Diabetes In Children

What Is Diabetes in Children?

Diabetes affects the way the body uses food. It is caused by a lack of insulin, a hormone made in the pancreas that is essential for converting energy from food. Insulin is necessary for the body to process nutrients (carbohydrates, fats, and proteins), and its absence causes high sugar (glucose) levels in the blood.

There are two types of diabetes:

  • In type 1 diabetes, which usually starts in childhood, the pancreas stops making insulin altogether. It is also called insulin-dependent diabetes.
  • In type 2 diabetes, which starts in adulthood (and in some teenagers) the body still makes some insulin. But it doesn’t make enough insulin, or the body can’t use it properly. It is also called non-insulin-dependent diabetes.

Type 2 diabetes can often be controlled by weight loss, sensible eating, and pills to improve the insulin supply or help it work better.

But type 1 diabetes must always be treated with insulin injections. Insulin can’t be taken by mouth because it would be digested in the stomach, just like food, and the body would be unable to use it.

What Does Insulin Do?

Insulin is a hormone released from the pancreas. A hormone is a chemical messenger secreted by a gland that then travels in the blood to act on other parts of the body. Insulin is the primary substance responsible for maintaining appropriate blood sugar levels. Insulin allows sugar (glucose) to be transported into cells so that they can produce energy or store the glucose until it is needed.

Most of the food we eat is turned into glucose, which serves as our main source of energy. Insulin is the “key” that allows glucose to move from the bloodstream into the body’s billions of cells, where it serves as fuel.

Here’s what happens without insulin:

  • Glucose can’t get into the cells, so the cells begin to starve. Symptoms: The child feels tired and short of energy and may lose weight, even if eating more than usual.
  • When the cells can’t get glucose, the body turns to its own store of fat for fuel. The process of burning fat produces acids called ketones. In people with diabetes, these build up in the blood. Symptoms: The child will urinate much more than usual, as the body tries to wash excess glucose and ketones out of the body. The child will also drink more than usual to make up for lost fluid.
  • As ketones reach toxic levels, the combination of dehydration and excess ketones may cause a serious condition called ketoacidosis. Symptoms: The child may feel nauseous and sleepy, with deep and rapid breathing. Without treatment with insulin and fluids, ketoacidosis can result in coma and eventually death.

Nice To Know:

It’s normal for parents to be upset and depressed when a child is diagnosed with diabetes. You also may feel overwhelmed by how much there is to learn. But very soon you and your child will feel more in control of the situation and more optimistic.

Although diabetes is a lifelong condition, modern treatment methods make it possible for a person with diabetes to do anything other people can do. So there is no reason why your child should miss out on any of the normal activities of childhood.

Your child’s doctor and other members of the diabetes team will be your main source of information. They can show you and your child what needs to be done. This information will serve as a reminder of how to carry out the many tasks involved in keeping your child’s diabetes under control and what to do in emergencies.

Facts About Diabetes

  • Almost 16 million Americans have diabetes, but about one-third of them are not aware of their condition because they have no symptoms.
  • Nearly 800,000 new cases of diabetes are diagnosed each year in the U.S.
  • The chance of developing diabetes increases with age. It affects 0.16% of people under age 20, 8.2% of people age 20 and older, and 18.4% of people over age 65.
  • Non-Hispanic blacks are 1.7 times as likely to have diabetes as non-Hispanic whites.
  • Hispanic/Latino Americans are almost twice as likely to have diabetes as non-Hispanic whites of similar age.
  • The direct medical cost of diabetes in the U.S. is $44 billion. Indirect costs, such as disability and work loss, are $54 billion.


What Causes Type 1 Diabetes?

Diabetes is an autoimmune disease. That means the body’s defense system attacks some of the body’s own cells. In type 1 diabetes, the cells in the pancreas that make insulin are destroyed, and therefore they are no longer capable of making insulin.

We don’t know exactly why this happens, but we do know that some people are born with a tendency to develop diabetes. Then something “triggers” the onset of the disease. It may be a virus that triggers the onset, or it may be something in the environment. There is nothing a parent can do to prevent this from happening.

The Diabetes Team

Treating diabetes is a team effort. You (the parents or guardians) and the child are the most important members of this team, working closely with the child’s doctor, who may be a pediatrician or an endocrinologist.

In addition, the care team may include:

  • A diabetes educator (often a nurse)
  • A dietitian
  • A psychologist or other counselor
  • A pharmacist
  • An exercise specialist

The diabetes team will help you and your child master these skills:

  • Drawing up insulin and giving shots
  • Doing finger-stick blood tests
  • Doing a simple test with strips or tablets to measure the concentration of ketones in the urine when the child is ill or blood glucose levels are high
  • Adjusting meals and snacks to meet the child’s needs
  • Getting plenty of exercise and adjusting food or insulin to accommodate changes in insulin requirements that exercise brings
  • Handling sick days and emergencies

Living With Diabetes

Diabetes is not like other health problems. It needs attention many times a day, every day. It also requires knowledge on how to cope with special occasions, sickness, and emergencies. Your family will become the greatest experts on your child’s diabetes!

Although there is no cure for diabetes, it can be successfully controlled. Insulin injections will enable the child to recover quickly from the acute phase. With good nutrition and a healthy lifestyle, children with diabetes can grow and develop normally.

