Type 1 diabetes in children

Symptoms

Symptoms of type 1 diabetes in children typically come on quickly. Watch for symptoms such as:

• Feeling very thirsty.
• Needing to urinate often. This may include bed-wetting in a child who has already toilet trained.
• Feeling very hungry.
• Stomach pain, nausea or vomiting.
• Losing weight without trying.
• Feeling tired or low on energy.
• Mood changes or unusual behavior, such as irritability.
• Breath that smells fruity.

When to see a doctor

Contact your child's healthcare professional if you notice any of these symptoms. Getting a diagnosis and starting treatment right away can help prevent serious health issues.

Risk factors

Type 1 diabetes typically begins in children, but it can start at any age. Several things may raise the risk of developing the condition:

• Family history. A child has a slightly higher risk if a parent or sibling has type 1 diabetes.
• Genetics. Some genes are linked to a higher chance of developing type 1 diabetes.
• Races and ethnic groups. In the United States, type 1 diabetes is more common in children who are white and not Hispanic than in children of other racial or ethnic groups.
• Infections caused by viruses. Exposure to certain viruses may play a role in triggering the immune system to attack the cells that make insulin in the pancreas.

Prevention

Right now, there's no proven way to prevent type 1 diabetes. But researchers are working hard to find a way to prevent the condition, and it's a very active area of study.

In children at high risk of type 1 diabetes, certain autoantibodies can be found months or even years before symptoms begin. A blood test can find these autoantibodies. They are a warning sign that the immune system is attacking the cells that make insulin in the pancreas. Researchers are working on:

• Finding ways to prevent or delay type 1 diabetes in people who are at high risk of developing the disease.
• Stopping further damage to the cells that make insulin in people who have just been diagnosed.

Treatment

Type 1 diabetes treatment includes many important daily tasks:

• Taking insulin.
• Monitoring blood sugar levels. These also are called blood glucose levels.
• Eating a healthy, balanced diet.
• Getting regular physical activity.

Parents and caregivers are an important part of a child's healthcare team. You'll work closely with your child's diabetes treatment team to help your child learn to manage diabetes. The team may include a doctor or other healthcare professional, a certified diabetes educator, and a registered dietitian. The goal is to keep your child's blood sugar in a healthy range. This helps lessen the risk of serious health issues later.

Your child's target blood sugar range will change over time as your child grows. The care team will let you know what that range should be.

Insulin

Children with type 1 diabetes will need insulin every day for life. There are several types of insulin. Each works at different speeds:

• Rapid-acting insulin. This type of insulin starts working within 15 minutes. It reaches peak effect in about one hour and lasts about four hours. This type of insulin often is taken 15 to 20 minutes before meals. Examples are lispro (Humalog, Admelog), aspart (NovoLog, Fiasp) and glulisine (Apidra).
• Short-acting insulin. Sometimes called regular insulin, this type starts working in about 30 minutes. It peaks in 1 1/2 to 2 hours and lasts about 4 to 6 hours. An example is human insulin (Humulin R, Novolin R).
• Intermediate-acting insulin. Also called NPH insulin, this type of insulin starts working in about 1 to 3 hours. It peaks in 6 to 8 hours and lasts 12 to 24 hours. An example is NPH insulin (Humulin N, Novolin N).
• Long-acting and ultra-long-acting insulin. This type of insulin may work for as long as 14 to 40 hours. It helps maintain steady blood sugar levels throughout the day and night. Examples are glargine (Lantus, Toujeo, Basaglar, others), detemir (Levemir) and degludec (Tresiba).

How insulin is given

Insulin can be given in a few different ways. Most children start with multiple daily injections of long-acting and rapid-acting insulin. Injections are given using insulin pens or syringes. Once a child and the family are comfortable managing diabetes, children are typically offered the option of an insulin pump, usually within a few months to a year.

• Syringe and fine needle. This looks like a shot you might get in a healthcare professional's office, but it has a smaller syringe and a much thinner, shorter needle.
• Insulin pen. This device looks like an ink pen with a small needle. It has a cartridge filled with insulin. It is easy to carry and use.
• Insulin pump. This is a small device worn on the outside of the body that you program to deliver specific amounts of insulin throughout the day and when you eat. A tube connects a reservoir of insulin to another thin tube, called a catheter, that's inserted under the skin of your stomach.
• Tubeless insulin pump. Also called a patch pump, this device delivers insulin without any external tubing. Instead of using a tube to a separate pump worn on a belt or in a pocket, the entire pump is built into a small, lightweight pod that sticks directly to the skin. Once the pod is in place, a tiny, flexible needle inserts just under the skin to deliver insulin throughout the day. This type of pump may be a good choice for families who want to avoid daily injections and tubing. It's especially popular with active kids and those who prefer a less visible option.

Blood sugar monitoring

You or your child will need to check and record your child's blood sugar at least four times a day. Blood sugar also is called glucose. Typically, blood sugar needs to be checked before every meal and at bedtime. Sometimes you may need to take a test during the middle of the night. If your child doesn't use a continuous glucose monitor, you may need to test more often.

