Description

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 lack of insulin that 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 the age of your child — must learn how to give injections, count carbohydrates and monitor blood sugar.

There is No cure for type 1 diabetes in children, but can be controlled. Advances in glucose monitoring and insulin delivery have improved blood sugar, and management of the quality of life of children with type 1 diabetes.

Symptoms

The signs and symptoms of type 1 diabetes in children usually develop quickly, and can include:

  • Increased thirst
  • Frequent urination, possibly wet the bed, in a bathroom-child
  • Extreme hunger
  • Unintentional weight loss
  • Fatigue
  • Irritability or behavior changes
  • Fruity odor on the breath

When to see a doctor

See your health care provider if you notice any of the signs or symptoms of type 1 diabetes.

Causes

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. The genetic and environmental factors seem 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 criticism of the work of movement of the glucose (sugar) from the blood into the body's cells for energy.

The sugar enters the bloodstream when food is digested. Without enough insulin, the sugar builds up in the bloodstream of the child. This can cause life-threatening complications if not treated.

Risk factors

Type 1 diabetes occurs most often in children but can occur at any age. Risk factors for type 1 diabetes in children include:

  • The history of the family. Any person with a parent or sibling with type 1 diabetes has a slightly increased risk of developing the disease.
  • Genetics. Certain genes indicates an increased risk of type 1 diabetes.
  • Of the race. In the united States, the type 1 diabetes is more common among white children of non-Hispanic descent than among children of other races.
  • Certain viruses. The exposure to various types of viruses may trigger the autoimmune destruction of the islet cells.

Complications

Type 1 diabetes can affect major organs in your body. Keep your blood sugar level close to normal most of the time can dramatically reduce the risk of many complications.

Complications can include:

  • Heart and blood vessels. Diabetes increases the risk of your child developing conditions such as narrowing of the blood vessels, high blood pressure, heart disease and stroke later in life.
  • Damage to the nerves. Excess sugar can injure the walls of the small blood vessels that nourish your child's nerves. This can cause tingling, numbness, burning or pain. Damage to the nerves in general occur gradually over a long period of time.
  • The kidney damage. Diabetes can damage the numerous small blood vessels of the clusters in the kidneys that filter waste from the blood of his child.
  • Damage to the eyes. Diabetes can damage the blood vessels of the retina of the eye, which can lead to vision problems.
  • Osteoporosis. Diabetes can decrease bone mineral density, increasing your child's risk of osteoporosis as an adult.

You can help your child to avoid the complications of diabetes by:

  • Work with your child to keep a good control of blood sugar as much as possible
  • Teach your child the importance of eating a healthy diet and engage in regular physical activity
  • Scheduling regular visits with your child's diabetes health care professional

Children with type 1 diabetes are at risk of other autoimmune disorders, such as thyroid disease and celiac disease. Your child's health care provider may recommend testing for these conditions.

Prevention

Currently there is no sure way to prevent type 1 diabetes, but this is a very active area of research.

The antibodies associated with type 1 diabetes in children who have a high risk of the disorder can be detected months or even years before the first symptoms of type 1 diabetes appears. Researchers are working on:

  • Prevent or delay the onset of type 1 diabetes in people who have a high risk of the disease.
  • The prevention of further destruction of islet cells in people who are newly diagnosed.

Diagnosis

There are several blood tests for diabetes type 1 in children. These tests are used to diagnose diabetes and monitor diabetes management:

  • Random blood sugar. This is the main screening test for type 1 diabetes. A blood sample is taken at a random time. A blood sugar level of 200 milligrams per deciliter (mg/dL), or 11.1 millimoles per liter (mmol/L), or higher, along with the symptoms, suggests diabetes.
  • The glycosylated hemoglobin (A1C) test. This test shows that your child's average blood sugar level over the past 3 months. An A1C level of 6.5 percent or higher on two separate tests indicates diabetes.
  • The fasting blood sugar test. A blood sample is taken after your child has not eaten (fasting) for at least 8 hours or overnight. A level of blood sugar fasting glucose of 126 mg/dL (7.0 mmol/L ) or higher suggests that type 1 diabetes.

