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Type 1 diabetes in children is a condition where your child's body stops making insulin. Insulin is an important hormone that helps sugar from food enter the body's cells for energy. Sugar from food also is called glucose. Without insulin, the body can't work as it should. To stay healthy, your child needs to get insulin through injections or an insulin pump. Type 1 diabetes in children used to be known as juvenile diabetes or insulin-dependent diabetes.

Being told your child has type 1 diabetes can feel overwhelming, especially at first. You and your child, depending on their age, need to learn how to give insulin, count carbohydrates and check blood sugar levels regularly.

There's no cure for type 1 diabetes, but it can be managed. Thanks to new technology, it's easier than ever to track blood sugar and deliver insulin. These advances help children with type 1 diabetes live active, healthy lives.

Symptoms of type 1 diabetes in children typically come on quickly. Watch for symptoms such as:

• Feeling very thirsty.
• Needing to urinate often. This may include bed-wetting in a child who has already toilet trained.
• Feeling very hungry.
• Stomach pain, nausea or vomiting.
• Losing weight without trying.
• Feeling tired or low on energy.
• Mood changes or unusual behavior, such as irritability.
• Breath that smells fruity.

When to see a doctor

Contact your child's healthcare professional if you notice any of these symptoms. Getting a diagnosis and starting treatment right away can help prevent serious health issues.

The exact cause of type 1 diabetes isn't known. But in most people, the body's immune system — which typically protects against harmful germs — mistakenly attacks and destroys cells in the pancreas that make insulin. These cells are called islet cells or beta cells. Genetics and environmental factors, such as certain viruses, may raise the risk of this happening.

Once the islet cells of the pancreas are gone, your child's body makes little or no insulin. Insulin is important because it helps move sugar from the blood into the body's cells where it's used for energy. Sugar from food also is called glucose.

After you eat, sugar from food enters the bloodstream. Without enough insulin, that sugar builds up in the blood instead of reaching the cells. High blood sugar can lead to serious and even life-threatening health issues if not treated.

Type 1 diabetes typically begins in children, but it can start at any age. Several things may raise the risk of developing the condition:

• Family history. A child has a slightly higher risk if a parent or sibling has type 1 diabetes.
• Genetics. Some genes are linked to a higher chance of developing type 1 diabetes.
• Races and ethnic groups. In the United States, type 1 diabetes is more common in children who are white and not Hispanic than in children of other racial or ethnic groups.
• Infections caused by viruses. Exposure to certain viruses may play a role in triggering the immune system to attack the cells that make insulin in the pancreas.

Type 1 diabetes can affect many parts of the body. Keeping your child's blood sugar level as close to a healthy range as possible most of the time can greatly lower the risk of serious conditions related to diabetes. These conditions also are called complications.

Complications can include:

• Heart and blood vessel disease. Over time, diabetes can raise the risk of high blood pressure, narrowed blood vessels, heart disease and stroke. These issues typically develop later in life.
• Nerve damage. High blood sugar can damage the small blood vessels that supply blood to your child's nerves. This may lead to tingling, numbness, burning or pain, often in the hands and feet. Nerve damage tends to develop slowly over time.
• Kidney damage. Diabetes can harm the tiny blood vessels in the kidneys that filter waste from the blood. This may affect how well the kidneys work over time.
• Eye issues. High blood sugar can damage the blood vessels in the retina. The retina is the part of the eye that senses light. This damage can lead to vision changes or vision loss.
• Weaker bones, called osteoporosis. Diabetes may lessen bone strength, raising your child's risk of osteoporosis as an adult.

You can help protect your child's health by:

• Helping keep blood sugar levels in a healthy range as often as possible.
• Encouraging healthy eating and regular physical activity.
• Making sure to see the diabetes care team regularly for checkups and guidance.

Children with type 1 diabetes also are more likely to develop other autoimmune conditions, such as thyroid disease and celiac disease. Your child's healthcare professional may recommend testing for these conditions as part of ongoing care.

Right now, there's no proven way to prevent type 1 diabetes. But researchers are working hard to find a way to prevent the condition, and it's a very active area of study.

In children at high risk of type 1 diabetes, certain autoantibodies can be found months or even years before symptoms begin. A blood test can find these autoantibodies. They are a warning sign that the immune system is attacking the cells that make insulin in the pancreas. Researchers are working on:

• Finding ways to prevent or delay type 1 diabetes in people who are at high risk of developing the disease.
• Stopping further damage to the cells that make insulin in people who have just been diagnosed.