Frequent testing is the only way to make sure that your child's blood sugar level stays within the target range.

The goal is to keep the blood sugar level as close to target levels as possible to delay or prevent complications. Generally, the goal is to keep the daytime blood sugar levels before meals between 70 and 130 mg/dL (4.44 to 7.2 mmol/L). After-meal numbers should be no higher than 180 mg/dL (10 mmol/L) two hours after eating.

Continuous glucose monitoring

Continuous glucose monitoring (CGM) devices check blood sugar levels automatically every few minutes using a small sensor placed under the skin. Blood sugar levels also are called blood glucose levels. Some CGM devices display readings continuously on a smartphone, smartwatch or receiver. Others require scanning the sensor to get a reading.

Closed loop system

A closed loop system combines a continuous glucose monitor with an insulin pump. The two devices communicate with each other to adjust insulin delivery automatically based on your child's blood sugar levels. Blood sugar also is called glucose. This helps keep blood sugar more stable throughout the day and night.

You may hear this called an automated insulin delivery (AID) system or an artificial pancreas. And you may hear this called a hybrid closed loop because it still needs input from you or your child. You or your child needs to enter information such as how many carbohydrates your child eats and confirm glucose readings.

Technology is improving quickly, and more advanced systems are currently being tested in clinical trials.

Healthy eating

Eating well is a key part of managing type 1 diabetes, but your child doesn't need a special or strict diet. In fact, the meals can look just like what the rest of the family eats. A healthy diet should regularly include foods that are high in nutrition and low in fat and calories, such as:

• Vegetables.
• Fruits.
• Lean protein, such as chicken, fish and tofu.
• Whole grains, such as whole-wheat bread and brown rice.

Your child's registered dietitian can help you create a meal plan that fits your child's food needs and food preferences. The dietitian also can show you how to count carbohydrates, which is important when deciding how much insulin your child needs, especially around mealtimes. When eating well, occasional treats can still be part of the plan.

Physical activity

Everyone needs regular exercise, and that includes kids with type 1 diabetes. Try to make regular physical activity part of your child's daily routine. Aim for at least 60 minutes of movement every day. If possible, be active together as a family.

Keep in mind that exercise affects blood sugar levels. This effect can last for several hours or even overnight. You may need to adjust your child's food or insulin to keep blood sugar steady after physical activity.

When your child starts a new activity or sport, check blood sugar more often until you understand how their body responds.

Handling everyday challenges

Blood sugar can change for many reasons. Frequent blood sugar checks during challenging times can help find problems and guide treatment. Talk with your child's diabetes care team for advice on how to manage situations such as:

• Picky eating. If your child takes insulin before a meal but doesn't finish eating, their blood sugar may drop too low. Your child's care team can help you plan for this, especially with young children.
• Illness. When your child is sick, insulin needs may change. Illness can raise blood sugar due to stress hormones. But if your child eats less or vomits, that may mean less insulin is needed. Make sure your child gets a flu shot every year. Talk to your child's care team about the pneumonia vaccine and the COVID-19 vaccine if your child is age 5 or older.
• Growth spurts and puberty. As your child grows, insulin needs can change quickly. Hormones during puberty, especially around menstrual periods, also can affect blood sugar.
• Sleep. Blood sugar can drop overnight. You may need to adjust bedtime snacks or insulin doses to help prevent nighttime lows.
• Temporary changes in routine. Life doesn't always go as planned. When schedules change, such as during vacations, holidays or special events, check your child's blood sugar more often.

Ongoing medical care

Your child needs regular checkups to help manage diabetes and stay healthy. These appointments are a chance to review your child's blood sugar patterns, insulin needs, eating habits and physical activity.

At each visit, your child's healthcare professional will check your child's A1C level. This is a blood test that shows the average blood sugar over the past three months. The American Diabetes Association typically recommends an A1C of 7% or lower for most children and teens with diabetes.

Your child's healthcare professional also will regularly check for other important health markers, including:

• Blood pressure.
• Growth and development.
• Cholesterol levels.
• Thyroid function.
• Liver function.
• Kidney function.
• Foot health.
• Eye health.

These regular checks help catch problems early and make sure your child's treatment plan continues to meet their needs as they grow.

Signs of trouble

Even with careful diabetes management, problems can still happen. Some complications of type 1 diabetes can become serious very quickly and need fast treatment. These include:

• Low blood sugar, also called hypoglycemia.
• High blood sugar, also called hyperglycemia.
• Diabetic ketoacidosis (DKA).

Low blood sugar

Low blood sugar means your child's blood sugar has dropped below their target range. The medical term for low blood sugar is hypoglycemia. This can happen if your child skips a meal, is more active than usual or takes too much insulin. Mild low blood sugar is common in people with type 1 diabetes. But if low blood sugar isn't treated quickly, symptoms can get worse.

Symptoms of low blood sugar may include:

• Shakiness.
• Hunger.
• Sweating.
• A change in skin color. Skin may look pale, dull or gray depending on your child's skin color.
• Mood swings or irritability.
• Trouble focusing or confusion.
• Dizziness.
• Loss of coordination.
• Slurred speech.
• Passing out.
• Seizures.

