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What is type 1 diabetes?
Type 1 diabetes is an autoimmune disease that causes an unhealthy amount of a simple sugar (glucose) to build up in a person's blood. Someone with type 1 diabetes can't produce enough insulin, a hormone that moves glucose from the bloodstream into cells throughout the body, where it supplies energy and fuels growth.
Normally, a child's immune system protects her body from diseases by destroying unhealthy cells and germs. But when a child has type 1 diabetes, her body also mistakenly attacks the healthy insulin-producing cells of the pancreas (a gland behind the stomach). Without these cells, her pancreas produces very little or no insulin, which leads to an abnormally high amount of sugar in her blood.
Without proper care, type 1 diabetes can cause serious, wide-ranging health problems that can damage organs throughout the body over the long-term.
If your child has been diagnosed with type 1 diabetes, it's understandable that you might worry. But diabetes can be kept under control by carefully monitoring your child's blood sugar and following her treatment plan. A team of doctors, nurses, and nutritionists can help your child be as healthy as possible and teach her to manage the condition so she stays that way.
What are the symptoms of type 1 diabetes in children?
Symptoms of type 1 diabetes include:
- Extreme thirst
- Peeing more than usual (You might notice more wet diapers if your child is very young, or "accidents" if your child is potty trained.)
- Extreme hunger
- Weight loss
- Unusual tiredness
- Yeast infection or diaper rash
If your child has one or more of these symptoms, call his doctor right away. Type 1 diabetes symptoms can start quickly and become very serious without treatment.
Get medical care immediately if your child has any of the following emergency symptoms in addition to the signs of type 1 diabetes:
- Breath that smells fruity, sweet, or wine-like
- Stomach pain
- Fast breathing and sleepiness
- Loss of consciousness
What causes type 1 diabetes in children?
Experts believe a combination of genes and environmental factors cause type 1 diabetes, but they're still not sure exactly how. Researchers have identified several genes that make children more likely to have type 1 diabetes, yet many kids inherit these genetic markers and never develop the condition. Most children with type 1 diabetes have no family history of the disease.
Although people diagnosed with type 1 diabetes tend to be underweight, researchers have found obesity on the rise in children with type 1 diabetes. It isn't clear yet how being overweight might be affecting the rise of the condition in children.
What is the treatment for type 1 diabetes?
Type 1 diabetes requires daily monitoring and care. You and your child's other caregivers need to actively manage your child's condition with a customized treatment plan, and your child's health care team will review it periodically as he gets older. Eventually your child will learn to monitor his own blood sugar, administer insulin, and take care of his overall health as he matures.
Here's what's involved in managing type 1 diabetes:
Blood sugar (glucose) monitoring: When your child has type 1 diabetes, his blood sugar needs to be tested several times a day to make sure it stays within a safe range. This requires pricking your child's finger to get a drop of blood and then putting it on a test strip to be read by a blood glucose meter. Or you can use a continuous glucose monitor (CGM) inserted under your child's skin.
Blood glucose is measured in milligrams (mg) per deciliter (dL). The daily target for blood sugar varies from child to child, but it's usually between 90 and 130 mg/dL before meals, and 90 to 150 mg/dL overnight.
Your child's health care team will do another blood test, called an A1C test, every few months to check how well blood sugar is controlled over a three-month period.
Insulin injections or pump: Children with type 1 diabetes need insulin, which can be given with daily injections or continuously through a small machine called an insulin pump. Discuss these options with your child's doctor (including when and how to use them) to determine which one is best for your child.
Injections are given several times a day, typically in the belly, the front of the thighs, or the upper arm. These shots usually aren't very painful.
An insulin pump is a small, computerized device that supplies insulin through a thin plastic tube (catheter) inserted just under the skin's surface. Some people who use a pump also use a continuous glucose monitor.
