Type 1 Diabetes in Children

Type 1 diabetes (T1D) is commonly diagnosed during childhood. T1D is when your child’s immune system mistakenly attacks the cells in the pancreas that make insulin.

Insulin is a hormone that helps control blood sugar. If you don’t have enough insulin, too much sugar builds up in your blood. This can cause serious health problems. About 1 in 500 children and teens under age 20 in the U.S. have Type 1 diabetes. It’s a lifelong condition that requires careful management.

Life won’t be the same for your family after a childhood Type 1 diabetes diagnosis. But over time, you’ll learn how to adapt, and you’ll find a new normal. Your child’s healthcare team will teach you how to manage the condition by tracking glucose, following a meal plan and giving insulin.

There’s no cure for T1D. But new technologies make it easier for kids with Type 1 diabetes to stay active and healthy.

Symptoms of Type 1 diabetes in children

T1D symptoms in children include:

• Feeling very thirsty or drinking more than usual
• Needing to pee often (this can include wetting the bed, frequently having full diapers or having accidents when potty trained)
• Being extremely hungry
• Feeling tired or lacking energy
• Unexplained weight loss
• Vomiting and loss of consciousness

Without treatment, these symptoms can worsen and lead to a serious condition called diabetic ketoacidosis (DKA). Without treatment, it’s fatal.

Take your child to the emergency room if they have DKA symptoms.

It can be easy to overlook the early signs of T1D in your kid. You may just think they have the flu or are going through a growth spurt. But the symptoms get worse over time. If you think something is off, make an appointment with their pediatrician.

Causes of T1D in a child

Type 1 diabetes develops when your immune system mistakenly attacks the insulin-producing cells in your pancreas. But researchers don’t know exactly why this happens.

Insulin helps move sugar from your blood into your cells for energy. Without insulin, sugar builds up in your bloodstream. Hyperglycemia (high blood sugar) can be dangerous and lead to serious health problems.

Risk factors

Your child has a higher risk if a biological parent or sibling has Type 1 diabetes. But they can get it without an existing family history.

Researchers think certain situations can trigger your immune system to attack your pancreas, like viral infections or other environmental factors. But the exact cause isn’t fully understood.

Lowering your risk

T1D in children generally isn’t preventable. But if your child is in the early stage, an infusion called teplizumab-mzwv (Tzield®) can delay the onset of late-stage T1D, when they need insulin injections every day.

The only way to know whether your child is in the early stage is with blood tests that check for autoantibodies. If Type 1 diabetes runs in your family, you may want to get this testing for your children. Ask your healthcare provider for more information.

How doctors diagnose this condition

Healthcare providers diagnose Type 1 diabetes in children with blood tests, including:

• Blood glucose test: High blood glucose levels can usually confirm T1D. Blood sugar tests can either be taken at random or with fasting (your child avoids food/drinks for at least eight hours before the test).
• Glycosylated hemoglobin test (A1C): This measures your child’s average blood sugar levels over three months. An A1C higher than 6.5% on two separate tests can point to T1D.
• Antibody test: This blood test checks for certain autoantibodies to determine if your child has Type 1 or Type 2 diabetes. A positive test means they have Type 1.

Healthcare providers generally diagnose diabetes in a child if:

• A fasting blood glucose test shows a level of 126 milligrams per deciliter (mg/dL) or higher on two separate tests, or
• A random blood glucose test shows a level of 200 mg/dL or higher along with typical diabetes symptoms like excessive thirst and peeing frequently.

T1D in children can sometimes be missed at first because early symptoms look like other common illnesses. Children may have signs like stomach pain or peeing often, which can be mistaken for a virus or infection.

How is it treated?

Children with T1D need insulin every day. The goal of treatment is to keep blood sugar levels in a healthy range. This can be challenging because many things affect blood sugar levels. A few examples include food, physical activity, illness and puberty.

Your child’s diabetes care team will help create a treatment plan. But managing T1D often involves making decisions throughout the day about insulin, meals and blood sugar levels.

Insulin therapy

Your child will need insulin throughout the day and additional insulin with meals or snacks. Their provider will help figure out what type is best for your child and family.

Insulin can be given in different ways:

• Insulin pumps: An insulin pump is a small device your child wears on their body. It gives them insulin throughout the day using a small tube or patch.
• Insulin injections: You give your child insulin as an injection. You use a small needle and syringe to draw the insulin from a vial. Or you may use an insulin pen, which is pre-filled. You inject it into the fatty tissue just under their skin. Your child will need multiple injections per day.

Taking too much insulin can cause low blood sugar. It’s important to recognize the symptoms and treat it right away. This involves eating or drinking sugar.

Glucose monitoring

Checking your child’s glucose level is an important part of managing Type 1 diabetes. Healthcare providers recommend using a continuous glucose monitor (CGM), which tracks glucose levels throughout the day and night.

You can also use a blood glucose meter to check their levels. This is a device that checks blood sugar using a drop of blood from a finger stick.

At first, glucose monitoring may feel like a big adjustment. But over time, many families find that it becomes part of their daily routine. Monitoring helps you understand how food, physical activity, illness and insulin affect your child’s blood sugar so you can help keep it in a healthy range.

Education and support

A diabetes diagnosis can be complex and hard to navigate. You’ll learn a lot about the condition and how to manage your child’s blood sugar levels. Education and support may involve:

• Nutrition and meal planning, including how carbohydrates, protein and fat affect blood sugar
• How physical activity can raise or lower blood sugar levels
• What foods/drinks to have with you to treat low blood sugar episodes
• Ways to manage high blood sugar
• Planning for days when your child is sick, which makes blood sugar harder to manage
• How to use glucose monitors and insulin delivery devices
• Managing the condition at daycare or school, including 504 plans
• Mental health support for your child and family

Complications of this condition

High blood sugar can damage your child’s body and lead to serious health problems. That’s why getting a diagnosis and managing the condition is so important. Possible complications include:

• High blood pressure
• Heart disease
• Neuropathy (nerve damage)
• Eye problems, like retinopathy, macular edema, cataracts and glaucoma
• Kidney disease
• Oral health problems

Seek immediate medical care if your child shows signs of diabetic ketoacidosis (DKA), like fruity-smelling breath, rapid breathing or severe stomach pain. DKA can happen before and after diagnosis.

Living with Type 1 diabetes also increases your child’s risk of depression, anxiety, eating disorders and severe emotional burnout (diabetes burnout).

Children with this condition are at higher risk for other autoimmune conditions, like thyroid disease and celiac disease. Your child’s provider may test them for these conditions regularly.

What can I expect if I have a child with Type 1 diabetes?

Type 1 diabetes is a lifelong condition that requires ongoing attention.

In the beginning, there’s a lot to learn. As a parent or caregiver, you’ll likely do most of the management at first.

As your child gets older, they’ll gradually learn how to handle the condition on their own. Many children with Type 1 diabetes participate in sports and school and enjoy the same activities as their peers. It just takes extra planning.

This 24/7 condition can take a toll on your child’s mental health. It can greatly affect you and other family members, too. Getting mental health support for your child and family is key. Leaning on loved ones for support can make all the difference, as well.