Many blood tests can help diagnose type 1 diabetes in children. These tests also are used to monitor the condition over time. Typical tests include:

• Random blood sugar test. This often is the first test done. A blood sample is taken at any time of the day. If your child's blood sugar is 200 mg/dL (11.1 mmol/L) or higher and they have diabetes symptoms, this result strongly suggests diabetes.
• A1C test, also called glycated hemoglobin test. The A1C test shows your child's average blood sugar over the past three months. An A1C level of 6.5% or higher on two different tests means your child is likely to have diabetes.
• Fasting blood sugar test. A blood sample is taken after your child hasn't eaten for at least eight hours or overnight. Going for a time without eating is called fasting. A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or higher suggests diabetes.

Additional tests

If these tests show high blood sugar, your child's healthcare professional may do more blood tests to confirm the diagnosis. This also will show whether it's type 1 or type 2 diabetes. This may include tests for autoantibodies, which are usually present in type 1 diabetes but not in type 2. Knowing the type of diabetes is important because the treatment is different.

Type 1 diabetes treatment includes many important daily tasks:

• Taking insulin.
• Monitoring blood sugar levels. These also are called blood glucose levels.
• Eating a healthy, balanced diet.
• Getting regular physical activity.

Parents and caregivers are an important part of a child's healthcare team. You'll work closely with your child's diabetes treatment team to help your child learn to manage diabetes. The team may include a doctor or other healthcare professional, a certified diabetes educator, and a registered dietitian. The goal is to keep your child's blood sugar in a healthy range. This helps lessen the risk of serious health issues later.

Your child's target blood sugar range will change over time as your child grows. The care team will let you know what that range should be.

Insulin

Children with type 1 diabetes will need insulin every day for life. There are several types of insulin. Each works at different speeds:

• Rapid-acting insulin. This type of insulin starts working within 15 minutes. It reaches peak effect in about one hour and lasts about four hours. This type of insulin often is taken 15 to 20 minutes before meals. Examples are lispro (Humalog, Admelog), aspart (NovoLog, Fiasp) and glulisine (Apidra).
• Short-acting insulin. Sometimes called regular insulin, this type starts working in about 30 minutes. It peaks in 1 1/2 to 2 hours and lasts about 4 to 6 hours. An example is human insulin (Humulin R, Novolin R).
• Intermediate-acting insulin. Also called NPH insulin, this type of insulin starts working in about 1 to 3 hours. It peaks in 6 to 8 hours and lasts 12 to 24 hours. An example is NPH insulin (Humulin N, Novolin N).
• Long-acting and ultra-long-acting insulin. This type of insulin may work for as long as 14 to 40 hours. It helps maintain steady blood sugar levels throughout the day and night. Examples are glargine (Lantus, Toujeo, Basaglar, others), detemir (Levemir) and degludec (Tresiba).

How insulin is given

Insulin can be given in a few different ways. Most children start with multiple daily injections of long-acting and rapid-acting insulin. Injections are given using insulin pens or syringes. Once a child and the family are comfortable managing diabetes, children are typically offered the option of an insulin pump, usually within a few months to a year.

• Syringe and fine needle. This looks like a shot you might get in a healthcare professional's office, but it has a smaller syringe and a much thinner, shorter needle.
• Insulin pen. This device looks like an ink pen with a small needle. It has a cartridge filled with insulin. It is easy to carry and use.
• Insulin pump. This is a small device worn on the outside of the 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 another thin tube, called a catheter, that's inserted under the skin of your stomach.
• Tubeless insulin pump. Also called a patch pump, this device delivers insulin without any external tubing. Instead of using a tube to a separate pump worn on a belt or in a pocket, the entire pump is built into a small, lightweight pod that sticks directly to the skin. Once the pod is in place, a tiny, flexible needle inserts just under the skin to deliver insulin throughout the day. This type of pump may be a good choice for families who want to avoid daily injections and tubing. It's especially popular with active kids and those who prefer a less visible option.

Blood sugar monitoring

You or your child will need to check and record your child's blood sugar at least four times a day. Blood sugar also is called glucose. Typically, blood sugar needs to be checked before every meal and at bedtime. Sometimes you may need to take a test during the middle of the night. If your child doesn't use a continuous glucose monitor, you may need to test more often.

