Treatments and drugs

By Mayo Clinic Staff

Treatment for type 1 diabetes is a lifelong commitment of blood sugar monitoring, insulin, healthy eating and regular exercise — even for kids. And as your child grows and changes, so will his or her diabetes treatment plan. Over the years, your child may need different doses or types of insulin, a new meal plan, or other treatment changes.

If managing your child's diabetes seems overwhelming, take it one day at a time. Some days you'll manage your child's blood sugar perfectly. Other days, it may seem as if nothing works well. Don't forget that you're not alone.

You'll work closely with your child's diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your child's blood sugar level as close to normal as possible.

Blood sugar monitoring

Depending on what type of insulin therapy your child needs, you may need to check and record your child's blood sugar at least four times a day but probably more often. This requires frequent finger sticks.

Some blood glucose meters allow for testing at other sites. Frequent testing is the only way to make sure that your child's blood sugar level remains within his or her target range — which may change as your child grows and changes. Your child's doctor will let you know what your child's blood sugar target range is.

Your doctor may ask you to keep a log of the blood glucose readings, or he or she may download that information from the blood glucose meter.

Continuous glucose monitoring (CGM)

CGM is the newest way to monitor blood sugar levels and may be most helpful for people who have developed hypoglycemia unawareness. CGM attaches to the body using a fine needle just under the skin that checks blood glucose level every few minutes.

CGM isn't yet considered as accurate as standard blood sugar monitoring, so it's not considered a replacement method for keeping track of blood sugar but is used as an additional tool.

Insulin and other medications

Anyone who has type 1 diabetes needs insulin treatment to survive. Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar.

Many types of insulin are available, including:

  • Rapid-acting insulin, such as insulin lispro (Humalog) and insulin aspart (NovoLog), starts working in five to 15 minutes and peaks about an hour after injection.
  • Short-acting insulin, such as human insulin (Humulin R, Novolin R, others), starts working about 30 minutes after injection and generally peaks in two to four hours.
  • Long-acting insulin, such as insulin glargine (Lantus) and insulin detemir (Levemir), has almost no peak and may provide coverage for as long as 20 to 26 hours.
  • Intermediate-acting insulin, such as NPH insulin (Humulin N, Novolin N), starts working 30 minutes to an hour after it's taken and peaks in four to six hours. NPH insulin is similar in effectiveness to long-acting types of insulin but may be more likely to cause low blood sugar. Using NPH insulin allows for less flexibility with mealtimes, as well as in the amount of carbohydrates your child can eat.

Depending on your child's age and needs, the doctor may prescribe a mixture of insulin types to use throughout the day and night.

Insulin delivery options

Often insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin.

An insulin pump also may be an option for some children. The pump is a device about the size of a cell phone worn on the outside of the body. In most cases, a tube connects the reservoir of insulin to a catheter that's inserted under the skin of the abdomen.

A wireless pump that uses small pods filled with insulin is another available option. The pump is programmed to dispense specific amounts of insulin automatically. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.

Healthy eating

Contrary to popular perception, there's no diabetes diet. Your child won't be restricted to a lifetime of boring, bland foods. Instead, your child will need plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories.

Your child's dietitian will likely suggest that your child — and the rest of the family — consume fewer animal products and sweets. In fact, it's the best eating plan for the entire family. Sugary foods are OK once in a while, as long as they're included in your child's meal plan.

Yet understanding what and how much to feed your child can be a challenge. A registered dietitian can help you create a meal plan that fits your child's health goals, food preferences and lifestyle.

Certain foods, such as those with a high sugar or fat content, may be more difficult to incorporate into your child's meal plan than healthier choices. For example, high-fat foods — because fat slows digestion — may cause a spike in blood sugar several hours after your child has eaten.

Unfortunately, there's no set formula to tell you how your child's body will process different foods. But, as time passes, you'll learn more about how your child's favorites affect his or her blood sugar, and then you can learn to compensate for them.

