Diabetes

Finding out your child has a condition like diabetes can be overwhelming. And, although it’s a disease that will always be part of your child’s life, getting help sooner rather than later is key to successfully managing the disease so your child can live a childhood unrestricted by the condition.

When children are diagnosed with Type 1 or Type 2 diabetes, it means there’s too much glucose — the body’s main source of energy for cells — in their bloodstream. Although glucose is found naturally in child’s body, it also comes from the food they eat. Too much or too little glucose in the blood can cause serious health problems.

Both types of diabetes can occur at any age, but kids with Type 1 diabetes make no insulin, and kids with Type 2 make insulin, but it doesn't work as well as it should.

Insulin is a hormone found in the pancreas that allows sugar to get into cells of the body so that sugar can be used as energy.

 
Symptoms of Children with Diabetes
Some of the most common signs and symptoms of children with diabetes include:
  • extreme thirst
  • frequent urination
  • drowiness, lethargy
  • sugar in urine
  • sudden vision changes
  • increased appetite
  • sudden weight loss
  • fruity or sweet-like odor on breath
  • heavy or labored breathing
 
Diagnosing Children With Diabetes

Children diagnosed with Type 1 diabetes are typically diagnosed after presenting with symptoms such as unexplained weight loss, excessive urination, or excessive thirst. Children are diagnosed with Type 2 diabetes typically through a urine sample during a routine examination and symptoms are less dramatic.

Some lab tests that may be used to diagnose diabetes include:
  • fasting plasma test (FPG): a blood test that measures blood glucose in someone who has fasted for at least 8 hours
  • oral glucose tolerance test (OGTT): this test is given to someone who has fasted for 8 hours and then is asked to drink a glucose-containing beverage
  • random plasma glucose test: this blood glucose test is done without regard to fasting
 
Nutrition Tips for Children with Diabetes

At Nemours, our registered dietitians are part of your child’s diabetes care team. Nutrition is an important part of proper diabetes management. It’s not only about counting carbohydrates; it’s about healthy eating habits that are enjoyable.

Developing a Healthy Meal Plan

Healthy food choices should be encouraged for all family members. A registered dietitian at Nemours can help plan a healthy meal plan for your child with diabetes. Just as your child grows and develops, so must your child’s meal plan.

A healthy meal plan includes certain types of carbohydrates (carbs), lean protein, and fat and can be used for children with diabetes and without.

Carbohydrates are found in foods such as bread/starch, fruit, milk, and sweets. Eating carbs makes blood sugar levels rise, but that doesn’t mean that people with diabetes should avoid them — the body needs carbs. Since they affect blood sugar levels, it’s recommended children with diabetes track how many carbs they eat.

Follow these tips for healthy nutrition:

Choose healthy carbs that provide fiber, vitamins, and other nutrients,
such as:

  • whole wheat/grains instead of white bread, white pasta, or white rice
  • fresh fruit instead of fruit juices
  • fat-free or 1% milk instead of whole or 2% milk
  • light ice cream instead of full fat ice cream
  • limit desserts like cake, cookies, and candy, to special occasions

Choose protein from lean meats (cuts of beef and pork that end in “loin” or skinless chicken/turkey), egg whites, reduced-fat cheese, nuts, tofu, and beans.

Avoid foods high in saturated fats and trans fats, as these can raise heart-damaging cholesterol in the body. Choose heart-healthy fats, such as olive oil, canola oil, peanuts, and avocado. Remember that all fats are high in calories, so watch your portion sizes if you are trying to lose or maintain weight.

Drink mainly water instead of regular soda, fruit punch, sweet tea, and other sugary drinks. It’s OK to have calorie-free “diet” drinks occasionally.

Watch your portion sizes! Eating too much of even healthy foods can lead to excessive weight gain.

Treating Type 1 Diabetes

What Happens in Diabetes?

Treatment plans for type 1 diabetes are based on each child's needs and the suggestions of the diabetes health care team. Treatment approaches differ in, among other things, the types of insulin given and the schedules for giving insulin given each day. The advantages and disadvantages of a plan should be considered for each child.