How Well Can Your Family Cope?

It’s important for families to work together in dealing with a child’s diabetes:

  • Parents should share the responsibilities.
  • As children mature, they should take on more and more of the tasks themselves, with supervision.
  • Children should not be overprotected. Diabetes shouldn’t be an excuse to get out of anything or for receiving special privileges.

How To Information:

Controlling diabetes involves paying attention to many different aspects of life – not just for the child, but for the whole family. Here are the five “Es” of good diabetes control:

  • Emotions – Stay relaxed and confident about your ability to control diabetes.
  • Education – Continue to learn about diabetes in general, and your child’s diabetes in particular.
  • Exercise – For good diabetes control (and general health), stay fit and physically active.
  • Eating – Eat a healthy diet. Food that’s good for diabetes is a good diet for everyone.
  • Enthusiasm – Stay upbeat. Accept diabetes and feel confident that you can handle it.

Goals for the child’s social development

Here are the goals for your child’s social development:

  • Normal emotional development. Children who are involved in helping to control their diabetes may be more mature than average for their age.
  • Not using diabetes to manipulate others. The child shouldn’t get away with anything because of diabetes (and parents shouldn’t use diabetes as a way to control the child’s behavior).
  • Learning to take responsibility for his/her own day-to-day care. It’s important to encourage children not to be too dependent on parents or other adults.
  • No absences from school just because of diabetes. Special arrangements can always be made for blood testing, insulin shots, or meals.
  • Full participation in sports and other types of exercise. Some of our best athletes have diabetes! Exercise just requires some adjustment to the timing of meals, snacks, and/or insulin shots.
  • Full participation in social events. Miss America 1999 hastype 1 diabetes.
  • Understanding diabetes and feeling confident about controlling it. Everyone in the family may be anxious in the early stages, but as you all settle into a routine, anxiety levels should drop.

Remember, the goal is to live with diabetes, not for it!

How Much Diabetes Care Should A Child Be Responsible For?

Each child is different. One might be ready to give injections at the age of 6 or 7, while another might still be reluctant at 11 or 12. Here are some guidelines:


What the Child Can Do

Special Considerations

At/under 5 years of age

Can get a feeling of control by choosing the finger to use for blood testing, or where the injection should go. Older preschoolers may prick their own fingers, and learn to deal with symptoms of low blood sugar.

Try to use a matter-of-fact approach when giving finger-sticks and shots, with a lot of hugs and affection. Parents need to watch babies and small children closely for signs of low blood sugar.

At age 5 to 7

Can draw up insulin of one type. May give themselves shots under close supervision. Can do blood testing with assistance. Can begin to identify a healthy diet.

Young children may feel diabetes is a punishment for something they did. Day camps and summer camps for children with diabetes can help them work through these feelings.

At age 8 to 11

Can do their own blood testing, draw up insulin, and give themselves shots, but need to be supervised. Can keep logbook.

These children can develop a sense of responsibility in controlling their diabetes. Diabetes camps can give them social support.

At age 12 to 15

Should discuss their diabetes directly with the doctor and make many of their own decisions – although someone should make sure they are monitoring blood sugar regularly and taking enough insulin. Some teens prefer checking in regularly by phone with the diabetes team rather than having parents supervise.

Teenagers are very conscious of anything that makes them different. Teenage support groups and camps can be very helpful in allowing them to feel better about themselves.


Balancing Insulin And Blood Sugar

Successful management of type 1 diabetes means balancing insulin and blood sugar.

Normally, the body makes insulin when it’s needed. Right after meals, it produces enough insulin to process the blood sugar from that meal, moving it out of the blood and into the body’s cells. Between meals, the level of insulin drops before it drives blood sugar levels too low.

When the insulin comes from injections, it’s harder to maintain levels of insulin that keep blood sugar from going too low, or too high.

High Blood Sugar

If there’s not enough insulin to let glucose enter the cells (which is most likely to happen if the child is sick) too much glucose remains in the blood. This can bring back the strong symptoms of diabetes: fatigue, frequent urination, thirst, and a risk of ketoacidosis (a dangerous condition with warning signs that include rapid deep breathing and sweet-smelling breath.

Low Blood Sugar

Low blood sugar (hypoglycemia) can occur if the child has more insulin than usual, has eaten too little food, or has been extra active (exercise helps insulin work better). Hypoglycemia can be unpleasant and even dangerous.

The Good News

With good diabetes control, your child can feel as healthy as any other child and can avoid serious problems from high or low blood sugar.

Blood Sugar Monitoring

Diabetes has one big advantage over other diseases: you can always tell how well your child is doing. Blood sugar levels can be checked many times a day in the home and elsewhere. This shows how much glucose is present in the blood at different times of day, so you can adjust insulin or food accordingly.

When To Test?

It is usually best to test at least four times a day.

  • One test is always done first thing in the morning, when the blood sugar level should be at its lowest for the day.
  • The other tests may be before lunch, before dinner, at bedtime, or after meals.

Extra Tests

You will need extra tests:

  • When the child is sick or under stress. Certain hormones produced in sickness or times of stress can make insulin less efficient, so blood glucose levels may rise.
  • When the child has symptoms of hypoglycemia.
  • When the dose of insulin is being changed, and you need to see how well the new dose is working.

