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diabetes in children guide

Diabetes in Children: A Guide for Parents and Families

Learn more about diabetes in children - types of diabetes, symptoms, prevention, management and resources.

Although the majority of people diagnosed with diabetes are adults, the disease is increasing in children at an alarming rate. About 210,000 of the 26 million people diagnosed with diabetes are 20 years or younger. These diagnoses include Type 1 and Type 2 diabetes — but obesity-related Type 2 is becoming more common in children.

The Basics of Diabetes

Diabetes is a chronic condition that changes the way your body processes sugar. Insulin is responsible for moving sugar out of your bloodstream and into your cells, creating energy. Depending on the type, diabetes can inhibit insulin production, your body’s ability to use insulin effectively, or both. This causes a buildup of sugar (glucose) in your child’s bloodstream, leading to potentially serious complications.

The Four Types of Diabetes

Type 1 and Type 2 diabetes are the most commonly talked about types. However, the differences between these types are less well-known. Understanding the mechanisms behind these types of diabetes — and two other diabetes-adjacent syndromes — will help you to navigate this world. Educating yourself on the type of diabetes that your child or teen has will better equip you to prevent complications.

1. Type 1 Diabetes

Type 1 diabetes is most commonly diagnosed in children and young adults. It is the less common type of diabetes, affecting only about five percent of individuals across the globe.

Type 1 diabetes is classified as an autoimmune disease. This is due to your child’s immune system overworking and destroying insulin-producing cells. This is an atypical immune response, as the immune system exists to fight harmful bacteria and viruses. Instead, Type 1 diabetes causes the immune system to attack cells within the pancreas responsible for regulating insulin and blood glucose levels.

While the exact cause of Type 1 diabetes isn’t known, it’s thought to have genetic and environmental origins. This type is more common in young people because it’s typically diagnosed early on in life. However, it can occur at any age.

2. Type 2 Diabetes

Adults are more commonly diagnosed with Type 2 diabetes, but this doesn’t mean that children cannot be diagnosed as well. Particularly with the rise of childhood obesity, children and teens may also become resistant to insulin.

Obesity raises your chances of developing Type 2 diabetes, but there are underdeveloped studies that may suggest it also morphs into an autoimmune disease. In any case, it’s best to practice proper diet, lifestyle, and exercise for prevention, because excess weight puts you — and your child — at a greater risk of developing diabetes and heart-related complications.

3. Gestational Diabetes

This type of diabetes occurs when pregnant women that didn’t have diabetes before pregnancy develop the condition. However, it’s important to note that mothers with gestational diabetes are more likely to have children prone to obesity — raising their propensity to develop Type 2 diabetes.

4. Prediabetes

When your child’s blood glucose levels are elevated but not enough to be considered diabetes, this is considered prediabetes. This syndrome is incredibly common, but most people go undiagnosed until the problem worsens.

This highlights the importance of monitoring your child’s health from an early age. Even if your child or teen isn’t showing symptoms of diabetes, you should still schedule regular checkups and bloodwork to make sure prediabetes isn’t present. This is especially true if their diet and lifestyle are unhealthy or there is a family history of diabetes.

Symptoms and Warning Signs of Diabetes in Children

Prediabetes often doesn’t exhibit any signs or symptoms, so regular checkups are necessary, especially if the child has risk factors such as family predisposition or excess weight and sedentary activities. Type 1 and Type 2 diabetes will have more clear warning signs to look for in your child or teen.

Symptoms of Type 1 or Type 2 diabetes in children may include:

  • Breath that smells vaguely fruity;
  • Complaints of blurred vision;
  • Darkened areas of skin;
  • Excess sweating;
  • Increased hunger;
  • Increased thirst;
  • Fatigue;
  • Frequent urination, urge to urinate, soiling of clothes, or bed-wetting;
  • Nausea or vomiting;
  • Slow-healing injuries;
  • Tingling and numbness in extremities;
  • Unexplained weight loss;
  • Unusual irritability and mood swings.

Note that, on their own, most of these symptoms may be normal or indicate other issues than diabetes. However, if you notice a big change in your child’s behavior or body, it’s best to make an appointment with your pediatric or regular physician as soon as possible. Type 1 diabetes is often more life-threatening — and more common in children — so it’s best to err on the side of caution with any of these warning signs.