Additional tests

If the blood sugar test indicates diabetes, your doctor may recommend additional tests to distinguish between type 1 diabetes and type 2 diabetes because treatment strategies differ by type. Additional tests include blood tests to look for antibodies that are common in type 1 diabetes.

Treatment

The treatment for type 1 diabetes includes:

  • Taking insulin
  • Monitoring blood sugar
  • Eat healthy foods
  • Exercise regularly

You are going to work closely with your child's diabetes treatment team physician, certified diabetes care and education specialist, and a registered dietitian. The goal of treatment is to keep your child's blood sugar within a certain numbers. This target range helps to keep your child's blood sugar level as close to normal as possible.

Your child's health care provider will let you know what your child's blood sugar target range is. This range can change as your child grows and changes.

Insulin

Any person who has type 1 diabetes need lifelong treatment with one or more types of insulin to survive.

Many types of insulin are available, including:

  • Rapid-acting insulin. This type of insulin starts to work within 15 minutes. You are reaching the maximum effect at 60 minutes and lasts about 4 hours. This type is often used for 15 to 20 minutes before meals. Examples are lispro (Humalog, Admelog), aspart (NovoLog, Fiasp) and glulisine (Apidra).
  • The short-acting insulin. It is sometimes called the regular insulin, this type starts to work about 30 minutes after the injection. It achieves the maximum effect in 90 to 120 minutes and lasts for about 4 to 6 hours. Examples are the human insulin (Humulin R, Novolin R).
  • Intermediate-acting insulin. Also called the NPH insulin, this insulin starts to work in about 1 to 3 hours. You are reaching the maximum effect at 6 to 8 hours and lasts 12 to 24 hours. Examples are insulin NPH (Humulin N, Novolin N).
  • Long and ultra-long-acting insulin. This type of insulin can provide coverage for as long as 14 to 40 hours. Examples are glargine (Lantus, Toujeo, others), detemir (Levemir) and degludec (Tresiba).

The insulin delivery options

The insulin delivery options are:

  • Fine needle and syringe. This looks like a shot that you could get in a doctor's office, but with a small syringe and a much thinner, shorter needle.
  • Insulin pen with a fine needle. This device looks like an ink pen, except the cartridge is filled with insulin. A needle is attached to the injection.
  • An insulin pump.This is a small device worn on the outside of your body that you program to deliver specific amounts of insulin throughout the day and when you eat. A tube that is connected to a reservoir of insulin to a catheter that's inserted under the skin of your abdomen. There is also a tubeless pump option that involves the use of a sheath that contains the insulin in your body combined with a small catheter that is inserted under the skin.

An insulin pump. This is a small device worn on the outside of your body that you program to deliver specific amounts of insulin throughout the day and when you eat. A tube that is connected to a reservoir of insulin to a catheter that's inserted under the skin of your abdomen.

There is also a tubeless pump option that involves the use of a sheath that contains the insulin in your body combined with a small catheter that is inserted under the skin.

Glucose monitoring

You or your child will need to check and record your child's blood sugar at least four times a day. Normally, you or your child test their blood glucose before each meal and at bedtime, and once in a while during the middle of the night. But you or your child may need to check more often if your child does not have a continuous glucose monitor.

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

Continuous glucose monitoring (CGM)

Continuous glucose monitoring (CGM) devices measure your blood sugar every few minutes using a temporary sensor inserted under the skin. Some devices show your blood sugar reading at all times in a receiver or your smartphone or smartwatch, while others require you to check your blood sugar by running the receiver over the sensor.

Closed loop system

A closed loop system is a device that is implanted in the body that links a continuous glucose monitor to an insulin pump. The monitor checks your blood sugar levels regularly. The device automatically provides the correct amount of insulin when the monitor shows that it is necessary.