Your diabetes team may also suggest extra tests:

  • If the child starts an exercise program, because exercise helps the body use glucose, so blood glucose levels may become low.
  • When the child eats more than usual, for example, at a birthday party, and blood glucose levels may rise.

What You Need For Testing

Your diabetes team will advise you on what supplies you need and show you how to use them. You will probably need:

  • Lancets to prick the finger. (A new laser lancing device is now available. It is less painful but expensive.)
  • A small, inexpensive meter to analyze the blood.
  • Test strips. Most meters require these. Some can be used alone, changing color according to glucose levels.
  • A logbook.

Choosing A Meter

  • Meters should store test results with the time and date.
  • You may be able to upload results into your computer, then e-mail or fax them to the doctor’s office.
  • Some meters allow you to send the data over the telephone.

Getting A Blood Sample

  • Wash hands well.
  • Use the lancet to get a good drop of blood from the side of the finger. The side has a good blood supply and is less sensitive than the tip.
  • Put the blood on the test strip, where the meter will read it (or if you are not using a meter, check the color of the strip).

Numbers To Aim For

Here are the normal glucose levels for people without diabetes:

  • Before breakfast: 70-110
  • Before lunch, supper, and bedtime snack: 70-120
  • One hour after meals: 140 or less
  • Two hours after meals: 120 or less

You can see how much these “normal” levels go up and down. But you won’t be expected to match these numbers exactly! Really “tight” control, with glucose levels close to these normal numbers, brings a risk of hypoglycemia.

How To Information:

Your diabetes team will tell you what range of numbers is safe for your child to aim for, and how to adjust insulin or food intake if the numbers are too high or low. Most of your child’s blood sugars should be between 70 and 160, but talk to the doctor about specific goals.

  • If your child’s glucose is below 60, see the “Coping with low blood sugar” section.
  • If blood sugar is above 240, test forketones.

Long-Term Monitoring

The doctor will order a blood test about every three months to check long-term glucose control. This hemoglobin A1c test measures the amount of glucose that has stuck to red blood cells over a period of time, which can show how well blood sugar has been controlled over the previous two to three months.

The test can help in two ways:

  • It gives a good measurement of long-term control.
  • It can be motivating. Children can compare the results with their score in the previous test and set goals for improvement (“Normal” is 4 to 6; children with diabetes do well with a score of 7 or 8).

All About Insulin

Before the 1920s, there was no treatment for diabetes, and type 1 was always fatal. Then in 1922, insulin was extracted from the pancreases of animals and given to people with diabetes. Since then, insulin has been greatly improved.

  • Through genetic engineering, we can now make insulin that is the same as that made in the human body.
  • It now comes in very short-acting as well as intermediate and long-acting forms.

Children use a combination of short-acting and longer-acting types of insulin. Together, they can provide a background level throughout the day with peaks of insulin after meals, when it is most needed.

Nice to know information:

Insulin has to be given by injection. That’s because it’s a protein. If it were given by mouth, it would be digested in the stomach, just like food. It is injected into the fat just under the skin, where it can be absorbed into the bloodstream.

Different Types Of Insulin

These are types of insulin presently used.



Starts to work

Peak effectiveness


Ultra short (clear)

Lispro (Humalog)

5-15 minutes

45-90 minutes

2-4 hours

Short (clear)

Regular (R)

30 minutes

2-5 hours

5-8 hours

Intermediate (cloudy)

NPH (N) or Lente (L)

1-3 hours

6-12 hours

16-24 hours

Long acting


4-6 hours

8-20 hours

24-28 hours

Preparing The Insulin

Sometimes you may use a single type; sometimes you may need to mix two types and give them together in one shot.

  • If there are clumps in the cloudy insulin or it is sticking to the sides of the bottle, get a new bottle. You can return the clumpy one to the pharmacy.
  • Roll cloudy insulin in your hands or shake it gently to mix.
  • Wipe the rubber stoppers of the bottles with alcohol.

Drawing Up A Single Type Of Insulin

Bottles of insulin are airtight. Before you take insulin out, you need to pump in some air.

  1. Wash your hands with soap and water.
  2. Pull air into the syringe by drawing back the plunger to the mark that shows the amount of the insulin dose.
  3. Stick the needle through the rubber stopper and pump the air from the syringe into the bottle.
  4. Holding the bottle and syringe, turn it so the bottle is on top.
  5. Draw out the amount of insulin you need. If there are bubbles in the syringe, tap it gently to make the bubbles move up. Push in the plunger to get the bubbles back into the bottle; then withdraw a dose of insulin without bubbles. (Bubbles won’t harm the child but make it hard to measure an exact dose.)

Mixing Two Types Of Insulin

If your child uses a combination of fast-acting insulin and the intermediate type (which is cloudy), follow these steps:

  1. Draw enough air into the syringe to match the dose of cloudy insulin.
  2. Pump that air into the bottle of cloudy insulin but don’t withdraw any of that insulin yet.
  3. Draw air into the syringe to match the dose of clear insulin. Pump that air into the clear bottle, then turn it over and withdraw that amount of insulin, as in steps 2 – 5 above.
  4. Now stick the needle through the top of the cloudy bottle. Be careful not to move the plunger. Turn the bottle over, and pull back the plunger to match the total dose of insulin.