Physical activity

Everyone needs regular aerobic exercise, and children who have type 1 diabetes are no exception. Encourage your child to get regular physical activity. Sign up for a sports team or dance lessons. Better yet, exercise together. Play catch in the backyard. Walk or run through your neighborhood. Visit an indoor climbing wall or local pool. Make physical activity part of your child's daily routine.

But remember that physical activity usually lowers blood sugar, and it can affect blood sugar levels for up to 12 hours after exercise. If your child begins a new activity, check your child's blood sugar more often than usual until you learn how his or her body reacts to the activity. You might need to adjust your child's meal plan or insulin doses to compensate for the increased activity.

Flexibility

Even if your child takes insulin and eats on a rigid schedule, the amount of sugar in his or her blood can change unpredictably. With help from your child's diabetes treatment team, you'll learn how your child's blood sugar level changes in response to:

  • Food. What and how much your child eats will affect your child's blood sugar level. Food can pose a particular challenge for parents of very young children with type 1 diabetes. That's because young children are notorious for not finishing what's on their plate, and that's a problem if you've given the child an insulin injection to cover more food than he or she ate.

    If you know this will be an issue, let your child's doctor know so that he or she can work with you to come up with an insulin regimen that works for your family.

  • Physical activity. Physical activity moves sugar from your child's blood into his or her cells. The more active your child is, the lower his or her blood sugar level. To compensate, you might need to lower your child's insulin dose before unusual physical activity, or your child may need to have a snack before exercise.
  • Medication. Your child needs insulin to lower his or her blood sugar. But any other medication your child takes may affect his or her blood sugar level as well — sometimes requiring changes in your child's diabetes treatment plan.
  • Illness. During a cold or other illness, your child's body will produce hormones that raise his or her blood sugar level. In addition, a fever increases your child's metabolism. As a result, your child may need to take more frequent or larger doses of insulin.

    If your child has an illness that's causing vomiting and he or she can't keep any food down, his or her body still needs insulin to cover the glucose produced in the liver. Ask your doctor about coming up with a sick-day management plan.

  • Growth spurts and puberty. Just when you've mastered your child's insulin needs, he or she sprouts up seemingly overnight and suddenly isn't getting enough insulin. Hormones also can affect insulin requirements, particularly for teenage girls as they begin to menstruate.
  • Sleep. Depending on your child's insulin regimen, he or she may be at risk of low blood sugar during the night. For that reason, your child's blood sugar levels should be slightly higher before bed than they are during the day.

    For children younger than age 6, a good pre-bedtime level is 110 to 200 mg/dL (6.1 to 11.1 mmol/L), while a child between ages 6 and 12 should be in the 100 to 180 mg/dL (5.6 to 10 mmol/L) range. Teenagers' blood sugar levels should be between 90 and 150 mg/dL (5.0 to 8.3 mmol/L) before bed.

Investigational treatments

  • Pancreas transplant. With a successful pancreas transplant, your child would no longer need injected insulin. But pancreas transplants aren't always successful — and the procedure poses serious risks.

    Your child would need a lifetime of potent immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects, including a high risk of infection and organ injury.

    Eligibility for a pancreas transplant is limited mostly to people with kidney failure, and the majority of surgeries also include kidney transplantation.

  • Islet cell transplantation. Researchers also are experimenting with islet cell transplantation, which provides new insulin-producing cells from a donor pancreas. Although this experimental procedure has met with problems in the past, new techniques and better drugs to prevent islet cell rejection may hold promise for the future.

    However, islet cell transplantation still requires the use of immune-suppressing medications, and just as it did with its own natural islet cells, the body often destroys transplanted islet cells, making the time off insulin short-lived.

Signs of trouble

Despite your best efforts, sometimes problems will arise. Certain short-term complications of type 1 diabetes require immediate care. Left untreated, these conditions can cause seizures and loss of consciousness (coma).

