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This topic covers type 1 diabetes in children. For information about type 1 diabetes in adults and about preventing complications from type 1 diabetes, see the topic Type 1 Diabetes.
Type 1 diabetes develops when the
pancreas stops making
insulin. Your body needs insulin to let sugar
(glucose) move from the blood into the body's cells, where it can be used for
energy or stored for later use.
Without insulin, the sugar cannot
get into the cells to do its work. It stays in the blood instead. This can
cause high blood sugar levels. A person has diabetes when the blood sugar is
Your child can live a long, healthy life by learning
to manage his or her diabetes. It will become a big part of your and your
You play a major role in helping your child take
charge of his or her diabetes care. Let your child do as much of the care as
possible. At the same time, give your child the support and guidance he or she
The key to managing
diabetes is to keep blood sugar levels in a target range. To do
this, your child needs to take insulin, eat about the same amount of
carbohydrate at each meal, and exercise. Part of your
child's daily routine also includes checking his or her blood sugar levels at
certain times, as advised by your doctor.
The longer a person has
diabetes, the more likely he or she is to have problems, such as diseases of
the eyes, heart, blood vessels, nerves, and kidneys. For some reason, children
seem protected from these problems during childhood. But if your child can
control his or her blood sugar levels every day, it may help prevent problems
Even when you
are careful and do all the right things, your child can have problems with low
or high blood sugar. Teach your child to look for signs of low and high blood
sugar and to know what to do if this happens.
Young children can't tell if they have low blood sugar as
well as adults can. Also, after your child has had diabetes for a long time, he
or she may not notice low blood sugar symptoms anymore. This raises the chance
that your child could have low blood sugar emergencies. If you are worried
about your child's blood sugar, do a
home blood sugar test. Don't rely on symptoms alone.
Both low and high blood sugar can cause problems and need to be
treated. Your doctor will suggest how often your child's blood sugar should be
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 some tests to
see if your child's blood sugar is under control. Based on these results, the
doctor may change your child's treatment plan.
When your child is
10 years old or starts puberty, he or she will start having exams and tests to
look for any problems from diabetes.
Your child's insulin dose and possibly the types of insulin may change
over time. The way your child takes insulin (with shots or an
insulin pump) also may change. This is especially true
during the teen years when your child grows and changes a lot.
What and how much food your child needs will also change over the years.
But it will always be important to eat about the same amount of carbohydrate at
each meal. Carbohydrate is the nutrient that most affects blood sugar.
Learning about a child living with type 1 diabetes:
Living with a child who has type 1 diabetes:
Health Tools help you make wise health decisions or take action to improve your health.
Type 1 diabetes develops when your
child's pancreas stops producing enough
insulin. Insulin lets blood sugar—also called
glucose—enter the body's cells, where it is used for energy. Without insulin,
the amount of sugar in the blood rises above a safe level. As a result, your
child experiences high and low blood sugar levels from time to time. High blood
sugar can damage blood vessels and nerves throughout the body and increases
your child's risk of eye, kidney, heart, blood vessel, and nerve
Experts do not know what causes type 1 diabetes. But the
cause may involve family history and maybe environmental factors like diet or
Because your child has
type 1 diabetes, he or she will experience high and
low blood sugar levels from time to time. High blood sugar usually develops
slowly over hours or days, so you can treat the symptoms before they become
severe and require medical attention. On the other hand, your child's blood
sugar level can drop to dangerously low levels in minutes.
distinguish between high and low blood sugar symptoms,
especially if your child is very young. Test your child's blood sugar whenever
you think it may be high or low so that you can treat it appropriately. If your
child has symptoms of very high blood sugar, such as a fruity breath odor,
vomiting, and/or belly pain, seek emergency care. These symptoms may point to
diabetic ketoacidosis, which is a life-threatening
Every child experiences
type 1 diabetes differently.
The negative effects of
diabetes are caused by blood sugar levels that are above or below a
Very low blood sugar is a
frightening experience for you and your child. But if low blood sugar levels
are treated quickly and appropriately, your child should have no lasting
Young children cannot recognize low blood sugar symptoms
as well as adults can, which puts them at risk for low blood sugar emergencies.
Children who develop
hypoglycemia unawareness, which is the inability to recognize early symptoms of low blood sugar until they become severe, or who are trying to keep their
blood sugar levels tightly within a target range are also at risk for low blood
Make sure your child's caregivers, such as
school nurses, know:
Let your doctor know if your child is having frequent
episodes of low blood sugar. You can use this formuse this form(What is a PDF document?) to keep a record of your child's very high or very low blood sugar levels.
