Type 1 diabetes in children

Diagnosis

The following will help healthcare provider in diagnosis and providing appropriate treatment for monitoring and management of diabetes type 1 in children:

• Physical examination: The healthcare provider will assess about the child’s symptoms and medical background as well as the family’s health history.
• Random blood sugar test: Blood sample is obtained at a random time. Diabetes is indicated by a blood sugar level of 200 mg/dL (11.1 mmol/L) or greater and by the presence of symptoms.
• Glycated hemoglobin (A1C) test: This test reveals the child’s three-month average blood sugar level. Diabetes is diagnosed when two separate tests show an A1C level of 6.5% or above.
• Fasting blood sugar test: The child will fast for at least eight hours or overnight before having a blood sample drawn. An indication of type 1 diabetes is a fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or greater.

Additional testing will be recommended if blood sugar indicates diabetes. These tests will determine between type 1 diabetes and type 2 diabetes as each kind has a different course of treatment. Blood tests to look for antibodies that are frequently found in type 1 diabetes are among the additional examinations.

Treatment

Parents and the diabetes care team for their child will work closely. Maintaining the child’s blood sugar within a target or normal range is the goal of the treatment. This target range helps in maintaining the child’s blood sugar level as closely as possible to normal.

The child’s blood sugar target range will be disclosed by the child’s healthcare provider. As the child grows, the range might change.

Type 1 diabetes is treated with the following:

• Insulin: Type 1 diabetic children must get lifetime care with one or more types of insulin:
  • Rapid-acting insulin: Within 15 minutes, this kind of insulin begins to function. It lasts about 4 hours and achieves its peak effect about 60 minutes. This kind is frequently taken 15 to 20 minutes before meals. Lispro (Humalog, Admelog), aspart (NovoLog, Fiasp), and glulisine (Apidra) are three examples.
  • Short-acting insulin: Often known as regular insulin, begins to function about 30 minutes after injection. It lasts between 4 and 6 hours and reaches its peak effect around 90 to 120 minutes. Human insulin (Humulin R, Novolin R) is an example.
  • Intermediate-acting insulin: Which is also known as NPH insulin, begins to function in 1 to 3 hours. It takes 6 to 8 hours to attain its peak effect and lasts 12 to 24 hours. NPH insulin (Humulin N, Novolin N) is one example.
  • Long- and ultra-long-acting insulin: This kind of insulin may offer protection for up to 14 to 40 hours. Glargine (Lantus, Toujeo, etc), detemir (Levemir), and degludec (Tresiba) are among examples.

Insulin could be administered by the following:

• • Fine needle and syringe: The shot that you may get is similar to a regular shot but the syringe is smaller and the needle is considerably thinner and shorter.
  • Insulin pen with fine needle: The insulin-filled device that looks like an ink pen. There is an injection needle attached.
  • Insulin pump: This is a small device that could be worn on the outside the body and that may program to release a certain quantity of insulin at certain times of the day and during meals. A catheter that is implanted under the skin of the belly is connected by a tube to an insulin reservoir.

A tubeless pump option that includes inserting a small catheter beneath your skin and wearing a pod carrying the insulin on your body.

• Blood sugar monitoring: At least four times per day, either parents or the child must check and record the child’s blood sugar. Normally, parents or children check blood sugar levels before each meal, before going to bed, and occasionally in the middle of the night. However, if they do not have a continuous glucose monitor, it is then necessary for the parents or the child to frequently monitor. Frequent testing can guarantee that the child’s blood sugar level stays within the target range.
  • Continuous glucose monitoring (CGM): This device uses a temporary sensor implanted beneath the skin to measure blood sugar every few minutes. Some devices require users to run the receiver over the sensor to check their blood sugar, while others display the blood sugar measurement at all times on a receiver, their smartphone, or smartwatch.
  • Closed loop system: A continuous glucose sensor and an insulin pump that interact with one another to check blood sugar levels every five minutes. When the monitor shows that more insulin is needed, the device automatically administers the proper dosage or withholds it.

Although the device regulates insulin delivery throughout the day automatically, parents or the child must still specify how many carbohydrates are ingested and regularly check blood sugar levels.

• Healthy foods: Any diabetes treatment plan that involves food, but it does not mean that the child must follow a strict “diabetic diet.” The child’s diet should consistently include items that are high in nutrition and low in fat and calories, like vegetables, fruits, lean protein, or whole grains, just like the rest of the family.

Dietitians can assist the parents in developing a meal plan that takes into account the child’s dietary preferences, health objectives, and plans for occasional treats. The dietician will also show how to calculate the appropriate insulin doses by teaching how to count the carbohydrates in food.

• Physical activity: Everyone, even children with type 1 diabetes, needs regular aerobic activity. It’s important to keep in mind that exercise can impact blood sugar levels. After exercise, this impact on blood sugar levels may last for hours or even overnight. The child’s food plan or insulin dosage may need to be modified for the additional activity.

Include exercise in your child’s daily routine. Encourage the kid to exercise for at least 60 minutes per day, or better that parent’s join with their children during exercise. Before how the parents and child understand how the body responds to the new activity, check the child’s blood sugar more frequently than usual if they start a new activity.

Challenges

Sometimes, blood sugar levels can fluctuate unexpectedly. More frequent blood sugar testing can help in problem identification and treatment planning during these difficulties. Consult the diabetes treatment team about how to address these and other challenges:

• Picky eating: If they’ve previously gotten insulin for that food, it can be challenging if children with type 1 diabetes don’t finish what’s on their plates.
• lnIless: Children’s insulin requirements are impacted differently by illness. Although reduced carbohydrate intake due to nausea or poor appetite reduces the need for insulin, hormones generated during illness increase blood sugar levels. Every year, the child’s doctor will advise getting them vaccinated against the flu. The child may also be advised getting pneumonia and the COVID-19 vaccine.
• Growth spurts and puberty: When you think you have a handle on your child’s insulin requirements, he or she seems to sprout up overnight and stops taking adequate insulin. The need for insulin can also be influenced by hormones, especially in adolescent girls who are starting to menstruate.
• Sleep: It might be necessary to modify the child’s insulin schedule and snack timings to prevent issues with low blood sugar during the night.
• Changes in routine: Even with preparation, days don’t always go as planned. When plans unexpectedly alter, monitor blood sugar levels frequently. For holidays, special occasions, and vacations, make advance plans.

Ongoing medical care

For effective diabetes management, the child will require regular doctor visits. This may involve an analysis of the child’s food and physical activity habits, insulin requirements, and blood sugar trends. The A1C levels of your youngster are also examined by your healthcare provider. For all diabetic kids and teenagers, the American Diabetes Association generally advises an A1C of 7% or lower.

Additionally, your pediatrician will routinely examine:

• Growth
• Feet
• Eyes
• Blood pressure
• Cholesterol levels
• Thyroid function
• Kidney function