so that you can treat it appropriately. If your child has symptoms of very high blood sugar, such as a fruity breath odor, vomiting, and/or belly pain, seek emergency care. These symptoms may point to diabetic ketoacidosis, which is a life-threatening emergency.
Every child experiences type 1 diabetes differently.
The negative effects of diabetes are caused by blood sugar levels that are above or below a target range.
Very low blood sugar is a frightening experience for you and your child. But if low blood sugar levels are treated quickly and appropriately, your child should have no lasting effects.
Young children cannot recognize low blood sugar symptoms as well as adults can, which puts them at risk for low blood sugar emergencies. Children who develop hypoglycemia unawareness, which is the inability to recognize early symptoms of low blood sugar until they become severe, or who are trying to keep their blood sugar levels tightly within a target range are also at risk for low blood sugar emergencies.
Make sure your child's caregivers, such as school nurses, know:
Let your doctor know if your child is having frequent episodes of low blood sugar. You can use this form to keep a record of your child's very high or very low blood sugar levels.
Very high blood sugar puts your child at risk for diabetic ketoacidosis, a life-threatening emergency. Skipping insulin injections, stress, illness, injury, and puberty can trigger high blood sugar. Because blood sugar levels usually rise slowly, you can treat symptoms early and, most often, prevent diabetic ketoacidosis.
High blood sugar can also lead to:
The best way to help your child with type 1 diabetes live a long and healthy life is to keep his or her blood sugar levels within a target range. Work with your child's doctor, and monitor blood sugar levels frequently.
Risk factors for very high or low blood sugar levels in a child with type 1 diabetes include:
Call 911 or other emergency services immediately if your child:
Call a doctor now if your child:
Check with your doctor if your child:
A child with type 1 diabetes needs to visit his or her doctor at least every 3 to 6 months. During these visits, the doctor reviews your child's blood sugar level records and asks about any problems you and your child may have. Your child's blood pressure is checked, and growth and development is evaluated. The doctor examines your child for signs of infections, especially at injection sites. Your child usually has the following tests at office visits:
If your child is at least 10 years old, your child's doctor may do a cholesterol (LDL and HDL) test when type 1 diabetes is diagnosed or as soon as blood sugars are under control. If the LDL cholesterol is less than 100 mg/dL (2.60 mmol/L), the doctor may repeat this test every 3 to 5 years.
Diabetes increases your child's risk for dental problems. Experts suggest dental checkups every 6 months.
Once a year, you and your child may also see other members of the diabetes team, for example:
Your child will have an initial dilated eye exam (ophthalmoscopy) by an ophthalmologist or an optometrist if your child has had diabetes for 3 to 5 years and has started puberty or has had diabetes for 3 to 5 years and is at least 10 years old. This eye exam checks for signs of diabetic retinopathy and glaucoma. Thereafter, your child may have an eye exam every year. If your child is at low risk for vision problems, your doctor may consider follow-up exams less often.
Your child may have a test for thyroid antibodies when type 1 diabetes is diagnosed. Also, a thyroid-stimulating hormone (TSH) test and a thyroxine (T4) test may be done every 1 to 2 years. These tests check for thyroid problems, which are common among people who have type 1 diabetes.
Some other tests include:
The goal of your child's treatment for type 1 diabetes is to always keep his or her blood sugar levels within a target range. A target range reduces the chance of diabetes complications. Daily diabetes care and regular medical checkups will help you and your child accomplish this goal.
Your child's daily care includes:
Some problems you may encounter include:
You will also want to:
Your child needs to see his or her doctor every 3 to 6 months. During these checkups, the doctor will evaluate and adjust your child's treatment. The doctor will do a hemoglobin A1c or similar test (glycosylated hemoglobin or glycohemoglobin) to check your child's blood sugar control over the previous 2 to 3 months, and a blood glucose test.
If your child's LDL cholesterol is less than 100 mg/dL (2.60 mmol/L) and there is no family history of high cholesterol, the doctor may do a cholesterol (LDL and HDL) test every 5 years. If your child's blood pressure is consistently high and not reduced with weight control or exercise, the doctor may consider medicine.
