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Type 1 Diabetes Management for Adolescents
WHAT YOU NEED TO KNOW:
As you get older, you will be able to manage your own health. You may be away from home more often. You may spend more time with your friends or be involved in sports. When you manage your blood sugar levels, you will feel well and be able to enjoy your activities. Your diabetes care team providers can show you how to fit diabetes care into your schedule. Adults, such as your parents and care team providers, are available to help you as you become more active in your diabetes care.
Why you may still need diabetes education:
Your needs and wants change as you get older. Diabetes education will help you continue to manage your diabetes, make changes to your plan, and prevent complications. As you get older, you may be able to do diabetes education on your phone or computer. Diabetes education can help you continue learning about the following:
- How to check your blood sugar level: You will learn what your blood sugar level should be. You will be given information on when to check your blood sugar level. You will learn what to do if the level is too high or too low. Your care team provider may recommend a continuous glucose monitor (CGM). A CGM is a device that is worn at all times. The CGM checks your blood sugar every 5 minutes. It sends results to an electronic device such as a smart phone.
- Insulin and insulin pumps: Your diabetes care team provider will teach you 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 you insulin 24 hours a day. An insulin pump keeps you from needing multiple insulin injections in a day.
- Nutrition: A dietitian will help you make changes to your meal plan to keep your blood sugar level steady. You will learn how certain foods affect your blood sugar levels. You will also learn to keep track of sugar and starchy foods (carbohydrates). Do not skip meals. Blood sugar levels may drop too low if you have had insulin and do not eat. You may need to check in with the dietitian at least one time per year.
- Exercise and diabetes: You will learn why physical activity, such as exercise, is important. A plan will be made for your activity. A goal of 60 minutes of moderate to intense aerobic activity every day will be in the plan. You 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. You may need to have a snack before activity to prevent low blood sugar levels. Do not exercise if your blood sugar level is 350 mg/dL or higher. You may need to check your level before, during, and after exercise.
- Complications of diabetes: You 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.
What you can do to manage your blood sugar levels if you do not have a CGM:
- Know what your blood sugar levels should be. Before meals , your blood sugar should be between 90 and 130 mg/dL. At bedtime , it should be between 90 and 150 mg/dL.
- Check your blood sugar level as directed and as needed.
- Look at your schedule and make a plan for how you will check your blood sugar levels throughout the day.
- Check more often if you think your blood sugar is too high or too low. This will allow you to take care of any low or high blood sugar levels so they do not interfere with your activities.
- Rotate the sites where you do fingersticks. This will help make the checks less painful, and make fingerstick sites less noticeable.
- Write down your blood sugar levels so you can show them to your care team provider during your visits. Talk to your care team provider if you are having trouble keeping your blood sugar at the recommended levels.
- Take your insulin as directed. Your care team provider will teach you how and when to give yourself insulin injections or use an insulin pump. Your care team provider can also teach you how to adjust your insulin dose. This will be helpful when you are going to change the amount of food you usually eat or the physical activity you do.
What you need to know about low blood sugar:
You can prevent symptoms such as shakiness, dizziness, irritability, or confusion by preventing your blood sugar from going too low.
- Treat low blood sugar right away. Eat 15 grams of carbohydrate. This amount of carbohydrate can be found in 4 ounces (½ cup) of fruit juice or 4 ounces of regular soda. Other examples are 2 tablespoons of raisins or 1 tube of glucose gel.
- Your blood sugar can drop too low if you take insulin and do not eat enough food. Eat a snack in the evening to prevent low blood sugar at night. Do not skip meals.
- Increased physical activity can cause low blood sugar. Check your blood sugar level before you exercise. If it is below 100 mg/dL, eat 15 grams of carbohydrate. If you will exercise for more than 1 hour, check your blood sugar level every 30 minutes. You may need to adjust your insulin before exercise and have a carbohydrate snack during exercise.
