Treatment for children with diabetes is a team effort that often involves caregivers, family members, school personnel, and a diabetes health care team. Individual treatment depends on the type of diabetes and the fluctuation of blood sugar levels. However, by eating properly, exercising, and taking medications and/or insulin as directed, most children can manage diabetes quite effectively.
One of the biggest adjustments for a child who has diabetes involves consistent testing of blood sugar levels. Children with type 2 diabetes often must test twice a day; those with type 1 may need to test 3 or 4 times a day, or even more. Blood sugar readings help determine how much insulin is needed or whether an adjustment in food intake is necessary.
There are many blood sugar meters on the market and a physician can help parents determine which is best suited for the child. Usually, testing blood sugar involves a quick finger prick using a sharp instrument called a lancet. The resulting drop of blood is then placed on a test strip, which is inserted into the meter. The meter provides the reading immediately. Another type of test, called the hemoglobin A1C check, can provide information about blood sugar readings over the course of the past 3 months.
Keeping blood sugar under control is a balancing act. Certain foods can cause blood sugar levels to rise (e.g., foods high in carbohydrates) and insulin and physical activity can make levels fall. These ups and downs must be considered when planning the child's menus, exercise, and medicine.
Diet is an important aspect of diabetes management. Children can eat a variety of foods, but must be careful about balancing carbohydrates, proteins, fats, and other nutrients. For example, carbohydrates increase blood sugar much more than proteins and fats do. A licensed dietician can guide parents on proper food choices. Often, meal plans for children with diabetes include snacks in between meals to prevent blood sugar levels from fluctuating too much. For special occasions, management sometimes can be adjusted to allow the child to have birthday cake or holiday cookies.
Physical activity is also important in diabetes management. Regular exercise can help control weight and maintain overall health, helping to reduce diabetes complications. However, some children with diabetes must check their blood sugar readings before or after exercise, and must have snacks or insulin on hand in case of unexpected fluctuations in blood sugar.
Children who have diabetes must watch out for low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia). Both cases require adjustments in glucose and a child who experiences symptoms, such as heart palpitations, anxiety, sweating, headache, extreme thirst, dry mouth, or increased urination, should tell an adult immediately. Parents and caregivers should monitor young children with diabetes for these symptoms.
Because the pancreas can no longer produce insulin, children with type 1 diabetes need insulin injections for the rest of their lives. Currently, injection (either through a needle or an insulin pump) is the only way to administer insulin. It cannot be taken in pill form because the digestive system would break it down, making it useless. Some children with type 2 diabetes also need insulin, but others can manage blood sugar effectively through medication, diet, and exercise.
Children with diabetes often become frustrated with constant blood sugar checking and meal planning. Some may be frightened at the thought of insulin injections. Others may not want to participate in their treatment plan because it makes them feel different from other children. Parents, caregivers, and physicians should let children know that controlling their blood sugar will help them feel well and allow them to participate in activities just like other kids. Connecting with other children who have diabetes can help them feel less alone.
There are several different types of insulin used to treat type 1 diabetes in children. Insulin can be classified by how long it takes to start working (onset), by when it works hardest to reduce blood sugar levels (peak), and by how long it works (duration). The effects of insulin vary from child to child and from day to day, so it is important to check blood glucose levels regularly.
Types of insulin include rapid-acting insulin (begins working in 1015 minutes, peaks in about 3090 minutes, and lasts about 4 hours), short-acting insulin (begins working in 3060 minutes, peaks in about 24 hours, and lasts 69 hours), intermediate-acting insulin (begins working in 14 hours, peaks in about 314 hours, and lasts 1024 hours), and long-acting insulin (begins working in 14 hours, does not peak, and lasts 1824 hours).
In children with type 2 diabetes, physicians may prescribe an oral medication to help the body produce more insulin or use insulin more efficiently. These medications also may help children with diabetes lose weight and help lower blood cholesterol levels.
Many oral medications that are used to treat adults with type 2 diabetes have not been studied in children. Medicines that may be used in children include metformin (e.g., Glucophage) and combination metformin and glyburide (e.g., Glucovance). Side effects include appetite loss, changes in taste, upset stomach, abdominal pain, vomiting, and diarrhea. In most cases, these side effects are less severe when the medication is taken with food.
Extremely low blood glucose levels in a child with diabetes may cause a medical emergency. If the child experiences confusion, seizures, or a loss of consciousness, call 911 and administer a medication called glucagon. This medicine, which is given by injection, raises the child's blood sugar level quickly. All parents and caregivers of children with diabetes should have access to glucagon and should know how to administer this medication.