Nice to Know Information:

Insulin pens come ready-loaded with the insulin you need, whether it is a single type or a mixture. The pens consist of a cartridge with a needle attached. You set a dial to the dose you want. Pens have enough insulin for several days and are convenient to carry to school or when traveling.

Where To Give The Shot

The insulin goes into the fat just beneath the skin. Ask your health care team about good sites to use, because there is a difference in the rate that insulin is absorbed from different sites. The best places for the injection are:

  • The abdomen
  • The upper arms
  • The thighs
  • The hips (not the buttocks)
  • The calves

Choosing a Spot

Pick a spot about half an inch from the place where the previous shot was given.

Rotate sites around the body so you give each spot a couple of weeks to recover.

How To Give The Shot

  1. Pull the skin tight. If the child is thin, pinch up the skin, so the insulin goes into fat – not the muscle.
  2. Insert the needle straight in as far as it will go.
  3. Let go of the skin.
  4. Push in the plunger, then quickly remove the needle.
  5. If there is blood or fluid, apply pressure with a tissue.
  6. Note the time and the dose in the logbook.

How To Store Insulin

Injections may be more comfortable when insulin is at room temperature.

  • Some people store insulin in the refrigerator door where it will be less cold than in the main compartment. Then they hold it in their hands to warm it before the shot.
  • Others keep their insulin outside the refrigerator. It will stay fresh for one month. If you do this, mark the date. Throw out unused insulin after 30 days.

Keep a spare bottle of each type of insulin in the refrigerator in case there is a problem with the bottle you are using.

How To Information:

Insulin won’t work if it is stored below 36 degrees or above 86 degrees. It also can be damaged by sunlight.

  • Don’t leave bottles in a car on a hot or cold day.
  • Keep them out of direct sunlight.
  • If traveling by plane, keep the insulin in the hand luggage – not in the cargo hold where it may get too hot or cold.

Care Of Syringes

Syringes can be used more than once but must never be shared. If you are reusing a syringe:

  1. Draw air in and out a couple of times.
  2. Cap the needle. (Don’t wipe with alcohol! This will damage the coating.)
  3. Put the syringe back in its protective tube or envelope and store it in the refrigerator.

When the needle starts to get blunt after three or four shots, throw it out. Many states require you to use a special “sharps” container for the disposal of used needles. You can get one of these containers from your pharmacy.

How Much Insulin?

Immediately after diagnosis, your child may need a lot of insulin – and a lot of food – to rebuild the body tissues that were broken down because of lack of insulin.

After the body repairs itself, less insulin will be needed. Once the diabetes is under control, the child will probably need two or more shots a day. One common pattern is:

  • A shot before breakfast, combining intermediate and short-acting insulins.
  • Another combined shot before the evening meal.

As The Child Grows…

The total insulin required will increase as the child grows. As a rule of thumb, the dose is about 1 unit for every 3 pounds of body weight in the course of a day. In adolescence, the need for insulin rises sharply, to about 1 unit for every 2 pounds of body weight.

What May Affect The Need For Insulin?

Precise needs for insulin depend on a number of factors and may vary throughout the day. For example, a child who exercises vigorously may need less insulin (or more food). A child who is sick or under stress may also need more.

  • Your diabetes team will tell you how to increase the short-acting insulin if blood glucose levels rise in response to sickness, anxiety, or a big meal.
  • The team will tell you how to adjust insulin, food, or both on days when the child exercises vigorously.
  • If there’s a definite trend towards higher or lower blood sugar, you may need to make long-term adjustments.

Long-Term Adjustments

Your diabetes team will always be your guide in making long-term adjustments, but there are some rules of thumb.

  • Don’t change the intermediate insulin on the basis of only one day’s measurements. Observe blood sugars closely for a few days to see if the trend lasts.
  • After you adjust the dose of intermediate insulin, wait at least three days before you adjust it again. It can take that long for blood sugar levels to respond.

Here are some examples of when adjustments might be needed:

Scott’s morning blood sugar is low.

Scott’s diabetes team suggests lowering the before-supper intermediate dose by 10-20%, which increases his morning blood sugar level.

Latisha’s blood sugar is low before lunch.

The fast-acting insulin before breakfast is reduced or eliminated.

Paul’s blood sugar is high before dinner.

The intermediate insulin before breakfast is increased 10-20%.

Katie’s blood sugar is high at bedtime.

The before-supper dose of fast-acting insulin is raised by 10-20%.

The Insulin Pump: Adjustments On Demand

Older teenagers who are highly motivated to control their blood sugar should ask their doctors about the insulin pump. This device lets you fine-tune insulin doses in a way that can almost match nature. But, it requires 6-8 blood sugar tests a day.

The pump is about the size of a beeper and is worn on a belt around the waist. A plastic tube leads to a needle that is implanted in the abdomen. The pump delivers a flow of insulin throughout the day plus extra insulin on demand – for example, before meals.

