Diabetes: Type 1

What is diabetes?

Type 1 diabetes is a disorder where the body does not make enough of a hormone called insulin. Type 1 diabetes is also called insulin-dependent diabetes, childhood diabetes, or juvenile diabetes.

Type 1 diabetes usually starts in childhood or early adulthood. It must be treated with insulin shots. With treatment, blood sugar levels can be controlled.

Type 1 diabetes is not the same as type 2 diabetes (non-insulin dependent diabetes). The bodies of people with type 2 diabetes may produce insulin, but it may not be enough or may not be able to be used properly. Type 2 diabetes may be treated with pills instead of insulin shots. Type 2 diabetes is usually linked to being overweight. It is becoming more common in children ages 10 to 18 years old.

What is insulin?

Insulin is a hormone produced by an organ in your body called the pancreas. When food is digested, the body breaks down much of the food into sugar (glucose). Blood carries the sugar to the body's cells for energy. Insulin helps the sugar enter the cells and controls the level of sugar in the blood.

When there is not enough insulin in the body, the amount of sugar in the blood can reach very high levels. Too much sugar in the body can cause many serious problems. If the problems are not treated, they can be life-threatening.

What causes type 1 diabetes?

In type 1 diabetes, destruction of cells in the pancreas causes the pancreas to make very little insulin. Often it is not known why the cells are destroyed. One possible cause is that the body's own immune system destroys the cells. Also, diabetes tends to run in families.

How is it diagnosed?

Some of the signs that your child may have diabetes include:

• urinating a lot (some children wet the bed when they didn’t before)
• being thirsty and drinking a lot of fluids
• losing weight without trying.

If you think your child has diabetes, call your healthcare provider. If you want to test for diabetes at home, you can buy a simple urine test called Keto-Diastix at a pharmacy. Keto-Diastix can be used to check the level of sugar and other chemicals (ketones) in your child's urine. Call your child's provider immediately if the test for sugar in the urine is positive.

Your healthcare provider will do one or more blood sugar tests. If the results are not completely clear, your child may have an oral glucose tolerance test. This test involves drinking a sugary drink and following the blood sugar levels for 2 hours afterward.

What is the treatment?

1. Education and diet.

   When a child is diagnosed with diabetes, there is a lot the family must learn about the disease. This education is usually done for 2 or 3 days at a children's diabetes clinic. Healthcare providers will teach you what diabetes is and how to give shots of the proper amounts of insulin to your child. You will learn how to test for sugar in the blood and for ketones in the blood or urine. You will learn how to treat low blood sugar and other procedures needed to keep your child healthy.

   A dietitian will teach you about food management. A child with diabetes needs to be careful about eating carbohydrates, and should eat and snack the same way each day.

2. Control of blood sugar levels.

   Home care involves balancing diet, exercise, and stress with insulin. Children with type 1 diabetes must get insulin shots. The dosage of insulin in the shots is not always the same. The dose must be adjusted according to the food the child eats and the level of sugar in the child's blood at the time of the shot. If a child gets too much insulin, low blood sugar could result. Just as prevention of high blood sugar is important, prevention of low blood sugar is also very important.

   Most families use a home meter to measure the level of sugar in their child's blood 3 or 4 times each day. After your child is around 7 to 10 years old, he can learn how to test his own blood sugar. Families also learn how to give the insulin shots. Children can learn to do their own shots when they are 10 or 11 years old. Measuring blood sugar and giving insulin shots at home allows you to adjust the treatment as needed for the best blood sugar control.

   Blood sugar levels that are measured when a child has not eaten for at least 8 hours (fasting), and 2 hours after meals, should be kept in the following ranges:

   • Children under the age of 5 years: 100 to 200 mg/dL (5.5 to 11.1 mmol/L).
   • Children ages 5 to 11 years: 70 to 180 mg/dL (3.9 to 10.0 mmol/L)
   • Children over 12 years old: 70 to 150 mg/dL (3.9 to 8.3 mmol/L).
3. Follow-up visits with your child's healthcare provider.

   Your child's provider will check the overall blood sugar control every 3 months with a test called the hemoglobin A1C (HbA1C). If the HbA1C is kept in a good range, the risk for eye, kidney, heart, and nerve problems in later life is greatly reduced. Children over 13 years of age who have had diabetes for 3 years or longer, should also have annual eye exams and kidney tests.

4. Ketone tests

   Fat breaks down into ketones when not enough insulin is available. Ketones can make a person very sick, if they cause ketoacidosis. It is important to keep a method of measuring ketones at home. You can use the urine ketone dipstick tests (Ketostix or Keto-Diastix) or a blood ketone test (Precision Xtra). You need to test for ketones if a child with diabetes is sick (even vomiting once), or if the blood sugar is high (for example, above 300 mg/dL, or 16.7 mmol/L).

5. Checking other family members

   Other family members have a 1 in 20 chance (5%) that they will also develop diabetes. A blood glucose level test is not very helpful to predict diabetes because the test does not show high glucose levels unless the person already has diabetes. A test called the "islet cell antibody" test is now available that can predict diabetes as much as 10 years before a person gets diabetes. It is a free test through the TrialNet/Natural History Study. Call 1-800-425-8361 for more information (in Denver call 303-724-6745).

When should I call my child's healthcare provider?

Call immediately if:

• Your child's urine tested positive for sugar and he or she has not been diagnosed with diabetes.
• Your child with known diabetes often has low blood sugar, particularly if your child loses consciousness or has seizures.
• A urine test shows that there are moderate or large amounts of ketones in your child's urine or the blood ketone test is >0.6 mmol/L.

Call during office hours if:

• Blood sugar tests at home are constantly above the desired range for your child's age.
• Blood sugars tests at home are often (1 or 2 times a day) below the desired range for your child's age.
• Another illness (for example, flu) occurs, which might upset the diabetes.
• If you have other questions about diabetes.

For more information:

Several books are available for families who have a family member with type 1 diabetes:

• First Book for Learning about Diabetes
• Understanding Diabetes
• Understanding Insulin Pumps and Continuous Glucose Monitors

You can order the books by writing or calling:

The Children's Diabetes Foundation
777 Grant Street, Suite 302
Denver, Colorado 80203
800-695-2873 or 303-863-1200

You can also order online at: http://www.childrensdiabetesfdn.org