Treatment Of Type 1 Diabetes In Child

When Do I Check My Child’s Blood Sugar Level

You will need to check your child’s blood sugar level at least 3 times each day. Ask your child’s care team when and how often to check during the day. Before meals , your child’s blood sugar level should be between 90 and 130 mg/dL. At bedtime , it should be between 90 and 150 mg/dL. You may need to check for ketones in your child’s urine or blood if his or her level is higher than directed. Write down the results and show them to your child’s care team. The team may use the results to make changes to your child’s medicine, food, or activity schedules.

What Do I Need To Know About Nutrition For My Child

A dietitian will help you and your child create a meal plan. The plan will help keep your child’s blood sugar level steady. The plan may change as your child grows and wants different foods. Do not let your child skip meals. His or her blood sugar level may drop too low if he or she takes insulin and does not eat.

• Keep track of carbohydrates . Your child’s blood sugar level can get too high if he or she eats too many carbohydrates. The dietitian will help you plan meals and snacks that have the right amount of carbohydrates.
• Give your child low-fat and low-sodium foods. Examples of low-fat foods are lean meat, fish, skinless chicken or turkey, and low-fat milk. Limit high-sodium foods, such as potato chips and soup. Do not add salt to food you cook. Limit your child’s use of table salt.
• Give your child high-fiber foods. Foods that are a good source of fiber include vegetables, whole-grain bread, and beans.

School And Child Care

As a large portion of a child’s day is spent in school, close communication with and the cooperation of school or day care personnel are essential for optimal diabetes management, safety, and maximal academic opportunities. Refer to the ADA position statements Diabetes Care in the School Setting and Care of Young Children With Diabetes in the Child Care Setting for additional details.

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Medical Management Of Type 1 Diabetes

Pediatric patients, regardless of diabetes type, must be treated and educated differently from adults with diabetes. Diabetes is a lifelong disease that requires constant vigilance and adjustments as pediatric patients progress through childhood. Examples which can highly influence treatment strategies are age at diagnosis, ability of the child to communicate, infant and child eating patterns, sporadic play/activity, pubertal status and development, family dynamics, caregiver involvement in diabetes daily management, psychological adaptation to the diagnosis by both the patient and the caregiver, and daycare and school training. Goals of therapy are to maintain normal growth and development and avoid both short- and long-term complications. Striving for an A1c goal of less than 7.5% is currently recommended for all pediatric patients. However, individualization is critical, specifically minimizing risk of hypoglycemia or hyperglycemia based on the unique needs of the patient. Children with T1DM should be assessed initially and followed until adulthood by a comprehensive multidisciplinary team and center experienced in addressing the special needs of this population.

Diabetes And Your Child

For a parent whose child is diagnosed with a life-long condition, the job of parenting becomes even tougher.

Although being diagnosed with type 1 diabetes will involve coming to terms with the diagnosis, getting used to treatment and making changes to everyday life, your child can still lead a normal and healthy life.

The Diabetes UK website has information and advice about your child and diabetes.

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What Are The Causes Of Type 1 Diabetes In Children

Glucose comes from food and is the major source of energy for your body. After eating, your body breaks down food into glucose, which is absorbed into the bloodstream. The glucose level rises, triggering the pancreas to produce insulin and release it into the bloodstream. Type 1 diabetes is a result of the pancreas not producing any insulin. This is due to an autoimmune reaction where the body destroys the cells in the pancreas that make insulin. The causes of type 1 diabetes are still being researched. Possible causes include:

• Genes
• Virus or trigger in the environment

Symptoms And Risk Factors

It can take months or years for enough beta cells to be destroyed before symptoms of type 1 diabetes are noticed. Type 1 diabetes symptoms can develop in just a few weeks or months. Once symptoms appear, they can be severe.

Some type 1 diabetes symptoms are similar to symptoms of other health conditions. Dont guessif you think you could have type 1 diabetes, see your doctor right away to get your blood sugar tested. Untreated diabetes can lead to very seriouseven fatalhealth problems.

Risk factors for type 1 diabetes are not as clear as for prediabetes and type 2 diabetes, though family history is known to play a part.

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The Type 1 Diabetes And Celiac Disease Connection

Research shows a link between Type 1 diabetes and celiac disease. Some studies suggest that children with Type 1 diabetes are more likely to be diagnosed with celiac disease. According to the National Institute of Diabetes and Digestive and Kidney Diseases , about 3 to 8 percent of people with Type 1 diabetes will have biopsy-confirmed celiac disease. Celiac disease associated with diabetes is usually silent, showing no symptoms, and may only be found upon screening. Like Type 1 diabetes, celiac disease is also an autoimmune disease. At Riley at IU Health, your child will be screened for celiac disease approximately every two years. If your child has an elevated antibody level for celiac disease, he or she will be referred to the Gastroenterology Department for further evaluation.

Getting Regular Physical Activity

Keeping active every day is a key part of diabetes treatment. Exercise strengthens your childs muscles and bones, helps them feel good, and controls blood sugar levels. In fact, exercise makes insulin work better. Kids with type 1 diabetes can and should exercise.

