Treatment

You'll work closely with your child's diabetes treatment team — doctor, diabetes educator and dietitian — to keep your child's blood sugar level as close to normal as possible. Treatment for type 1 diabetes includes:

• Taking insulin
• Carbohydrate counting
• Frequent blood sugar monitoring
• Eating healthy foods
• Exercising regularly

Blood sugar monitoring

You will need to check and record your child's blood sugar at least four times a day. But you'll probably need to check it more often if your child doesn't have a continuous glucose monitor.

Frequent testing is the only way to make sure that your child's blood sugar level remains within his or her target range — which may change as your child grows and changes. Your child's doctor will let you know what your child's blood sugar target range is.

Continuous glucose monitoring (CGM)

Continuous glucose monitoring (CGM) devices measure your blood sugar every few minutes using a temporary or implanted sensor inserted under the skin. Some devices show your blood sugar reading at all times on a receiver or your smartphone or smartwatch, while others require that you check your blood sugar by running the receiver over the sensor.

Insulin and other medications

Anyone who has type 1 diabetes needs lifelong treatment with one or more types of insulin to survive. Many types of insulin are available, including:

• Rapid-acting insulin. This type of insulin starts working within 15 minutes. Insulin lispro (Humalog, Admelog), aspart (NovoLog, Fiasp) and glulisine (Apidra) are examples.
• Short-acting insulin. Human insulin (Humulin R, Novolin R) starts working around 30 minutes after injection.
• Intermediate-acting insulin. NPH insulin (Humulin N, Novolin N, Novolin Relion Insulin N) starts working within about one to three hours and lasts 12 to 24 hours.
• Long- and ultra-long-acting insulin. Therapies such as insulin glargine (Basaglar, Lantus, Toujeo) and insulin detemir (Levemir) and degludec (Tresiba) may provide coverage for as long as 14 to 40 hours.

Insulin delivery options

There are several options for insulin delivery, including:

• Fine needle and syringe. This looks like a shot you might get in a doctor's office, but with a much thinner needle.
• Insulin pen with fine needle. This device looks like an ink pen, except the cartridge is filled with insulin.
• An insulin pump. This is a small device worn on the outside of your body that you program to deliver specific amounts of insulin throughout the day and when you eat. A tube connects a reservoir of insulin to a catheter that's inserted under the skin of your abdomen. There's also a tubeless pump option that involves wearing a pod containing the insulin on your body combined with a tiny catheter that's inserted under your skin.

Combined insulin pumps/continuous glucose monitors

A device called a sensor-augmented pump combines an insulin pump and a continuous glucose monitor with a sophisticated algorithm to automatically deliver insulin when it's needed. The goal is to develop a completely automatic "closed loop" system, called the artificial pancreas.

Right now, what's known as a hybrid closed loop system is available. People with type 1 diabetes still have to tell the device how many carbohydrates they eat, and periodically confirm blood sugar levels, but the device adjusts insulin delivery throughout the day automatically. The available devices continue to be refined, and research will likely be ongoing until a fully automated system is available.

Healthy eating

Food is a big component of any diabetes treatment plan, but that doesn't mean your child has to follow a strict "diabetes diet." Just like the rest of the family, your child's diet should regularly include foods that are high in nutrition and low in fat and calories, such as:

• Vegetables
• Fruits
• Lean protein
• Whole grains

Your child's dietitian can help you create a meal plan that fits your child's food preferences and health goals, as well as help you plan for occasional treats. He or she will also teach you how to count carbohydrates in foods so that you can use that information when figuring out insulin doses.

Physical activity

Everyone needs regular aerobic exercise, and children who have type 1 diabetes are no exception. Encourage your child to get at least 60 minutes of physical activity daily or, better yet, exercise with your child. Make physical activity part of your child's daily routine.

But remember that physical activity usually lowers blood sugar, and can affect blood sugar levels for hours after exercise, possibly even overnight. If your child begins a new activity, check your child's blood sugar more often than usual until you learn how his or her body reacts to the activity. You might need to adjust your child's meal plan or insulin doses to compensate for the increased activity.