Nutrition: The right diet can help keep type 1 diabetes under control. Nutritional therapy usually involves tracking carbohydrate consumption and maintaining a healthy weight. Talk to a nutritionist or a diabetes educator to plan a healthy diet for your child. Review it together periodically as your child grows and his needs change.
Exercise: Experts recommend that children with diabetes get an hour of aerobic activity each day, and do exercises to strengthen muscles and bones at least three times a week. Work with a doctor or a diabetes educator to come up with a plan because your child's insulin needs might change with exercise.
Emotional health: Depression, anxiety, eating disorders, and learning difficulties can make it harder to manage the condition. And coping with type 1 diabetes can be stressful not only for your child but also for the rest of your family. Talk to someone on your child's health care team or a therapist if you're concerned that your child (or another family member) needs support.
Ongoing care: Take your child to all his scheduled doctor's appointments so you can stay on top of his condition. It's also key to work with childcare providers and the staff at your child's school for help monitoring your child's blood sugar and providing treatment as needed.
What devices and new technologies can help manage type 1 diabetes?
Continuous glucose monitors and insulin pumps now make it much easier to track and adjust blood sugar. Apps like MySugr and Glucose Buddy can monitor blood sugar, insulin, medication, diet, activity, and more. You can also use these apps to generate charts and graphs to share with your child's health care team.
Apps can often sync with glucometers, be customized for your child, and offer extra coaching (for a fee). Ask your child's care providers to recommend one that suits your family's needs.
Using the data from these devices, you can spot patterns in blood sugar results and get better insight into your child's symptoms. Similarly, online tools, like BlueLoop, let you track and coordinate care with your child's doctor, childcare provider, and school staff.
The most promising new technology is an "artificial pancreas," which is a device that would fully automate continuous glucose monitoring and insulin injection. It checks blood sugar every few minutes and adjusts insulin automatically. It can also prevent blood sugar from dropping by predicting when it's most likely to happen.
In 2016, the U.S. Food and Drug Administration approved the first model for use in people age 14 and older, and the manufacturer is currently conducting trials with the intent of expanding its use to include younger children.
Researchers are also working on other technologies that would make it much easier to manage type 1 diabetes. For example, in addition to making smaller devices that can provide insulin more quickly, scientists are exploring the use of patches, implants, and even contact lenses to help manage the condition.
What short-term problems are associated with type 1 diabetes?
High blood sugar: Too little insulin leads to high blood sugar, or hyperglycemia. Stress, illness, hormones, diet, and exercise can all contribute to hyperglycemia. Common symptoms of hyperglycemia include:
- Needing to pee frequently
- High amounts of sugar in urine
Eating less or exercising might help, or your child's doctor can adjust her insulin or medication.
Low blood sugar: Too much insulin can cause blood sugar to drop, triggering low blood sugar, or hypoglycemia (sometimes called insulin shock). Symptoms come on quickly and vary from person to person, but they can include:
- Trembling or shakiness
- Fast heartbeat
- Hunger and nausea
- Vision problems
- Tiredness or weakness
- Loss of consciousness
Checking blood sugar regularly can prevent hypoglycemia, which is usually treated by eating something sugary or taking a glucose tablet. Your child's care team will give you instructions on how to recognize and manage symptoms of hypoglycemia.
Diabetic ketoacidosis (DKA): Without treatment, high blood sugar can lead to diabetic ketoacidosis (DKA). When a person's body can't produce enough insulin to use blood sugar for energy, fat is used instead. Burning fat for energy instead of sugar produces chemicals called ketones. DKA happens when ketones build up in blood and spill over into urine. (Surprisingly, exercise – which can lower high blood sugar – can actually worsen the problem if there are ketones in blood.)
Many children newly diagnosed with type 1 diabetes have symptoms of DKA. Check for ketones whenever your child's blood sugar is high. A simple urine test strip – available over the counter at drugstores – can show whether your child has ketones in her urine.
A child with ketones needs to see a doctor immediately. DKA is a serious condition that can cause a coma.
