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Type 1 Diabetes in Children
WHAT YOU NEED TO KNOW:
What is type 1 diabetes?
Type 1 diabetes is a disease that affects how your child's body makes insulin and uses glucose (sugar). Normally, when the blood sugar level increases, the pancreas makes more insulin. Insulin helps move sugar out of the blood so it can be used for energy. Type 1 diabetes develops because the immune system destroys cells in the pancreas that make insulin. The pancreas cannot make enough insulin, so the blood sugar level continues to rise. A family history of type 1 diabetes may increase your child's risk for diabetes. Type 1 diabetes cannot be cured, but it can be managed.
What are the signs and symptoms of type 1 diabetes?
- More thirst than usual
- Frequent urination or unexplained bedwetting
- Feeling hungry most of the time
- Weight loss without trying
How is type 1 diabetes diagnosed?
- An A1c test shows the average amount of sugar in your child's blood over the past 2 to 3 months.
- A fasting plasma glucose test checks your child's blood sugar level after he or she has fasted for 8 hours. Fasting means he or she has not eaten anything or had anything to drink except water.
- A 2-hour plasma glucose test starts with a blood sugar level check after your child has not eaten for 8 hours. Your child should only have sips of water during the 8 hours. Your child is then given a glucose drink. Your child's blood sugar level is checked after 2 hours.
- A random glucose test may be done any time of day, no matter how long it has been since your child ate.
- An antibody test may show that your child's immune system is attacking his or her pancreas.
How is type 1 diabetes treated?
The goal is to teach you and your child how to manage his or her diabetes. Management can prevent your child from having complications of diabetes.
- Your child will need insulin each day. Insulin can be injected or given through an insulin pump. Ask your child's diabetes care provider which method is best for your child. You and your child will be trained in the best method for him or her. Give your child insulin as directed. Too much insulin may cause his or her blood sugar level to go too low.
- You will also be taught how to adjust each insulin dose your child takes with meals. Always check his or her blood sugar level before the meal. The dose will be based on his or her blood sugar level, carbohydrates in the meal, and activity after the meal.
- Your child will have a diabetes care team. His or her care team may include physicians, nurse practitioners, and physician assistants. It may also include nurses, dietitians, exercise specialists, pharmacists, and a dentist. You, your child, and other family members will also be part of the team. The team will make goals and plans to manage diabetes and other health problems. The plans and goals will be specific to your child's needs.
What is diabetes education?
Diabetes education will start right away and continue through your child's life. Members of your child's team will teach you and your child the following:
- How to check your child's blood sugar level: You and your child will learn what his or her blood sugar level should be. You will be given information on when to check your child's blood sugar level. You will learn what to do if his or her level is too high or too low. Your child's diabetes care team will recommend a continuous glucose monitor (CGM). A CGM is a device that is worn at all times. The CGM checks your child's blood sugar every 5 minutes. It sends results to an electronic device such as a smart phone.
- About insulin and insulin pumps: Your child's diabetes educator will teach you, your child, and your family members about insulin. You will be taught how to draw insulin into a syringe, and how to inject it. You will also be taught the benefits of an insulin pump. An insulin pump is an implanted device that gives your child insulin 24 hours a day. An insulin pump prevents the need for multiple insulin injections in a day.
- About nutrition: A dietitian will help you make a meal plan to keep your child's blood sugar level steady. The plan will be made for your child's and family's needs. You will learn how food affects your child's blood sugar levels. You will also learn to keep track of sugar and starchy foods (carbohydrates). Do not let your child skip meals. Blood sugar levels may drop too low if your child has received insulin and does not eat. You and your child will meet with the dietitian at least one time per year.
- About exercise and diabetes: You and your child will learn why physical activity, such as exercise, is important. A plan will be made for your child's activity. A goal of 60 minutes of moderate to intense aerobic activity every day will be in the plan. Your child can choose from brisk walking, dancing, running, or jumping rope. The provider will also recommend flexibility and resistance training, which may include yoga and lifting weights. Your child may need to have a snack before activity to prevent low blood sugar levels. Do not allow exercise if your child's blood sugar level is 350 mg/dL or higher. Your child's level may need to be checked before, during, and after exercise.
- About complications of diabetes: You and your child will learn about complications, such as diabetic ketoacidosis (DKA), neuropathy, and retinopathy. You will learn how to prevent and recognize some of these complications. You will also learn about conditions that may happen with diabetes, such as high blood pressure and high cholesterol.
When do I check my child's blood sugar level?
