Treatment Overview

The goal of your child's treatment for type 1 diabetes is to always keep his or her blood sugar levels within a target range. A target range reduces the chance of diabetes complications. Daily diabetes care and regular medical checkups will help you and your child accomplish this goal.

Daily care

Your child's daily care includes:

• Exercise. Experts recommend that teens and children (starting at age 6) do moderate to vigorous activity at least 1 hour every day.¹
• Home blood sugar monitoring.

  Diabetes in Children: Checking Blood Sugar in a Child

• Preparing and giving insulin injections.

  Diabetes in Children: Giving Insulin Shots to a Child

• Living with an insulin pump.

  Diabetes: Living With an Insulin Pump

• Counting carbohydrate.

  Diabetes: Counting Carbs if You Use Insulin

• Dealing with low blood sugar levels.

  Diabetes in Children: Preventing Low Blood Sugar

• Preventing high blood sugar levels.

  Diabetes in Children: Preventing High Blood Sugar

Some problems you may encounter include:

• Changing appetite and "picky eating." A registered dietitian can help you develop a flexible meal plan to meet your child's appetite needs and allow for special events, such as parties and school activities. If you use rapid-acting insulin, you can give the insulin dose after a meal based on what your child ate. Some tips for mealtimes with young children include having alternative meal choices.
• Illness. Follow the sick-day guidelines that you and your child's doctor set up to prevent high blood sugar emergencies when your child is ill. Talk with the doctor before giving your child any nonprescription medicine.
• Exercise. If your child is not very active, limit his or her time playing video games, watching TV, or using the computer. Plan some activities to do along with your child, such as in-line skating or bicycling. Keep your child safe during exercise by:
  • Checking his or her blood sugar levels before and after vigorous activity.
  • Having a quick-sugar food on hand at all times.
  • Giving the coach a copy of the symptoms of low blood sugar and instructions about what to do if it occurs.

You will also want to:

• Always have your child wear medical identification to let medical personnel know that he or she has diabetes. You can buy medical identification bracelets, necklaces, or other forms of jewelry at a pharmacy or on the Internet.
• Have your child wear shoes that fit properly. Use the checklist for foot exams to check your child's feet if he or she has signs of injury or infection. Teach your child how to wash and dry his or her feet thoroughly. If you notice a foot problem, even a minor one, talk with your child's doctor before treating it.
• Keep your child's day care or school plan for diabetes care up to date. Have written instructions for your babysitter and other caregivers.

  Diabetes in Children: Preparing a Care Plan for School

• Help your child care for his or her skin and teeth and gums. Make sure your child has a dental checkup every 6 months.
• Keep your child's immunizations up to date. This includes a flu shot every year. For more information and a form for recording your child's immunizations, see the topic Immunizations.
• Participate in a support group for parents of children with diabetes. These groups can be very helpful, especially the first few years after diagnosis. Local groups are available in most areas.
• Encourage your child to attend camps for children with diabetes. Diabetes camps are a good learning experience for your child, and they will allow you some time to yourself.
• Allow your child with diabetes to help with the treatment, given his or her age and experience with the disease.

Regular medical checkups

Your child needs to see his or her doctor every 3 to 6 months. During these checkups, the doctor will evaluate and adjust your child's treatment. The doctor will do a hemoglobin A1c or similar test (glycosylated hemoglobin or glycohemoglobin) to check your child's blood sugar control over the previous 2 to 3 months, and a blood glucose test.

If your child's LDL cholesterol is less than 100 mg/dL (2.60 mmol/L) and there is no family history of high cholesterol, the doctor will do a cholesterol (LDL and HDL) test every 5 years. If your child's blood pressure is consistently high and not reduced with weight control or exercise, the doctor may consider medicine.

When your child has had diabetes for 5 years, the doctor will start yearly screening tests for protein in the urine, which points to diabetic nephropathy. At that same time, your child needs to see an ophthalmologist for yearly dilated eye exams (ophthalmoscopy) to check for signs of diabetic retinopathy.

Treatment for high blood sugar emergency

If your child does not take enough insulin, has a severe infection or other illness, or becomes severely dehydrated, his or her blood sugar level may rise very high and lead to diabetic ketoacidosis. Diabetic ketoacidosis is almost always treated in a hospital, often in the intensive care unit, where caregivers can watch your child closely and give him or her frequent blood tests for glucose and electrolytes. Insulin is given through a vein (intravenous, or IV) to bring blood sugar levels down. Fluids are given through the IV to correct the electrolyte imbalance. Your child may stay in the hospital for a few days until blood sugar levels are back in the target range and electrolytes have normalized.

What To Think About

A 10-year study, and its follow-up study, showed that keeping blood sugar levels within a target range helps decrease the chances of developing diabetes complications, such as eye, kidney, heart, blood vessel, and nerve damage. As a result of this study, experts recommend that people with diabetes carefully control their blood sugar levels. This is often called strict or tight blood sugar control.

When a child has diabetes, keeping blood sugar levels within a target range helps the child grow and develop normally, but it increases the risk for frequent low blood sugar episodes. Your doctor will figure the safest range for your child's blood sugar level.

For some children, using an insulin pump may help keep their blood sugar levels within a target range.

Diabetes: Should I Get an Insulin Pump?

Diabetes: Living With an Insulin Pump

If your child has frequent low blood sugar levels, especially at night (nocturnal hypoglycemia), the doctor may suggest continuous ambulatory blood glucose monitoring. This means your child wears a special monitor that records his or her blood sugar level continuously for 24 to 72 hours. The monitor stores the results, which allows you to look for patterns of high or low blood sugar levels.²

Scientists are looking for pain-free ways to give insulin and test blood sugar levels. Under development are improved insulin pumps, and better needles and lancets. New glucose monitors may be worn continuously and be able to signal insulin pumps when the rate of insulin needs to be changed. Scientists are also studying ways to prevent or decrease complications from diabetes. If you're interested, talk to your child's doctor about participating in any of these studies.