Diagnosis

There are several blood tests for type 1 diabetes in children:

  • Random blood sugar test. This is the primary screening test for type 1 diabetes. A blood sample is taken at a random time. Regardless of when your child last ate, a random blood sugar level of 200 milligrams per deciliter (mg/dL), or 11.1 millimoles per liter (mmol/L), or higher suggests diabetes.
  • Glycated hemoglobin (A1C) test. This test indicates your child's average blood sugar level for the past two to three months. Specifically, the test measures the percentage of blood sugar attached to the oxygen-carrying protein in red blood cells (hemoglobin). An A1C level of 6.5 percent or higher on two separate tests indicates diabetes.
  • Fasting blood sugar test. A blood sample is taken after your child fasts overnight. A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher indicates type 1 diabetes.

Additional tests

Your doctor will likely recommend additional tests to confirm the type of diabetes that your child has. It's important to distinguish between type 1 diabetes and type 2 diabetes because treatment strategies differ.

These additional tests include:

  • Blood tests to check for antibodies that are common in type 1 diabetes
  • Urine tests to check for the presence of ketones, which also suggests type 1 diabetes rather than type 2

After the diagnosis

Your child will need regular follow-up appointments to ensure good diabetes management and to check his or her A1C levels. The American Diabetes Association recommends an A1C of 7.5 or lower for all children.

Your doctor also will periodically use blood and urine tests to check your child's:

  • Cholesterol levels
  • Thyroid function
  • Kidney function

In addition, your doctor will regularly:

  • Assess your child's blood pressure and growth
  • Check the sites where your child tests blood sugar and delivers insulin

Your child will need regular eye examinations. Your child also might be screened for celiac disease at the time of diagnosis of diabetes and at intervals afterward, depending on your child's age and symptoms.

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.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease.

Lifestyle and home remedies

Type 1 diabetes is a serious disease. Helping your child follow his or her diabetes treatment plan takes round-the-clock commitment and will initially require some significant lifestyle changes.

But your efforts are worthwhile. Careful management of type 1 diabetes can reduce your child's risk of serious — even life-threatening — complications.

As your child gets older:

  • Encourage him or her to take an increasingly active role in diabetes management
  • Stress the importance of lifelong diabetes care
  • Teach your child how to test his or her blood sugar and inject insulin
  • Help your child make wise food choices
  • Encourage your child to remain physically active
  • Foster a relationship between your child and his or her diabetes treatment team
  • Make sure your child wears a medical identification tag

Above all, stay positive. The habits you teach your child today will help him or her enjoy an active and healthy life with type 1 diabetes.

School and diabetes

You'll need to work with your child's school nurse and teachers to make sure they know the symptoms of high and low blood sugar levels. The school nurse might need to administer insulin or check your child's blood sugar levels. Federal law protects children with diabetes, and schools must make reasonable accommodations to ensure that all children get a proper education.

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.

Coping and support

Living with type 1 diabetes isn't easy — for you or for your child. Good diabetes management requires a lot of time and effort, especially in the beginning. There are several issues to address.

Your child's emotions

Diabetes can affect your child's emotions both directly and indirectly. Poorly controlled blood sugar can cause behavior changes, such as irritability. If that happens at a birthday party because your child forgot to take insulin before having a piece of cake, he or she could end up fighting with friends.

Diabetes can also make your child feel different from other kids. Having to draw blood and give themselves shots sets kids with diabetes apart from their peers. Getting your child together with other children who have diabetes may help make your child feel less alone.

Mental health and substance abuse

People with diabetes have an increased risk of depression and anxiety, which may be why many diabetes specialists regularly include a social worker or psychologist as part of their diabetes care team.

Teenagers, in particular, may have a particularly hard time dealing with diabetes. A child who has been very good about sticking to his or her diabetes regimen may rebel in the teen years by ignoring his or her diabetes care.

Teens may also have a harder time telling friends that they have diabetes because they want to fit in. They may also experiment with drugs, alcohol and smoking, behaviors that can be even more dangerous for people with diabetes. Eating disorders and forgoing insulin to lose weight are other problems that can occur more often in the teen years.

Talk to your teen, or ask your teen's doctor to talk to your teen, about the effects of drugs, alcohol and smoking on someone with diabetes.

If you notice that your child or adolescent is persistently sad or pessimistic, or experiences dramatic changes in sleeping habits, friends or school performance, have your child assessed for depression. Also tell your child's doctor if you notice that your son or daughter is losing weight or doesn't seem to be eating well.

Support groups

Talking to a counselor or therapist may help your child or you cope with the dramatic lifestyle changes that come with a diagnosis of type 1 diabetes. Your child may find encouragement and understanding in a type 1 diabetes support group for children. Support groups for parents are also available.

Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences or helpful information, such as where to find carbohydrate counts for your child's favorite takeout restaurant. If you're interested, your doctor may be able to recommend a group in your area.

Websites that offer support include:

  • The American Diabetes Association (ADA). The ADA also offers diabetes camp programs that provide education and support for children and teens with diabetes.
  • JDRF.
  • Children with Diabetes.

Putting information in context

Complications from poorly controlled diabetes can be frightening. It's important to remember that many studies — and therefore, a lot of literature you may be reading — were completed before many advances in diabetes care occurred. If you and your child work with your child's doctor and do your best to control blood sugar levels, your child will likely live a long and normal life.

Preparing for your appointment

Your child's primary care doctor will probably make the initial diagnosis of type 1 diabetes. Hospitalization might be needed to stabilize your child's blood sugar levels.

Your child's long-term diabetes care likely will be handled by a doctor who specializes in metabolic disorders in children (pediatric endocrinologist). Your child's health care team will also generally include a dietitian, a certified diabetes educator and a doctor who specializes in eye care (ophthalmologist).

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment take these steps:

  • Write down any concerns you have about your child's well-being.
  • Ask a family member or friend to join you. Managing diabetes requires you to remember a lot of information. Someone who accompanies you may recall something that you missed or forgot.
  • Write down questions to ask your doctor. Your time with your doctor is limited, so it can be useful to prepare a list of questions you have about your child's care. Ask your doctor for a referral to a dietitian or a diabetes nurse educator if you have concerns that might be addressed by him or her.

Topics you might want to discuss with your doctor, dietitian or diabetes educator include:

  • The frequency and timing of blood glucose monitoring
  • Insulin therapy — types of insulin used, timing of dosing and amount of dose
  • Insulin administration — shots versus pumps
  • Low blood sugar (hypoglycemia) — how to recognize and treat
  • High blood sugar (hyperglycemia) — how to recognize and treat
  • Ketones — testing and treatment
  • Nutrition — types of food and their effects on blood sugar
  • Carbohydrate counting
  • Exercise — adjusting insulin and food intake for activity
  • Dealing with diabetes at school or summer camp and on special occasions, such as sleepovers
  • Medical management — how often to visit the doctor and other diabetes care specialists

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

  • How comfortable are you with managing your child's diabetes?
  • Has your child had any low blood sugar episodes?
  • What's a typical day's diet like?
  • Is your child exercising? If so, how often?
  • On average, how much insulin are you using daily?

Contact your child's doctor or diabetes educator between appointments if your child's blood sugar isn't well-controlled or if you're not sure what to do in a certain situation.

Aug. 16, 2017
References
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  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.
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  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.

Type 1 diabetes in children