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 5) do moderate to vigorous activity at least 1 hour every day.^{footnote 2}
• 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: Treating 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 build 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. Work with your doctor to set up sick-day guidelines for your child. These help you prevent high blood sugar emergencies when your child is ill. Talk with the doctor before giving your child any non-prescription medicine.
• Exercise. Plan some activities to do along with your child, such as in-line skating or bicycling. Use these tips for exercising safely to help prevent low blood sugar in your child. Limit daily screen time (not including time for schoolwork).
  • None for children younger than 2 years
  • One hour or less for children ages 2 to 4 years^{footnote 3}
  • 2 hours or less for children 5 years and older^{footnote 2}

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 jewellery at a pharmacy or on the Internet. Temporary medical identification tattoos are another form of medical identification.
• Teach your child about good foot care. Foot problems are rare in children who have diabetes. But adults can have foot problems, especially with diabetic neuropathy. Teach your child the importance of wearing shoes that fit properly. Check your child's feet if he or she has signs of injury or infection. Teach your child to get in the habit of washing and drying 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 daycare 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.
• Participate in a support group for parents of children who have 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 who have diabetes. Diabetes camps are a good learning experience for your child, and they will allow you some time to yourself.
• Allow your child who has 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 doesn't have risk factors for high cholesterol (BMI greater than 95th percentile, or family history of high cholesterol), the doctor will do a cholesterol (LDL and HDL) test beginning at age 12 and then 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 is at least 12 years old and has had diabetes for 5 years, the doctor will start yearly screening tests for protein in the urine, which points to diabetic nephropathy.

When your child is at least 15 years old and has had diabetes for 5 years, he or she needs to see an ophthalmologist for yearly dilated eye examinations (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

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

If your child has frequent low blood sugar levels, especially at night (nocturnal hypoglycemia), the doctor may suggest a continuous glucose monitor (CGM). A CGM checks and records blood sugar day and night. Most CGMs sound an alarm if blood sugar levels are moving out of target range.