Possible Complications of Diabetes in Children and Teens

Type 2 diabetes is typically milder than Type 1. In Type 1, your child’s pancreas isn’t supplying insulin, and Type 2 diabetes means that your child’s pancreas does make insulin but their body doesn’t respond to the insulin effectively. Both types come with possible complications if not treated effectively.

Diabetes-Related Ketoacidosis (DKA) is most common in undiagnosed Type 2 diabetes, but it can happen in Type 1 or Type 2 patients. DKA occurs when high levels of ketones build up in your blood. Too many ketones are produced when the body starts processing fat instead of glucose for energy. Ketones are a byproduct of breaking down fat — but too many of them make your blood acidic.

If this happens to your child, it is life-threatening and requires immediate attention. Early symptoms of DKA are often what alert parents and caretakers that there is an issue in the first place, as they are warning signs of Type 1 diabetes. If the DKA is progressively getting worse, your child may experience:

  • Abdominal pain, nausea, or vomiting;
  • Dry mouth and excess thirst;
  • Difficulty breathing;
  • Dry or flushed skin;
  • Extreme, constant fatigue;
  • Fogginess or confusion;
  • Frequent urination;
  • Fruity-smelling breath.

If DKA is suspected, healthcare providers will test for high levels of glucose in the blood and high levels of ketones in the urine. If you have test strips for ketones at home, you may do so yourself. However, keep in mind that severe cases of DKA can lead to coma or even death. If you suspect DKA, stop your child from exerting too much energy and contact your healthcare provider immediately for further assistance.

Other Potential Diabetes Complications

Type 1 and Type 2 diabetes can both come with several complications for your child or teen, such as:

  • Eye issues and vision loss;
  • Foot ulcers;
  • Heart disease;
  • High blood pressure;
  • Oral health issues;
  • Nerve damage, especially in the extremities;
  • Skin conditions, such as diabetes rash;
  • Sleep apnea;
  • Stroke;
  • Vascular disease.

These complications are typically when diabetes is left untreated or is uncontrolled for a long period of time. Your child should be monitored for any of the above complications. You should also take preventative measures to reduce the risk of any diabetes-related issues.

What To Do When Your Child Receives a Diabetes Diagnosis

It may come as a shock when your child first receives a diagnosis of diabetes. Your healthcare team should be cognizant of this and guide the next steps, as well as help throughout the lifecycle of the disease. With the knowledge and resources available to you, you and your child will be able to live a happy and healthy life.

Mental Health Considerations

Kids with diabetes may grapple with feelings that are less common for their age group. They may feel isolated, scared, guilty, resentful, or even in denial. While your child may become more dependent on you and their healthcare team, they should practice healthy independence. Help your child by encouraging them to:

  • Ask questions about diabetes;
  • Be prepared for questions from family and friends;
  • Build up their strengths;
  • Communicate their feelings;
  • Foster positive friendships;
  • Take responsibility for their healthcare.

You will also have to adjust to your new role as caretaker of a child with diabetes. Make sure to take time for self-care. Reach out to friends and family for help. Professional therapy can also help you and your child cope with any new stressors this diagnosis may bring into your lives.

Diabetes Prevention, Reversal, and Management

While Type 1 diabetes cannot be prevented, there are clear steps to preventing Type 2 diabetes. Since this type is linked to childhood obesity, you can practice and help children sustain a healthy lifestyle. Keep an eye on excess weight gain. Develop an exercise and diet plan that works for their schedule. This may help stave off Type 2 diabetes.

Both types of diabetes can be detected early through blood tests and monitoring for any warning signs. Once diagnosed, many sources claim that diabetes can go into remission. In reality, Type 1 diabetes is incurable, and Type 2 diabetes can be controlled. Many Type 2 patients can put their disease into remission by following a diabetes-minded healthy lifestyle. This doesn’t reverse the disease, per se, but it can thwart symptoms and prevent further complications.

In any case, your child’s diabetes needs to be managed. Whether it is lifelong, Type 1, or Type 2, there are ways to manage the severity of the complications that come along with diabetes. This is typically done through medication management, monitoring of blood glucose levels, and lifestyle changes.

Insulin: Types, Terms, Dosing, and Proper Storage

Since your child’s body isn’t getting the amount of insulin necessary for the healthy metabolism of glucose, there are supplemental insulin sources available. Your child’s doctor will likely offer information on the best type of insulin for your specific situation. However, it’s important to be knowledgeable about the types of insulin and their uses.