What to do

Teach your child what low blood sugar feels like. It's important to treat low blood sugar right away. When in doubt, test blood sugar. If a test isn't available and your child has symptoms, treat for low blood sugar right away. Then test as soon as possible.

Steps to treat low blood sugar:

• Give a fast-acting carbohydrate. Have your child eat or drink 15 to 20 grams of a fast-acting carbohydrate, such as fruit juice, regular (not diet) soda, glucose tablets, or hard candy or another source of sugar. Avoid chocolate and ice cream. They don’t work as quickly because of their fat content.
• Test again. After 15 minutes, check blood sugar again. If it's still low, repeat giving a fast-acting carbohydrate and test again in 15 minutes. If it's still low, repeat giving a fast-acting carbohydrate and testing in 15 minutes until you get a reading in your child's target range.
• Follow with a snack or meal. Once blood sugar is back in the target range, give your child a healthy snack or a meal to help prevent another low blood sugar level.

If your child passes out from low blood sugar, they may need a shot of glucagon, a medicine that raises blood sugar. Ask your child's care team how and when to use it.

High blood sugar

High blood sugar means your child's blood sugar is higher than the target range. This can happen for several reasons, including being sick, eating too much, eating certain foods and not taking enough insulin.

Symptoms of high blood sugar include:

• Needing to pee often.
• Feeling very thirsty or having a dry mouth.
• Blurred vision.
• Feeling tired.
• Feeling sick to the stomach.

If you think your child has high blood sugar, check their glucose level. If it's high, follow your child's diabetes care plan or contact your child's healthcare professional. High blood sugar doesn't drop quickly, so ask how long to wait before checking again.

If your child's blood sugar is above 240 mg/dL (13.3 mmol/L), use a ketone test kit that you can buy without a prescription to check for ketones in their urine or blood. If there are ketones, follow your child's care plan. If there are ketones and your child feels sick, call your child's healthcare professional right away. This may be a sign of diabetic ketoacidosis, often shortened to DKA.

Diabetic ketoacidosis (DKA)

DKA is a serious and dangerous condition. It happens when the body doesn't have enough insulin and starts breaking down fat for energy. This makes ketones, which can build up in the blood, creating a potentially life-threatening condition.

Symptoms of DKA include:

• Extreme thirst or very dry mouth.
• Needing to pee more than usual.
• Dry, flushed skin.
• Nausea, vomiting or stomach pain.
• A sweet, fruity smell on your child's breath.
• Confusion or trouble thinking clearly.

If you think your child may have DKA, test for ketones right away using a urine or blood ketone test. If the ketone levels are high, call your child's healthcare professional right away or seek emergency care.

Coping and support

Managing your child's diabetes can feel overwhelming, and that's OK. Some days will go smoothly, and other days will be frustrating. No one can manage diabetes perfectly all the time. What matters most is doing your best and knowing that your efforts make a big difference. And remember, you don't have to do this alone. Your child's diabetes care team is here to help.

Your child's emotions

Diabetes doesn't just affect the body, it can affect emotions too.

• When blood sugar is too high or too low, it can cause mood swings or irritability.
• Kids may feel different from their peers because they have to check blood sugar and take insulin.
• Connecting with other children who have diabetes can help your child feel less alone and more confident. Ask your child's care team about local meetups or diabetes camps in your area.

Mental health and risky behaviors

Children and teens with diabetes are more likely to experience anxiety, depression, and diabetes burnout or frustration. That's why some diabetes specialists regularly include a mental health professional, such as a social worker or psychologist, who can support your child emotionally.

Watch for signs of mental health concerns, especially in teens, such as feeling sad most of the time. Also watch for changes in sleep, appetite, friendships and school performance. If you see signs that worry you, talk to your child's care team about screening for depression or other issues.

Rebellion also may be an issue, especially for teens. A child who has been good about sticking to their diabetes treatment plan may rebel in the teen years by ignoring diabetes care.

Also, be aware that the use of alcohol, drugs or tobacco products can be more risky for young people with diabetes compared to those who don't have the condition. Talk openly with your child or teen about these dangers and offer support through this stage of life.

Support groups and counseling

It helps to talk with others who understand what you're going through. Support groups for both children and parents can offer connection, encouragement and practical tips.

• Children's support groups help kids feel understood and less alone.
• Parent support groups give caregivers a space to share their concerns and learn from others.
• Talking to a counselor or therapist also can help you or your child cope with the emotional impact of diabetes.

Ask your child's care team for recommendations, or explore support through these websites:

• American Diabetes Association (ADA). Offers resources and support for children and teens with diabetes.
• Juvenile Diabetes Research Foundation (JDRF). Provides support, education and community programs.

Looking ahead

It's normal to worry about the long-term effects of diabetes. But when you and your child work together with your child's diabetes care team and follow a treatment plan, you prepare your child to lead a full, healthy and active life. You're building skills and habits that help your child now and in the future.