Flexibility

Blood sugar can sometimes change unpredictably. Ask your child's diabetes treatment team how to handle these and other challenges:

• Picky eating. Very young children with type 1 diabetes might not finish what's on their plates, which can be a problem if you've already given them insulin for that food.
• Illness. Sickness has varying effects on your child's insulin needs. Hormones produced during illness raise blood sugar levels, but reduced carbohydrate intake due to poor appetite or vomiting lowers the insulin requirement. Your child's doctor will recommend a flu shot for your child every year, and may recommend the pneumonia vaccine too.
• Growth spurts and puberty. Just when you've mastered your child's insulin needs, he or she sprouts up seemingly overnight, and suddenly isn't getting enough insulin. Hormones also can affect insulin requirements, particularly for teenage girls as they begin to menstruate.
• Sleep. To avoid problems with low blood sugar during the night, you might need to adjust your child's insulin routine.

Follow-up medical care

Your child will need regular follow-up appointments to ensure good diabetes management and to check his or her A1C levels. The American Diabetes Association generally recommends an A1C of 7.5 or lower for all children and teens.

Your doctor also will periodically check your child's:

• Blood pressure
• Growth
• Cholesterol levels
• Thyroid function
• Kidney function
• Liver function

Signs of trouble

Despite your best efforts, sometimes problems will arise. Certain short-term complications of type 1 diabetes require immediate care or they could become very serious, including:

• Low blood sugar (hypoglycemia)
• High blood sugar (hyperglycemia)
• Diabetic ketoacidosis (DKA)

Low blood sugar (hypoglycemia)

Hypoglycemia is a blood sugar level below your child's target range. Blood sugar levels can drop for many reasons, including skipping a meal, getting more physical activity than normal or injecting too much insulin. Low blood sugar is not uncommon in people with type 1 diabetes, but if it isn't treated quickly, symptoms will get worse.

Signs and symptoms of low blood sugar include:

• Shakiness
• Hunger
• Sweating
• Irritability and other mood changes
• Difficulty concentrating or confusion
• Dizziness or lightheadedness
• Loss of coordination
• Slurred speech
• Loss of consciousness

Teach your child the symptoms of low blood sugar. When in doubt, he or she should always do a blood sugar test. If a blood glucose meter isn't readily available and your child is having symptoms of a low blood sugar, treat for low blood sugar, and then test as soon as possible.

If your child has a low blood sugar reading:

• Have him or her consume 15 to 20 grams of a fast-acting carbohydrate, such as fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Foods with added fat, such as chocolate or ice cream, don't raise blood sugar as quickly because fat slows down the absorption of the sugar.
• Retest your child's blood sugar in about 15 minutes to make sure it's normal, and repeat as necessary until you get a normal reading.

If a low blood sugar causes your child to lose consciousness, an emergency injection of a hormone that stimulates the release of sugar into the blood (glucagon) may be necessary.

High blood sugar (hyperglycemia)

Hyperglycemia is a blood sugar level above your child's target range. Blood sugar levels can rise for many reasons, including illness, eating too much, eating the wrong types of foods and not taking enough insulin.

Signs and symptoms of high blood sugar include:

• Frequent urination
• Increased thirst or dry mouth
• Blurred vision
• Fatigue
• Nausea

If you suspect a high blood sugar, test your child's blood sugar. If your child's blood sugar is higher than the target range, follow your child's diabetes treatment plan or check with your child's doctor. High blood sugar levels don't come down quickly, so ask your doctor how long to wait until you check your child's blood sugar again.

If your child has a blood sugar reading above 240 mg/dL (13.3 mmol/L), your child should use a urine test stick to test for ketones. Don't allow your child to exercise if his or her blood sugar level is high or if ketones are present.

Diabetic ketoacidosis (DKA)

A severe lack of insulin causes your child's body to break down fat for energy. This causes the body to produce a substance called ketones. Excess ketones build up in your child's blood, creating a potentially life-threatening condition known as diabetic ketoacidosis.

Signs and symptoms of DKA include:

• Thirst or very dry mouth
• Increased urination
• Dry or flushed skin
• Nausea, vomiting or abdominal pain
• A sweet, fruity smell on your child's breath
• Confusion

If you suspect DKA, check your child's urine for excess ketones with an over-the-counter ketone test kit. If the ketone levels are high, call your child's doctor or seek emergency care.