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Type 1 Diabetes in Kids--What Parents Need to Know

More kids are being diagnosed with juvenile diabetes. Here’s how to manage the disease and keep your kid healthy.

Type 1 Diabetes in Kids--What Parents Need to Know

Photo: iStockphoto

“We just thought he had a stomach bug,” Rebecca Cook recalls, thinking back to the day two years ago when her only child, 10-month-old Theo, became ill. “He was throwing up, seemed really thirsty and was peeing a lot.” But then Theo took a turn for the worse. “He started doing this strange breathing pattern and he was actually borderline unconscious.”

Cook and her husband called the public health nurse who got an ambulance to bring their limp, non-responsive son to Janeway Children’s Health & Rehabilitation Centre ER in St. John’s. A blood test conducted by the paramedics revealed that Theo had type 1 diabetes. His extreme thirst and vomiting were classic signs of the disease, which can also include symptoms such as extreme tiredness, frequent urination and sudden weight loss despite constant hunger.

“We were shocked,” Cook says. “It all happened so fast. In a matter of 24 hours, we went from thinking he had a stomach bug to realizing he has a lifelong illness.”

What Causes Type 1 Diabetes?

Diabetes occurs when the body is unable to produce or respond to insulin, the hormone that is produced by the pancreas and is needed to convert glucose (sugar) into energy. In type 1, the immune system destroys the cells that make insulin, causing insulin production to cease, explains Diane Wherrett, a paediatric endocrinologist at Toronto’s Hospital for Sick Children. With type 2 diabetes, the pancreas continues to produce insulin, but for reasons we don’t completely understand, the body doesn’t respond to it.

If left untreated, both illnesses cause glucose to build up in the bloodstream, which damages blood vessels, leading to complications such as heart disease, blindness and nerve damage. Prior to the discovery of insulin, most type 1 diabetics died within months of developing the illness. But today, Wherrett says, “With well-managed diabetes, the prospect of a long and healthy life is excellent."

Prior to her son’s diagnosis, Cook admits that she knew little about type 1 diabetes. The week after the diagnosis, while Theo was stabilized in the hospital, she and her husband were given a crash course in how to give insulin injections, how to check their son’s blood sugar and how to watch for signs that it was too high or low.

The Rise in Type 1 Diabetes

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While Theo, now three, developed the disease at an unusually young age, his diagnosis is not rare. According to Diabetes Canada, an estimated 36,000 Canadians under 20 have the disorder, a figure that Munier Nour, a paediatric endocrinologist at the University of Saskatchewan, says is steadily rising.

Studies have found that type 1 diabetes has been increasing by one to five percent every year in Canada. JDRF, a research funding organization that aims to bring an end to type 1 diabetes, reports that globally, the disease has been doubling in incidence about every 20 years, and that Canada has the sixth-highest incidence in children 14 years and younger.

What is Causing the Rise in Type 1 Diabetes?

There’s currently no agreed upon reason for why this increase is happening, says Nour. Because northern countries have the highest rates of the disease, some experts suspect there is a connection with a lack of vitamin D. Another theory, called the hygiene hypothesis, suggests that reduced exposure to germs may be to blame.

Nour explains that rates of type 1 diabetes are highest in developed nations, where children are exposed to fewer of the microbes that some suspect are needed to develop a healthy immune system. “The theory is that living in a sterile environment may lead to more autoimmune conditions such as type 1,” says Nour. And there does seem to be a genetic link.  “About 15 percent of people who have type 1 have a family member who has type 1,” says Wherrett.

Young boy pricking his finger with an insulin pen iStock

Is Type 2 Diabetes Also on the Rise in Kids?

Type 2 diabetes is also on the rise in kids. Nour says that, 20 years ago, it was almost unheard of in children, but a 2010 study found that there are 1.54 cases of type 2 diabetes per 100,000 Canadian kids. “That increase is largely the result of the obesity epidemic,” says Nour, explaining that being overweight is a key trigger for the illness.

What are the Potential Long-term Complications of Type 1 Diabetes in Children?

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Dr. Erika Lundgrin, MD, an assistant professor at Case Western Reserve University, if type 1 warns that uncontrolled type 1 diabetes in children can result in severe health complications.

