Illness & Conditions - Health Conditions
Type 1 Diabetes: Children Living With the Disease
What is type 1 diabetes?
Type 1 diabetes is a lifelong disease that 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.
What will it be like for your child to live with type 1 diabetes?
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.
How can you manage diabetes?
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.
What symptoms should you watch for?
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.
How often does your child need to see the doctor?
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.
How will your child's treatment change over time?
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.
Frequently Asked Questions
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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.
Experts do not know what causes type 1 diabetes. But the cause may involve family history and maybe environmental factors like diet or infections.
Causes of high blood sugar
Causes of low blood sugar
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:
How can you tell the difference?
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 indicate 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.
Low blood sugar
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.
High blood sugar
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:
What can be done?
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. Two important studies, Diabetes Control and Complications Trial (DCCT) and its follow-up study, showed that keeping blood sugar levels in this range greatly decreases the chance of complications. Work with your child's doctor, and monitor blood sugar levels frequently.
What Increases Your Risk
Risk factors for very high or low blood sugar levels in a child with type 1 diabetes include:
Risk factors for these complications include:
When To Call a Doctor
Call 911 or other emergency services right away if your child is:
Call a doctor right away if:
Call a doctor if your child:
Who to see
Health professionals who may care for a child with type 1 diabetes include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
Exams and Tests
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. A doctor will examine your child for signs of infections, especially at injection sites. Your child will usually have the following tests at office visits:
If your child has a family history of high cholesterol or heart disease and is over 2 years old, your child's doctor will do a cholesterol (LDL and HDL) test when type 1 diabetes is diagnosed or as soon as blood sugars are under control. If there is no family history of high cholesterol, your child will have a cholesterol test at puberty. If the LDL cholesterol is less than 100 mg/dL (2.60 mmol/L) and there is no family history of high cholesterol, the doctor will repeat this test every 5 years.
Diabetes increases your child's risk for dental problems. Experts suggest dental checkups every 6 months.
Children's nutritional needs change as they grow and develop. See a registered dietitian at least once a year to review your child's meal plan.
5 years after diagnosis
Your child will have an initial dilated eye exam (ophthalmoscopy) by an ophthalmologist or an optometrist when your child is at least 10 years old and has had diabetes for 3 to 5 years. This eye exam checks for signs of diabetic retinopathy and glaucoma . Thereafter, your child should 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 should also begin having annual microalbumin urine tests. This test helps detect diabetic nephropathy .
Your child may have a test for thyroid antibodies when type 1 diabetes is diagnosed. Also, a thyroid-stimulating hormone (TSH) test should be done every 1 to 2 years. This test checks for thyroid problems, which are common among people who have type 1 diabetes.
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:
Regular medical checkups
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 will 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 .
Treatment for high blood sugar emergency
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.
What to think about
A 10-year study, and its follow-up study, showed that keeping blood sugar levels within a target range helps decrease the chances of developing diabetes complications, such as eye, kidney, heart, blood vessel, and nerve damage. As a result of this study, experts recommend that people with diabetes carefully control their blood sugar levels. This is often called strict or tight blood sugar control.
When a child has diabetes, keeping blood sugar levels within a target range helps the child grow and develop normally, but it increases the risk for frequent low blood sugar episodes. Your doctor will figure the safest range for your child's blood sugar level.
For some children, using an insulin pump may help keep their blood sugar levels within a target range.
If your child has frequent low blood sugar levels, especially at night ( nocturnal hypoglycemia ), the doctor may suggest continuous ambulatory blood glucose monitoring. This means that your child wears a special monitor that records his or her blood sugar level continuously for 24 to 72 hours. The monitor stores the results, which allows you to look for patterns of high or low blood sugar levels. 2
Scientists are looking for pain-free ways to give insulin and test blood sugar levels. Under development are improved insulin pumps, and better needles and lancets. New glucose monitors may be worn continuously and be able to signal insulin pumps when the rate of insulin needs to be changed. Scientists are also studying ways to prevent or decrease complications from diabetes. If you're interested, talk to your child's doctor about participating in any of these studies.
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:
The daily care for your child with type 1 diabetes can seem overwhelming, leading to conflicts between you and your child. Here are some tips that may help:
Make eating less stressful
Mealtimes can become a battleground when you want your child to get a certain amount of carbohydrate . You can:
Make giving insulin less difficult
Your child may take several insulin injections each day or use an insulin pump .
Keep monitoring reasonable
If you test several times a day (before breakfast, with meals, and at bedtime), you can tell how well your child's blood sugar levels stay within a target range. You need to test more often when your child is sick. Follow the sick-day guidelines that you and your child's doctor set up, or call for help. Do not give your child nonprescription medicines without talking with the doctor.
Encourage physical activity
Experts recommend that teens and children (starting at age 6) do moderate to vigorous activity at least 1 hour every day. 1 And 3 or more days a week, what they choose to do should:
It's okay for them to be active in smaller blocks of time that add up to 1 hour or more each day.
Children with type 1 diabetes can participate in sports just like children without diabetes. But children who use insulin are at risk for low blood sugars during and after exercise. Some tips for exercising safely for your child with type 1 diabetes can help prevent low blood sugar levels. These include making sure your child drinks water and being sure your child's blood sugar is in the target range before exercising.
If your child has a tendency to be inactive, you may need to:
Catch the ups and downs
Because blood sugar levels can drop to dangerous levels very quickly:
High blood sugar levels develop more slowly, over a period of hours or days.
Keep your child healthy and safe
With planning and care, your child can live a safe and healthy life. Here are some suggestions:
Keep your balance
It's difficult to deal with such a demanding disease as diabetes. You can:
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.
What to think about
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.
Surgery is not a routine treatment for type 1 diabetes, and children do not meet the criteria for the surgeries that are available. Surgeries for type 1 diabetes are:
You'll hear about products that promise a "cure" for type 1 diabetes. Avoid them. No such cure exists. Also, avoid products for diabetes that are advertised only by "satisfied customers." These products or remedies may be harmful and costly. They also might cause you to delay or avoid getting treatment for your child that really works. If you have questions about a product for diabetes, check with your local American Diabetes Association office, your doctor, or a diabetes educator.
Other types of meal plans
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.
Complementary therapies such as relaxation techniques may help relieve stress and muscle tension and improve your child's overall well-being and quality of life. None of these complementary therapies are proved to effectively treat diabetes. But children may benefit from safe, nontraditional therapies that complement their current treatment.
Do not use complementary therapies alone to treat your child's diabetes.
Talk with your child's doctor if you are using any of the following or other complementary or alternative therapies to treat your child's diabetes:
Other Places To Get Help
Last Revised: March 7, 2011
Author: Healthwise Staff
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.
American Diabetes Association (2004). Tests of glycemia in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S91–S93.
American Diabetes Association (2004). Smoking and diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74–S75.
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