Diabetes Mellitus Type 1

What is diabetes?

Type 1 diabetes is a disorder where the body does not make enough of a hormone called insulin. Children with diabetes usually urinate a lot, drink a lot of fluids, and lose weight. Type 1 diabetes is also called insulin-dependent diabetes mellitus (IDDM), childhood diabetes, or juvenile diabetes.

Childhood (type 1) diabetes mellitus should not be confused with type 2 diabetes, also called non-insulin dependent diabetes (NIDDM). People with type 2 diabetes can still produce insulin in regular amounts and receive different treatments. Type 2 diabetes is becoming more common in children ages 10 to 18 years old.

What is insulin?

Insulin is a hormone produced by an organ in your body called the pancreas. When food is digested, the body breaks down much of the food into sugar (glucose). Blood carries the sugar to the body's cells for energy. Insulin helps the sugar enter the cells and controls the level of sugar in the blood.

What causes type 1 diabetes?

In type 1 diabetes, destruction of cells in the pancreas causes the pancreas to produce very little insulin. When there is not enough insulin in the body, the amount of sugar in the blood can reach very high levels. Too much sugar in the body can cause many serious problems. If the problems are not treated, they can be life-threatening.

Often it is not known why the insulin producing cells of the pancreas are destroyed. There is a tendency for diabetes to run in families. Destruction of these cells could be the result of an immune response, possibly triggered by a viral infection.

What is the treatment?

Type 1 diabetes usually develops in childhood or early adulthood and must be treated with insulin shots. With treatment, blood sugar levels can be controlled.

1. Initial test for diabetes

   If you suspect your child has diabetes, call your physician. If you want to test for diabetes before you are able to see your doctor, you can purchase a simple urine dipstick test called Keto-Diastix at a pharmacy. Keto-Diastix can be used to check the level of sugar and other chemicals (ketones) in your child's urine. Call your child's physician immediately if the test for sugar in the urine is positive.

2. Education and diet

   When a child is diagnosed with diabetes, there is a lot the family must learn about the disease. This education is usually done for 2 or 3 days at a children's diabetes specialty clinic. Health care providers will teach you what diabetes is and how to give shots of the proper amounts of insulin to your child. You will learn how to test for sugar in the blood and for ketones in the blood or urine. You will learn how to treat low blood sugar and other procedures needed to keep your child healthy.

   A dietitian will teach you about food management. A child with diabetes should not eat too many carbohydrates, particularly between meals, and should eat and snack consistently from day to day.

   For more information see: Diabetes: Food Management

3. Control of blood sugar levels

   Home care involves balancing diet, exercise, and stress with insulin. Children with type 1 diabetes must get insulin shots. The dosage of insulin in the shots is not always the same. The dosage must be adjusted according to the food the child eats and the level of sugar in the child's blood at the time of the shot. If a child gets too much insulin, low blood sugar (hypoglycemia) could result. Just as prevention of high blood sugar is important, prevention of low blood sugar is also very important.

   Most families use a home meter to measure the level of sugar (glucose) in their child's blood 3 or 4 times each day. After the age of 7 to 10 years, the child can learn how to test his own blood sugar. Families also learn how to give the insulin shots, and children can learn when they are 10 or 11 years old to do their own shots. Measuring blood sugar and giving insulin shots at home allows the best adjustment of insulin dosages and thus the best control of sugar in the blood.

   Blood sugar levels measured when a child has not eaten for at least 2 hours ("fasting blood sugar") and 2 hours after meals should be kept in the following ranges:

   • Children under the age of 5 years: 100 to 200 mg/dL (5.5 to 11.1 mmol/L).
   • Children ages 5 to 11 years: 80 to 180 mg/dL (4.4 to 10.0 mmol/L)
   • Children over 12 years old: 70 to 150 mg/dL (3.9 to 8.3 mmol/L).
4. Follow-up visits with your child's doctor.

   Your child's doctor will measure the overall glucose control every 3 months with a test called the hemoglobin A1c (HbA1c). If the HbA1c is kept in a good range, the risk for eye, kidney, and nerve problems is greatly reduced.

5. Ketone tests

   It is important to keep a method of measuring ketones at home. You can use the urine ketone dipstick tests (Ketostix or Keto-Diastix) or a blood ketone test (Precision Xtra). You need to test for ketones if a child with diabetes is sick (even vomiting once), or if the blood sugar is high (for example, above 240 mg/dL, or 13.3 mmol/L). Fat breaks down into ketones when not enough insulin is available. Ketones have acid properties that can make a person very sick, causing a condition called ketoacidosis.

6. Checking other family members

   Other family members have a 1 in 20 chance (5%) for also developing diabetes. A blood glucose level test is not very helpful for predicting diabetes because the test does not show high glucose levels unless the person already has diabetes. Fortunately, a test called the "islet cell antibody" test is now available that can predict diabetes as much as 10 years before a person gets diabetes. It is a free test through the TrialNet/Natural History Study. Call 1-800-425-8361 for more information (in Denver call 303-315-6397).

When should I call my child's health care provider?

Call immediately if:

• A urine dipstick test is positive for sugar in a child who has not yet been diagnosed with diabetes.
• Your child with known diabetes frequently has low blood sugar (hypoglycemic reactions), particularly if your child loses consciousness or has seizures.
• A urine dipstick test shows that there are moderate or large amounts of ketones in your child's urine or the blood ketone test is >0.6 mmol/L.

Call during office hours if:

• Blood sugar values measured at home are constantly above the desired range for your child's age (see recommended values under "Treatment").
• Blood sugars done at home are frequently (1 or 2 times a day) below the desired range for your child's age.
• Another illness (for example, flu) occurs, which might upset the diabetes.
• If you have other questions about diabetes.

For more information:

A book is available for families who have a family member with type 1 diabetes that explains home care in detail. It is called "Understanding Diabetes." The book is available for $15.00 (this includes shipping and handling and is payable by check made out to CDF-Guild or by credit card). You can order the book by writing or calling:

The Guild of Children's Diabetes Foundation
777 Grant Street, Suite 302
Denver, Colorado 80203
303-863-1200

You can also order online at: http://www.childrensdiabetesfdn.org