Type 1 Diabetes Treatment Basics

The blood glucose level is the amount of glucose in the blood. Glucose is the main source of energy for the body's cells and is carried to each cell through the bloodstream. The hormone insulin allows the glucose to get into the cells. In type 1 diabetes, the body can no longer make insulin, so the glucose can't get into the body's cells. This causes the blood glucose level to rise.

Treatment goals for kids with diabetes are to control the condition in a way that minimizes symptoms, prevents short- and long-term health problems, and helps them to have normal physical, mental, emotional, and social growth and development. To do this, parents and kids should aim for the goal of keeping blood sugar levels as close to normal as possible.

In general, kids with type 1 diabetes need to:

  • take insulin as prescribed
  • eat a healthy, balanced diet, paying special attention to the amount of carbohydrates in each meal and the diabetes meal plan
  • monitor blood sugar levels several times a day
  • get regular physical activity

Following the treatment plan helps kids stay healthy, but treating diabetes isn't the same as curing it. Right now, there's no cure for diabetes, so kids with type 1 diabetes will need treatment for the rest of their lives. But with proper care, they should look and feel healthy and go on to live long, productive lives, just like other kids.

Taking Insulin as Prescribed

Children and teens who have type 1 diabetes must take insulin as part of their treatment plan. Insulin is the only medicine that can keep their blood sugar levels in a healthy range.

Taking insulin as prescribed lets them use the glucose in their blood for energy. When glucose is entering and being used by the cells properly, its level in the blood generally remains within a healthy range.

Unless they're using an insulin pump, most kids require two or more injections every day to keep blood sugar levels under control. Usually, they inject a combination of different types of insulin to handle the sugar that circulates in the blood after eating and between meals. The acids and digestive juices in the stomach and intestines can break down and destroy insulin if it is swallowed, so it can't be taken as a pill. The only way to get insulin into the body now is by injection with a needle or with an insulin pump.

There is no-one-size-fits-all insulin schedule — the types of insulin used and number of daily injections a child needs will depend on the diabetes management plan. Also, you can't turn off the action of insulin once it's been injected, so insulin doses need to be adjusted to handle the rise in blood sugar that occurs with meals and provide the amounts of insulin the body needs between meals and overnight.

Eating meals at regular times generally makes this easier. Although eating on schedule may work well for younger kids, sticking to a routine can be a challenge for older kids, whose school, sleep, and social schedules might not be as routine. The diabetes health care team can help you work through any problems your child might have with scheduling meals and insulin injections.

Getting insulin injections today is nearly painless, thanks to smaller needles. Insulin pumps, which deliver insulin through a small tube that is placed just under the skin, cut down on the number of injections needed.

Insulin is usually injected into the fatty layer under the skin of the abdomen, hips/buttocks, or thighs. The health care team will teach you when and how to give the insulin, as well as the best sites in which to inject it, based on your child's weight, age, and activity patterns.

Healthy Eating and Following a Meal Plan

Eating a balanced diet and following a meal plan are important components of type 1 diabetes treatment. Kids with diabetes benefit from the same kind of healthy diet as those without diabetes — one that includes a variety of nutritious foods that help the body grow and function properly.

Kids with diabetes also have to balance the type and timing of their meals with the amount of insulin they take and with their activity level. That's because eating some foods will cause blood sugar levels to go up more than others, whereas insulin and exercise will make blood sugar levels go down.

How much the blood sugar level goes up after eating depends on the type of nutrients the food contains. The three main types of nutrients found in foods are carbohydrates (carbs), proteins, and fats, which provide energy in the form of calories. Foods containing carbs cause blood sugar levels to go up the most. Foods that are mostly protein and/or fat don't affect blood sugar levels nearly as much.

Our bodies need many nutrients — in different amounts — to function normally. So when you and the diabetes health care team create a diabetes meal plan to help keep your child's blood sugar within the target range, it will include a variety of nutrients.

Meal plans usually consist of breakfast, lunch, and dinner with scheduled between-meal snacks. The plan won't restrict your child to eating specific foods, but will guide you in selecting from the basic food groups to achieve a healthy balance. Meal plans are based on a child's age, activity level, schedule, and food likes and dislikes, and should be flexible enough to accommodate special situations like parties and holidays.