Encourage your child to stay active, and set a goal of 60 minutes each day. Let them choose what they enjoy whether thats walking the dog, riding a bike, or playing team sports. For some kids, starting a new exercise habit might be hard at first. But if they enjoy the activity and feel good when they do it, theyll find it easier to stick with it.

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Differentiating Between Type 1 And Type 2 Diabetes

Differentiating between T1DM and T2DM is important and can be difficult, especially in overweight children. When the diagnosis of T1DM or T2DM is in question, insulin autoantibodies to glutamic acid decarboxylase , islet cell autoantibodies , and antibodies to tyrosine phosphatase should be obtained. Recently, a new enzyme-linked immunosorbent assay to detect ZnT8 autoantibody is being used. This test can help distinguish those with type 1 diabetes by detecting zinc transporter protein, which is not found in those with T2DM.

Diabetes Care At School And Day Care

Children usually spend 48 h and sometimes up to 12 h each day in school and/or extended day care. To optimize the childs diabetes management, school/day care personnel must be knowledgeable about diabetes care issues and provide an environment that promotes excellence in diabetes management. The student with diabetes should be able to participate fully in all school activities while performing blood glucose testing, eating appropriately, and administering insulin as needed. The ADA position statement Care of Children With Diabetes in the School and Day Care Setting outlines the responsibilities of the child, the parent, and the school/day care to ensure a safe learning environment for the child. This position statement and the recent publication Helping the Student with Diabetes Succeed: A Guide for School Personnel by the National Diabetes Education Program also contains an example of a diabetes medical management plan, which may be used to provide the school/day care with the information needed to care for a child with diabetes. A safe environment includes, at a minimum, the ability to measure blood glucose levels to recognize and treat hypoglycemia, including the ability to administer glucagons and to recognize impending DKA. Knowledgeable individuals must be present to assist the student during the school day and after-school activities.

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So Far Type 1 Diabetes Is Neither Preventable Nor Curable

Pediatricians Dr. Louis Geoffroy and Dr. Monique Gonthier co-authored a book entitled Diabetes in Children , published by CHU Sainte-Justine, replete with useful information for parents and written in a Q & A format.

Do you or does your child have Type 2 Diabetes, gestational diabetes or other pancreas and glucose metabolic disorders? We advise you to contact these organizations:

• Canadian Pediatric Society

Basal Bolus Insulin Regimens

The combination of rapid-acting insulin analogs and a long-acting peakless insulin offers an excellent option for basal and bolus insulin administration. Glargine is the first long-acting analog to have received Food and Drug Administration approval. It is an almost peakless insulin, with a duration of action of 2024 h. Usually it is given at bedtime, although administration at other times of the day may result in similar levels of coverage and glycemic control. In some patients glargine may not last 24 h, and anecdotal experience has suggested dividing the dose into two daily injections. Glargine has been approved for use in pediatric patients 6 years of age. Ongoing clinical studies in the pediatric population will define the most effective use of this insulin preparation in young children. Because there is some increase in effective insulin action during the initial 35 h after administration, nocturnal hypoglycemia, in theory, may be reduced in young children by administering glargine in the morning or before supper.

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Nutrition For Children And Adolescents With Type 1 Diabetes

Nutrition recommendations for children and adolescents with type 1 diabetes should focus on achieving blood glucose goals without excessive hypoglycemia , lipid and blood pressure goals, and normal growth and development. This can be accomplished through individualized meal planning, flexible insulin regimens and algorithms, SMBG, and education promoting decision-making based on documentation and review of previous results.

Nutrient recommendations are based on requirements for all healthy children and adolescents because there is no research on the nutrient requirements for children and adolescents with diabetes. Children and adolescents should adopt healthful eating habits to ensure adequate intake of essential vitamins and minerals. In general, U.S. children are not eating recommended amounts of fruits and vegetables , although children with diabetes may be doing somewhat better than the general population in some areas. A 1996 report on dietary intake of 4- to 9-year-old children with type 1 diabetes found that energy, vitamin, and mineral intakes were adequate while fiber intake was less than recommended . However, many children consumed levels of saturated fat well above the National Cholesterol Education Program recommendations .

Treating Type 1 Diabetes

It’s important that diabetes is diagnosed as early as possible. If left untreated, type-1 diabetes is a life-threatening condition. It’s essential that treatment is started early.

Diabetes can’t be cured, but treatment aims to keep your blood glucose levels as normal as possible and control your symptoms, to prevent health problems developing later in life.

If you’re diagnosed with diabetes, you’ll be referred to a diabetes care team for specialist treatment and monitoring.

As your body can’t produce insulin, you’ll need regular insulin injections to keep your glucose levels normal. You’ll be taught how to do this and how to match the insulin you inject to the food you eat, taking into account your blood glucose level and how much exercise you do.

Insulin injections come in several different forms, with each working slightly differently. You’ll most likely need a combination of different insulin preparations.

