Type 1 Diabetes in Children

Condition Basics

What is type 1 diabetes?

Type 1 diabetes is a disease that starts when the pancreas stops making enough of a hormone called insulin. Insulin helps the body use sugar from food as energy or store it for later use. If there isn't any insulin, too much sugar stays in the blood. Over time, high blood sugar can harm many parts of the body. These include the eyes, heart, blood vessels, nerves, and kidneys.

Type 1 diabetes can occur at any age, but it usually starts in children or young adults. It's a lifelong disease. But with treatment and a healthy lifestyle, people can live a long and healthy life.

What causes it?

The body makes insulin in beta cells, which are in a part of the pancreas called the islet (say "EYE-let") tissue. Type 1 diabetes starts because the body's immune system destroys those beta cells. So people who have type 1 diabetes can't make their own insulin.

What are the symptoms?

Symptoms of type 1 diabetes include urinating often, being very thirsty, losing weight without trying, being hungrier than usual, and having blurry vision. Symptoms are caused by high blood sugar. They usually develop quickly, over a few days to weeks. At first, symptoms may be overlooked or mistaken for another illness, like the flu.

How is it diagnosed?

The doctor will ask about past health issues and do a physical exam. Blood tests are done to measure how much sugar is in the blood. The doctor will use those blood test results and the American Diabetes Association criteria to diagnose diabetes.

How is type 1 diabetes treated?

Treatment for type 1 diabetes focuses on keeping blood sugar levels within a target range and doing things to reduce complications. Taking insulin, making healthy food choices, and getting regular exercise can help control blood sugar. You'll also need to check blood sugar levels several times a day.

Cause

The body makes insulin in beta cells, which are in a part of the pancreas called the islet (say "EYE-let") tissue. Type 1 diabetes starts because the body's immune system destroys those beta cells. So people who have type 1 diabetes can't make their own insulin.

Causes of low blood sugar

Your child isn't likely to get low blood sugar unless your child takes insulin or certain diabetes medicines that lower blood sugar. Then low blood sugar may happen if your child:

• Takes too much insulin or other diabetes medicine.
• Skips or delays a meal or snack.
• Is more physically active than usual without eating enough food.
• Takes a medicine that can lower blood sugar as a side effect.
• Starts a menstrual period. This causes hormonal changes that may affect how well insulin works.

Causes of high blood sugar

High blood sugar occurs when the sugar (glucose) level in the blood rises above your child's target range. It can happen if your child:

• Misses a dose of insulin or diabetes medicine.
• Eats more than usual.
• Is under emotional stress.
• Has an illness, such as the flu or an infection.
• Takes a medicine that raises blood sugar as a side effect. Examples include medicines that reduce inflammation (corticosteroids) and some decongestants.
• Starts puberty. Hormonal changes affect how well the body uses insulin. These changes can cause higher blood sugar levels.

Some children who take insulin may have very high blood sugar in the morning, even if it was low at bedtime. This could be caused by the dawn phenomenon. Talk with your child's doctor if this happens.

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What Increases Your Risk

Risk factors are things that increase the chances of getting sick or having a problem. Risk factors for type 1 diabetes include:

• Family history. A family history of type 1 diabetes increases the chance of a person having autoantibodies such as islet cell antibodies. These antibodies attack the cells in the pancreas that produce insulin. But a family history of type 1 diabetes doesn't mean that someone will definitely have the disease.
• Presence of autoantibodies in the blood. People who have both a family history of type 1 diabetes and two or more autoantibodies in their blood are likely to get type 1 diabetes. If a person has family members with type 1 diabetes, the person can be tested to look for autoantibodies.
• Race. White people have a greater risk for type 1 diabetes than Black, Asian, or Hispanic people.

Symptoms

Symptoms of type 1 diabetes are caused by high blood sugar. They usually develop quickly, over a few days to weeks. At first, symptoms may be overlooked or mistaken for another illness, like the flu.