Types of Insulin

The type of insulin your child’s doctor prescribes will depend on several factors, such as activity level, diet, age, and ability to manage blood glucose levels effectively. Different people absorb — and use up — insulin at different rates. This is why it’s so important to get a professional opinion on the type of insulin that is best for your child.

Typically, children and teens with Type 1 diabetes will be instructed to take a combination of two types of insulin. Type 2 diabetes requires external insulin less commonly, but it is sometimes used.

There are seven main categories of insulin, including:

  • Rapid-acting;
  • Rapid-acting inhaled;
  • Regular- or short-acting;
  • Intermediate-acting;
  • Long-acting;
  • Ultra-long acting;
  • Premixed.

These categories of insulin refer to the onset, peak time, and duration of the medication.

Insulin Terms

To differentiate the types of insulin, you have to understand what certain insulin terms mean. Some examples of common terms used are:

  • Onset — the amount of time it takes the insulin to lower your blood sugar initially;
  • Peak time — the time at which the insulin is at its maximum working ability;
  • Duration — how long the insulin will last and lower your blood sugar;
  • Bolus — short- or rapid-acting insulin taken at or before meals;
  • Basal — intermediate- or long-acting insulin is taken between meals or overnight;
  • Basal-bolus — a combination of rapid- and long-acting insulin taken to cover all bases.

There are also several ways to administer insulin, including:

  • Inhalers;
  • Pens;
  • Pumps;
  • Syringes.

Younger patients may find pens easier to use and more discreet. Again, it’s best to consult your child’s doctor when determining the right type of insulin and dosing for your child’s diabetes management.

Monitoring Blood Glucose and Ketones in Children

A diabetes diagnosis also introduces frequent monitoring into a child’s life. At first, it will take some getting used to this monitoring schedule — but it’s crucial to managing your child’s diabetes. Although children and teens may be more resistant or downright defiant, monitoring is an important step that cannot be skipped. Make sure they know the ramifications of not monitoring their levels, and offer rewards for monitoring where possible.

Blood Glucose Monitoring

Your child’s healthcare provider can give you instructions on how to use a blood glucose meter. Generally, checking your blood sugar levels involves:

  • Starting with clean hands;
  • Inserting a test strip into the meter;
  • Pricking the side of your child’s fingertip;
  • Applying a drop of blood to the test strip;
  • Reading and interpreting the result.

The results should be entered into a logbook to refer back to when consulting with your child’s doctor. This gives you and your healthcare team a clear picture of how your child’s levels fluctuate and react to external factors. It may be helpful to even log the activity your child was doing just before reading.

There are certain times you will need to check your child’s blood sugar levels — or have them check the levels — including:

  • As symptoms occur;
  • At bedtime;
  • Before and after exercise;
  • Before meals;
  • During any additional illness your child may have.

There are exceptions to this, such as a low reading at a meal. If that’s the case, you will want to check your child’s blood sugar again two hours after the said meal. It’s also wise to check blood sugar levels during the night if your child has exhibited elevated levels, sickness, or different symptoms than usual. In any case, make sure to check their blood sugar levels at least four times per day.

The blood glucose levels that are normal for your child will vary depending on several factors and should always be determined with the guidance of a healthcare professional. Hypoglycemia — or lower than normal blood sugar — is equally as dangerous as high blood sugar, so be sure to track dosing carefully.

Ketone Monitoring

Children with diabetes can monitor ketone levels via blood or urine. While urine testing is more reliable and accurate, blood testing may be more feasible and practical for your child or teen. Typically, elevated blood glucose levels will go hand-in-hand with elevated ketones in blood or urine.

This is because higher levels of ketones are present from the breaking down of fats at too fast of a rate. If you cannot test your child’s blood sugar for any reason — or if you notice symptoms of DKA mentioned above — you should test ketone levels via blood or urine test strips. Further, if your child’s blood sugar is elevated — typically over 240 mg/dl — or they are sick, you should contact their doctor immediately.

Child and Teen Diabetes and Nutrition

Considering blood sugar originates from the foods we eat, your child’s diet is of utmost importance in managing diabetes. Keeping tabs on your child’s nutrition is a great tool for managing symptoms and keeping further complications at bay. Of course, consult your healthcare provider before making any dietary changes.

