What is Type 1 Diabetes?

Type 1 diabetes is the most common chronic illness that can develop in childhood, and it affects 1 in every 600 children in the United States. While the exact cause of this disease is really not known at this time, it is suspected that it is caused by an autoimmune disorder that affects the islet cells in the pancreas which are responsible for the production of insulin. Without an adequate amount of insulin, the body’s cells are not able to use glucose to generate fuel for metabolism, and as a result the cells basically starve to death. In addition to cell degeneration, the build up of glucose in the blood can also lead to conditions like Hemochromatosis, Frozen Shoulder, organ damage, blood vessel damage, blindness, and eventually even organ failure. In order to reduce the chances of developing these serious conditions, type 1 diabetics need to take supplemental or replacement insulin through regular injections of synthetic insulin. These insulin injections help to regulate blood sugar levels, and help to maintain a diabetic’s health. Children diagnosed with type 1 diabetes do have an advantage over adults, as they usually don’t develop the serious health complication like organ failure, blindness, and lesions that adult diabetics tend to develop, however, because they are still growing and developing, children face challenges that adult diabetics don’t.

The Importance of Early Intervention

Diabetes can have a major impact on a child’s ability to grow and develop. If a child’s blood sugar is not kept under control, then they will develop slower than non-diabetic children will. This means that not only will they tend to be shorter than their peers are, but also, they will enter puberty later than their peers will. In addition to affecting a child’s growth and development, diabetes also affects their immune system. Children with type 1 diabetes are more prone to catching colds and getting infections then their peers. In order to help diabetic children have as healthy and normal a life as possible, it is important to diagnose type 1 diabetes as early as possible to make nutritional adjustments and insulin injection schedules that can help offset any negative effects diabetes has had, or will have on their development.

Diagnosing Type 1 Diabetes

The Fasting Blood Glucose Level Test and the Oral Glucose Tolerance Test are generally what are used to determine if a child has type 1 diabetes or not. The Fasting Blood Glucose Level Test is the primary test used to determine if a child has type 1 diabetes. For this test, the child will need to fast the night before the test, usually not eating anything after midnight. When the child arrives at the hospital their doctor will take a blood glucose level reading. This is done by testing a small blood sample with a blood glucose meter. If their level is above 140 mg/dl then they will be scheduled for another Fasting Blood Glucose Level Test in a few days. If the reading is again at or above 140 mg/dl then the child will be diagnosed as having type 1 diabetes.

The second diagnostic test for type 1 diabetes is the Oral Glucose Tolerance Test. Again the child will need to fast for 10 to 16 hours before they start the testing process. This test begins with a fasting blood glucose level reading, and then they will be given a sugary mixture to drink. After the child drinks the soda pop-like mixture their blood glucose levels will be taken at various intervals of time usually at 30 minutes, 1 hour, 2 hours, and 3 hours. What the doctor is looking for here is the natural fluctuation in blood glucose levels. In a normal person who consumes something sugary, their blood glucose levels should peak immediately after drinking the concoction, and then quickly return to normal as their body produces insulin to burn the glucose. However, in a diabetic person, their body is not able to produce insulin and they are unable to utilize the glucose in their blood. As a result their blood glucose levels will remain high even after a significant amount of time. If the child’s blood glucose level remains 200 mg/dl or higher after the 2 hour mark, then they will be scheduled to be tested again to make sure the results are accurate. If a similar result occurs in the second test, then the child is diagnosed as having type 1 diabetes.

Educating Children About Their Type 1 Diabetes

Diabetes can be difficult to manage when the patient is an adult, but it is even more difficult when the patient is a child. Children have constantly changing nutritional needs as they flux between growth and development spurts and plateaus. Children are also faced with more chances to catch illnesses and diseases at school then adult diabetics face at work or at home. In addition to these challenges, they also face more temptations to stray away from their diabetic diet. School parties, birthdays, holidays, and other functions provide many opportunities for diabetic children to eat foods that could be harmful to their health. In order to combat all of these potentially hazardous elements of being a child with type 1 diabetes, the diabetic child needs to be educated about their condition and about their treatment plan.

Parents with children who have just been diagnosed with type 1 diabetes may be just as confused and overwhelmed with what they need to know and do as the children are. Education should therefore be a family event. Everyone in the family will need to know five major pieces of information in order to provide the support and treatment the diabetic child will need to stay healthy. The first piece of information is how to recognize and treat hyperglycemia. Hyperglycemia is high blood sugar, and it is the main cause of health complications in diabetics. The symptoms of this condition are sometimes hard to identify as they are similar to symptoms of common illnesses, and sometimes this condition has no symptoms at all. This makes frequent blood glucose monitoring critical to maintaining a healthy glucose level. The main symptoms for hyperglycemia are: thirst, more urges to urinate, high levels of sugars and proteins in the urine, and high levels of glucose in the blood. This condition can often be effectively treated simply with exercise, however if there is a high concentration of ketones in the urine, exercise should not be used as a treatment method as this could increase the severity of a tangent condition called ketoacidosis. Ketoacidosis is a life-threatening condition that occurs when the body is unable to eliminate proteins known as ketones that are created when fat is broken down. If the body is unable to eliminate these ketones they build up to toxic levels in the body. The symptoms of this condition include fruity smelling breath, nausea, vomiting, shortness of breath, and dry mouth. If these symptoms accompany high blood glucose the diabetic needs emergency medical care.