Symptoms include:

• Urinating often. This may be more noticeable at night.
• Being very thirsty. This happens if a person urinates so often that they get dehydrated.
• Losing weight without trying. This happens because the body isn't able to get energy from sugar. Instead, the body uses muscle and fat for energy.
• Increased hunger. The body isn't using all the calories that it can. Many calories leave the body through urine.
• Blurry vision. When sugar builds up in the lens of the eye, it sucks extra water into the eye. This changes the shape of the lens and blurs vision.
• Feeling very tired. The body isn't using the calories it takes in, and it isn't getting the energy it needs.

Symptoms of high and low blood sugar

Even if you're careful and do all the right things, your child can have problems with low or high blood sugar. Teach your child to be aware of the symptoms and what to do if they occur.

Symptoms of low blood sugar include:

• Sweating.
• Feeling weak and hungry.

But your child's symptoms may be different.

Symptoms of high blood sugar include:

• Feeling very thirsty.
• Passing urine more often than usual.

Both low and high blood sugar need to be treated. Your doctor will suggest how often to test your child's blood sugar.

Symptoms in very young children

A very young child with low or high blood sugar may:

• Be cranky or angry.
• Cry.
• Look pale.
• Be nervous or shaky.
• Stare off or not respond when touched or spoken to.
• Have dark urine with a strong sweet odor.
• Be drowsy or hard to wake up.

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What Happens

Your child can live a long, healthy life by learning to manage diabetes. Daily diabetes care and regular medical checkups will become a big part of your and your child's lives. If your child can control their blood sugar levels every day, it may help prevent other health problems later on.

Problems caused by high blood sugar

In children, ongoing high blood sugar can lead to:

The body adjusting to high levels.

For example, if your child's blood sugar level is consistently at 250 milligrams per deciliter (mg/dL) and suddenly drops to 100 mg/dL, you or your child may think that this level is too low when it isn't. Your child may even have symptoms of low blood sugar at target blood sugar levels.

Delayed growth and maturity.

A child who has type 1 diabetes may grow and mature more slowly. During puberty, this can delay normal sexual development. It may also delay the start of menstruation. And your child may not gain weight properly if your child doesn't have enough insulin.

Early complications of diabetes.

Complications include eye, kidney, heart, blood vessel, and nerve disease. If blood sugar levels stay high, children are more likely to show early signs of these problems, especially eye and kidney disease. Also, high blood sugar levels during childhood and adolescence put your child at risk for these diseases in early adulthood.

Very high blood sugar puts your child at risk for diabetic ketoacidosis. This is a life-threatening emergency. Blood sugar levels usually rise slowly, so in most cases you can treat symptoms early and prevent this problem.

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When to Call a Doctor

Call 911 or other emergency services immediately if your child:

Call a doctor now if your child:

• Is sick and has blood sugar that can't be managed. Your doctor may have given you instructions on how to manage blood sugar when your child is sick.
• Has been vomiting or has had diarrhea for more than 6 hours.
• Has blood sugar that stays higher than the level the doctor has set for your child (for example, 240 mg/dL for two or more readings).
• Has blood sugar that stays lower than the level the doctor has set for your child (for example, 70 mg/dL for two or more readings).
• Has symptoms of low blood sugar, such as:
  • Sweating.
  • Feeling nervous, shaky, and weak.
  • Extreme hunger and slight nausea.
  • Dizziness and headache.
  • Blurred vision.
  • Confusion.

Check with your doctor if your child:

• Often has problems with high or low blood sugar levels.
• Has trouble knowing when their blood sugar is low (hypoglycemia unawareness).
• Or you have questions or want to know more about diabetes.

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Exams and Tests

The doctor will ask about past health issues and do a physical exam. Blood tests are done to measure how much sugar is in the blood. The doctor will use those test results and the American Diabetes Association criteria to diagnose diabetes.

Some people are diagnosed with type 1 diabetes because they have symptoms of diabetic ketoacidosis.