What you need to know about high blood sugar:
High blood sugar may not cause any symptoms. It may cause you to feel more thirsty than usual or urinate more often than usual. Over time, high blood sugar levels can damage your nerves, blood vessels, tissues, and organs. You may need to check for ketones in your urine or blood if your level is higher than directed. Ask your care team provider when and how to check for ketones. High blood sugar that is not controlled can lead to diabetic ketoacidosis (DKA). This is a serious condition that can become life-threatening.
- A lower dose of insulin or a late dose can raise your blood sugar. There is not enough time for your insulin to work as it should if you take it late. When you take a lower dose of insulin, there is not enough insulin needed to lower your blood sugar.
- Large meals or large amounts of carbohydrates at one time can raise your blood sugar. You may need to adjust your insulin dose to handle these changes.
- Decreased physical activity can raise your blood sugar. For example, your blood sugar can increase if you stop playing a sport or getting regular physical activity. Do not sit for longer than 90 minutes at a time.
- Stress can raise your blood sugar. Ask your parents or care team provider for help if you are having trouble managing stress.
- Illness can raise your blood sugar. This can happen even if you eat less than usual while you are sick. Work with your care team provider and parents to develop a sick day plan. This is a plan that helps you manage your blood sugar levels while you are sick.
Other things you can do to manage your diabetes:
- Wear medical alert jewelry or carry a card that says you have diabetes. Ask your care team provider where to get these items.
- Tell a friend or 2 that you have diabetes. Teach them what to do and who to call if you have problems.
- Make healthy food choices. Healthy foods can give you energy to learn and be active. They can also help you keep your blood sugar in balance, and manage or lose weight safely. Work with a dietitian to develop a meal plan that works for you and your schedule. A dietitian can help you learn how to eat the right amount of carbohydrates during your meals and snacks. Carbohydrates can raise your blood sugar if you eat too many at one time. Some foods that contain carbohydrates include breads, cereals, french fries, chips, sweets, soda, and juice.
- Be safe when you learn to drive. Check your blood sugar before you drive. If your blood sugar is low, have 15 grams of carbohydrate and wait for it to go back to normal. Keep snacks that contain carbohydrate in the car. If you feel like your blood sugar is low, pull over and check it. Treat your blood sugar before you start driving again, if needed.
- Do not drink alcohol or smoke. Alcohol affects your blood sugar level and can make it harder for you to manage your diabetes. You may not be aware of low blood sugar when you drink alcohol. Nicotine can damage blood vessels and make it more difficult to manage your diabetes. Do not use e-cigarettes or smokeless tobacco in place of cigarettes or to help you quit. They still contain nicotine. Ask your care team provider for information if you currently smoke and need help quitting.
- Get your eyes checked as directed. You will need an eye exam every 1 to 2 years. The provider will check for changes in your sight. He or she will also check for retinopathy (damage to the retina). You are at risk for retinopathy when puberty starts and after having type 1 diabetes 5 to 10 years.
- Have screenings for complications of diabetes and other conditions that can happen with diabetes. You will need to be screened for 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. You will need to continue screenings through your lifetime. Keep your follow-up appointments with all providers.
- Ask about vaccines. You have a higher risk for serious illness if you get the flu, pneumonia, or hepatitis. Ask your care team provider if you should get a flu, pneumonia, or hepatitis B vaccine, and when to get the vaccine.
What you need to know about diabetes and pregnancy:
If you are female, talk to your care team provider about how to prevent an unplanned pregnancy. While you can have a safe pregnancy with diabetes, it is important to plan your pregnancy. Healthcare providers can help you have a healthy pregnancy and baby. Tell your care team provider immediately if you are pregnant or think you are pregnant.
Follow up with your care team providers as directed:
You may need to return to have your A1c every 3 months. An A1c test shows the average amount of sugar in your blood over the past 2 to 3 months. Your A1c should be less than 7.5%. You may also need to return at least once each year to have your feet checked.
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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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