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This topic covers type 1 diabetes in children. For information about type 1 diabetes in adults and about preventing complications from type 1 diabetes, see the topic Type 1 Diabetes.
What is type 1 diabetes?
Type 1 diabetes develops when the pancreas stops making insulin. Your body needs insulin to let sugar (glucose) move from the blood into the body's cells, where it can be used for energy or stored for later use.
Without insulin, the sugar cannot get into the cells to do its work. It stays in the blood instead. This can cause high blood sugar levels. A person has diabetes when the blood sugar is too high.
What will it be like for your child to live with type 1 diabetes?
Your child can live a long, healthy life by learning to manage his or her diabetes. It will become a big part of your and your child's life.
You play a major role in helping your child take charge of his or her diabetes care. Let your child do as much of the care as possible. At the same time, give your child the support and guidance he or she needs.
How can you manage diabetes?
The key to managing diabetes is to keep blood sugar levels in a target range. To do this, your child needs to take insulin, eat about the same amount of carbohydrate at each meal, and exercise. Part of your child's daily routine also includes checking his or her blood sugar levels at certain times, as advised by your doctor.
The longer a person has diabetes, the more likely he or she is to have problems, such as diseases of the eyes, heart, blood vessels, nerves, and kidneys. For some reason, children seem protected from these problems during childhood. But if your child can control his or her blood sugar levels every day, it may help prevent problems later on.
What symptoms should you watch for?
Even when you are careful and do all the right things, your child can have problems with low or high blood sugar. Teach your child to look for signs of low and high blood sugar and to know what to do if this happens.
- If your child has low blood sugar, he or she may sweat a lot and feel weak, shaky, or hungry. But your child's symptoms may be different. Low blood sugar happens quickly. A person can get low blood sugar within minutes after exercise or after taking insulin without eating enough.
- If your child has high blood sugar, he or she may be very thirsty or hungry, have to urinate more often than usual, or have blurry vision. High blood sugar usually develops slowly over hours or days.
Young children can't tell if they have low blood sugar as well as adults can. Also, after your child has had diabetes for a long time, he or she may not notice low blood sugar symptoms anymore. This raises the chance that your child could have low blood sugar emergencies. If you are worried about your child's blood sugar, do a home blood sugar test. Don't rely on symptoms alone.
Both low and high blood sugar can cause problems and need to be treated. Your doctor will suggest how often your child's blood sugar should be checked.
How often does your child need to see the doctor?
See your child's doctor at least every 3 to 6 months to check how well the treatment is working. During these visits, the doctor will do some tests to see if your child's blood sugar is under control. Based on these results, the doctor may change your child's treatment plan.
When your child is 12 years old, he or she will start having examinations and tests to look for any problems from diabetes.
How will your child's treatment change over time?
Your child's insulin dose and possibly the types of insulin may change over time. The way your child takes insulin (with shots or an insulin pump) also may change. This is especially true during the teen years when your child grows and changes a lot.
What and how much food your child needs will also change over the years. But it will always be important to eat about the same amount of carbohydrate at each meal. Carbohydrate is the nutrient that most affects blood sugar.
Type 1 diabetes develops because the body's immune system destroys beta cells in a part of the pancreas called the islet tissue. Beta cells produce insulin. So children with type 1 diabetes can't make their own insulin. Experts do not know what causes this to happen. But the cause may involve family history and maybe environmental factors like diet or infections.
Type 1 diabetes develops when your child's pancreas stops producing enough insulin. Insulin lets blood sugar—also called glucose—enter the body's cells, where it is used for energy. Without insulin, the amount of sugar in the blood rises above a safe level. As a result, your child experiences high and low blood sugar levels from time to time. High blood sugar can damage blood vessels and nerves throughout the body and increases your child's risk of eye, kidney, heart, blood vessel, and nerve diseases.
Causes of high blood sugar
- Not getting enough insulin or eating more than usual
- Experiencing emotional stress
- Having an illness, such as the flu or an infection
- Taking certain medicines that can raise blood sugar levels, such as medicines that reduce swelling and inflammation (corticosteroids) and growth hormone
- Experiencing the dawn phenomenon or the Somogyi effect, which causes high blood sugar in the morning
- Entering puberty. Hormonal changes affect how well the body uses insulin. These changes can cause higher blood sugar levels.