Frequent testing is the only way to make sure that your child's blood sugar level stays within the target range.

The goal is to keep the blood sugar level as close to target levels as possible to delay or prevent complications. Generally, the goal is to keep the daytime blood sugar levels before meals between 70 and 130 mg/dL (4.44 to 7.2 mmol/L). After-meal numbers should be no higher than 180 mg/dL (10 mmol/L) two hours after eating.

Continuous glucose monitoring

Continuous glucose monitoring (CGM) devices check blood sugar levels automatically every few minutes using a small sensor placed under the skin. Blood sugar levels also are called blood glucose levels. Some CGM devices display readings continuously on a smartphone, smartwatch or receiver. Others require scanning the sensor to get a reading.

Closed loop system

A closed loop system combines a continuous glucose monitor with an insulin pump. The two devices communicate with each other to adjust insulin delivery automatically based on your child's blood sugar levels. Blood sugar also is called glucose. This helps keep blood sugar more stable throughout the day and night.

You may hear this called an automated insulin delivery (AID) system or an artificial pancreas. And you may hear this called a hybrid closed loop because it still needs input from you or your child. You or your child needs to enter information such as how many carbohydrates your child eats and confirm glucose readings.

Technology is improving quickly, and more advanced systems are currently being tested in clinical trials.

Healthy eating

Eating well is a key part of managing type 1 diabetes, but your child doesn't need a special or strict diet. In fact, the meals can look just like what the rest of the family eats. A healthy diet should regularly include foods that are high in nutrition and low in fat and calories, such as:

• Vegetables.
• Fruits.
• Lean protein, such as chicken, fish and tofu.
• Whole grains, such as whole-wheat bread and brown rice.

Your child's registered dietitian can help you create a meal plan that fits your child's food needs and food preferences. The dietitian also can show you how to count carbohydrates, which is important when deciding how much insulin your child needs, especially around mealtimes. When eating well, occasional treats can still be part of the plan.

Physical activity

Everyone needs regular exercise, and that includes kids with type 1 diabetes. Try to make regular physical activity part of your child's daily routine. Aim for at least 60 minutes of movement every day. If possible, be active together as a family.

Keep in mind that exercise affects blood sugar levels. This effect can last for several hours or even overnight. You may need to adjust your child's food or insulin to keep blood sugar steady after physical activity.

When your child starts a new activity or sport, check blood sugar more often until you understand how their body responds.

Handling everyday challenges

Blood sugar can change for many reasons. Frequent blood sugar checks during challenging times can help find problems and guide treatment. Talk with your child's diabetes care team for advice on how to manage situations such as:

• Picky eating. If your child takes insulin before a meal but doesn't finish eating, their blood sugar may drop too low. Your child's care team can help you plan for this, especially with young children.
• Illness. When your child is sick, insulin needs may change. Illness can raise blood sugar due to stress hormones. But if your child eats less or vomits, that may mean less insulin is needed. Make sure your child gets a flu shot every year. Talk to your child's care team about the pneumonia vaccine and the COVID-19 vaccine if your child is age 5 or older.
• Growth spurts and puberty. As your child grows, insulin needs can change quickly. Hormones during puberty, especially around menstrual periods, also can affect blood sugar.
• Sleep. Blood sugar can drop overnight. You may need to adjust bedtime snacks or insulin doses to help prevent nighttime lows.
• Temporary changes in routine. Life doesn't always go as planned. When schedules change, such as during vacations, holidays or special events, check your child's blood sugar more often.

Ongoing medical care

Your child needs regular checkups to help manage diabetes and stay healthy. These appointments are a chance to review your child's blood sugar patterns, insulin needs, eating habits and physical activity.

At each visit, your child's healthcare professional will check your child's A1C level. This is a blood test that shows the average blood sugar over the past three months. The American Diabetes Association typically recommends an A1C of 7% or lower for most children and teens with diabetes.

Your child's healthcare professional also will regularly check for other important health markers, including:

• Blood pressure.
• Growth and development.
• Cholesterol levels.
• Thyroid function.
• Liver function.
• Kidney function.
• Foot health.
• Eye health.

These regular checks help catch problems early and make sure your child's treatment plan continues to meet their needs as they grow.