Coping With Low Blood Sugar

Hypoglycemia – episodes of low blood sugar – can occur when there is too much insulin or not enough food. In people without diabetes, insulin levels fall naturally between meals. When you take injections, some insulin will keep circulating, and this can drive blood sugar too low. It is especially likely to dip:

  • If a meal or snack is missed or delayed or is smaller than usual
  • If the child exercises more than usual (sometimes the blood sugar can fall hours later)
  • If the child has taken more insulin than usual
  • If an older child drinks alcohol on an empty stomach

Even children under age 5 can learn to watch out for the signs of hypoglycemia and take action.

Symptoms To Watch For

Hypoglycemia can be unpleasant and embarrassing, as the child feels a loss of control. If untreated, hypoglycemia can also be dangerous, especially in a very young child.

When blood sugar drops, the body responds with a burst of adrenaline, just as if it were in danger.

Early symptoms of hypoglycemia are:

  • Feeling nervous or irritable
  • Sweating
  • Tightness in the stomach
  • Trembling
  • Turning pale

Later symptoms, as the brain cells run short of fuel, are:

  • Drowsiness
  • Confusion
  • Coma and seizures

If the sugar supply to the brain is impaired for very long, there may be permanent damage.

What To Do

At the first signs of hypoglycemia, the child should immediately eat or drink something that provides about 10-15 grams of sugar. Good sources are:

  • 2-3 glucose tablets
  • 4 ounces of juice
  • 4 ounces of regular soda (not “diet”)
  • 2-3 teaspoons of honey or sugar
  • 3-5 pieces of hard candy
  • 1 cup (8 ounces) of skim milk

What Happens Next

About 15 minutes after the child has consumed some sugar, give him or her more sugar if he or she is still not feeling well, or if you test blood sugar and find it is still below 70.

Giving More Food

As soon as the child feels better, he or she should eat something substantial. If it’s nearly mealtime, have that meal early. If it’s not mealtime, the child should have a solid snack, such as a cheese sandwich or peanut butter and crackers.

You can’t go wrong feeding a child with diabetes!

In Emergencies

If the child cannot eat, try inserting cake icing or honey into the corner of his or her mouth. If that doesn’t work, give an injection of glucagon, which you can get at your pharmacy. This forces the liver to make sugar.

Make sure that everyone at home knows how to give the injection. Also make sure that adults at school or at after-school activities have glucagon available and know how to use it. If there’s no glucagon available, call 911.

Do Diabetic Children Need Special Foods?

Children with diabetes need to eat the same nutritious food that other family members should be eating.

  • They won’t be on a “diet.”
  • They can eat everything in moderation – including foods containing sugar.
  • Special diabetic and dietetic foods are not necessary.

But people with diabetes need to watch:

  • What time they eat (meals and snacks should be about the same time every day).
  • How much they eat (meals and snacks should be about the same size every day, provided there is no change in activity).
  • The balance of what they eat at each meal (not too much of one type of food).

Planning Meals

Each child’s needs are different. In the beginning, you will probably work closely with a dietitian to plan meals and snacks. Many dietitians recommend a plan called “carbohydrate counting.” This means keeping track of sugars and starchy foods, which have the most effect on blood sugar. You match up the amount of carbohydrate to the amount of insulin your child takes.

With practice, it will become second nature for you and your child to:

  • Balance food intake with insulin levels.
  • Provide enough calories for normal growth.
  • Make meals satisfying, so the child won’t feel deprived.

The Balanced Diet

Meals and snacks will be based on the principles of the diabetes food pyramid.

  • About 50 percent of calories should be from complex carbohydrates such as breads, pasta, and rice, and starchy vegetables such as potatoes, corn, peas, and beans.
  • The child should eat plenty of vegetables and fruit.
  • Protein should come from lean meats, chicken, turkey, fish, beans, eggs, or low-fat cheese.
  • Dairy foods should be either nonfat or low-fat.
  • Added fats and sugars are acceptable but only in small amounts.

The Diabetes Pyramid

This food pyramid shows what should go into the day’s meals and snacks, with much more from the wide parts than the narrow.

Picky Eaters

If young children don’t eat enough to balance their insulin shots, there’s a risk of low blood sugar. One solution is to give a shot of very fast-acting insulin right after meals. You can calculate the dose according to what the child just ate. Check with your doctor before starting this system.

Weight Gain

Insulin may cause some teenagers to gain weight.

  • Work with the dietitian to get a better balance of insulin, calories, and exercise.
  • Unless your dietitian recommends one, don’t try any of the popular weight-loss programs!

Sugar: Just Another Food

Until quite recently, people with diabetes were told to think of sugar almost as a poison. Now we realize that it raises blood sugar no higher than the “complex carbohydrates,” such as bread and potatoes, do. But it may raise blood sugar too high if children have sugary foods and drinks in addition to regular food.

  • Give sugar as part of a meal (for example, in fruit pies, frozen yogurt, or pudding).
  • Avoid too much sugar between meals. For example, the child should drink diet soft drinks, not regular.

Are Fats Bad?

Fats don’t have much effect on blood sugar, and children need some fat. But, there’s another problem with fat. Adults with diabetes have much higher than average rates of heart disease. And, heart disease can start in children who eat a lot of saturated fat, which is found in food such as meat and dairy products.

  • Choose lean meats and take the skin off chicken.
  • Instead of butter or hard margarine, give fats that aren’t saturated, such as those in liquid oils, nuts, and margarine that lists a liquid oil as the first ingredient.
  • Buy skim or low-fat milk, and nonfat or low-fat yogurt. Limit the amount of regular cheese: choose a low-fat type.
  • Avoid fried foods. Barbecue, broil, boil, or bake instead.

