Diabetes: Type 1

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KEY POINTS

• Having diabetes means that there is too much glucose (sugar) in your child’s blood. Type 1 diabetes happens when the pancreas stops making insulin. When your child’s body does not have enough insulin, glucose cannot get into the cells and builds up in your child’s blood.
• The goal of treatment is to control the level of glucose in your child’s blood and keep it in a normal range. Your child will need to take insulin for life. Your child will learn about diabetes, how to check blood glucose levels, and how to treat high and low blood glucose. Other important parts of diabetes treatment are meal planning and physical activity.

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What is diabetes?

Having diabetes means that there is too much glucose (sugar) in your child’s blood. Your child’s body breaks down some of the foods your child eats into glucose. The blood carries the glucose to the cells of the body. Your child needs some glucose in the cells for energy, but too much or too little glucose in the blood causes symptoms and is not good for your child’s health.

Type 1 diabetes is a lifelong disorder that usually starts in childhood or early adulthood. It was once called juvenile diabetes. Type 1 diabetes cannot be prevented. Screening tests for type 1 diabetes are not done in people who have no symptoms.

What is the cause?

Type 1 diabetes happens when the pancreas stops making insulin. Insulin is a hormone made by the pancreas, which is an organ in the upper belly. The body uses insulin to help move glucose from the blood into the cells. When your child’s body does not make enough insulin or has trouble using the insulin the body makes, glucose cannot get into the cells and builds up in your child’s blood. Uncontrolled diabetes can damage small blood vessels and nerves, causing problems in the eyes, heart, brain, liver, kidneys, skin, and feet. Your child’s diabetes treatment plan often must change over time to successfully manage your child’s diabetes.

The pancreas stops making insulin when cells in the pancreas have been injured or destroyed. What causes this to happen is not always known. It may happen after a viral infection or an injury to the pancreas. It may be caused by a problem with your child’s immune system. The immune system is the body’s defense against infection. The body's defenses against infection may attack the body's own tissue. When your child has type 1 diabetes, the attack is mostly against the pancreas.

What are the symptoms?

Symptoms may start suddenly, or they may develop over days to weeks. Not everyone has the same symptoms. Symptoms may include:

• Urinating a lot
• Increased thirst
• Increased hunger
• Blurry vision
• Dry mouth
• Tiredness
• Unexpected weight gain or loss
• Fruity-smelling breath
• Dry, itchy skin
• Frequent infections such as of the skin, gums, bladder, or vagina
• Infections that heal slowly
• Infections of the foreskin in uncircumcised males
• Thickened, darkened skin on the neck or in body folds such as under the arms
• Bed wetting in children who previously didn’t wet the bed during the night

If diabetes is not diagnosed and treated, your child’s blood glucose levels could get so high that it causes your child to go into a coma and die.

How is it diagnosed?

Your child’s healthcare provider will ask about your child’s symptoms and medical history and examine your child. Your child’s provider will also ask about your child’s personal and family medical history. Your provider will check the level of glucose in your child’s blood. For most people, 2 abnormal test results are used to confirm the diagnosis. The tests may be done on different days. If your child is having severe symptoms of high or low blood glucose, a single random blood glucose test may be used to confirm your child’s diagnosis.

Your child will have tests to measure the level of glucose in the blood. Tests may include:

• Fasting blood glucose test (FBG). For this test, your child’s blood glucose is checked in the morning after not eating any food or drinking anything except water for at least 8 hours.
• A 2-hour oral glucose tolerance test (OGTT). Your child’s blood glucose is checked when your child has fasted. Then your child drinks a special sugar drink and your child’s blood is checked again 2 hours later to see how well your child’s body has processed the sugar.
• Hemoglobin A1C. This blood test is used to check your child’s average blood glucose over the past 3 months. Hemoglobin A1C is also known as HbA1C and A1C.
• Random blood glucose test (RBG) at a time when your child has been eating normally.

Your child may have other blood tests to see what type of diabetes your child has.

How is it treated?

The goal of treatment is to control the level of glucose in your child’s blood and keep it in a normal range. Controlling your child’s blood glucose can prevent or delay serious problems caused by diabetes.

With type 1 diabetes, your child will need to take insulin for life. Your child will learn about diabetes, how to check blood glucose, and how to treat high and low blood glucose. Other important parts of diabetes treatment are meal planning and physical activity.

Insulin

• Different types of insulin may be used to treat diabetes. They differ by how quickly they act to lower the blood glucose level and how long their effects last. You and your healthcare provider will work together to find the types and doses of insulin that will keep your child’s glucose levels in the target range. You or your child will need to check your child’s blood glucose levels, often 4 or more times a day to start. Based on when the glucose is high or low, your child’s daily activities including meals and work or school schedule, your child will probably take a combination of insulins, usually a short acting insulin and a longer acting insulin, to give better control of the blood glucose levels. Your child’s dosage of insulin may change based on the food your child eats and the level of glucose in the blood. If your child gets too much insulin, your child’s blood glucose could get too low. Low blood glucose levels can make your child feel shaky and faint. Very low blood glucose levels can cause your child to have a seizure or go into a coma.
• Shots of insulin may be given under the skin of the thigh or belly one or more times a day. You or your child will learn how to measure insulin doses, clean your child’s skin, and give the shots. Your child can learn to give the shots of insulin between the ages of 10 or 11 years. Your child may be able to use an insulin pump.
• Your child’s healthcare provider may prescribe other medicines to help control the blood glucose level.
• Healthcare providers are working to find new and more effective ways to treat diabetes. For example, surgical transplants of the whole pancreas or just a few cells from the pancreas are becoming more frequent. The transplanted tissue may make enough insulin every day so your child can stop taking insulin.