It may be hard to tell what type of diabetes a person has. If so, the doctor may do a C-peptide test or test for autoantibodies to diagnose type 1 diabetes or a slowly developing form of type 1 diabetes called latent autoimmune diabetes in adults (LADA). Some rare forms of diabetes are caused by a genetic problem. Genetic testing may be done to diagnose them. This includes maturity onset diabetes of the young (MODY). There are many types of MODY, depending on the gene that is affected.

Follow-up visits and tests

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 tests to see if your child's blood sugar has been in the target range. Based on these results, the doctor may change your child's treatment plan.

When your child is 10 years old or starts puberty and has had diabetes for 3-5 years, they will start having exams and tests to look for any health problems from diabetes. These problems include eye disease (diabetic retinopathy) and diabetic kidney disease.

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Treatment Overview

Treatment for type 1 diabetes focuses on keeping blood sugar levels within a target range. This will help prevent problems from diabetes such as eye, kidney, heart, and nerve disease.

To manage type 1 diabetes, a person will:

• Take insulin every day. This may be done through an insulin pump or a syringe (needle).
• Check blood sugar levels often.
• Make healthy food choices.
• Get regular physical activity. Exercise helps the body to use insulin in a more efficient way.
• Get routine screening tests and exams. These are done to watch for signs of problems.
• Avoid smoking.

Blood sugar levels are easier to manage when mealtimes, amount of food, and exercise are similar every day.

Medicine to treat other health problems, like high blood pressure or high cholesterol, may be needed. This may help prevent problems from diabetes.

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Caring For Your Child

It can be challenging to manage type 1 diabetes in a child. Here are some ideas that may help you.

• Learn about insulin.

  Things you need to know include:

  • What the dose is for each type of insulin your child takes.
  • When your child should take the doses.
  • How long it takes for each type of insulin to start to work (onset).
  • When each type of insulin will have its greatest effect (peak).
  • How long each type of insulin will work (duration).
• Help your child make healthy food choices.

  A child with type 1 diabetes needs to watch their diet closely. This is hard for many adults, and it can be even harder on a child.

  • Help your child understand the relationship between food and blood sugar. Make it clear to your child that eating equals a need for insulin.
  • Help your child understand the idea of balance. If your child wants to eat a food not on the meal plan for the day, then your child needs to adjust the insulin dose to reflect this change.
  • Teach your child to always tell an adult when they eat something that's not on that day's meal plan. Many children eat extra foods without telling their parents or other adults. This can lead to high blood sugar levels.
  • Get the whole family involved. It helps if the entire family eats healthy foods and learns about counting carbohydrates.
• Help your child be active.

  Encourage your child to find an activity they enjoy doing. Exercise helps with diabetes treatment. But physical activity will now take more planning than before. Your diabetes team can help you adjust your child's diabetes treatment plan for physical activity.

• Work with your child's school.

  School can present a special challenge for children with type 1 diabetes. Your child needs to take insulin throughout the day and eat on a regular schedule, which can be hard. Work with your diabetes team to make a care plan for school. Then meet with your child's teacher and school staff to discuss your child's care. This can help your child manage diabetes while at school.

• Help your child become independent.
  • As children with type 1 diabetes grow, encourage them to take more control over their treatment. For example, if your child is very young, you may need to give the insulin shots. When your child is older, they can take on this responsibility.
  • Consider a summer camp for children who have diabetes. It can help children learn about their disease and about how to manage it. It also introduces them to other children who have type 1 diabetes.
• Get support.

  Remember that your family isn't alone in dealing with diabetes. Your diabetes team can direct you to local support groups and online resources such as the American Diabetes Association. Support groups can provide emotional support as well as information to help you cope with your child's diabetes.

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Medicines

Insulin is the only medicine that can treat type 1 diabetes. Your child will most likely take more than one type of insulin. Your child may take several shots (injections) a day or use an insulin pump. Both methods work well to keep blood sugar levels in a target range.

The amount and type of insulin your child takes will likely change over time. This will depend on changes that occur with normal growth, physical activity level, and hormone changes (such as during adolescence). Your child may also need higher doses of insulin when feeling sick or stressed.

Don't let your child skip a dose of insulin without a doctor's advice.

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