Treatment

Treatment for type 1 diabetes is lifelong and includes blood sugar monitoring, insulin therapy, healthy eating and regular exercise — even for kids. As your child grows and changes, so will his or her diabetes treatment plan.

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 and on 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 dietitian — to keep your child's blood sugar level as close to normal as possible.

Blood sugar monitoring

You will 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 sites other than the fingertips.

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.

Continuous glucose monitoring (CGM)

Continuous glucose monitoring (CGM) is the newest way to monitor blood sugar levels. It may be most helpful for people who don't experience the usual warning symptoms of hypoglycemia.

CGM uses a fine needle inserted just under the skin that checks blood glucose level every few minutes. CGM isn't yet considered as accurate as standard blood sugar monitoring. It can be an additional tool but generally doesn't replace regular blood sugar monitoring.

Insulin and other medications

Anyone who has type 1 diabetes needs insulin treatment to survive. Many types of insulin are available, including:

  • Rapid-acting insulin. Insulin therapies such as lispro (Humalog), aspart (NovoLog) and glulisine (Apidra) start working within 15 minutes, peak in about one hour and last four hours.
  • Short-acting insulin. Therapies such as human insulin (Humulin R) should be injected 20 to 30 minutes before a meal, peak in 1.5 to two hours and last four to six hours.
  • Intermediate-acting insulin. Therapies such as NPH insulin (Humulin N) start working within about one hour, peak in about six hours and last 12 to 24 hours.
  • Long-acting insulin. Therapies such as insulin glargine (Lantus) and insulin detemir (Levemir) have almost no peak and may provide coverage for as long as 20 to 26 hours.

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

Insulin delivery options

There are several options for insulin delivery, including:

  • Fine needle and syringe. An advantage of needle and syringe is that some different types of insulin can be mixed in a single injection, reducing the number of injections.
  • Insulin pen. This device looks like an ink pen, except the cartridge is filled with insulin. Pens with mixed insulin preparations are available, but these mixtures generally aren't tailored for children.
  • Insulin pump. This is a device about the size of a cellphone that is worn on the outside of the body. A tube connects a reservoir of insulin to a catheter inserted under the skin of the abdomen. The pump can be used in conjunction with CGM.

Healthy eating

Your child won't be restricted to a lifetime "diabetes diet" of boring, bland foods. Instead, your child needs plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories. Ideally, your child's intake of carbohydrates should be consistent.

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

Understanding what and how much to feed your child can be a challenge. A 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 may cause a spike in blood sugar several hours after your child has eaten, because fat slows digestion.

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 and, better yet, exercise with your child. Make physical activity part of your child's daily routine.

But remember that physical activity usually lowers blood sugar, and 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. Food can be a particular challenge for very young children with type 1 diabetes because they often don't finish what's on their plates. That's a problem if you've given the child an insulin injection to cover more food than he or she ate. Tell your doctor if this will be an issue with your child, so you and the doctor can come up with an insulin regimen that works for your family.
  • Physical activity. The more active your child is, the lower his or her blood sugar level can get. To compensate, you might need to lower your child's insulin dose before unusual physical activity. Or your child may need a snack before exercise.
  • Illness. Sickness has varying effects on your child's insulin need. Hormones produced during illness raise blood sugar levels, but reduced carbohydrate intake due to poor appetite or vomiting lowers the insulin requirement. Ask your doctor about 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. To avoid problems with low blood sugar during the night, you might need to adjust your child's insulin routine. Ask your doctor about good pre-bedtime blood sugar levels.

Signs of trouble

Despite your best efforts, sometimes problems will arise. Certain short-term complications of type 1 diabetes — such as low blood sugar, high blood sugar and ketoacidosis, generally diagnosed by finding ketones in the urine — require immediate care. Left untreated, these conditions can cause seizures and loss of consciousness (coma).

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, getting more physical activity than normal or injecting too much insulin.

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

  • Pale complexion
  • Sweating
  • Shakiness
  • Hunger
  • Irritability
  • Nervousness or anxiety
  • Headaches

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

  • Lethargy
  • Confusion or agitation
  • Drowsiness
  • Slurred speech
  • Loss of coordination
  • Odd behavior
  • Loss of consciousness

If your child has a low blood sugar reading:

  • Give your child fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar
  • Retest the blood sugar in about 15 minutes to make sure it has gone up into the normal range
  • If the blood sugar level is still low, re-treat with more sugar and then retest in another 15 minutes

Left untreated, low blood sugar will cause your child to lose consciousness. If this occurs, the child may need an emergency injection of a hormone that stimulates the release of sugar into the blood (glucagon). Make sure your child always carries a source of fast-acting sugar.