Knowing the amount of carbs in meals and snacks will help you determine how much insulin to give your child. Mismatching carbs and insulin can result in either high or low blood sugar levels.

The meal plan also might recommend limiting extra fat and "empty" calories (foods that contain lots of calories but few nutrients). Everyone should limit these foods anyway because eating too much of them can lead to excess weight gain or long-term health problems like heart disease, for which people with diabetes are already at risk.

Monitoring Blood Sugar Levels

Treating type 1 diabetes also involves checking blood sugar levels regularly and responding to the results. Controlling blood sugar levels helps kids with diabetes feel well, grow and develop normally, and also reduces the risk of long-term diabetes complications.

The diabetes treatment plan will recommend how many times a day to check blood sugar levels, which is the only way to monitor the effectiveness of your child's day-to-day blood sugar control.

The diabetes health care team also will let you know what your child's target blood sugar levels are. In general, kids with type 1 diabetes should test their blood sugar levels with a blood glucose meter at least twice a day, but preferably three or four times a day. Depending on your child's management plan and any problems that arise, blood sugar levels could need to be tested more often.

A blood glucose meter measures the blood sugar level at the moment of testing. Another blood sugar test, the glycosylated hemoglobin (hemoglobin A1c or HbA1c) test, indicates what blood sugar levels have been over the past few months.

Getting Regular Physical Activity

Exercise is good for everyone — adults and kids, with or without diabetes. Getting regular physical activity is also an important part of diabetes treatment. It helps control blood sugar levels and may reduce the risk of other chronic illnesses, like heart disease.

Besides helping keep blood sugar levels under control, exercise can help kids with diabetes:

  • maintain a healthy body weight
  • keep blood lipids and blood pressure under control
  • get and keep their heart, lungs, and blood vessels in good shape
  • feel more normal by doing things that kids without diabetes can

Encouraging kids with diabetes to exercise might make parents uneasy, but exercise actually helps insulin work better in the body. Some adjustments of meals and insulin may be needed, but they can and should exercise.

All exercise is great — from walking the dog or riding a bike to playing team sports. Encourage your child to exercise, and set 60 minutes daily as a goal. New exercise habits might be hard for kids to adopt at first, but feeling the benefits can help them stick with it.

Avoiding Problems During Exercise

To help avoid problems during exercise, kids with diabetes might need to:

  • have an extra snack prior to activity
  • carry snacks, water, and supplies with them when they exercise
  • check their blood sugar levels before, during, or after exercise
  • make sure their coaches know about their diabetes and what to do if problems occur

Make sure your child wears a medical identification bracelet (this should always be worn, but it's even more important during exercise, sports, and and fitness activities).

The diabetes health care team will make suggestions to help your child get ready for exercise or join a sport. They'll also provide instructions to help you and your child respond to any diabetes problems that could occur during exercise, like hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).

Putting It All Together

Treating and managing diabetes can seem overwhelming at times. But the diabetes health care team is there for you. Your child's diabetes management plan should be easy to understand, detailed, and written down for easy reference. You also should have the names and phone numbers of the health care team members in case of emergencies or if you have questions about how to take care of your child's diabetes.

Besides the standard diabetes treatments, you also might hear of alternative or complementary treatments, such as herbal remedies and vitamin or mineral supplements. Although research continues into their possible benefits, studies thus far haven't proved their effectiveness. Aside from being potentially ineffective, they could even be dangerous for kids and teens with type 1 diabetes, especially if used to replace medically recommended treatments. Talk to the diabetes health care team if you have questions.

Each day, researchers all over the world are working to find a cure for diabetes, and many treatment advances have made treatment easier and more effective. Insulin might soon be available in pill, patch, and spray forms, and scientists continue efforts to improve results of pancreas or islet cell transplants. Versions of an artificial pancreas — a device that senses blood sugar and gives insulin — also are being tested.

These new developments are exciting, but they still need extensive testing — especially for use in kids — before they become available.

Reviewed by: Steven Dowshen, MD
Date reviewed: May 2011