“The moment we accumulate sugar within the body, it can create problems for our eyes, kidneys, and other parts of the body. If we don't control the blood sugar, the sugar will start burning the body's tissue, damaging the vessels and creating other long-term health issues,” she tells Today’s Parent. Psychological impacts, including stress, anxiety, and depression, can result from untreated type 1 diabetes in children, as indicated by a 2014 systematic review published in the Current Diabetes Report.

How is Type 1 Diabetes Diagnosed in Children?

Dr. Lundgrin states that type 1 diabetes is typically identified through symptoms such as frequent urination, thirst, unexplained weight loss, and poor wound healing, which are indicative of high blood sugar. These symptoms are then confirmed through lab tests that show high blood glucose and a lack of insulin. However, type 1 diabetes can also be detected before symptoms appear if two or more pancreatic antibodies are found in the blood. “Early detection allows for prompt treatment and the prevention of complications related to diabetes”, says Dr. Lundgrin.

How Can I Talk to My Child About Their Type 1 Diabetes Diagnosis?

If a child is diagnosed with type 1 diabetes, parents may find it difficult to break the bad news to their child. This is why Dr. Ilan Shapiro, MD, chief health correspondent and medical affairs officer at AltaMed Health Services, stresses the need for parents to initially gather all the information from their healthcare provider.

After that, it is essential to ensure that your child comprehends what the diagnosis entails and most importantly, that it is not a burden or something that will lead to a poor quality of life. “In the past, a Type 1 diabetes diagnosis was a burden,” says Dr. Shapiro. “Now, patients who have a great healthcare team, alongside a supportive family can help the child thrive and live healthy. New technology that controls and monitors sugar levels can also improve the quality of life.”

parent helping child prick their finger to test blood sugar levels iStock

How Often Should My Child See Their Healthcare Provider for Type 1 Diabetes?

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Following a diagnosis of type 1 diabetes, Dr. Lundgrin highlights the need for support and education for both the patient and their family. “It is essential for all involved to learn about the operation of the patient's required machines and tools, the mechanics of insulin, and how to sustain a healthy lifestyle,” says Dr. Lundgrin.

In addition, regular physician appointments are recommended to devise a plan for properly regulating the child's blood sugar levels. According to Dr. Lundgrin, this plan will be greatly influenced by the control of the sugar levels and the management of the patient's diabetes by their health team.

What is the Treatment for Type 1 Diabetes?

Type 1 diabetes may not have a cure, but it does have a proven treatment: injections of synthetic insulin that are usually administered three or more times a day. Unfortunately, insulin and other necessary supplies such as blood sugar testing strips aren’t cheap. According to Diabetes Canada, those items can run someone without private health insurance for more than $5,000 a year.

About 70 percent of Theo’s diabetes-related expenses are covered by Cook’s workplace health insurance. She considers herself lucky to have that coverage. Some families struggle to pay for diabetic supplies out of pocket. While some financial assistance is available, it varies greatly across the country and isn’t comprehensive. For example, some provinces might cover the cost of insulin for low-income families, but not the cost of the needles needed to inject it.

Currently, Theo receives four injections a day—two in the morning, one at dinner and one before bed. Until recently, receiving those needles didn’t faze him, but that’s changing. “Lately, he’s started to really hate the injections,” says Cook, who believes that as Theo grows up, he is becoming more aware of his body and feelings. “Now he’s like, ‘No mommy. Hurts.’”

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Theo’s growing complaints about injections have Cook seriously considering switching to an insulin pump in the next 12 to 18 months. Worn under clothing, this small device delivers insulin to the body via a thin tube placed under the skin, usually in the abdomen, eliminating the need for needles. While expensive, all provincial and territorial healthcare plans cover insulin pumps, though some regions cap the amount of funding or restrict it to individuals who meet specific criteria.

“We use insulin pumps for all ages, though often the age of switching to a pump is when a child is more independent in their ability to operate it,” says Wherrett. That way, children can tell the pump how much carbohydrates they are consuming so the pump can use that information, along with their blood sugar, to calculate the dose of insulin required. To help make the math a little easier, Wherrett says, “Parents will label their child’s lunch with things like, ‘Your sandwich is 30 grams of carbohydrates.’”