Very high blood sugar puts your
child at risk for
diabetic ketoacidosis, a life-threatening emergency.
Skipping insulin injections, stress, illness, injury, and puberty can trigger high blood sugar. Because
blood sugar levels usually rise slowly, you can treat symptoms early and, most
often, prevent diabetic ketoacidosis.
High blood sugar can also
The best way to help your child
with type 1 diabetes live a long and healthy life is to keep his or her blood
sugar levels within a target range. Work with your
child's doctor, and monitor blood sugar levels frequently.
Risk factors for very high or
low blood sugar levels in a child with
type 1 diabetes include:
Call 911 or other emergency services right away if your child:
Call a doctor if your child:
Check with your doctor if your child:
Health professionals who may care for a child who has with
type 1 diabetes include:
To prepare for your appointment, see the topic Making the Most of Your Appointment.
A child with
type 1 diabetes needs to visit his or her doctor at
least every 3 to 6 months. During these visits, the doctor reviews your child's
blood sugar level records and asks about any problems you and your child may
have. Your child's blood pressure is checked, and growth and development is
evaluated. The doctor examines your child for signs of infections, especially
at injection sites. Your child usually has the following tests at office
If your child has a family history of high
cholesterol or heart disease and is over 2 years old, your child's doctor may
cholesterol (LDL and HDL) test when type 1 diabetes is
diagnosed or as soon as blood sugars are under control. If there is no family history of high cholesterol, your child may
have a cholesterol test at puberty. If the
LDL cholesterol is less than 100 mg/dL (2.60 mmol/L)
and there is no family history of
high cholesterol, the doctor may repeat this test
every 5 years.
Diabetes increases your child's risk for dental
problems. Experts suggest dental checkups every 6 months.
Nutritional needs change as children grow and develop. See a
registered dietitian at least once a year to review
your child's meal plan.
Your child will have an
initial dilated eye exam (ophthalmoscopy) by an
ophthalmologist or an
optometrist when your child is at least 10 years old
and has had diabetes for 3 to 5 years. This eye exam checks for signs of
diabetic retinopathy and
glaucoma. Thereafter, your child may have an eye
exam every year. If your child is at low risk for vision
problems, your doctor may consider follow-up exams less often.
Your child's doctor will also start doing an annual urine test to check for protein (microalbumin). This test helps detect
Your child may have a
test for thyroid antibodies when type 1 diabetes is diagnosed. Also, a thyroid-stimulating hormone (TSH) test and a thyroxine (T4) test may be done every 1 to 2
years. These tests check for thyroid problems, which are common among people
who have type 1 diabetes.
Other tests include:
The goal of your child's treatment
type 1 diabetes is to always keep his or her blood
sugar levels within a
target range. A target range reduces
the chance of diabetes complications. Daily diabetes care and regular medical
checkups will help you and your child accomplish this goal.
Your child's daily care
Some problems you may encounter include:
You will also want to:
Your child needs to see
his or her doctor every 3 to 6 months. During these checkups, the doctor will
evaluate and adjust your child's treatment. The doctor will do a hemoglobin A1c
or similar test (glycosylated hemoglobin or
glycohemoglobin) to check your child's blood sugar
control over the previous 2 to 3 months, and a
blood glucose test.
If your child's
LDL cholesterol is less than 100 mg/dL (2.60 mmol/L)
and there is no family history of
high cholesterol, the doctor will do a
cholesterol (LDL and HDL) test every 5 years. If your child's blood pressure is consistently high and not reduced with weight control or exercise, the doctor may consider medicine.
When your child has had diabetes for 5 years, the doctor will start
yearly screening tests for protein in the urine, which points to
diabetic nephropathy. At that same time, your child
needs to see an
ophthalmologist for yearly dilated eye exams (ophthalmoscopy) to check for signs of
child does not take enough insulin, has a severe infection or other illness, or
dehydrated, his or her blood sugar level may rise very
high and lead to
diabetic ketoacidosis. Diabetic ketoacidosis is almost always treated in a hospital, often in the intensive care unit, where
caregivers can watch your child closely and give him or her frequent blood
tests for glucose and
electrolytes. Insulin is given through a vein
(intravenous, or IV) to bring blood sugar levels down. Fluids are given through
the IV to correct the electrolyte imbalance. Your child may stay in the
hospital for a few days until blood sugar levels are back in the target
range and electrolytes have normalized.
For some children, using an
insulin pump may help keep their blood sugar levels
within a target range.