The Food and Drug Administration has approved several hybrid closed loop systems for type 1 diabetes. Are the so-called "hybrid", because these systems require the user to enter something. For example, you may need to tell the device how many carbohydrates are eaten, or to confirm the levels of blood sugar once in a while.

A closed loop system that does not need any user input is not available yet. But most of these systems are currently in clinical trials.

Healthy eating

The food is an important part of any treatment plan for your diabetes, but that doesn't mean your child has to follow a strict "diabetes diet." 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:

  • Vegetables
  • Fruits
  • Lean protein
  • Whole grains

Your child registered dietitian can help you create a meal plan that fits your child's food preferences and health goals, as well as help you plan to occasional treats. The dietitian will also teach you how to count the carbohydrates in the food, so that you can use that information to determine the dose of insulin.

Physical activity

Everyone needs regular aerobic exercise, and the children who have type 1 diabetes are not the exception.

But remember that physical activity may affect your blood sugar. This effect on the blood sugar levels can remain for hours after exercise, possibly, even during the night. You or your child may need to adjust your child's meal plan or the dose of insulin for the increased activity.

If your child starts a new activity, ask your child's blood sugar more often than usual, until you and your child to learn how your body reacts to the activity.

Make physical activity part of your child's daily routine. Encourage your child to get at least 60 minutes of physical activity daily, or, better yet, exercise with your child.

Handling challenges

Of sugar in the blood can sometimes change in an unpredictable way. During these challenges, the more frequent blood sugar testing can help to identify problems and to guide treatment. Ask your child to the treatment of the diabetes team about how to manage these and other challenges:

  • Picky eating. Very young children with type 1 diabetes could not finish what is on their plates, which can be a problem if you have already received insulin for that meal.
  • Disease. The disease has different effects on the children of the insulin needs. The hormones produced during the disease raise the blood sugar levels, but reduced intake of carbohydrates due to the lack of appetite or vomiting decreases the insulin requirement. Your doctor will recommend a flu vaccine for their child each year, and will be able to recommend the pneumonia vaccine, as well as the COVID-19 vaccine if your child is 5 years of age or older.
  • Periods of growth and puberty. Only when you've mastered your child needs insulin, he or she springs up seemingly overnight, and suddenly it is not getting the sufficient amount of insulin. Hormones can also affect insulin requirements, especially for women and teens when they begin to menstruate.
  • The dream. To avoid problems with low blood sugar during the night, you may need to adjust your child's insulin routine and snacks.
  • Temporal changes in the routine. Despite the planning, the days don't always stay in the same. Check your blood sugar often when schedules change unexpectedly. Plan ahead for holidays, special occasions and holidays.

Ongoing medical care

Your child will need regular appointments to ensure the good management of diabetes. This may include a review of your child's blood sugar patterns, needs insulin, food and physical activity.

Your health care provider will also check your child's A1C levels. The American Diabetes Association recommends an A1C of 7% or less for all children and adolescents with diabetes.

Your health care provider also will periodically check your child:

  • Blood pressure
  • The growth of the
  • Cholesterol levels
  • The function of the thyroid
  • Renal function
  • Feet
  • Eyes

Signs of problems

Despite their best efforts, sometimes problems arise. Certain short-term complications of type 1 diabetes will require immediate attention or could prove to be very serious, including:

  • Low blood sugar (hypoglycemia)
  • High blood sugar (hyperglycemia)
  • Diabetic ketoacidosis (dka)

Low blood sugar (hypoglycemia)

Hypoglycemia is a blood sugar level below your child's target range. Blood sugar levels can drop for many reasons, including skipping a meal, do more physical activity than typical or inject too much insulin. Low blood sugar is not uncommon in people with type 1 diabetes, but if not treated quickly, the symptoms get worse.