Can You Test and Monitor Blood Sugar at Home?

According to a 2023 article by Diabetes Canada, there are multiple methods for testing and monitoring blood sugar at home, including the use of a blood glucose meter, flash glucose meter, and continuous glucose monitor.

Parents of kids with diabetes also need to keep a close eye on blood sugar, which is done by pricking a finger to test a drop of blood with specialized strips and a meter before every insulin dose and sometimes more often. Because of Theo’s young age and his unpredictable eating habits, the Cooks must check his blood every four or five hours—even during the night.

What Is a Normal Blood Sugar Range for a Child with Type 1 Diabetes?

It is Dr. Shapiro's recommendation that a child's blood sugar should generally be below 100 mg/dL. This is why it is important to monitor A1C levels to ensure that blood sugar levels remain within a healthy range (80-100 mg/dL after meals and should not exceed 180 mg/dL two hours after eating).

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“A1C level tracks the body's blood sugar level for three months and can give a clear picture if the sugar is being used by the body correctly,” explains Dr. Shapiro. “With new devices, physicians can now measure the patient's blood sugar level down to the minute, making sure it's maintained at a healthy level.”

young girl checking her insulin patch on her arm with a phone iStock

What Should My Child's Diet Look Like with Type 1 Diabetes?

While injections and finger pricks can be painful, getting kids to eat properly and monitor their carbohydrate consumption are the bigger challenges for many parents, particularly as kids become more independent. “Parents will come in and say, ‘My child is sneaking candy,’” recounts Wherrett. She explains that contrary to popular belief, kids with type 1 diabetes can eat ice cream, birthday cake and other sugary foods. “They just need to know how much carbohydrates are in the treat and make sure that they’ve taken enough insulin.”

Tasks such as counting carbs mean that if Theo were to attend daycare, he would require his own dedicated worker. Cook, who is an HR consultant, ended up putting her plans to return to work full-time on hold and instead now works a part-time schedule. Three days a week, her parents, who have been trained in diabetes management, watch Theo.

In addition to keeping an eye on carbs, a 2023 article published by the University of Florida Diabetes Institute advises ensuring that your child is consuming adequate amounts of protein and fat, as these play a role in blood sugar levels. To meet your child’s protein and fat needs, The American Diabetes Association (ADA)suggests incorporating foods like fish, seafood, chicken, beans, and nuts into your child's diet.

How Does Exercise Affect Children with Type 1 Diabetes?

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Exercise is also important in assisting your child in controlling type 1 diabetes, as Dr. Shapiro emphasizes that "exercise is a crucial factor in maintaining a healthy body. We advise children with Type 1 diabetes to continue exercising as part of their health regimen."

However, it is important to ensure that your child exercises safely, as fluctuations in blood glucose levels can occur during or after physical activity. To avoid this, the American Diabetes Association recommends checking your child's blood sugar before exercising, considering the intensity of the workout, and offering a pre-exercise snack if necessary.

How Can I Help My Child Manage Their Diabetes at School?

Even though school is still a couple of years away for Theo, Cook has already started reaching out to local schools in an effort to find one that has experience with diabetic students. Once they choose one, a diabetes educator or public health nurse will teach relevant staff about how Theo’s illness should be managed and create a personalized diabetes management and emergency plan—a practice that’s mandated in several provinces. Some parents choose to (or are forced to) homeschool their child with type 1 diabetes.

While Cook realizes that Theo’s diagnosis has the potential to lead to serious health problems, she prefers to focus on the present. “We try not to dwell too much on the negative things or even what the challenges are,” she says. “We really just move forward with each day as a new day.”

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Experts:

  • Diane Wherrett, a paediatric endocrinologist at Toronto’s Hospital for Sick Children
  • Munier Nour, a paediatric endocrinologist at the University of Saskatchewan
  • Dr. Erika Lundgrin, MD, an assistant professor at Case Western Reserve University
  • Dr. Ilan Shapiro, MD, chief health correspondent and medical affairs officer at AltaMed Health Services
This article was originally published on Sep 07, 2017

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