When your child has had diabetes for 5 years, the doctor will start yearly screening tests for protein in the urine, which points to diabetic nephropathy. At that same time, your child needs to see an ophthalmologist for yearly dilated eye exams (ophthalmoscopy) to check for signs of diabetic retinopathy. If your child is at low risk for vision problems, your doctor may consider doing follow-up exams less often.
If your child does not take enough insulin, has a severe infection or other illness, or becomes severely dehydrated, his or her blood sugar level may rise very high and lead to diabetic ketoacidosis. Diabetic ketoacidosis is almost always treated in a hospital, often in the intensive care unit, where caregivers can watch your child closely and give him or her frequent blood tests for glucose and electrolytes. Insulin is given through a vein (intravenous, or IV) to bring blood sugar levels down. Fluids are given through the IV to correct the electrolyte imbalance. Your child may stay in the hospital for a few days until blood sugar levels are back in the target range and electrolytes have normalized.
If your child has frequent low blood sugar levels, especially at night (nocturnal hypoglycemia), the doctor may suggest a continuous glucose monitor (CGM). A CGM checks and records blood sugar day and night. Most CGMs sound an alarm if blood sugar levels are moving out of target range.
Your child with type 1 diabetes will have high and low blood sugar levels from time to time. You can help avoid many immediate problems and long-term complications, such as eye, kidney, heart, blood vessel, and nerve disease, by:
Insulin is the only medicine that can treat type 1 diabetes, and your child is most likely taking more than one type of insulin. Your child may take several injections a day or use an insulin pump. The insulin pump provides insulin with fewer injections and is as effective as multiple daily injections for keeping blood sugar levels in a target range.
The amount and type of insulin your child takes will likely change over time, depending on changes that occur with normal growth, physical activity level, and hormones (such as during adolescence). Your child may also need higher doses of insulin when feeling sick or stressed.
A rapid-acting insulin is given with a meal or immediately afterward. The dose is based on what your child actually ate, not what the meal plan required. If your child is a "picky eater," this provides flexibility that may reduce mealtime battles.
Scientists are looking at new types of insulin and better ways to give it.
You may hear of people with diabetes following other types of meal plans or using low glycemic index foods to prevent high blood sugar levels after meals. Talk with a registered dietitian before trying a new meal plan.
Along with medical treatment, you may wonder if complementary therapies, especially dietary supplements, will help your child. There isn't enough scientific evidence to say that any dietary supplement can prevent or manage type 1 diabetes.footnote 2
Talk with your doctor about any complementary health practice that you would like your child to try or that your child is already using. Your doctor can help you manage your child's health better if he or she knows about all of your child's health practices.
- U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/guidelines/default.aspx.
- National Center for Complementary and Integrative Health (2008, updated 2014). Diabetes and dietary supplements: In depth. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/diabetes/supplements.
Other Works Consulted
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- American Diabetes Association (2012). Diabetes care for emerging adults: Recommendations for transition from pediatric to adult diabetes care systems. Diabetes Care, 34(11): 2477–2485.
- American Diabetes Association (2012). Diabetes management at camps for children with diabetes. Diabetes Care, 35(Suppl 1): S72–S75.
- Beaser RS (2010). Designing a conventional insulin treatment program. In RS Beaser, ed., Joslin's Diabetes Deskbook: A Guide for Primary Care Providers, 2nd ed., pp. 297–340. Boston: Joslin Diabetes Center.
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- Jackson CC, et al. (2015). Diabetes care in the school setting: A position statement of the American Diabetes Association. Diabetes Care, 38(1): 1958–1963. DOI: 10.2337/dc15-1418. Accessed January 11, 2016.
- Pignone M, et al. (2010). Aspirin for primary prevention of cardiovascular events in people with diabetes: A position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation, 121(24): 2694–2701.
- Rewers M, et al. (2014). Diabetes mellitus. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 22nd ed., pp. 1097–1105. New York: McGraw-Hill.
- Rosenbloom AL (2011). Diabetes mellitus. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 2104–2125. New York: McGraw-Hill.
- Siminerio LM, et al. (2014). Care of young children with diabetes in the child care setting: A position statement of the American Diabetes Association. Diabetes Care, 37(10): 2834–2842. DOI: 10.2337/dc14-1676. Accessed October 9. 2014.
- Wolfsdorf J, et al. (2006). Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association. Diabetes Care (29): 1150–1159.
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