Diabetes is one of the most common diseases in school-aged children.
About 208,000 young people in the US under age 20 had diabetes in 2012. Both type 1 and type 2 diabetes are increasing in U.S. children and adolescents.
Type 1 diabetes accounts for most of the cases of diabetes in children less than 10 years of age. As more children and adolescents in the United States become overweight or obese and inactive, type 2 diabetes is occurring more often in young people aged 10 or older.
Type 2 diabetes is more common in certain racial and ethnic groups such as African Americans, American Indians, Hispanic/Latino Americans, and some Asian and Pacific Islander Americans.
What can I do to help my child?
What are the symptoms of diabetes?
Type 1 diabetes mostly has an acute onset, with children and adolescents usually able to pinpoint when symptoms began.
Onset can occur at any age.
Children and adolescents may present with ketoacidosis as the first indication of type 1 diabetes. Type 2 diabetes usually develops slowly and insidiously.
The immunologic process that leads to type 1 diabetes can begin years before the symptoms of type 1 diabetes develop.
Early symptoms, which are mainly due to hyperglycemia, include increased thirst and urination, constant hunger, weight loss, and blurred vision.
Children also may feel very tired.
Some children or adolescents with type 2 diabetes may show no symptoms at all. In others, symptoms may be similar to those of type 1 diabetes. A youth may feel very tired, thirsty, or nauseated and have to urinate often. Other symptoms may include weight loss, blurred vision, frequent infections, and slow healing of wounds or sores. Some youth may present with vaginal yeast infection or burning on urination due to yeast infection.
Do I need to change my child’s diet?
Yes. Children or adolescents and their families should learn how different types of food – especially carbohydrates such as breads, pasta, and rice – can affect blood glucose levels.
Portion sizes, the right amount of calories for the child’s age and activity level, and ideas for healthy food choices at meal and snack time also should be discussed, including reduction in soda and juice intake.
Family support for following the meal plan and setting up regular meal times are keys to success, especially if the child or teen is taking insulin. All people with diabetes are advised to avoid “liquid carbs (carbohydrates)” such as sugar-containing soda, sports or energy drinks, juices (including 100 percent fruit juice), and regular pancake syrup. These liquid carbs raise blood glucose rapidly, contain large amounts of sugars in small volumes, are hard to balance with insulin, and provide little or no nutrition.
Children receiving fixed insulin doses of intermediate- and rapid-acting insulins must have food given at the time of peak action of the insulin. They need a consistent meal plan that aims for a set amount of carb grams at each meal (e.g., 60 grams of carbs at lunch) and snack since they do not adjust their mealtime insulin for the amount of carb intake.
Carb counting involves calculating the number of grams of carbohydrate, or choices of carbohydrate, the youth eats. One carb choice equals 15 grams of carbohydrate. Sources of carbs include starches (breads, crackers, cereal, pasta, rice), fruits and vegetables, dried beans and peas, milk, yogurt and sweets. In addition to the amount of insulin needed to cover the carbs (called the carb dosage), extra insulin might be needed if the youth’s blood glucose is above the target range before a meal or snack.
What kind of medications my child will need?
If your child has type 1 diabetes, he or she needs insulin shots which help lower the blood sugars. Sometimes your child may need insulin pump which delivers the insulin slowly into the body. If your child has type 2 diabetes, then they may need oral medications or insulin.
In addition to medications, nutrition management, physical activity, blood glucose testing, and the development of strategies to avoid hypoglycemia and hyperglycemia that may lead to DKA are as important as medications.
What is hypoglycemia and how do I manage it in my child?
Diabetes treatment can sometimes cause hypoglycemia (low blood glucose levels). Taking too much insulin, missing a meal or snack, strenuous exercise, or illness may cause hypoglycemia. In addition, hypoglycemia can occur with no apparent cause.
When hypoglycemia is recognized, the child should drink or eat 15 grams of a glucose-containing carbohydrate source to quickly raise the blood glucose to normal levels. Examples of 15grams of carbohydrate include 3 or 4 glucose tablets, or 4 ounces of fruit juice (not low-calorie or reduced sugar).
Further adjustment of insulin or food intake may be made based on anticipation of special circumstances such as increased exercise or acute illness. Children on these regimens are expected to check their blood glucose levels routinely before meals and at bedtime.
Click for more information on managing low blood sugars.
What type of blood tests and other tests my child needs?
If the child has type 1 diabetes, he or she may need blood sugar checked 3-4 times a day. Your child may also need a blood test called A1c (checks the average blood sugar level over the past 2-3 months) on a regular basis.
For children with type 1 diabetes, the first ophthalmologic examination should be obtained once the child is 10 years of age or older and has had diabetes for 3 to 5 years. In type 2 diabetes, the initial examination should be shortly after diagnosis.
For children with type 1 diabetes, annual screening for microalbuminuria should be initiated once the child is 10 years of age and has had diabetes for 5 years. In type 2 diabetes, annual screening should be considered at diagnosis. Screening may be done with a random spot urine sample analyzed for microalbumin-to-creatinine ratio.
Children with diabetes should have a lipid profile at puberty (greater than 10 years) or at diagnosis, if less than 10 years, after glucose control has been established. If lipids are abnormal, monitor annually.
What about the physical activity of the child?
Children with diabetes need regular physical activity, ideally a total of 60 minutes each day. Physical activity helps to lower blood glucose levels and increase insulin sensitivity. Physical activity is also a good way to help children control their weight.
In children with type 1 diabetes, the most common problem encountered during physical activity is hypoglycemia. If possible, a child or a teen should check blood glucose levels before beginning a game or a sport. If blood glucose levels are too low, the child should not be physically active until the low blood glucose level has been treated.
How do I manage blood sugar at school?
Children with diabetes––depending on their age and level of maturity––will learn to take over much of their care. Most school-age children can recognize symptoms of hypoglycemia and monitor blood glucose levels. They also participate in nutrition decisions. They often can give their own insulin injections but may not be able to draw up the dose accurately in a syringe until a developmental age of 11 to 12 years.
School principals, administrators, nurses, teachers, coaches, bus drivers, health care professionals, counselors, and office and lunchroom staff all play a role in helping students with diabetes succeed. Accommodations may need to be made in the classroom, with physical education, on field trips, and/or for after-school activities. Written plans outlining each student’s diabetes management help students, their families, school staff, and the student’s health care providers know what is expected of them.