If your child has frequent low blood sugar levels,
especially at night (nocturnal hypoglycemia), the doctor may
suggest a continuous glucose monitor (CGM). A CGM reports blood sugar at least every 5 minutes, day and night. It sounds an alarm if blood sugar levels are moving out of range.
The monitor stores the results, which allows you to look for
patterns of high or low blood sugar levels.
Your child with
type 1 diabetes will have high and low blood sugar
levels from time to time. You can help avoid many immediate problems and
long-term complications, such as eye, kidney, heart, blood vessel, and nerve
Insulin is the only medicine that can treat
type 1 diabetes, and your child is most likely taking
more than one
type of insulin. Your child may take several
injections a day or use an
insulin pump. The insulin pump provides insulin with
fewer injections and is as effective as multiple daily injections for
blood sugar levels in a target range.
The amount and type of insulin your child takes will likely change over
time, depending on changes that occur with normal growth, physical activity
level, and hormones (such as during adolescence). Your child may also need
higher doses of insulin when feeling sick or stressed.
A rapid-acting insulin is given
with a meal or immediately afterward. The dose is based on what your child
actually ate, not what the meal plan required. If your child is a "picky
eater," this provides flexibility that may reduce mealtime battles.
Scientists are looking at new types of insulin and better ways to give
You may hear of people
with diabetes following other types of meal plans or using low
glycemic index foods to prevent high blood sugar
levels after meals. Talk with a
registered dietitian before trying a new meal
may benefit from safe, nontraditional therapies that complement their current
But do not use complementary therapies alone to treat your
Talk with your child's doctor before using
any of the following or other complementary or alternative therapies:
The American Diabetes Association (ADA) is a national organization
for health professionals and consumers. Almost every state has a local office.
ADA sets the standards for the care of people with diabetes. Its focus is on
research for the prevention and treatment of all types of diabetes. ADA
provides patient and professional education mainly through its publications,
which include the monthly magazine Diabetes Forecast,
books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also
provides information for parents about caring for a child with diabetes.
The Juvenile Diabetes Research Foundation International is dedicated to finding a cure for type 1 diabetes and its complications. The organization funds research on type 1 diabetes, including research on prevention and treatment. This
organization publishes a wide variety of booklets, magazines, and e-newsletters on complications and
treatments of type 1 diabetes.
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Other Works Consulted
Alemzadeh R, Ali O (2011). Diabetes mellitus. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 1968–1997. Philadelphia: Saunders.
American Diabetes Association (2012). Diabetes care for emerging adults: Recommendations for transition from pediatric to adult diabetes care systems. Diabetes Care, 34(11): 2477–2485.
American Diabetes Association (2012). Diabetes care in the school and day care setting. Diabetes Care, 35(Suppl 1): S76–S80.
American Diabetes Association (2012). Diabetes management at camps for children with diabetes. Diabetes Care, 35(Suppl 1): S72–S75.
American Diabetes Association (2013). Standards of medical care in diabetes—2013. Diabetes Care, 36(Suppl 1): S11–S66.
Beaser RS (2010). Designing a conventional insulin treatment program. In RS Beaser, ed., Joslin's Diabetes Deskbook: A Guide for Primary Care Providers, 2nd ed., pp. 297–340. Boston: Joslin Diabetes Center.
Campbell AP, Beaser RS (2010). Medical nutrition therapy. In RS Beaser, ed., Joslin's Diabetes Deskbook: A Guide for Primary Care Providers, 2nd ed., pp. 91–136. Boston: Joslin Diabetes Center.
Pignone M, et al. (2010). Aspirin for primary prevention of cardiovascular events in people with diabetes: A position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation, 121(24): 2694–2701.
Rewers M, et al. (2012). Diabetes mellitus. In WW Hay et al., eds., Current Diagnosis and Treatment: Pediatrics, 21st ed., pp. 1053–1061. New York: McGraw-Hill.
Rosenbloom AL (2011). Diabetes mellitus. In CD Rudolph et al., eds., Rudolph's Pediatrics, 22nd ed., pp. 2104–2125. New York: McGraw-Hill.
Wolfsdorf J, et al. (2006). Diabetic ketoacidosis in infants, children,
and adolescents: A consensus
statement from the American Diabetes
Diabetes Care (29): 1150–1159.
Wolfsdorf JI, Garvey K (2012). Type 1 diabetes mellitus. In EG Nabel, ed., ACP Medicine, section 9, chap. 1. Hamilton, ON: BC Decker.
August 16, 2013
John Pope, MD - Pediatrics & Stephen LaFranchi, MD - Pediatrics, Pediatric Endocrinology
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