Low blood sugar (hypoglycemia). If your child's blood sugar level drops below his or her target range, it's known as low blood sugar. Ask your doctor what's considered a low blood sugar level for your child.

Blood sugar levels can drop for many reasons, including skipping a meal, getting more physical activity than normal or injecting too much insulin. Hypoglycemia occurs more frequently with intermediate-acting insulin, such as NPH.

Teach your child the symptoms of low blood sugar and that when in doubt, he or she should always do a blood sugar test. Early signs and symptoms of low blood sugar include:

  • Sweating
  • Shakiness
  • Drowsiness
  • Hunger
  • Dizziness
  • Irritability
  • Headaches
  • Dramatic behavior changes
  • Confusion
  • Loss of consciousness

Later signs and symptoms of low blood sugar, which are sometimes mistaken for alcohol intoxication in teens and adults, include:

  • Lethargy
  • Confusion or agitation
  • Seizure
  • Loss of consciousness

If your child develops hypoglycemia during the night, he or she might wake with sweat-soaked pajamas or a headache. Thanks to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning.

If your child has a low blood sugar reading, give him or her fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Then retest his or her blood sugar in about 15 minutes to make sure it has gone up into the normal range. If it's not in the normal range, re-treat with more sugar (juice, candy, glucose tablets or another source of sugar) and then retest in another 15 minutes. Keep doing this until you get a normal reading.

It's a good idea to have your child eat another snack, this one containing a mixed food source, such as peanut butter and crackers, to help stabilize the blood sugar.

If a blood glucose meter isn't readily available, treat for low blood sugar anyway if your child has symptoms of hypoglycemia and then test as soon as possible.

Make sure your child always carries a source of fast-acting sugar with him or her.

Left untreated, low blood sugar will cause your child to lose consciousness. If this occurs, he or she may need an emergency injection of glucagon — a hormone that stimulates the release of sugar into the blood. Be sure your child always has a glucagon emergency kit available — at home, at school, during sports and on sleepovers — and make sure it hasn't expired.

High blood sugar (hyperglycemia). As with low blood sugar, your child's blood sugar can rise for many reasons, including eating too much, eating the wrong types of foods, not taking enough insulin or illness.

Watch for:

  • Frequent urination
  • Increased thirst
  • Dry mouth
  • Blurred vision
  • Yeast infection, often in the diaper area in infants and toddlers
  • Fatigue
  • Nausea

If you suspect hyperglycemia, check your child's blood sugar. You might need to adjust your child's meal plan or medications. If your child's blood sugar is higher than his or her target range, you'll likely need to administer a "correction" using an insulin shot or through an insulin pump. A correction is an additional dose of insulin that should bring your child's blood sugar back into the normal range.

Ask your doctor how long to wait until you recheck, although most of the time 15 minutes is appropriate. If your child uses an insulin pump, you may need to change the pump site if blood sugar levels don't come down.

If your child has a blood sugar reading above 250 mg/dL (13.9 mmol/L), have your child test for ketones using a urine test stick. Don't allow your child to exercise if his or her blood sugar level is high or anytime ketones are present.

If your child's blood sugar is persistently above 300 mg/dL (16.7 mmol/L), call your child's doctor or seek emergency care.

Increased ketones in your child's urine (diabetic ketoacidosis). If your child's cells are starved for energy, your child's body may begin to break down fat — producing toxic acids known as ketones.

Signs and symptoms of this serious condition include:

  • Loss of appetite
  • Nausea
  • Vomiting
  • Abdominal pain
  • Dry or flushed skin
  • A sweet, fruity smell on your child's breath
  • Confusion
  • Difficulty breathing
  • Exhaustion

If you suspect diabetic ketoacidosis, check your child's urine for excess ketones with an over-the-counter ketones test kit. If your child has a large amount of ketones in his or her urine, call your child's doctor right away or seek emergency care. Also, call your doctor if your child has vomited more than twice in a four-hour period and has ketones in his or her urine.

    Apr. 01, 2014

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