Causes of low blood sugar
- Taking too much insulin
- Skipping or delaying a meal or snack
- Being more physically active than usual without eating enough food
- Taking certain medicines that may lower blood sugar levels, such as those that reduce fever and pain
- Starting your menstrual period, because hormonal changes may affect how well insulin works
Because your child has type 1 diabetes, he or she will experience high and low blood sugar levels from time to time. High blood sugar usually develops slowly over hours or days, so you can treat the symptoms before they become severe and require medical attention. On the other hand, your child's blood sugar level can drop to dangerously low levels in minutes.
Be alert for:
How can you tell the difference?
Sometimes it's hard to distinguish between high and low blood sugar symptoms, especially if your child is very young. Test your child's blood sugar whenever you think it may be high or low so that you can treat it appropriately. If your child has symptoms of very high blood sugar, such as a fruity breath odour, vomiting, and/or belly pain, seek emergency care. These symptoms may point to diabetic ketoacidosis, which is a life-threatening emergency.
Every child experiences type 1 diabetes differently.
The negative effects of diabetes are caused by blood sugar levels that are above or below a target range.
Low blood sugar
Very low blood sugar is a frightening experience for you and your child. But if low blood sugar levels are treated quickly and appropriately, your child should have no lasting effects.
Young children cannot recognize low blood sugar symptoms as well as adults can, which puts them at risk for low blood sugar emergencies. Children who develop hypoglycemia unawareness, which is the inability to recognize early symptoms of low blood sugar until they become severe, or who are trying to keep their blood sugar levels tightly within a target range are also at risk for low blood sugar emergencies.
Make sure your child's caregivers, such as school nurses, know:
Let your doctor know if your child is having frequent episodes of low blood sugar. You can use this form to keep a record of your child's very high or very low blood sugar levels.
High blood sugar
Very high blood sugar puts your child at risk for diabetic ketoacidosis, a life-threatening emergency. Skipping insulin injections, stress, illness, injury, and puberty can trigger high blood sugar. Because blood sugar levels usually rise slowly, you can treat symptoms early and, most often, prevent diabetic ketoacidosis.
High blood sugar can also lead to:
- Adjustment of the body to high levels. For example, if your child's blood sugar level is consistently over 16.0 millimoles per litre (mmol/L) and suddenly drops to 5.5 mmol/L, you or your child may think this level is too low when it is really not. Your child may even have symptoms of low blood sugar at target blood sugar levels.
- Delayed growth and maturity. If your child has high blood sugar levels over a long period of time, he or she may grow and mature more slowly. During puberty, this can delay normal sexual development and the onset of menstruation. And your child may not gain weight properly if he or she doesn't have enough insulin.
- Complications from the disease (eye, kidney, heart, blood vessel, and nerve disease). But if their blood sugar levels are persistently high, children are more likely to show early signs of these problems, particularly eye and kidney disease. Also, high blood sugar levels during childhood and adolescence put your child at risk for these diseases in early adulthood.
What can be done?
The best way to help your child with type 1 diabetes live a long and healthy life is to keep his or her blood sugar levels within a target range. Work with your child's doctor, and monitor blood sugar levels frequently.
What Increases Your Risk
Risk factors for very high or low blood sugar levels in a child with type 1 diabetes include:
- Age. Very young children are at the greatest risk for very low blood sugar, because they are often not able to communicate symptoms.
- Tight blood sugar control. Although keeping your child's blood sugar levels tightly within a target range is important, this puts him or her at risk for frequent low blood sugar levels.
- Persistent high blood sugar levels. Children who have persistent high blood sugar, indicated by higher hemoglobin A1c test results, are at greater risk for diabetic ketoacidosis than children who have lower levels.
- Puberty. Growth spurts and changing hormone levels that occur during puberty make it difficult to keep a child's blood sugar level within a target range.
- Psychiatric conditions. Children with depression, anxiety disorder, panic disorder, or eating disorders are at increased risk for frequent high and low blood sugar levels.
When To Call
Call 911 or other emergency services immediately if your child:
- Has symptoms of diabetic ketoacidosis (DKA), such as:
- Blurred vision.
- Trouble staying awake or trouble being woken up.
- Fast, deep breathing.
- Breath that smells fruity.
- Belly pain, not feeling hungry, and vomiting.
- Feeling confused.
- Has passed out (lost consciousness) or has suddenly become very sleepy or confused. (Your child may have very low blood sugar, called hypoglycemia.)
Call a doctor now if your child:
- Is sick and has blood sugar that can't be managed. Your doctor may have given you instructions on how to manage blood sugar when your child is sick.
- Has been vomiting or has had diarrhea for more than 6 hours.
- Has blood sugar that stays higher than the level the doctor has set for your child (for example, 14.0 mmol/L for two or more readings).