Insulin is given to some patients by a continuous infusion of fast acting insulin . This is where a small device constantly pumps insulin into your bloodstream through a plastic tube that’s inserted under the skin with a needle.

There are alternatives to insulin injections and pumps, but they’re only suitable for a small number of patients. They are:

Read more about diagnosing diabetes and treating type 1 diabetes

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Key Points To Remember

• In people with Type 1 diabetes, the pancreas does not produce insulin.
• People with Type 1 diabetes require daily insulin injections, given through a syringe or an insulin pen or pump.
• Type 1 diabetes develops from a combination of factors, but the condition is not preventable.
• At first, a parent or guardian may need to give insulin injections to a child, but over time the child can learn to give his or her own injections.
• Children with Type 1 diabetes can live a normal, healthy life when proper attention is given to the balance of food, insulin, activity and stress to keep blood sugars within a target range.

Diabetes Sick Day Rules

If you need to take insulin to control your diabetes, you should have received instructions about looking after yourself when you’re ill known as your “sick day rules”.

Contact your diabetes care team or GP for advice if you haven’t received these.

The advice you’re given will be specific to you, but some general measures that your sick day rules may include could be to:

• keep taking your insulin it’s very important not to stop treatment when you’re ill your treatment plan may state whether you need to temporarily increase your dose
• test your blood glucose level more often than usual most people are advised to check the level at least four times a day
• keep yourself well hydrated make sure you drink plenty of sugar-free drinks
• keep eating eat solid food if you feel well enough to, or liquid carbohydrates such as milk, soup and yoghurt if this is easier
• check your ketone levels if your blood glucose level is high

Seek advice from your diabetes care team or GP if your blood glucose or ketone level remains high after taking insulin, if:

• you’re not sure whether to make any changes to your treatment
• you develop symptoms of diabetic ketoacidosis
• you have any other concerns

Read more about sick day rules

Diagnosis Of Type 1 Diabetes

If your child is showing symptoms of Type 1 diabetes, a doctor can use the following blood tests to make a diagnosis:

• Hemoglobin A1c. A hemoglobin A1c blood test provides your child’s average blood sugar levels over a period of two to three months. High A1c values are a sign of poor blood sugar control and indicate the presence of diabetes.
• Random blood sugar test. A blood sugar test is performed at a random time. A normal result is based on when your child last ate.
• Fasting blood sugar test. A fasting blood sugar test measures your child’s blood sugar levels after he or she has not had anything to eat or drink for at least eight hours.

Mechanism That Triggers Type 1 Diabetes

When our body is attacked by viruses, the T-cells of the body produce antibodies which help to fight against these viruses. Now sometimes, these antibodies act against the beta cells when both these types have the same property. Beta cells are the ones which help the pancreas to produce insulin. The process takes a long time and is this mechanism that triggers the onset of type 1 diabetes in any person. The viruses which can affect and destroy the beta cells are the ones which have the same type of antigens as the virus which has attacked the body. These include German measles, Rotavirus, mumps, and others.

Assessment Of Child And Family Risk Factors At Diagnosis

It is well-documented that over the first few years after the diagnosis of type 1 diabetes in childhood, child adherence to the diabetes regimen, family diabetes-related behavior patterns, as well as glycemic control tend to become established or track and are difficult to change . Therefore, it is important to assess both the risk factors and the strengths of the child and family at the time of diagnosis, with the hope of intervening before child and family behavior patterns become firmly established.

Chronic Poor Metabolic Control

A careful multidisciplinary assessment should be undertaken for every child with chronically poor metabolic control to identify potential causative and associated factors, such as depression , eating disorders , lower socioeconomic status, lower family support and higher family conflict , and to identify and address barriers to improved glycemic control. Use of a standardized measure of risk factors has been shown to identify those at high risk for poor control, emergency room visits and DKA . Glycemic control may be particularly challenging during adolescence due to physiologic insulin resistance, depression and other psychological issues, and reduced adherence during a time of growing independence. Multipronged interventions that target emotional, family and coping issues have shown a modest reduction in A1C with reduced rates of hospital admission .

Primary Treatment Of Type 2 Diabetes

Children with T2D are almost always started on metformin. Metformin is a drug that is classified as a biguanide. This drug functions by reducing glucose production and by activating glucose uptake in peripheral tissues. Metformin is administered in children at a 500 mg dose, and is ingested at meal times daily. The dose is increased by 500 mg each week until the dose equals 2,000 mg. There are some adverse events associated with the use of metformin including gastrointestinal problems , which may result in a patient not reaching optimal dose of metformin. In some rare instances, lactic acidosis and renal dysfunction can occur in individuals taking metformin . Metformin reduces glycated hemoglobin levels to 2% and also aids in weight loss. Clinical trials have shown that the use of metformin is safe for T2D pediatric patients. Another study found that in patients aged 1017, metformin and 4 mg rosiglitazone was a superior therapy for T2D than metformin alone .