Signs of trouble

Even with careful diabetes management, problems can still happen. Some complications of type 1 diabetes can become serious very quickly and need fast treatment. These include:

• Low blood sugar, also called hypoglycemia.
• High blood sugar, also called hyperglycemia.
• Diabetic ketoacidosis (DKA).

Low blood sugar

Low blood sugar means your child's blood sugar has dropped below their target range. The medical term for low blood sugar is hypoglycemia. This can happen if your child skips a meal, is more active than usual or takes too much insulin. Mild low blood sugar is common in people with type 1 diabetes. But if low blood sugar isn't treated quickly, symptoms can get worse.

Symptoms of low blood sugar may include:

• Shakiness.
• Hunger.
• Sweating.
• A change in skin color. Skin may look pale, dull or gray depending on your child's skin color.
• Mood swings or irritability.
• Trouble focusing or confusion.
• Dizziness.
• Loss of coordination.
• Slurred speech.
• Passing out.
• Seizures.

What to do

Teach your child what low blood sugar feels like. It's important to treat low blood sugar right away. When in doubt, test blood sugar. If a test isn't available and your child has symptoms, treat for low blood sugar right away. Then test as soon as possible.

Steps to treat low blood sugar:

• Give a fast-acting carbohydrate. Have your child eat or drink 15 to 20 grams of a fast-acting carbohydrate, such as fruit juice, regular (not diet) soda, glucose tablets, or hard candy or another source of sugar. Avoid chocolate and ice cream. They don’t work as quickly because of their fat content.
• Test again. After 15 minutes, check blood sugar again. If it's still low, repeat giving a fast-acting carbohydrate and test again in 15 minutes. If it's still low, repeat giving a fast-acting carbohydrate and testing in 15 minutes until you get a reading in your child's target range.
• Follow with a snack or meal. Once blood sugar is back in the target range, give your child a healthy snack or a meal to help prevent another low blood sugar level.

If your child passes out from low blood sugar, they may need a shot of glucagon, a medicine that raises blood sugar. Ask your child's care team how and when to use it.

High blood sugar

High blood sugar means your child's blood sugar is higher than the target range. This can happen for several reasons, including being sick, eating too much, eating certain foods and not taking enough insulin.

Symptoms of high blood sugar include:

• Needing to pee often.
• Feeling very thirsty or having a dry mouth.
• Blurred vision.
• Feeling tired.
• Feeling sick to the stomach.

If you think your child has high blood sugar, check their glucose level. If it's high, follow your child's diabetes care plan or contact your child's healthcare professional. High blood sugar doesn't drop quickly, so ask how long to wait before checking again.

If your child's blood sugar is above 240 mg/dL (13.3 mmol/L), use a ketone test kit that you can buy without a prescription to check for ketones in their urine or blood. If there are ketones, follow your child's care plan. If there are ketones and your child feels sick, call your child's healthcare professional right away. This may be a sign of diabetic ketoacidosis, often shortened to DKA.

Diabetic ketoacidosis (DKA)

DKA is a serious and dangerous condition. It happens when the body doesn't have enough insulin and starts breaking down fat for energy. This makes ketones, which can build up in the blood, creating a potentially life-threatening condition.

Symptoms of DKA include:

• Extreme thirst or very dry mouth.
• Needing to pee more than usual.
• Dry, flushed skin.
• Nausea, vomiting or stomach pain.
• A sweet, fruity smell on your child's breath.
• Confusion or trouble thinking clearly.

If you think your child may have DKA, test for ketones right away using a urine or blood ketone test. If the ketone levels are high, call your child's healthcare professional right away or seek emergency care.

Managing type 1 diabetes takes effort every day, around the clock. It involves big changes to daily routines. But careful management of type 1 diabetes helps your child stay healthy and lowers the risk of serious complications.

As your child grows, help them learn how to take care of themselves. This includes:

• Taking a more active role in managing diabetes.
• Understanding that diabetes care is lifelong.
• Learning how to check blood sugar and take insulin.
• Making healthy food choices.
• Staying active and moving every day.
• Building a good relationship with their diabetes care team.
• Wearing a medical ID that shows they have diabetes.

These healthy habits will help your child stay strong and active for years to come.

School and diabetes

Work with your child's day care, school nurse and teachers so they know how to help with diabetes care. This includes knowing the signs of low or high blood sugar. And it includes knowing when to check blood sugar levels and when to give insulin.