Blood glucose checks

• You and your child will learn how to check your child’s blood glucose level with a small machine called a blood glucose meter. Check blood glucose levels as often as advised by your child’s healthcare provider. When your child is 7 to 10 years old, your child can learn how to check blood glucose levels.
• You will need to keep a record of your child’s blood glucose measurements. Your provider will check the record at appointments to see if any changes need to be made to your child’s medicine.
• A continuous glucose monitor (CGM) is a device worn on the skin that reads blood glucose levels at set times. Talk to your child’s healthcare provider about the best device for your child’s needs.
• Your child may have an A1C test every 3 to 6 months to check overall control of blood glucose levels. The A1C test is a way of measuring average blood glucose over a 3-month period. It’s a good way to see if your child’s diabetes is under control. However, it does not replace daily blood glucose measurements. Daily checks of your child’s blood glucose levels show whether your child’s treatment is working throughout the day.

Meal planning

• Your child’s healthcare provider will give you guidelines about which foods your child should eat and how many carbohydrates (carbs) and calories to eat each day. Your child’s meal plan will include fruits, vegetables, complex carbohydrates (carbs) such as whole grain pastas, breads, and cereals, lean protein, and high-fiber grains. Include healthy fats such as small servings of nuts, seeds, avocado, olive oil, and fish oil. Your child may be able to have an occasional snack with sugar, but your child’s regular meal plan should not include sugary food such as soft drinks, candy, and desserts. You will also learn how to space your child’s meals so your child eats as often as needed.
• Your provider may refer you to a dietitian or certified diabetes educator for help with meal planning.

Physical activity

• Physical activity is very important. Physical activity improves blood flow, uses up more of the glucose in the blood, and helps your child’s body use insulin better. A good activity plan can help control your child’s blood glucose level. It also helps keep your child healthy and avoid some of the problems caused by diabetes. Talk to your healthcare provider about the right activity plan for your child.

Education

• When a child is diagnosed with diabetes, there is a lot to learn about the disease. This education is usually done at a diabetes clinic. This education is very important. Ask your healthcare provider about your choices.
• Healthcare providers, including certified diabetes educators and dietitians, will teach you what diabetes is, and how to give shots of the right amounts of insulin. You and your child will learn how and when to check for glucose in the blood and for ketones in the blood or urine. You will learn how to treat high and low blood glucose and other ways to keep your child healthy.

How can I take care of my child?

To manage type 1 diabetes and avoid complications, you and your child should work with your child’s healthcare provider, learn to change your child’s eating habits, add or continue physical activities, and check your child’s blood glucose levels as often as advised by your healthcare provider. Carefully controlling blood glucose and taking care of any other health problems may prevent or delay serious health problems. Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Try to help your child have meals, snacks, and physical activity near the same time each day when possible. Your child should carry a protein snack, such as cheese and crackers or peanuts, to make sure your child eats as often as needed.
• Make sure your child carries glucose to take if blood glucose levels get too low. Glucose tablets or gel are good for emergencies.
• Follow your healthcare provider's instructions for checking or scanning your child’s blood glucose levels and adjusting insulin dosage according to the results of the blood tests. Ask your child’s healthcare provider when you should check for ketones.
• Get your child’s eyes checked as often as advised by your child’s healthcare provider.
• Make sure that your child stays physically active as advised by your child’s provider.
• Get other medical problems treated, especially high blood pressure and high cholesterol.
• Your child should carry a medical ID such as a card or bracelet that says he or she has diabetes.
• Learn about diabetes and its complications so you can make the decisions needed to control your child’s blood glucose levels. There is a lot to learn. It's good for everyone in your family to learn about diabetes.
• Adolescent females must manage their diabetes well to help prevent problems if they get pregnant. Ask your teenager’s healthcare provider to talk to your child about effective ways to prevent pregnancy, and the importance of keeping blood glucose in the recommended range.
• Following all the steps to manage your child’s diabetes may feel overwhelming. If you or your child feel stressed or depressed, talk with a counselor.

Children with diabetes are faced with the same pressures as other kids. They may be curious about smoking and using e-cigarettes, drinking alcohol, or using drugs. Smoking and using e-cigarettes speeds up damage to the heart and blood vessels. Alcohol and drugs can make blood glucose harder to control and can cause nerve damage over time. Talk to your child about the risks of smoking and using e-cigarettes, drinking alcohol, and using drugs.

Ask your child’s provider:

• How and when you will get your child’s test results
• How long it will take for your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests. Be sure to take your child’s glucose records and glucose meter to all appointments.

For more information, contact:

• American Diabetes Association
  800-342-2383
  https://www.diabetes.org
• Children's Diabetes Foundation
  800-695-2873
  https://www.childrensdiabetesfoundation.org/