The signs and symptoms of low blood sugar include:

  • Pallor
  • Tremors
  • The hunger
  • Sweating
  • Irritability and mood swings
  • Difficulty concentrating or confusion
  • Dizziness or lightheadedness
  • Loss of coordination
  • Speech difficulty
  • Loss of consciousness
  • Seizures

Teach your child the symptoms of low blood sugar. In case of doubt, he or she should always do a blood sugar test. If a blood glucose meter is not readily available and your child has symptoms of a low level of sugar in the blood, the treatment for low blood sugar, and then test as soon as possible.

If your child has a low level of sugar in the blood of the reading:

  • Giving a fast-acting carbohydrate. Has your child consumes 15 to 20 grams of fast-acting carbohydrate, such as fruit juice, glucose tablets, hard candy, regular (not diet) soda or other source of sugar. Foods with added fat, such as chocolate or ice cream, do not raise the blood sugar quickly, because the fat slows down the absorption of sugar.
  • Repeat the test for sugar in your blood. Repeat the test your child's blood sugar in about 15 minutes to make sure that it is back in the target range. If not, repeat giving a fast-acting carbohydrate and tests in 15 minutes as needed until you get a reading in your child's target range.
  • Follow that up with a meal or snack. Once the blood sugar is back in the target range, your child should eat as a snack or a meal to help prevent a low blood sugar level.

If a low blood sugar causes your child to lose consciousness, an emergency injection of a hormone that stimulates the release of sugar in the blood (glucagon) may be necessary.

High blood sugar (hyperglycemia)

Hyperglycemia is a blood sugar level above your child's target range. Blood sugar levels can increase for many reasons, including disease, eating too much, eating certain types of foods and not taking enough insulin.

The signs and symptoms of high blood sugar include:

  • Frequent need to urinate
  • Increased thirst or dry mouth
  • Blurred vision
  • Fatigue
  • Nausea

If you suspect that a high level of blood sugar, test your child's blood sugar. If the blood sugar is greater than the range of the target, follow your child's diabetes treatment plan, or consult with your pediatrician. High levels of blood sugar does not come down quickly, so I ask how long you should wait until you check your blood sugar again.

If your child has a blood sugar reading above 240 mg/dL (13.3 mmol/L ), your child should use a over-the-counter ketone test kit to check the level of ketones.

Diabetic ketoacidosis (dka)

A severe lack of insulin causes the body of her son to break down fats to obtain energy. This causes the body to produce a substance called ketones. Excess ketones build up in the blood of his child, the creation of a life-threatening condition known as diabetic ketoacidosis.

The signs and symptoms of CAD include:

  • The thirst or a very dry mouth
  • Increased urination
  • Dry or redness of the skin
  • Nausea, vomiting, or abdominal pain.
  • A sweet, fruity smell of your child in the breathing
  • The confusion

If you suspect DKA , check your child's urine for excess ketones. If ketone levels are high, call your doctor or seek emergency care.

Lifestyle and home remedies

After a diabetes treatment plan requires 24-hour care, and significant lifestyle changes. Careful management of type 1 diabetes helps to reduce the risk of your child from serious complications.

As your child grows:

  • Encourage him to take an increasingly active role in the management of diabetes
  • To emphasize the importance of life diabetes care
  • Teach your child to test their blood sugar and inject insulin
  • Help your child to make wise food choices
  • Encourage your child to be physically active
  • Foster a relationship between your child and his / her team of treatment of diabetes
  • Make sure that your child wears a medical identification tag

The habits you teach your child today will help you enjoy an active and healthy life with type 1 diabetes.

The school and the diabetes

You will have to work with your child on the day of the doctor or nurse of the school and the teachers to ensure that they know the signs and symptoms of high and low blood sugar levels. The school nurse may need to administer insulin, or check your child's blood sugar levels.

The Federal law protects children with diabetes, and schools must make reasonable accommodations to ensure that all children receive a suitable education.

Ask your health care provider

Please contact your physician, certified diabetes care and education specialist, or registered dietitian between appointments if you have questions.