The second piece of information that the family will need is how to identify the symptoms and how to treat hypoglycemia. Hypoglycemia is low blood sugar, and is easier to identify than hyperglycemia. Here the signs will be: shakiness, dizziness, paleness of the skin, sweating, hunger, difficulty concentrating, and if left untreated, the loss of consciousness. In order to treat this condition the child should drink ½ cup of juice, eat 5-6 pieces of hard candy, take 3 glucose tabs, or get an injection of Glucogen. Glucogen is injected like insulin and can be found at most pharmacies.

The third piece of information that diabetic families need to know is what exactly is type 1 diabetes and how does it effect the body. This information should be delivered in a manner that the child can understand. To effectively inform children about diabetes special materials geared for children should be used.

Books Geared for Children:

* 487 Really Cool Tips for Kids with Diabetes by Spike Nasmyth Loy and Bo Nasmyth Loy. Published by the American Diabetes Association, 2004. ISBN 1-58040-191-0. 262 pages, $14.95;

* Even Little Kids Get Diabetes by Connie White Pirner. Pictures by Nadine Bernard Westcott. Published by Ablert Whitman & Company, 1991. ISBN 0-8075-2158-2 (hardcover) or 0-8075-2159-0 (paperback). Books Geared for Parents with Diabetic Children:

* Diabetes Care for Babies, Toddlers, and Preschoolers: A Reassuring Guide by Jean Betschart, C.R.N.P., C.D.E. Published by John Wiley & Sons, 1999. US$14.95. ISBN 0471346764.

Videos:

"The Doctor Is In: Pediatric Diabetes" by the Dartmouth-Hitchcock Medical Center. VHS videotape. 28 minutes.

Diabetes effects every aspect of a child’s life and this includes their personal care and hygiene. Diabetes causes medical problems that, if left untreated can turn into life-threatening conditions. To avoid this, it is important to educate diabetic children to recognize changes in their bodies, and to inform their parents when they notice these changes. The areas of the most concern are changes in vision, and pain experienced in the feet, gums, and joints. All of these changes or experiences of pain can be symptoms of diabetic health conditions that are developing. In order to prevent damage to organs and senses, frequent visits to the dentist, eye doctor, nutritionist, and pediatrician are recommended for children with type 1 diabetes. Also it is important for diabetic children to have shoes that fit well and that do not rub, as diabetics are prone to developing foot lesions. One helpful hint to protect young feet is to buy runner’s socks. They are more absorbent and cushioning than regular socks and will help to keep the feet healthy.

The final piece of information diabetic families need to learn is how to keep the child healthy. This means learning proper nutrition for growing children, how to snack right, what foods are diabetic friendly, and what foods should be avoided. To accomplish this it is important for diabetic families to meet with a nutritionist at least once a year to review eating plans and to design eating and snacking strategies to help balance the child’s blood sugar most effectively. In addition to good nutrition, the child will also need to develop an exercise plan that keeps their body fit and their blood glucose levels low. Families can play sports together, walk together, or bike together to make sure the diabetic child is getting enough exercise to keep them healthy.

Putting Together a Treatment Pack

Accessibility to supplies and treatment is key to successfully managing your child’s diabetes. You can help your child manage their treatment schedule by putting together a treatment pack that has everything they need for their regular insulin injections, as well as instructions for emergency situations.

Start out by having your child select a fanny pack or an insulated pack that matches their personality and preferences. These types of packs come in a wide variety of colors and designs, and they can be further personalized by sewing on or hot gluing on patches and buttons selected by the child. Inside you will want to include the following items:

• ice pack
• insulin pen or syringe
• laminated instructions for regular treatment and emergency treatment procedures
• hard candy
• glucose tabs
• medication
• blood glucose meter and supplies
• swabs
• misc. supplies

With all of these things on hand, your child will be able to handle any diabetic situation that they are faced with.

Creating a Diabetes Team

Children with diabetes also need to have a support team to help them manage all of the responsibilities that come with the disease. To do this, all the people that work with or are around the child will need to be educated on what diabetes is, what symptoms need to be watched out for, and how to treat the conditions if the diabetic child is unable to do it themselves. One way to recruit members for the child’s treatment team is to talk with his or her teachers and classmates. This information session will not only help protect the child in case they have a diabetic emergency, but will also help to reduce the stigmatization the child may face by having to carry around the treatment pack, and by being diabetic.

External Links:

• Children With Diabetes - Information for kids with diabetes
• American Diabetes Association - Detailed information and resources for diabetics