Know what symptoms to look out for, as well as more about diagnosis, treatment and daily living with this lifelong insulin-dependent condition.
Type 1 diabetes in children is a condition in which your child's body no longer produces an important hormone (insulin). Your child needs insulin to survive, so the missing insulin needs to be replaced with injections or with an insulin pump. 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, especially in the beginning. Suddenly you and your child — depending on his or her age — must learn how to give injections, count carbohydrates and monitor blood sugar.
There's no cure for type 1 diabetes in children, but it can be managed. Advances in blood sugar monitoring and insulin delivery have improved blood sugar management and quality of life for children with type 1 diabetes.
The signs and symptoms of type 1 diabetes in children usually develop quickly, and may include:
See your child's doctor if you notice any of the signs or symptoms of type 1 diabetes.
The exact cause of type 1 diabetes is unknown. But in most people with type 1 diabetes, the body's immune system — which normally fights harmful bacteria and viruses — mistakenly destroys insulin-producing (islet) cells in the pancreas. Genetics and environmental factors appear to play a role in this process.
Once the islet cells of the pancreas are destroyed, your child produces little or no insulin. Insulin performs the critical job of moving sugar (glucose) from the bloodstream to the body's cells. Sugar enters the bloodstream when food is digested.
Without enough insulin, sugar builds up in your child's bloodstream, where it can cause life-threatening complications if left untreated.
Risk factors for type 1 diabetes in children include:
Type 1 diabetes can affect the major organs in your body. Keeping your blood sugar level close to normal most of the time can dramatically reduce the risk of many complications.
Complications can include:
There's currently no known way to prevent type 1 diabetes, but this is a very active area of research. Researchers are working on:
Doctors can detect the antibodies associated with type 1 diabetes in children who have a high risk of the disorder. These antibodies can be detected months or even years before the first symptoms of type 1 diabetes appear, but there's currently no known way to slow or prevent the disease when antibodies are found. It's also important to know that not everyone with these antibodies goes on to develop type 1 diabetes.
While there's nothing you could have done to prevent your child's type 1 diabetes, you can help your child prevent its complications by:
There are several blood tests for type 1 diabetes in children:
If blood sugar testing indicates diabetes, your doctor will likely recommend additional tests to distinguish between type 1 diabetes and type 2 diabetes because treatment strategies differ by type.
These additional tests include:
You'll work closely with your child's diabetes treatment team — doctor, diabetes educator and dietitian — to keep your child's blood sugar level as close to normal as possible. Treatment for type 1 diabetes includes:
You will need to check and record your child's blood sugar at least four times a day. But you'll probably need to check it more often if your child doesn't have a continuous glucose monitor.
Frequent testing is the only way to make sure that your child's blood sugar level remains within his or her target range — which may change as your child grows and changes. Your child's doctor will let you know what your child's blood sugar target range is.
Continuous glucose monitoring (CGM) devices measure your blood sugar every few minutes using a temporary or implanted sensor inserted under the skin. Some devices show your blood sugar reading at all times on a receiver or your smartphone or smartwatch, while others require that you check your blood sugar by running the receiver over the sensor.
Anyone who has type 1 diabetes needs lifelong treatment with one or more types of insulin to survive. Many types of insulin are available, including:
There are several options for insulin delivery, including:
A device called a sensor-augmented pump combines an insulin pump and a continuous glucose monitor with a sophisticated algorithm to automatically deliver insulin when it's needed. The goal is to develop a completely automatic "closed loop" system, called the artificial pancreas.
Right now, what's known as a hybrid closed loop system is available. People with type 1 diabetes still have to tell the device how many carbohydrates they eat, and periodically confirm blood sugar levels, but the device adjusts insulin delivery throughout the day automatically. The available devices continue to be refined, and research will likely be ongoing until a fully automated system is available.
Food is a big component of any diabetes treatment plan, but that doesn't mean your child has to follow a strict "diabetes diet." Just like the rest of the family, your child's diet should regularly include foods that are high in nutrition and low in fat and calories, such as:
Your child's dietitian can help you create a meal plan that fits your child's food preferences and health goals, as well as help you plan for occasional treats. He or she will also teach you how to count carbohydrates in foods so that you can use that information when figuring out insulin doses.
Everyone needs regular aerobic exercise, and children who have type 1 diabetes are no exception. Encourage your child to get at least 60 minutes of physical activity daily or, better yet, exercise with your child. Make physical activity part of your child's daily routine.
But remember that physical activity usually lowers blood sugar, and can affect blood sugar levels for hours after exercise, possibly even overnight. 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.
Blood sugar can sometimes change unpredictably. Ask your child's diabetes treatment team how to handle these and other challenges:
Your child will need regular follow-up appointments to ensure good diabetes management and to check his or her A1C levels. The American Diabetes Association generally recommends an A1C of 7.5 or lower for all children and teens.
