Type 1 Diabetes

How is type 1 diabetes diagnosed?

To confirm a diagnosis, your child’s doctor may order some or all of the following blood and urine tests:

• hemoglobin A1C test: a blood test that indicates your child’s average blood sugar level for the past two to three months
• random blood sugar test: a blood sample taken at a random time
• fasting blood sugar test: a blood sample taken after an overnight fast
• To help distinguish between type 1 and type 2 diabetes, your child’s doctor may also check for autoantibodies in the blood that are common in type 1 diabetes.
• ketones test: a test that measures ketones, byproducts from the breakdown of fat in children without enough insulin in the urine or blood

Your child may need to have blood drawn more than once so the test results can be confirmed with a second test on a different day. Distinguishing between type 1 and type 2 diabetes in children can sometimes be difficult, and your child's doctor may need to do additional testing or monitor your child for some time before the type of diabetes can be confirmed.

How is type 1 diabetes treated?

The goal of type 1 diabetes treatment is to control glucose levels and prevent your child’s blood sugar from being too high. The ideal diabetes management regimen includes insulin therapy, glucose and ketones monitoring, regular exercise, and healthy eating.

Insulin therapy replaces insulin the body cannot make on its own. Usually, this is done with both long-acting (basal) and short-acting (bolus) insulin injections. Many people with type 1 diabetes use insulin pumps instead of injections. Your diabetes team can teach you more about insulin pumps.

Glucose monitoring: It is very important to monitor glucose levels throughout the day. You can do this with finger-stick blood glucose checks and/or with a continuous glucose monitor (CGM). CGM devices measure blood sugar with a subcutaneous glucose sensor and report a value every five minutes. Some devices can report values directly to a parent or patient’s mobile phone. The FDA has approved some CGM devices for use as a replacement for finger-stick tests.

Ketone monitoring: When the body doesn’t have enough insulin, the liver compensates by producing extra ketones, a chemical that converts fat into energy. High levels of ketones in the blood can become a medical emergency. Therefore, in addition to monitoring glucose levels, it is very important to monitor ketones when your child’s glucose level is very high or when your child is sick.

The role of food in diabetes management

It is important to understand how food impacts blood glucose for children with diabetes.

Food causes blood glucose to go up. Insulin causes blood glucose to go down. Too much food with not enough insulin can cause blood glucose to go too high. Not enough food with too much insulin can cause blood glucose to go too low. Further, the type and amount of food will affect how much and how quickly the blood glucose goes up. Balancing food and insulin together can help keep blood glucose in a normal range.

Carbohydrates, also known as carbs, are an important source of energy. They are also the main nutrient the body turns into blood glucose, also known as blood sugar. Everyone needs to eat some carbohydrates to stay healthy. Common carbohydrate foods include: bread, crackers, cereal, pasta, rice, fruit, and milk.

• Carbohydrates that are high in fiber such as whole grains, fruits, and vegetables slow digestion and contribute to a feeling of fullness. High-fiber food can also reduce spikes in blood glucose after eating.
• Processed carbohydrates that are low in fiber can raise blood sugars too high. Eating fewer processed carbohydrates helps manage blood glucose levels.

A dietitian can help determine the right amount of carbohydrates and types for your child.

Proteins and fats help kids feel full and have less impact on blood glucose levels than carbohydrates. Because of this, children with diabetes are encouraged to include protein and healthy fats at meals and snacks. Examples of healthy proteins include poultry, fish, beef, pork, peanut butter, cheese, and eggs. Healthy fats include avocados, olive oil, eggs, nuts, and cheese.

While these foods can be a part of a healthy diet, appropriate portion sizes are important. Too much protein can cause blood glucose to rise. Too much fat can slow down how food digests, making it difficult to balance food and insulin. Too much fat can also contribute to the risk for heart disease.

A healthy diet can mean different things to different people. A dietitian is very important to help with meal planning and understanding the right balance of foods for your child.

What are the possible complications of type 1 diabetes?

Even with careful management, type 1 diabetes can put your child at risk of some serious complications that require prompt medical attention. These include hypoglycemia, hyperglycemia, and diabetic ketoacidosis.

Hypoglycemia, also known as low blood sugar or insulin reaction, can happen when your child’s blood sugar drops too low and their body doesn’t have enough energy to function properly. Hypoglycemia can result from too high an insulin dose, a missed meal or snack, more physical activity than usual, or illness that causes vomiting and/or diarrhea.

• Symptoms of hypoglycemia include shakiness, sweating, weakness, blurry vision, and rapid heartbeat.
• If your child has any of these symptoms, measure their blood glucose level (if possible) and give them a fast-acting carbohydrate, such as fruit juice, hard candy, or raisins. Seek medical attention right away.
• If left unchecked, hypoglycemia can result in a medical emergency. Your child could lose consciousness or go into seizure.

Hyperglycemia, also known as high blood sugar, happens when blood sugar is too high and builds up in the blood stream. It can be caused by not having enough insulin, eating too much food or the wrong kinds of food, getting too little physical activity, or illness.

• Symptoms of hyperglycemia can resemble those of diabetes: excessive urination, bedwetting, weight loss, thirst, yeast infections, nausea, and vomiting.
• If your child has signs or symptoms of hyperglycemia, measure their blood sugar and check their urine or blood for ketones. If ketones are elevated, call your diabetes team for further guidance.

Diabetic ketoacidosis is a life-threatening condition that can result from low insulin and high blood sugar. Without insulin, the body is deprived of glucose for energy and starts breaking down fat for fuel. This releases toxins into the blood faster than the kidneys can get rid of them.

Diabetes ketoacidosis can cause fluid to build up in the brain and lead to a loss of consciousness, cardiac arrest, or kidney failure.

Your child should receive medical attention right away if they have any of these symptoms:

• confusion or trouble paying attention
• sweet or fruity-smelling breath
• trouble breathing
• nausea or vomiting