Hyperglycemia

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

Signs and symptoms of high blood sugar include:

  • Frequent urination
  • Increased thirst or dry mouth
  • Blurred vision
  • Fatigue
  • Nausea

If you suspect hyperglycemia:

  • Check your child's blood sugar
  • You may need to administer an additional dose of insulin if blood sugar is above your child's target range
  • Wait 15 minutes, and then recheck your child's blood sugar
  • Adjust your child's meal plan or medications to prevent high blood sugar in the future

If your child has a blood sugar reading above 240 mg/dL (13.3 mmol/L), your child should use a urine test stick to test for ketones. Don't allow your child to exercise if his or her blood sugar level is high or if ketones are present.

Diabetes ketoacidosis

Severe lack of insulin causes your child's body to produce ketones. Excess ketones build up in your child's blood and are spilled in the urine, a condition known as diabetic ketoacidosis (DKA). Untreated DKA can be life-threatening.

Signs and symptoms of DKA include:

  • Thirst or very dry mouth
  • Increased urination
  • Exhaustion
  • Dry or flushed skin
  • Nausea, vomiting or abdominal pain
  • A sweet, fruity smell on your child's breath
  • Confusion

If you suspect DKA, check your child's urine for excess ketones with an over-the-counter ketone test kit. If the ketone levels are high, call your child's doctor or seek emergency care.

Alternative medicine

There is no treatment that can replace insulin for anyone with type 1 diabetes. People who have type 1 diabetes must use injected insulin every day to survive.

March 15, 2017
References
  1. Levitsky LL, et al. Epidemiology, presentation and diagnosis of type 1 diabetes mellitus in children and adolescents. http://www.uptodate.com/home. Accessed Nov. 4, 2016.
  2. Kliegman RM, et al. Diabetes mellitus in children. In: Nelson Textbook of Pediatrics. 20th ed. Philadelphia, Pa.: Elsevier; 2016. http://www.clinicalkey.com. Accessed Nov. 5, 2016.
  3. AskMayoExpert. Type 1 diabetes mellitus. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2015.
  4. Levitsky LL, et al. Management of type 1 diabetes mellitus in children and adolescents. http://www.uptodate.com/home. Accessed Nov. 4, 2016.
  5. Goldman L, et al., eds. Diabetes mellitus. In: Goldman-Cecil Medicine. 25th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Nov. 5, 2016.
  6. Cameron FJ, et al. Care of diabetes in children and adolescents: Controversies, changes, and consensus. The Lancet. 2015;385:2096.
  7. Jameson L, et al., eds. Management of diabetes in children. In: Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, Pa.: Saunders Elsevier; 2016. http://www.clinicalkey.com. Accessed Nov.5, 2016.
  8. Rewers M, et al. Environmental risk factors for type 1 diabetes. The Lancet. 2016;387:2340.
  9. Levitsky LL, et al. Complications and screening in children and adolescents with type 1 diabetes mellitus. http://www.uptodate.com/home. Accessed Nov. 4, 2016.
  10. Chiang JL, et al. Type 1 diabetes through the life span: A position statement of the American Diabetes Association. Diabetes Care. 2014;37:2034.
  11. Levitsky LL, et al. Special situations in children and adolescents with type 1 diabetes mellitus. http://www.uptodate.com/home. Accessed Nov. 4, 2016.
  12. Tools for effective diabetes management. National Institute of Diabetes and Digestive and Kidney Diseases. www.niddk.nih.gov/health-information/health-communication-programs/ndep/health-care-professionals/school-guide/Pages/publicationdetail.aspx. Accessed Nov. 5, 2016.
  13. Hyperglycemia (high blood glucose). American Diabetes Association. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/hyperglycemia.html. Accessed Nov. 5, 2016.
  14. DKA (ketoacidosis) & ketones. American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html. Accessed Nov. 5, 2016.
  15. School responsibilities under federal laws. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/health-communication-programs/ndep/health-care-professionals/school-guide/section4/Pages/default.aspx. Accessed Nov. 5, 2016.
  16. Buchberger B, et al. Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and meta-analysis. Psychoneuroendocrinology. 2016;70:70.