Coping and support

If managing your child's diabetes seems overwhelming, take it one day at a time. Some days you going to manage your child's blood sugar ideally and on other days, it may seem as if nothing works well. No one can do it perfectly. But their efforts are worth it. Don't forget that you're not alone, and that his treatment of the diabetes team can help.

Your child's emotions

Diabetes can affect your child's emotions, both directly and indirectly. Poorly controlled blood sugar can cause changes in behavior, such as irritability.

Diabetes can also make your child feel different from other children. Having to draw blood and give shots sets of children with diabetes, apart from their peers. Reach out to your child with other children who have diabetes or spend time in the field of diabetes can help your child feel less alone.

Mental health and substance abuse

People with diabetes have a higher risk of depression, anxiety, and diabetes-related distress. That is why some specialists in diabetes, regularly include a social worker or a psychologist as part of your diabetes care team.

If you notice that your child or teen is persistently sad or pessimistic, or experiences dramatic changes in sleeping habits, the weight, the friends or the school performance of your child screened for depression.

The rebellion can also be a problem, especially for teenagers. A child who has been very good in order to comply with your treatment plan for diabetes may rebel in adolescence, ignoring his diabetes care. In addition, experimentation with drugs, alcohol and smoking can be even more dangerous for people with diabetes.

Support groups

Speak with a counselor or therapist can help your child cope with the dramatic lifestyle changes that come with a diagnosis of type 1 diabetes. Your child may find encouragement and understanding in type 1 diabetes support group for children. Support groups for parents are also available.

If you are interested, your doctor may be able to recommend a group in your area. Websites that offer support services include:

  • The American Diabetes Association (ADA). The ADA also offers the field of diabetes of programs that provide education and support for children and adolescents with diabetes.
  • Juvenile Diabetes Research Foundation (JDRF).

Put the information in perspective

The threat of complications of poorly managed diabetes can be scary. If you and your child work with your doctor, and do your best to manage your child's diabetes, it is likely that his child to live a long and enjoyable life.

Preparing for your appointment

Your child's primary care provider will probably make the initial diagnosis of type 1 diabetes. Hospitalization may be necessary to stabilize your child's blood sugar levels.

Your child's long-term care of diabetes is likely to be managed by a paediatric endocrinologist. Your child's health care team in general also includes a certified diabetes care and education specialist, a registered dietitian, and a social worker.

Here's some information to help you prepare for your appointment.

What you can do

Prior to her appointment, take these steps:

  • Make a list of any concerns you have about your child's well-being.
  • Ask a family member or friend to accompany you. The management of diabetes requires you to remember a large amount of information. Someone who accompanies you may remember something that you missed or forgot.
  • Make a list of questions to ask your health care provider. Ask your health care provider for a referral to a certified diabetes care and education specialist and a registered dietitian to provide additional education about diabetes management.

The topics that you may want to talk with your health care team include:

  • Blood sugar monitoring of the frequency and rhythm, and the continuous monitors glucose
  • The therapy of insulin — types of insulin, the dose, timing and the amount
  • The administration of insulin — shots in front of the pumps and the new diabetes technology
  • Low blood sugar — how to recognize and treat
  • High blood sugar — how to recognize and treat
  • Ketone — testing and treatment
  • Nutrition — types of food and their effects on the blood sugar
  • Carbohydrate counting
  • Exercise — the adjustment of the insulin and food intake for the activity
  • Deal with special situations, such as in the nursery, to school or summer camp; during the illness; and, on special occasions, such as slumber parties, holidays and vacation
  • Medical management — how often they visit the health care provider and other specialists in the care of diabetes

What to expect from your doctor

Your health care provider is likely to ask a series of questions, such as:

  • How comfortable are you with the management of your child's diabetes?
  • How often does your child have a low blood sugar episodes?
  • What is a typical day in the diet?
  • How often does your child participate in physical activity?
Symptoms and treatment of Type 1 diabetes in children