What About Salt?

High blood pressure can be a serious problem in later life for people with diabetes. Help prevent it by keeping salt intake low.

Why Snacks Are Important

Snacks can be essential in preventing blood sugar from dipping too low between meals. These should not be snack foods high in sugar and fat, like candy or chips, but substantial foods such as:

  • Peanut butter and crackers
  • Cheese and crackers
  • Low-fat sugar-free yogurt
  • Fresh fruit
  • Bran muffins
  • Graham crackers
  • Cereal and milk

Children with diabetes should always carry a snack with them in case they can’t get to a meal on time. (Snacks can also be part of the treatment of low blood sugar, or hypoglycemia).

How To Information:

Children may feel “different” if they have to snack at times when other children don’t. Talk to teachers about rules for snacking. It may be possible for all children to be given a healthy snack at times when your child needs some food.

If your child is the only one with a snack, provide foods that he or she can eat discretely, such as raisins, pretzels, peanuts, or a juice box.


When A Child With Diabetes Gets Sick

Even “normal” illnesses like colds and flu can cause special problems for a child with diabetes.

  • Some illnesses interfere with the way insulin works, so the child will need extra insulin.
  • If a child can’t eat or is vomiting, it may be hard to keep blood sugar up.

Get A Written Plan

Get an action plan from your diabetes team to have ready in case your child gets sick. This plan should tell you:

  • When you should do extra blood tests
  • How to adjust insulin doses
  • When to check for ketones in the urine
  • What symptoms or test results mean you should call the doctor
  • What foods to give a child who can’t face solid food or can’t keep it down
  • What medications to have on hand to settle the stomach

Testing For Ketones

Ketones appear as a by-product when the body burns its own fat, because insulin is so low that the cells can’t use glucose. Excess ketones in the blood spill over into the urine. Test the urine with tablets or strips that change color:

  • Whenever blood sugar levels are above 240
  • If the child is vomiting
  • If the child is ill, regardless of the blood sugar level

Tell the doctor if this test indicates moderate or large amounts of ketones. This can be an early warning of the dangerous condition called ketoacidosis.

If there are signs of ketoacidosis (frequent urination, rapid deep breathing, and sweet-smelling breath, plus large amounts of ketones) call the doctor or take the child to the Emergency Department.

Food And Drink On Sick Days

Children who are too sick to eat their regular food need:

  • Fluids, especially if they are urinating more often than usual
  • Sugar, to prevent the body from using fat and muscle for fuel (unless blood sugar is over 240)

How To Information:

Examples of sick-day drinks include:

  • Ginger ale (not diet)
  • Other soda (not diet)
  • Apple juice

Examples of sick-day foods include:

  • Low-fat yogurt (not sugar free)
  • Pudding
  • Gelatin
  • Soups
  • Popsicles

Goals For Fluids

  • A 50-pound child should drink at least 4 ounces of fluid an hour when sick.
  • A 100-pound child should drink at least 8 ounces of fluid an hour.

If The Child Is Nauseous…

If the child has vomited and can’t keep anything down, start by giving him or her ice chips, then slowly increase the amount of fluid.

  • Shake the bubbles out of regular (non-diet) soda and have the child sip it to replace fluid and provide sugar.
  • Give Emetrol (available without prescription) to settle the stomach, or use phenergan suppositories if the child can’t keep anything down. If you are unsure of the dose, call the diabetes team.

Never skip an insulin shot, no matter how sick the child feels.

When A Child With Diabetes Is Away From Home

It is very important for the child, you, and other adults in the child’s life to keep the diabetes in perspective.

Remember, children with diabetes can do almost anything other kids can do, provided their diabetes is under control.

However, it’s important for teachers, the school nurse, school secretary, day care workers, and coaches to know about your child’s diabetes and know what to do if a problem arises.

What Others Need To Know

Adults who deal with your child may need information that includes:

  • What times your child needs to test his or her blood sugar or get an insulin shot.
  • What’s involved in blood testing or giving the child a shot. Your child may need to go to the school office for these procedures or have them done by the school nurse.
  • Special information about exercise. To avoid low blood sugar, children with diabetes need to eat before vigorous activity.
  • What times your child needs a snack.
  • Whether your child can eat food that’s distributed in the classroom.
  • What to do in case of hypoglycemia
  • What to do if there are signs of high blood sugar (increased urination, fatigue, vomiting).

Ask caregivers to call you:

  • If the child has signs of severe hypoglycemia and doesn’t respond to treatment with sugar followed by more solid food.
  • If the child shows greatly increased thirst, increased urination, or nausea.

How to information:

Supplies your child should carry:

  • Make sure your child always has a sugar source available in case of hypoglycemia and that an adult knows where it is.
  • In addition to their regular snacks, small children may carry a special lunch box with their emergency supplies, such as theglucose tablets or juice containers they may need if their blood sugar drops too low.
  • The child may carry a glucagon kit, or one should be available in the school office. All adults who have regular contact with the child should know where it is and how to use it.

