Diabetes: Type 1

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KEY POINTS

• Having diabetes means that there is too much sugar (glucose) 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, sugar cannot get into the cells and builds up in your child’s blood.
• The goal of treatment is to control the level of sugar in your child’s blood and keep it in a normal range. Your child will need to take insulin for the rest of his life. Your child will learn about diabetes, how to test blood sugar, and how to treat high and low blood sugar. Other important parts of diabetes treatment are diet and exercise.

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What is diabetes?

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

Type 1 diabetes is a lifelong disorder that usually starts in childhood or early adulthood. It’s also called juvenile diabetes. Type 1 diabetes cannot be prevented. There is no screening test for type 1 diabetes 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 sugar from the blood into the cells. When the body does not have enough insulin, sugar cannot get into the cells and builds up in your child’s blood. Diabetes can damage small blood vessels and nerves, causing problems in the eyes, heart, brain, kidneys, skin, and feet.

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:

• Increased thirst
• Urinating a lot
• Blurry vision
• Feeling tired and weak
• Increased hunger
• Irritability and other mood changes
• Unexpected weight loss
• Fruity smelling breath
• 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 sugar 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 will have tests to measure the level of sugar in the blood. Tests may include:

• Fasting blood sugar test (FBS). For this test, your child’s blood sugar is tested in the morning after not eating any food or drinking anything except water for at least 8 hours.
• Hemoglobin A1C. The A1C is a blood test that can be used to check your child’s average blood sugar over the past 2 to 3 months.
• Glucose tolerance test (GTT). For this test, a sample of your child’s blood is taken when he has not eaten anything since the night before. Then your child drinks a special sugar drink and his blood is tested again 1 to 2 hours later. Your child’s blood sugar may be tested several more times after the first test, every 30 to 60 minutes.
• Random blood sugar test (RBS) at a time when your child has been eating normally.

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

How is it treated?

The goal of treatment is to control the level of sugar in your child’s blood and keep it in a normal range. Controlling your child’s blood sugar can lessen the chance that your child will develop serious problems caused by diabetes.

When your child has type 1 diabetes, he will need to take insulin for the rest of his life. Your child will learn about diabetes, how to test his blood sugar, and how to treat high and low blood sugar. Other important parts of diabetes treatment are diet and exercise.

• Insulin

  Different types of insulin may be used to treat diabetes. They differ by how quickly they act to lower the blood sugar 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 sugar levels in the recommended range. You or your child will need to check your child’s blood sugars, often 4 or more times a day to start. Based on when the sugar is high or low, your child’s daily activities 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 sugar. Your child’s dosage of insulin may change based on the food your child eats and the level of sugar in his blood. If your child gets too much insulin, his blood sugar could get too low. Low blood sugar can make your child feel shaky, faint, have a seizure, or go into a coma.

  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 himself 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 sugar.

  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 sugar tests

  You and your child will learn how to check your child’s blood sugar with a small machine called a blood glucose meter. Your provider will tell you when and how often your child’s blood sugar needs to be checked. When your child is 7 to 10 years old, he can learn how to test his blood sugar himself.

  You will need to keep a record of your child’s blood sugar measurements. Your provider will check the record at appointments to see if any changes need to be made to your child’s medicine.

  Your child may have an A1C test every 3 to 6 months to check overall control of his blood sugar. The A1C test is a way of measuring average sugar 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 sugar measurements. Daily checks of your child’s blood sugar show whether your child’s treatment is working throughout the day.

• Diet

  Your healthcare provider will give you guidelines about which foods your child should eat and how many calories to eat each day. Your child’s prescribed diet will include a lot of lean protein, complex carbohydrates (such as whole grain pastas breads, and cereals), fresh fruits and vegetables, and foods with high fiber. Your child may be able to have an occasional snack with sugar, but your child’s regular diet should not include sugary food such as soft drinks, candy, and desserts. You will also learn how to space your child’s meals so he doesn’t go too long without food.

  Your provider may refer you to a dietitian or diabetes educator for help with meal planning.

• Exercise

  Exercise is very important. Exercise improves blood flow, helps your child’s body use insulin better, and uses up more of the sugar in the blood. A good activity plan can help control your child’s blood sugar level. It also helps keep him 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 for 2 or 3 days at a diabetes clinic. This education is very important. Ask your healthcare provider about your choices.

  Healthcare providers will teach you what diabetes is, and how to give shots of the right amounts of insulin. You and your child will learn how to test for sugar in the blood and for ketones in the blood or urine. You will learn how to treat high and low blood sugar and other ways to keep your child healthy.

How can I take care of my child?

You can learn to take good care of your child in a few weeks and your child can keep doing almost all of his favorite activities. You need to work with your healthcare provider, change your child’s eating habits, add or continue physical activities, and check your child’s blood sugar on the schedule your provider recommends. Carefully controlling blood sugar and taking care of any other health problems your child has may prevent or delay serious health problems. Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Try to always have your child’s meals, snacks, and exercise at the same time each day. Your child should carry a protein snack, such as cheese and crackers or peanuts, to make sure he eats as often as he should.
• Follow your healthcare provider's instructions for testing your child’s blood and adjusting his insulin dosage according to the results of the blood tests.
• Get your child’s eyes checked as often as your provider recommends.
• 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 has diabetes.
• Learn about diabetes and its complications so you can make the correct decisions to control your child’s blood sugar levels. There is a lot to learn. It's good for everyone in your family to learn about diabetes.
• Following all of 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, drinking alcohol, or using drugs. Smoking 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, 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 sugar logs or glucose meter to all appointments.

You can get more information from:

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