In addition to high blood sugar and ketones, signs of DKA include:
- Extreme thirst
- Needing to pee frequently
- Breath that smells fruity, sweet, or wine-like
- Flushed skin
- Nausea, vomiting, or stomach pain
- Difficulty breathing
What long-term problems are associated with type 1 diabetes?
That depends on how well your child's type 1 diabetes is managed. Generally, the chance of developing serious complications increases with age and the longer someone has the disease. Keeping blood sugar within the target range helps delay – or prevent – complications from the disease, which can include:
- Vision problems and blindness
- Problems with brain development
- Kidney disease
- Heart disease
- Nerve damage
- Gum disease
- Skin infections
- Weakened bones
- Loss of limbs
Children with type 1 diabetes are also more likely to have other autoimmune conditions – particularly thyroid disease and celiac disease, which share some of the same genes as type 1 diabetes.
What other types of diabetes are there?
There are three main forms of diabetes: type 1, type 2, and gestational. Type 1 and type 2 are both lifelong conditions that affect children and adults, and gestational diabetes is a temporary condition that affects pregnant women. An estimated 1 in 433 children in the United States have diabetes, most often type 1.
Babies who are 6 months or younger when diagnosed have neonatal (or congenital) diabetes. This happens to only 1 in about 400,000 babies, and half outgrow the condition by the time they're 18 months old. The rest have a lifelong condition known as permanent neonatal diabetes mellitus.
What are the main differences between type 1 and type 2 diabetes?
In type 1 diabetes, the pancreas doesn't produce enough insulin. In type 2 diabetes, the pancreas produces insulin, but muscle, fat, and liver cells become less able to absorb sugar from the blood effectively. As a result, the pancreas starts producing more insulin as cells become increasingly resistant.
Treatment for type 1 and type 2 diabetes is different too: Type 1 is treated primarily by supplementing the body with insulin, and type 2 is usually treated first with an oral medication to lower blood sugar (such as metformin), then eventually with insulin if needed.
Other differences between the two conditions include:
- Frequency: Type 1 diabetes is the most common form in children.
- Age at diagnosis: This condition is often diagnosed in childhood, which is why it used to be referred to as "juvenile diabetes," even though most of the estimated 3 million Americans living with the disease are adults. About two-thirds of children and teens younger than 20 with diabetes have type 1, and nearly half developed symptoms before age 10.
- Family history doesn't play a major role.
- Ethnicity: Type 1 diabetes is most common among white Americans and in people from Northern European countries, such as Sweden and Finland.
- Long-term care: Type 1 diabetes requires constant attention to monitor blood sugar level and adjust the amount of insulin to take.
- Frequency: Type 2 diabetes is diagnosed in about 5,000 children and teens younger than 20 each year. At current rates, 1 in 3 Americans will eventually develop the condition.
- Age at diagnosis: Type 2 diabetes used to be called "adult-onset diabetes" because it typically affected overweight adults older than age 40. It's still not usually diagnosed in young children, but the number of kids ages 10 to 19 who develop type 2 diabetes is rising in the United States. Being inactive, overweight, or obese are significant risk factors for type 2 diabetes, and as more Americans become obese, type 2 diabetes is diagnosed in more people at younger ages.
- Family history plays a major role.
- Ethnicity: Type 2 diabetes disproportionately affects African Americans, Native Americans, Asian Americans, Latinos, and native Hawaiians and Pacific Islanders.
- Long-term care: Type 2 diabetes tends to progress more quickly in children and lead to complications faster in adults than type 1 diabetes.
Where can I learn more about type 1 diabetes?
For more information and valuable tips on caring for a child with diabetes, visit the JDRF website (formerly the Juvenile Diabetes Research Foundation) or call the organization at (800) 533-2873. The American Diabetes Association is another excellent resource.
You can also find support and trade tips with other parents in the our site Community group for families of children with type 1 diabetes.