The Importance Of An Identification Bracelet

To be on the safe side, the child should wear a medical identification tag. If there is an accident or the child can’t explain what is going on, this ID will tell health care professionals that he or she has diabetes. MedicAlert bracelets or necklaces carry a toll-free number through which callers can get information about the child’s condition, the name of the doctor, and more.

Can A Child With Diabetes Participate In All Sports?

Encourage your child to take part in school-sponsored athletics and to sign up for sports teams after school. This will do two things:

  • It will program exercise into your child’s life. Ideally, children with diabetes should have at least 30 minutes of activity a day. Exercise helps their bodies use insulin more efficiently and gives them a more optimistic, self-confident outlook.
  • Being on a team can help your child see that diabetes is not a handicap. It needn’t affect athletic performance at all!

Exercise helps the tissues of the body use blood sugar, so it may bring a risk of hypoglycemia. Talk to the doctor about reducing insulin or giving extra snacks before a workout.

Diabetes Camps

Some children hate the fact that diabetes makes them different. Attending diabetes summer camps can help their sense of belonging, abolish self-pity, and teach confidence-building skills. Some camps have special weekend sessions that involve the whole family.

Instructions For Babysitters Looking After Diabetic Children

Finding a sitter for a young child with diabetes requires special consideration. The best choice may be a teenager who also has diabetes. You can find such people through your local chapter of the American Diabetes Association.

Here’s a checklist for notes to leave with the sitter. Write down:

  • Where you can be reached
  • Doctor’s name and number
  • Schedule and instructions for meals
  • Schedule and instructions for snacks
  • Time of insulin shots
  • Dose of insulin
  • Schedule and instructions for blood sugar monitoring


You also should leave careful instructions about:

  • How to recognize signs of hypoglycemia in a young child: List out the symptoms to watch for, such as sweating, shaking, staring, trembling, or frequent yawning.
  • What to do about hypoglycemia: What sources of sugar to give, where these are kept, what extra food to give as a follow-up.
  • What to do if child with hypoglycemia can’t eat: Call you if available, give glucagon, call the doctor or another emergency number.
  • When and how to test for ketones: Where to reach you (or the doctor) if moderate or large amounts of ketones are present.

The Long-Term Outlook of Diabetes in Children

If diabetes isn’t well controlled, over the years it can lead to a risk of other problems, such as:

  • Kidney trouble
  • Heart disease
  • Damage to the eyes
  • Problems in the nerves, especially those affecting the feet

Although these complications aren’t likely to cause problems until adulthood, damage to blood vessels and organs can start before that if blood sugar levels are allowed to be consistently high.

Good News

Recent studies of teenagers and young adults have shown that those who kept their blood sugar under control had about 60% fewer complications at the end of a 10-year period. This news should motivate older children to work extra hard at keeping blood sugar as close to normal as possible.

The Future

Research is underway to:

  • Develop new forms of insulin that better mimic the natural sort
  • Find ways to give insulin by inhaler instead of by injection
  • Find alternatives to insulin – specifically, substitutes which could be given in patch or pill form
  • Find a way to monitor blood sugar continuously without finger sticks, so that a pump could be programmed to supply insulin as needed
  • Transplant pancreases or the cells from the pancreas that make insulin.

Although it may be many years before any really new methods of treatment are available, improvements in treatment methods are likely to become available during your child’s lifetime. So, encourage your child to stay in the best shape possible, so that he or she can take advantage of treatment advances as they come along.

Diabetes in Children: Frequently Asked Questions

Here are some frequently asked questions related to diabetes in children.

Q: Diabetes runs in my family, and I’m concerned that my children might be affected. What symptoms should I watch for?

A: Only your children’s doctor can tell for sure if they have diabetes. They may have some or none of the following symptoms: frequent urination, excessive thirst, unexplained weight loss, extreme hunger, sudden vision changes, tingling or numbness in the hands or feet, feeling very tired much of the time, very dry skin, sores that are slow to heal, and more infections than usual.

Q: If type 1 diabetes runs in our family, can it be avoided if my child follows a healthy diet before the onset of the disease?

A: As far as we can tell, there isn’t anything that can be done to prevent diabetes in a person. Diabetes prevention trials and other studies are looking into various theories. But for now, there are no known lifestyle changes that can keep type 1 diabetes from developing.

Q: My 5-year-old daughter, who has type 1 diabetes, has numerous low blood sugar levels. What does this mean for her, and what should I do?

A: Many low blood sugar levels indicate that your daughter’s insulin and foods are not matching up. Discuss this with your child’s diabetes team and make the appropriate adjustments. Good control now is important to help avoid health problems later in life.

Q: Our 6-year-old son was just diagnosed with type 1 diabetes. Should we discuss with him the serious complications that he could experience if he does not monitor his blood sugars?

A: Fear is never an appropriate strategy for motivating children to control diabetes. It likely will cause your son undue anxiety. At his age, it is up to you as parents to be responsible for your son’s diabetes regimen, so he should not make the choices about monitoring blood sugars. When he is older and you believe he is ready, you can share the responsibility for controlling the diabetes.

Q: Why are we having such a hard time keeping our child’s blood sugar level between 80 and 120?

A: No one with diabetes is capable of keeping blood sugars between 80 and 120 all of the time. Setting unrealistic goals only sets everyone up to be miserable and feel like a failure. Most of your child’s blood sugars should be between 70 and 160, but your diabetes team will tell you what range of numbers to aim for.