You will need to check your child's blood sugar level at least 3 times each day. Ask your child's care team when and how often to check during the day. Before meals , your child's blood sugar should be between 90 and 130 mg/dL. At bedtime , it should be between 90 and 150 mg/dL. You may need to check for ketones in your child's urine or blood if his or her level is higher than directed. Write down the results and show them to your child's care team provider. The provider may use the results to make changes to your child's medicine, food, or activity schedules.
What should I do if my child's blood sugar level is too low?
Your child's blood sugar level is too low if it goes below 70 mg/dL. If the level is too low, have your child eat or drink 15 grams of fast-acting carbohydrate. These are found naturally in fruits and dairy products. Fast-acting carbohydrates will raise your child's blood sugar level quickly. Examples of 15 grams of fast-acting carbohydrate include:
- 4 ounces (½ cup) of fruit juice or 4 ounces of regular soda
- 2 tablespoons of raisins
- A tube of glucagon gel or 3 to 4 glucose tablets
What do I need to know about nutrition for my child?
A dietitian will help you and your child create a meal plan. The plan will help keep your child's blood sugar level steady. Do not let your child skip meals. His or her blood sugar level may drop too low if he or she takes insulin and does not eat.
- Keep track of carbohydrates (sugar and starchy foods). Your child's blood sugar level can get too high if he or she eats too many carbohydrates. His or her dietitian will help you plan meals and snacks that have the right amount of carbohydrates.
- Give your child low-fat and low-sodium foods. Examples of low-fat foods are lean meat, fish, skinless chicken or turkey, and low-fat milk. Limit high-sodium foods, such as potato chips and soup. Do not add salt to food you cook. Limit your child's use of table salt.
- Give your child high-fiber foods. Foods that are a good source of fiber include vegetables, whole-grain bread, and beans.
What other care will my child need for type 1 diabetes?
- Make sure your child always wears medical alert jewelry or carries a card that says he or she has diabetes. Ask your child's care team provider where to get these items.
- Give instructions to your child's school and care providers. Make sure your child's teachers and care providers know he or she has diabetes. Provide written instructions about what to do if your child has symptoms of high or low blood sugar levels.
- Do not smoke around your child. Do not let others smoke around him or her. Do not let your older child smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung and heart damage. Cigarette smoke can worsen the problems that occur with diabetes. Ask your care team provider for information if you or child currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your care team provider before you or your child use these products.
- Get your child's eyes checked as directed. Your child will need an eye exam every 1 to 2 years. The provider will check for changes in your child's sight. He or she will also check for retinopathy (damage to the retina). Your child is at risk for retinopathy when puberty starts and after having type 1 diabetes 5 to 10 years.
- Bring your child in for screenings as directed. Your child will need to be screened for complications of diabetes and other conditions that may develop. Examples include kidney problems, high cholesterol, high blood pressure, blood vessel problems, eye problems, and eating disorders. Some screenings may begin right away and some may happen within the first 5 years of diagnosis. Your child will need to continue screenings through his or her lifetime. Keep your child's follow-up appointments with all providers.
- Ask about vaccines. Your child has a higher risk for serious illness if he or she gets the flu or pneumonia. Ask your child's care team provider if your child should get a flu or pneumonia vaccine, and when to get the vaccine.
What can happen if my child's diabetes is not controlled?
Uncontrolled diabetes can damage your child's nerves and arteries. Long-term high blood sugar levels can damage his or her eyes and kidneys. Your child may develop thyroid disease. Diabetes is life-threatening if it is not controlled. Help your child control his or her blood sugar levels to reduce the risk for health problems.
When should I call my child's diabetes care team immediately?
- Your child has a low blood sugar level and it does not improve with treatment.
- Your child's blood sugar level is above 240 mg/dL and does not come down after a dose of insulin.
- Your child has ketones in his or her urine or blood.
- Your child has a fever.
- Your child has nausea or is vomiting and cannot keep any food or liquid down.
- Your child has symptoms of a low blood sugar level, such as trouble thinking, sweating, or a pounding heartbeat.
- Your child has blurred or double vision.
- Your child's breath has a fruity, sweet smell, or his or her breathing is deep and labored.
- Your child's heartbeat is fast and weak.
When should I call my child's doctor or care team?
- Your child's blood sugar levels are higher than his or her target goals.
- Your child often has low blood sugar levels.
- Your child has abdominal pain, diarrhea, or is vomiting.
- Your child has numbness in his or her arms or legs.
- Your child has warm, red patches of skin or a wound that does not heal.
- Your child gets easily irritated.
- Your child is anxious or depressed.
- You have questions or concerns about your child's condition or care.
Care AgreementYou have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's healthcare providers to decide what care you want for your child. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.
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