What is type 1 diabetes?

Type 1 diabetes is a disease that affects how your child's body makes insulin and uses glucose (sugar). Normally, when the blood sugar level increases, the pancreas makes more insulin. Insulin helps move sugar out of the blood so it can be used for energy. Type 1 diabetes develops because the immune system destroys cells in the pancreas that make insulin. The pancreas cannot make enough insulin, so the blood sugar level continues to rise. A family history of type 1 diabetes may increase your child's risk for diabetes.

What are the signs and symptoms of type 1 diabetes?

• More thirst than usual

• Frequent urination or unexplained bedwetting

• Feeling hungry most of the time

• Weight loss without trying

How is type 1 diabetes diagnosed?

• An A1c test shows the average amount of sugar in your child's blood over the past 2 to 3 months. Your child's doctor will tell you the level that is right for your child. The goal is usually below 7.5%. Your provider can help you make changes if your child's A1c is too high

• A fasting plasma glucose test is when your child's blood sugar level is tested after he or she has fasted for 8 hours. Fasted means he or she has not eaten anything or had anything to drink except water

• A 2-hour plasma glucose test starts with a blood sugar level check after your child has not eaten for 8 hours. Your child is then given a glucose drink. Your child's blood sugar level is checked after 2 hours

• A random glucose test may be done any time of day, no matter how long it has been since your child ate

• An antibody test may show that your child's immune system is attacking his or her pancreas

How is type 1 diabetes treated?

Type 1 diabetes cannot be cured, but it can be controlled. The goal is to keep your child's blood sugar at a normal level.

• Your child will need insulin each day. Insulin can be injected or given through an insulin pump. Ask your child's doctor which method is best for your child. You and your child will be trained in the best method for him or her. Give your child insulin as directed. Too much insulin may cause his or her blood sugar level to go too low

• You will also be taught how to adjust each insulin dose your child takes with meals. Always check his or her blood sugar level before the meal. The dose will be based on his or her blood sugar level, carbohydrates in the meal, and activity after the meal

How do I check my child's blood sugar level?

You will be taught how to check a small drop of blood with a glucose monitor. You will need to check your child's blood sugar level at least 3 times each day. Ask your child's doctor when and how often to check during the day. Before meals, your child's blood sugar 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 doctor. The provider may use the results to make changes to your child's medicine, food, or exercise schedules.

What should I do if my child's blood sugar level is too low?

Your child's blood sugar level is too low if it goes below 70 mg/dL. If the level is too low, have your child eat or drink 15 grams of fast-acting carbohydrate. These are found naturally in fruits and dairy products. Fast-acting carbohydrates will raise your child's blood sugar level quickly. Examples of 15 grams of fast-acting carbohydrate are 4 ounces (½ cup) of fruit juice or 4 ounces of regular soda. Other examples are 2 tablespoons of raisins or 3 to 4 glucose tablets. Check your child's blood sugar level 15 minutes later. If the level is still low (less than 100 mg/dL), give another 15 grams of carbohydrate. When the level returns to 100 mg/dL, have your child eat a snack or meal that contains carbohydrate and protein. This will help prevent another drop in blood sugar. Always carefully follow your doctor's instructions on how to treat low blood sugar levels.

What do I need to know about nutrition for my child?

A dietitian will help you create a meal plan to keep your child's blood sugar level steady. 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 (sugar and starchy foods). Your child's blood sugar level can get too high if he or she eats too many carbohydrates. His or her 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

What else can I do to manage my child's type 1 diabetes?

• Go to all follow-up appointments. Your child may need to return to have his or her A1c checked at least 2 times each year. Your child may also need tests to check his or her blood pressure, cholesterol, eyes, and feet

• Have your child exercise as directed. Exercise can help keep your child's blood sugar level steady. Encourage your child to exercise for at least 60 minutes on most days of the week. Help your child include activities 3 days each week that strengthen his or her muscles and bones. Work with your child's doctor to create an exercise plan:

· Check your child's blood sugar level before and after exercise. Doctors may tell you to change the amount of insulin your child takes or food he or she eats. If the blood sugar level is high, check your child's blood or urine for ketones before you exercise. Do not let your child exercise if the blood sugar level is high and he or she has ketones

· If your child's blood sugar level is less than 100 mg/dL, have him or her eat a carbohydrate snack before exercise. Examples are 4 to 6 crackers, ½ banana, 8 ounces (1 cup) of milk, or 4 ounces (½ cup) of juice. Have your child drink water or liquids that do not contain sugar before, during, and after exercise. Ask your dietitian or doctor which liquids your child should drink when he or she exercises

• Help your child maintain a healthy weight. Ask your child's doctor how much your child should weigh. A healthy weight can help control your child's diabetes. Ask your child's doctor to help you create a weight loss plan for your child if he or she is overweight. The provider can help your child set reasonable weight loss goals

• Check your child's feet each day for sores. Have your child's feet checked at least 1 time each year for problems that may develop if his or her diabetes is not controlled. Make sure his or her shoes and socks fit correctly. Ask your child's doctor for more details about foot care

What other care will my child need for type 1 diabetes?

• Make sure your child always wears medical alert jewelry or carries a card that says he or she has diabetes. Ask your child's doctor where to get these items

• Give instructions to your child's school. Make sure your child's teachers know he or she has diabetes. Provide written instructions about what to do if your child has symptoms of high or low blood sugar levels at school

• Do not smoke around your child. Do not let others smoke around him or her. Do not let your older child smoke. Nicotine and other chemicals in cigarettes and cigars can cause lung and heart damage. Cigarette smoke can worsen the problems that occur with diabetes. Ask your doctor for information if you or child currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your doctor before you or your child use these products

• Ask about vaccines. Your child has a higher risk for serious illness if he or she gets the flu or pneumonia. Ask your child's doctor if your child should get a flu or pneumonia vaccine, and when to get the vaccine

What are the risks of type 1 diabetes in children?

Uncontrolled diabetes can damage your child's nerves and arteries. Long-term high blood sugar levels can damage his or her eyes and kidneys. Your child may develop thyroid or celiac disease. Celiac disease is a condition that prevents your child's intestines from absorbing nutrients properly. Diabetes is life-threatening if it is not controlled. Control your child's blood glucose levels to reduce the risk for health problems.

When should I seek immediate care?

• Your child has a low blood sugar level and it does not improve with treatment

• Your child's blood sugar level is above 240 mg/dL and does not come down after a dose of insulin

• Your child has ketones

• Your child has a fever

• Your child has nausea or is vomiting and cannot keep any food or liquid down

• Your child has symptoms of a low blood sugar level, such as trouble thinking, sweating, or a pounding heartbeat

• Your child has blurred or double vision

• Your child's breath has a fruity, sweet smell, or his breathing is deep and labored

• Your child's heartbeat is fast and weak

When should I contact my child's doctor?

• Your child's blood sugar levels are higher than his or her target goals

• Your child often has low blood sugar levels

• Your child has abdominal pain, diarrhea, or is vomiting

• Your child has numbness in his or her arms or legs

• Your child has warm, red patches of skin or a wound that does not heal

• Your child gets easily irritated

• Your child is anxious or depressed

• You have questions or concerns about your child's condition or care

CARE AGREEMENT:

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

Click the link for more information on Pediatrics Clinical Service

Click the link for more information on Nutrition Health Service

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