Q: My 20-year-old son has type 1 diabetes and is planning a trip abroad. What documentation should he take with him so that he can travel safely with his needles and medicine?

A: The rule of thumb for traveling with diabetes is to take plenty of supplies and don’t let them out of your hands. Have prescriptions for everything, especially anything that could be interpreted as illegal. A customs letter signed by the doctor is usually all that is required.

Q: My teenage daughter has a lot of trouble with her morning blood sugars. I think she should use an insulin pump, but she can’t deal with the thought of something inside of her. Should we insist?

A: There certainly are a number of options other than the pump, so your daughter shouldn’t be pressed into something she doesn’t want. With the help of her diabetes team, she can try varying the timing or the dosages of insulin to see if it helps keep her morning blood sugars within a good range.

Q: My 10-year-old son has been insulin-dependent for three months, but we’re having a hard time with fluctuating blood sugars. How do we get through the honeymoon phase of his diabetes without continuous changes in his diet and insulin regimen?

A: Small adjustments to insulin dosing are frequently required to respond to high and low blood sugars. It is especially important to make adjustments in response to trends in blood sugars (for example, frequently being low at lunch). Every person’s metabolism of insulin is different. Your diabetes team can help you with the important decision of choosing the correct type of insulin.

Diabetes in Children: Putting It All Together

Here is a summary of the important facts and information related to diabetes in children.

Here’s a summary of what your child needs to do (with your help) in order to stay healthy:

  • Test blood sugar at least twice a day and keep results for reference.
  • Take insulin shots in the dose and at the times prescribed by the doctor.
  • With the help of the doctor, learn how to adjust insulin doses when circumstances change.
  • Eat meals that are approximately the same size each day and try to eat at the same time each day.
  • Eat satisfying snacks to help prevent hypoglycemia between meals.
  • Get regular exercise.
  • Know the signs of hypoglycemia and how to treat it.
  • Know when to test for ketones and what to do if levels are high.
  • Know how to cope with sick days.
  • Develop good general health habits, such as good nutrition, exercise, and no smoking or substance abuse.
  • Keep communicating with the doctor and the rest of the diabetes team. They’re there to help!

Diabetes in Children: Glossary

Here are definitions of medical terms related to diabetes in children.

Endocrinologist: A physician who specializes in the endocrine system, which is the network of glands and other structures that secrete hormones and affect the function of certain organs.

Finger stick: The act of puncturing the tip of the finger to get a small sample of blood.

Glucagon: A hormone made in the pancreas that raises blood sugar levels. It can be given by injection to treat severe hypoglycemia.

Glucose: Commonly referred to as “sugar,” it is the major source of energy used by the body’s cells. It is taken from foods we eat and can be made from protein.

Hemoglobin A1c test (HB A1c): This test indicates the average level of blood sugar over the previous one to two months. It shows how well blood sugar levels are being controlled.

Hormone: A chemical messenger secreted by a gland that then travels in the blood to act on other parts of the body.

Hyperglycemia: High levels of sugar in the blood. In diabetes, this can happen if there is not enough insulin or because of unusual food intake, less activity, illness, or other stress.

Hypoglycemia: Not enough sugar in the blood for those tissues that depend mainly on sugar for energy, such as the brain. This can happen after exercise, taking more insulin than usual, or skipping eating.

Insulin: A hormone made in the pancreas. It regulates the way sugar, fat, and protein are moved into the cells, and the way they are stored or used for energy.

Ketoacidosis: A condition caused by lack of insulin that could result in severe dehydration and a high-acid condition in the body.

Ketones: Acids created by the process of burning body fat; if the body produces too many ketones, they are excreted in the urine.

Lancet: A short pointed blade used to obtain a drop of blood; it has a guard above the blade that prevents a deep incision.

Pancreas: The organ inside the abdomen that secretes various substances, including enzymes needed for digestion, insulin, and glucagon.

Type 1 diabetes: A condition in which the body stops producing insulin, and sugar (glucose) builds up in the blood. It is also known as insulin-dependent diabetes and formerly as juvenile-onset diabetes.

Diabetes in Children: Additional Sources of Information

Here are some reliable sources that can provide more information on diabetes in children.

American Diabetes Association 
Phone: 1-800-DIABETES (1-800-832-6874)

(or find your local chapter in the phone book).

National Diabetes Information Clearinghouse 
Phone: 1-301-654-3327

MedicAlert Foundation International 
Phone: 1-800-432-5378

Juvenile Diabetes Research Foundation 
Phone: 1-800-533-CURE (2873)

Barbara Davis Center for Childhood Diabetes

The Centers for Disease Control’s diabetes information can be found at www.cdc.gov/diabetes/

If your child is considering an insulin pump, check out this slide show entitled “Is pumping for you?” It can be found at www.diabetesmonitor.com/presentations/pumps/sld001.htm

The Children With Diabetes Web site features a section that summarizes books and videos available for children and teens with diabetes. It can be found at www.childrenwithdiabetes.com/d_06_a00.htm

The Centers for Disease Control features a “What’s New” section on its Web site that provides links to the most current articles related to diabetes treatment and research.

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