The Plate Method

The Plate Method

A simple, effective way to control food intake in children with diabetes is to implement the Plate Method. This is a great option for younger eaters to learn because it provides a clear visual guide to healthy eating. There are five steps, including:

  1. Finding a plate that is roughly 9 inches in length — or smaller for very small children;
  2. Filling half the plate with non-starchy vegetables — such as broccoli, cauliflower, and carrots;
  3. Filling one-quarter of the plate with a lean protein — such as chicken, fish, or tofu;
  4. Filling the last quarter of the plate with a carb-rich food — such as grains like bread or dairy like yogurt;
  5. Pairing the meal with a simple, low- or zero-calorie drink — such as water or sugar-free flavored drinks. Flavoring water with liquid water enhancers can be a great way to encourage drinking more water.

This ensures the right amount of calories and vitamins are getting onto your child’s plate — while considering their diabetes and need for fewer foods that will raise their blood sugar.

Age-Based Carb Counting

Carbs play an important role in managing your child’s diabetes. Controlling carb intake in adolescents with Type 1 diabetes has shown a positive effect on metabolic control, reducing the frequency of hypoglycemic events and improving quality of life. Keeping tabs on how much carbs your child is taking in and controlling that for their age and weight can help formulate a healthy diet plan.

There are three types of carbohydrates:

  • Fiber — the indigestible part of plants that helps regulate the body’s use of sugar;
  • Starches — complex carbohydrates that provide energy and include vegetables like peas and potatoes, as well as grains, rice, and pasta;
  • Sugars — foods, such as fruits, that contain mostly natural sugar; or processed sugar, which is found in packaged desserts.

While carbs are crucial parts of a healthy diet, all of the carbs listed above contain glucose molecules. This just means that you and your child need to keep a closer eye on their daily carb intake. Counting carbs helps you keep control of the amount of glucose going into your child’s body. The exact amount of carbs that your child or teen needs will vary and should be determined by your physician or a registered dietitian.

Understanding Food Labels

In addition to diet plans for children with diabetes, you may also learn the ins and outs of what exactly is in the food your child is eating. Understanding food labels will give you better insight into food consumption. This is helpful when determining if a food is diabetes-friendly when shopping or out to eat with your child or teen.

In general, diabetes-friendly foods will include:

  • Protein foods — These are foods such as meat, fish, eggs, and cheese;
  • Low-carb snacks — Consuming under 100 carbs a day is considered a low-carb diet. Look for foods that fit into this carb count (or a carb count tailored for your child’s age). Beware of packaging that touts “net carbs” or “low carb”, because they typically don’t include fiber or sugar alcohols in the carb count;
  • Zero-sugar options — As often as possible, choose foods with zero grams of added sugar. This includes unprocessed meats, fish, and vegetables. There are also safe sugar replacements that are naturally sugar-free, such as monk fruit and stevia;
  • Low-sugar foods — Foods that naturally have low sugar are a great option, such as avocados and nuts. Look for diabetes-friendly recipes to keep an eye on the exact amount of sugar in your child’s food.

Again, it’s important to talk with your child’s physician or a registered dietitian to determine the right amount of calories, carbs, and sugar for your child’s diet. This way, you can find the best sweetener for your child with diabetes — helping them live and eat normally and not miss out on the sweet moments in life despite their diabetes diagnosis. Educate yourself on natural sugar replacements like stevia. The more you know about your child’s diet, the easier it will be to teach them how to eat intuitively while managing their condition.

Diabetes and Childrens’ Fitness

Along with proper dieting, children and teens with diabetes may benefit from adequate exercise. It’s easy to think that younger people get enough exercise because they seem to have endless energy. However, with a disease like diabetes, it’s important to keep tabs on just how active your child is on a day-to-day basis. Whether it’s alongside Type 1 or Type 2 diabetes, a proper fitness plan can help keep your child’s body healthy and prevent any complications down the line.

Formulating an Age-Appropriate, Diabetes-Friendly Exercise Plan

Children between ages 6 and 17 should get around an hour of exercise daily. This includes children with Type 1 and Type 2 diabetes. However, diabetes comes with extra considerations for exercising.

Monitoring Levels
Children and teens will likely get regular exercise during school days in activities like gym class, sports practice, and recess. However, this isn’t always consistent or regulated for children with diabetes.