- Has blood sugar that stays lower than the level the doctor has set for your child (for example, 4.0 mmol/L for two or more readings).
- Has symptoms of low blood sugar, such as:
- Feeling nervous, shaky, and weak.
- Extreme hunger and slight nausea.
- Dizziness and headache.
- Blurred vision.
Check with your doctor if your child:
- Often has problems with high or low blood sugar levels.
- Has trouble knowing when their blood sugar is low (hypoglycemia unawareness).
- Or you have questions or want to know more about diabetes.
Examinations and Tests
A child with type 1 diabetes needs to visit his or her doctor at least every 3 to 6 months. During these visits, the doctor reviews your child's blood sugar level records and asks about any problems you and your child may have. Your child's blood pressure is checked, and growth and development is evaluated. The doctor examines your child for signs of infections, especially at injection sites. Your child usually has the following tests at office visits:
- A hemoglobin A1c or similar test (glycosylated hemoglobin or glycohemoglobin) to check your child's blood sugar control over the previous 3 months
- A blood glucose test.
If your child has a body mass index (BMI) greater than the 97th percentile, or a family history of high cholesterol or heart disease, your child's doctor will do a cholesterol (LDL and HDL) test after type 1 diabetes is diagnosed when your child's blood sugars are under control. If there is no family history of high cholesterol, your child will have a cholesterol test at age 12 and 17.footnote 1
Diabetes increases your child's risk for dental problems. Experts suggest dental checkups every 6 months.
You and your child may also see other members of the diabetes team, for example:
- A certified diabetes educator or registered dietitian, for your child's changing nutritional needs.
- A psychologist, to help with any emotional or behavioural issues.
5 years after diagnosis
Your child will have an initial dilated eye examination (ophthalmoscopy) by an ophthalmologist or an optometrist when your child is 15 years old and has had diabetes for 5 years.footnote 1 This eye examination checks for signs of diabetic retinopathy and glaucoma. Thereafter, your child may have an eye examination every year. If your child is at low risk for vision problems, your doctor may consider follow-up examinations less often.
When your child is 12 years old and has had diabetes for 5 years, your child's doctor will also start doing an annual urine test to check for protein.footnote 1 This test helps detect diabetic nephropathy.
Experts recommend tests for thyroid antibodies and thyroid-stimulating hormone (TSH) when type 1 diabetes is diagnosed and at least every 2 years after. These tests check for thyroid problems, which are common among people who have type 1 diabetes.
Some other tests include:
- Annual foot examination starting at puberty.
- Screening for depression.
- Eating disorder evaluation if your child shows signs of an eating problem.
- Celiac disease testing if your child is not growing or gaining weight as much as expected.
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.
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.
- Preparing and giving insulin injections.
- Living with an insulin pump.
- Counting carbohydrate.
- Dealing with low blood sugar levels.
- Preventing high blood sugar levels.
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 yearsfootnote 3
- 2 hours or less for children 5 years and olderfootnote 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.
- 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.
- Diabetes Canada Clinical Practice Guidelines Expert Committee, et al. (2018). Type 1 diabetes in children and adolescents. Canadian Journal of Diabetes, 42(Suppl 1): S234–S246. DOI: 10.1016/j.jcjd.2017.10.036. Accessed October 15, 2018.
- Canadian Society for Exercise Physiology (2016). Canadian 24-Hour Movement Guidelines for Children and Youth (ages 5-17 years): An Integration of Physical Activity, Sedentary Behaviour and Sleep. Available online:https://csepguidelines.ca/children-and-youth-5-17.
- Canadian Society for Exercise Physiology (2016). Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour and Sleep. Available online: https://csepguidelines.ca/early-years-0-4.
- Canadian Society for Exercise Physiology (2011). Canadian Physical Activity Guidelines For Youth. Available online: http://www.csep.ca/CMFiles/Guidelines/CSEP-InfoSheets-youth-ENG.pdf.
Current as of: April 13, 2022
Author: Healthwise Staff
John Pope MD - Pediatrics
Donald Sproule MDCM, CCFP - Family Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
Stephen LaFranchi MD - Pediatrics, Pediatric Endocrinology
Current as of: April 13, 2022
Author: Healthwise Staff
Medical Review:John Pope MD - Pediatrics & Donald Sproule MDCM, CCFP - Family Medicine & Adam Husney MD - Family Medicine & Kathleen Romito MD - Family Medicine & Stephen LaFranchi MD - Pediatrics, Pediatric Endocrinology