Clinical Reference Systems: Pediatric Advisor 10.0
Type 1 (Insulin-Dependent) Diabetes Mellitus
What is diabetes?
Diabetes is a disorder where the body does not make enough
of a hormone called insulin. Children with diabetes usually
urinate a lot, drink a lot of fluids, and lose weight.
Diabetes is also called insulin-dependent diabetes mellitus,
childhood diabetes, juvenile diabetes, or type 1 diabetes.
Childhood (type 1) diabetes mellitus should not be confused
with adult-onset (type 2) diabetes. People with type 2
diabetes can still produce insulin in regular amounts and
are treated differently.
What cause type 1 diabetes?
Insulin is a hormone produced by an organ in your body
called the pancreas. When food is digested, the body breaks
down much of the food into sugar (glucose). Blood carries
the sugar to the body's cells for energy. Insulin helps the
sugar enter the cells and controls the level of sugar in the
In type 1 diabetes destruction of cells in the pancreas
causes the pancreas to produce very little insulin. When
there is not enough insulin in the body, the amount of sugar
in the blood reaches very high levels. Too much sugar in
the body can cause many serious problems. If the problems
are not treated, they can be life-threatening.
Often it is not known why cells of the pancreas are
destroyed. There is a tendency for diabetes to run in
families. Destruction of pancreas cells could be the result
of an immune response, possibly triggered by a viral
What is the treatment?
Type 1 diabetes usually develops in childhood or early
adulthood and must be treated with insulin shots. With
treatment, blood sugar levels can be controlled.
- Initial test for diabetes
If you suspect your child has diabetes, call your
physician. If you want to test for diabetes before you
are able to see your doctor, you can purchase a simple
urine dipstick test called Keto-Diastix at a pharmacy.
Keto-Diastix can be used to check the level of sugar and
other chemicals in your child's urine. Call your
child's physician immediately if the test of the urine
- Education and diet
When a child is diagnosed with diabetes, there is a lot
the family must learn about the disease. This education
is usually done for 2 or 3 days at a children's diabetes
specialty clinic. Health care providers will teach you
what diabetes is and how to give shots of the proper
amounts of insulin to your child. You will learn how to
test for sugar in the blood and for ketones in the
urine. You will learn how to treat low blood sugar and
other procedures needed to keep your child healthy.
A dietician will teach you about food management. A
child with diabetes should not eat too many
carbohydrates, particularly between meals, and should
eat and snack consistently from day to day.
- Control of blood sugar levels
Home care involves balancing diet, exercise, and stress
with the correct dosage of insulin. Children with
diabetes must get insulin shots. The correct dosage of
insulin in the shots is not always the same. The dosage
must be adjusted according to the level of sugar in the
child's blood at the time of the shot. If a child gets
too much insulin, low blood sugar (hypoglycemia) could
result. Just as prevention of high blood sugar is
important, prevention of low blood sugar is also very
Most families use a home meter to measure the level of
sugar (glucose) in their child's blood three or four
times each day. After the age of 7 to 10 years, the
child can learn how to test blood sugar. Families also
learn how to give the insulin shots, and children can
learn when they are 10 or 11 years old to do their own
shots. Measuring blood sugar and giving insulin shots
at home allows the best adjustment of insulin dosages
and thus the best control of sugar in the blood.
Blood sugar levels measured when a child has not eaten
for at least 2 hours ("fasting blood sugar") should be
kept in the following ranges:
- Children under the age of 5 years: 100 to 200 mg/dL
(5.5 to 11.1 mmol/L).
- Children ages 5 to 11 years: 80 to 180 mg/dL (4.4 to
- Children over 12 years old: 70 to 150 mg/dL (3.9 to
- Follow-up visits with your child's doctor.
Your child's doctor will measure the overall glucose
control every 3 months with a test called the hemoglobin
A1c (HbA1c). If the HbA1c is kept in a good range, the
risk is greatly reduced for the eye, kidney, and nerve
problems that diabetes can later cause.
- Urine dipstick tests
It is important to keep urine dipstick tests (Ketostix
or Keto-Diastix) at home to measure ketones in the urine
when necessary. The urine must be tested if a child
with diabetes is sick (even vomiting once), or if the
blood sugar is high (for example, above 240 mg/dL, or
13.3 mmol/L). Fat breaks down into ketones when not
enough insulin is available. Ketones have acid
properties that can make a person very sick, causing a
condition called ketoacidosis.
- Checking other family members
Other family members have a 1 in 20 chance (5%) for also
developing diabetes. A blood glucose level test is not
very helpful because the test does not show high glucose
levels unless the person already has diabetes.
Fortunately, a test called the "islet cell antibody"
test is now available that can predict diabetes as much
as 10 years before a person gets diabetes. It is a free
test through the Diabetes Prevention Trial (DPT-1).
Call 1-800-425-8361 for more information (in Denver call
Call Your Child's Doctor Immediately If:
- A urine dipstick test is positive for sugar in a child
who has not yet been diagnosed with diabetes.
- Your child frequently has low blood sugar (hypoglycemic
reactions), particularly if your child loses
consciousness or has seizures.
- A urine dipstick test shows that there are moderate or
large amounts of ketones in your child's urine.
Call Your Child's Doctor During Office Hours If:
- Blood sugar values measured at home are constantly above
the desired range for your child's age (see recommended
values under "Treatment").
- Blood sugars done at home are frequently (one or two
times a day) below the desired range for your child's
- Another illness (for example, flu) occurs, which might
upset the diabetes.
- If you have other questions about diabetes.
A book is available for families who have a family member
with type 1 diabetes that explains home care in detail. It
is called "Understanding Insulin Dependent Diabetes." The
book is available for $10.00 (this includes shipping and
handling and is payable by check made out to CDF-Guild).
You can get the book by writing to:
The Guild of Children's Diabetes Foundation
777 Grant Street, Suite 302
Denver, Colorado 80203