Before and after any sort of exercise, you’ll want to either monitor their blood sugar levels or teach them how to do so themselves. Blood sugar fluctuations in response to exercise will vary depending upon several factors, such as:

  • Blood sugar level at the beginning of the activity;
  • Current insulin doses;
  • Exercise intensity and length.

Note how each factor affects how your child feels and their blood glucose levels. Sometimes, people experience a dip in glucose levels after exercise. Other times, strenuous activity can raise blood glucose due to the stress hormones released. Keep track of changes in the monitoring logbook suggested above.

Eating for Exercise
Depending on the trends in blood sugar levels that you notice during your child’s exercise, you may want to incorporate snacks into a pre- or post-workout routine. For instance, if you notice your child’s blood sugar is low before exercise, it must be treated with a sugar source like a juice box and come up to a normal level before they can start exercising.

Most of this management is a matter of trial and error. Different fitness activities will trigger different blood glucose responses. It also depends on the time of day, the dose of insulin, and how your child metabolizes sugar. It’s best to maintain an overall healthy diet for children with diabetes. Low-sugar diets have been shown to help children lose excess weight, mitigating the risk of extra complications with diabetes.

Support Groups and Education

A sense of belonging is key to the healthy upbringing of any child. Humans innately want to feel included and connected to other humans — and diabetes has the potential to alienate kids or teens. However, it doesn’t have to be that way.

Many resources allow your child to connect with other kids going through the same or similar circumstances. While they don’t necessarily have to connect with kids that have the same disease, these diabetes-friendly groups and activities can offer support and friendship where it may otherwise not be possible.

If you notice your child is struggling to establish friendships and support groups on their own, it may be helpful to ask them if they’d like to take part in some forward-thinking, diabetes-centered groups such as:

Depending on the age of your child, you’ll want to accompany them to any in-person events. If your child is old enough to use the internet, there are virtual forums and webinars that they may want to participate in. Always monitor online activity for safety.

There are also support groups and resources available for parents and families of children with diabetes. Here are some to get you started connecting and learning:

With the prevalence of diabetes, you may already know several people that deal with this disease daily. Advocating for yourself and your child is the best way to open up to others, connect, and learn along the way.

Keeping Them Safe at School

It’s already tough sending your kids off to school. If your child is diagnosed with diabetes, it may feel scary to send them to an uncontrolled environment. However, there are ways to keep them safe at school — or any time you can’t keep an eye on them 24/7. ADA has a Safe at School campaign dedicated to doing just that — connecting parents, healthcare providers, and school faculty to keep children with diabetes as safe as possible under their care.

Some general tips for sending your child with diabetes to school include:

  • Notifying school officials and teachers of special accommodations — such as frequent bathroom breaks or extra snacks;
  • Packing a healthy lunch and snacks;
  • Preparing adequately for any school trips or activities;
  • Securing trained staff to assist with any medical needs or emergencies.

This, of course, is not an all-inclusive list. Your child’s schooling and activities will vary with their unique schedules and preferred hobbies. A good rule of thumb is to allow your child to do everything that kids without diabetes can do — just take extra considerations beforehand and notify all personnel involved of the situation. This shouldn’t be made apparent to the child, but it needs to be done in a discreet, thorough way.

Resources for Diabetes Supplies

Parents are financially responsible for so many things — and a diabetes diagnosis comes with extra financial responsibilities on top of the other new lifestyle changes. Luckily, some resources can help parents with procuring diabetes supplies for their children. Here are some to get you started:

Health insurance and state-funded programs may be able to help you cover the costs of diabetes-related supplies, such as insulin and blood glucose meters. You may also be able to receive free or low-cost care at a local healthcare facility. Search for local resources or ask your diabetes educator to find what resources are available in your area.

Additional Resources for Parents and Families of Children With Diabetes

Numerous groups exist to help families of children with Type 1 diabetes. These groups understand the struggles that come along with a diabetes diagnosis, and they’re here to help. Search your local library, as well as social media groups and search engines, for help navigating this new way of life. Here are some additional resources to get you started:

Remember that although your lives have changed, you and your child with diabetes have the tools to adapt. Your strength will allow you to bond with your child as you both learn to manage diabetes and fight complications along the way.

Written by the Splenda Healthcare Team.