Under federal law, children with diabetes have the right to support at school. Schools must make reasonable adjustments to help children learn safely and fully participate in school activities.

Ask your child's healthcare professional

Don't wait for your next appointment to ask for help if you have questions or concerns. Reach out to your child's healthcare professional, certified diabetes care and education specialist, or registered dietitian. They can help you troubleshoot challenges and adjust the care plan as needed.

Managing your child's diabetes can feel overwhelming, and that's OK. Some days will go smoothly, and other days will be frustrating. No one can manage diabetes perfectly all the time. What matters most is doing your best and knowing that your efforts make a big difference. And remember, you don't have to do this alone. Your child's diabetes care team is here to help.

Your child's emotions

Diabetes doesn't just affect the body, it can affect emotions too.

• When blood sugar is too high or too low, it can cause mood swings or irritability.
• Kids may feel different from their peers because they have to check blood sugar and take insulin.
• Connecting with other children who have diabetes can help your child feel less alone and more confident. Ask your child's care team about local meetups or diabetes camps in your area.

Mental health and risky behaviors

Children and teens with diabetes are more likely to experience anxiety, depression, and diabetes burnout or frustration. That's why some diabetes specialists regularly include a mental health professional, such as a social worker or psychologist, who can support your child emotionally.

Watch for signs of mental health concerns, especially in teens, such as feeling sad most of the time. Also watch for changes in sleep, appetite, friendships and school performance. If you see signs that worry you, talk to your child's care team about screening for depression or other issues.

Rebellion also may be an issue, especially for teens. A child who has been good about sticking to their diabetes treatment plan may rebel in the teen years by ignoring diabetes care.

Also, be aware that the use of alcohol, drugs or tobacco products can be more risky for young people with diabetes compared to those who don't have the condition. Talk openly with your child or teen about these dangers and offer support through this stage of life.

Support groups and counseling

It helps to talk with others who understand what you're going through. Support groups for both children and parents can offer connection, encouragement and practical tips.

• Children's support groups help kids feel understood and less alone.
• Parent support groups give caregivers a space to share their concerns and learn from others.
• Talking to a counselor or therapist also can help you or your child cope with the emotional impact of diabetes.

Ask your child's care team for recommendations, or explore support through these websites:

• American Diabetes Association (ADA). Offers resources and support for children and teens with diabetes.
• Juvenile Diabetes Research Foundation (JDRF). Provides support, education and community programs.

Looking ahead

It's normal to worry about the long-term effects of diabetes. But when you and your child work together with your child's diabetes care team and follow a treatment plan, you prepare your child to lead a full, healthy and active life. You're building skills and habits that help your child now and in the future.

Your child's regular healthcare professional likely will be the one to diagnose type 1 diabetes. Your child may need to stay in the hospital to get blood sugar under control if it's very high.

After the diagnosis, your child will most likely be cared for by a doctor who specializes in children's diabetes care, called a pediatric endocrinologist. Your child's diabetes care team also typically includes a certified diabetes care and education specialist, a registered dietitian, and a social worker. These experts help you and your child learn how to manage diabetes and adjust to your new routines.

What you can do

Before your appointment take these steps:

• Make a list of any concerns you have about your child's health and diabetes care.
• Bring a family member or friend along. Managing diabetes involves a lot of information. Having someone else with you can help you remember everything.
• Make a list of questions to ask your child's healthcare professional. Ask for a referral to a certified diabetes care and education specialist and a registered dietitian. They can give you more support and help you create a care plan that works for your family.

Topics you may want to talk about:

• How and when to check your child's blood sugar.
• Using a continuous glucose monitor (CGM).
• Insulin, such as types, how much to give and when.
• Giving insulin, such as using a syringe, pen or pump.
• How to treat low blood sugar.
• How to manage high blood sugar.
• Testing for ketones and what to do if they're high.
• Healthy eating and how different foods affect blood sugar.
• How to count carbohydrates.
• How to adjust insulin or food for exercise.
• How to handle diabetes at school, daycare, sleepovers, holidays and during illness.
• How often to see healthcare professionals.

What to expect from your doctor

Your child's healthcare professional will ask you a number of questions to better understand your needs. These might include:

• How comfortable are you with managing your child's diabetes?
• How often does your child have low blood sugar episodes?
• What does your child typically eat in a day?
• How often does your child get physical activity?