Your doctor also will periodically check your child's:
Despite your best efforts, sometimes problems will arise. Certain short-term complications of type 1 diabetes require immediate care or they could become very serious, including:
Hypoglycemia is a blood sugar level below your child's target range. Blood sugar levels can drop for many reasons, including skipping a meal, getting more physical activity than normal or injecting too much insulin. Low blood sugar is not uncommon in people with type 1 diabetes, but if it isn't treated quickly, symptoms will get worse.
Signs and symptoms of low blood sugar include:
Teach your child the symptoms of low blood sugar. When in doubt, he or she should always do a blood sugar test. If a blood glucose meter isn't readily available and your child is having symptoms of a low blood sugar, treat for low blood sugar, and then test as soon as possible.
If your child has a low blood sugar reading:
If a low blood sugar causes your child to lose consciousness, an emergency injection of a hormone that stimulates the release of sugar into the blood (glucagon) may be necessary.
Hyperglycemia is a blood sugar level above your child's target range. Blood sugar levels can rise for many reasons, including illness, eating too much, eating the wrong types of foods and not taking enough insulin.
Signs and symptoms of high blood sugar include:
If you suspect a high blood sugar, test your child's blood sugar. If your child's blood sugar is higher than the target range, follow your child's diabetes treatment plan or check with your child's doctor. High blood sugar levels don't come down quickly, so ask your doctor how long to wait until you check your child's blood sugar again.
If your child has a blood sugar reading above 240 mg/dL (13.3 mmol/L), your child should use a urine test stick to test for ketones. Don't allow your child to exercise if his or her blood sugar level is high or if ketones are present.
A severe lack of insulin causes your child's body to break down fat for energy. This causes the body to produce a substance called ketones. Excess ketones build up in your child's blood, creating a potentially life-threatening condition known as diabetic ketoacidosis.
Signs and symptoms of DKA include:
If you suspect DKA, check your child's urine for excess ketones with an over-the-counter ketone test kit. If the ketone levels are high, call your child's doctor or seek emergency care.
Following a diabetes treatment plan requires 24-hour care and significant lifestyle changes, which can be frustrating at times. No one can do it perfectly. But your efforts are worthwhile. Careful management of type 1 diabetes helps reduce your child's risk of serious complications.
As your child gets older:
The habits you teach your child today will help him or her enjoy an active and healthy life with type 1 diabetes.
You'll need to work with your child's school nurse and teachers to make sure they know the symptoms of high and low blood sugar levels. The school nurse might need to administer insulin or check your child's blood sugar levels. Federal law protects children with diabetes, and schools must make reasonable accommodations to ensure that all children get a proper education.
People who have type 1 diabetes must use insulin every day to survive. No alternative treatment or diet supplement can replace insulin for people with type 1 diabetes.
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 and on other days, it may seem as if nothing works well. Don't forget that you're not alone.
Diabetes can affect your child's emotions both directly and indirectly. Poorly controlled blood sugar can cause behavior changes, such as irritability.
Diabetes can also make your child feel different from other kids. Having to draw blood and give themselves shots sets kids with diabetes apart from their peers. Getting your child together with other children who have diabetes or spending time at a diabetes camp may help make your child feel less alone.
People with diabetes have an increased risk of depression, anxiety and diabetes-related distress. That's why some diabetes specialists regularly include a social worker or psychologist as part of their diabetes care team. If you notice that your child or adolescent is persistently sad or pessimistic, or experiences dramatic changes in sleeping habits, weight, friends or school performance, have your child screened for depression.
Rebellion also may be an issue, particularly for teens. 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. Additionally, experimenting with drugs, alcohol and smoking can be even more dangerous for people with diabetes.
Talking to a counselor or therapist may help your child or you cope with the dramatic lifestyle changes that come with a diagnosis of type 1 diabetes. Your child may find encouragement and understanding in a type 1 diabetes support group for children. Support groups for parents also are available.
If you're interested, your doctor may be able to recommend a group in your area. Websites that offer support include:
The threat of complications from poorly managed diabetes can be frightening. It's important to remember that many studies — and therefore, a lot of literature you may be reading — were completed before many advances in diabetes care occurred. If you and your child work with your child's doctor and do your best to manage your child's diabetes, your child will likely live a long and normal life.
Your child's primary care doctor will probably make the initial diagnosis of type 1 diabetes. Hospitalization is often needed to stabilize your child's blood sugar levels.
Your child's long-term diabetes care likely will 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).
Here's some information to help you get ready for your appointment.
Before your appointment take these steps:
Topics you might want to discuss with your doctor, dietitian or diabetes educator include:
Your doctor is likely to ask you a number of questions, such as:
Contact your child's doctor or diabetes educator between appointments if your child's blood sugar is consistently out of the target range your doctor recommended or if you're not sure what to do in a certain situation.
December 24th, 2020