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Reviewed by the Faculty of Harvard Medical School

Children And Diabetes

The path from childhood into adulthood is seldom a smooth one. Handling school, friends and family while growing up is not always easy. Adding a chronic illness can further complicate matters.

About 176,000 Americans younger than age 20 have diabetes. For them and their families, diabetes makes a big difference in everyday life. They must deal with emotional effects and days of both good and bad health. Hectic family schedules also must include time for medical treatment. Sometimes there's even a medical emergency.

Most children with diabetes have type 1 diabetes. However, more children and teens are being diagnosed with type 2 diabetes. This is thought to be linked to an increase in child obesity. Testing to detect type 2 diabetes and prediabetes should be considered in children and adolescents who are overweight and who have two or more additional risk factors for diabetes, according to American Diabetes Association guidelines.

Having diabetes may affect how a child performs at school, socializes with friends and interacts with family members. Whatever affects the child also will affect the family.

Until a few generations ago, type 1 diabetes couldn't be treated. It was almost always fatal. But the discovery of insulin in 1921 made type 1 diabetes a manageable condition.

With prompt diagnosis and the right treatment, most children with diabetes can live full and productive lives. Still, type 1 diabetes can pose major challenges for children and their families. It requires daily insulin injections and blood sugar tests. Diet and exercise also are important in maintaining blood sugar control and good health.

To manage the condition, it's essential to understand it. Almost all children who develop diabetes have type 1 diabetes. This is an autoimmune disorder. Normally, the immune system defends the body against infectious agents from the outside world. In an autoimmune disease, the immune system attacks a part of the body. In type 1 diabetes, the immune system attacks and destroys the beta cells in the pancreas. These are the cells that produce insulin.

Insulin is the hormone that helps sugar (glucose) get into cells. In the cells, sugar is broken down and used as the body's main source of energy. When glucose cannot be used properly, it builds up in the blood. This causes numerous problems.

The initial symptoms of childhood diabetes may look like the flu. Typically, a child becomes ill, urinates frequently and complains of constant thirst. This happens as the body tries to get rid of the extra glucose through the urine and then to replace the lost fluids. A child may begin wetting his bed long after he has stopped wearing diapers. He may feel constantly hungry because the body is not processing food into energy. He may be tired and begin to lose weight as he starts to burn fat for energy.

Type 1 diabetes is one of the most common chronic disorders of childhood. It affects an estimated 1 of every 400 to 600 people younger than 20. Diabetes seldom appears before age 4. For girls, the peak age of diagnosis is between 10 and 12. For boys, it is 12 to 14.

Controlling Type 1 Diabetes

Controlling type 1 diabetes involves replacing the insulin that the child cannot make. This helps to keep blood sugar from getting too high. Generally, as long as blood sugar levels are kept within a normal range, a child will feel better and grow normally. She also will be less likely to develop the related long-term medical problems. These include eye disease, kidney disease and nerve damage.

Insulin cannot be swallowed in pill or liquid form. It must be given through injections (shots), usually several times each day. You must monitor glucose levels throughout the day to make sure you give the right dose of insulin each time.

Following a regular meal plan with healthy food choices also helps to keep a child's blood glucose within normal levels.

Insulin Shots

Shots of precise amounts of insulin must be given up to four times per day. Usually parents give the shots until children are able to do so by themselves.

Young children may need help from others as well, such as the school nurse or babysitter. Parents generally also need to be involved in monitoring blood-sugar levels.

For some children, an insulin pump may be an option. This small, computerized device delivers insulin continuously throughout the day.

Diet

The goal of treatment for diabetes is to keep the levels of glucose in the blood as close to normal as possible.

A healthful, well-balanced diet that has plenty of whole grains, fruits and vegetables is the best way of ensuring health for all children, including those with diabetes. Foods that are full of sugar — candy, cookies, sugary snacks and sodas — must be limited.

For the most part, a child with diabetes can eat just about any food in moderation, as part of a balanced diet. At the same time, you have to be careful about the amount of complex carbohydrates in the diet. These include breads, cereals, rice and pastas. They can raise blood glucose as much as a simple sugar does.

When it comes to controlling diabetes, when a child eats is as important as what he eats. Eating usually has to be timed with insulin use. In general, a child with diabetes should eat the usual three meals. Any child who is taking insulin also needs three regularly scheduled snacks — mid-morning, mid-afternoon and bedtime.

You can work with your child's doctor and a dietitian to create a healthy meal plan for your child. If you are thoughtful about your child's diet, by the time she becomes a teenager, eating right will have become second nature to her.

Exercise And Activity

At one time, it was thought that children with diabetes should not be physically active. Today, doctors realize that physical activity and exercise are important factors in controlling blood sugar. Exercise also tones muscles and strengthens bones. Finally, it keeps the heart, blood vessels, brain and nerves healthier. This helps the body to withstand the potentially damaging effects of diabetes.

Everyday Life

Living with diabetes means making time for the condition in your child's (and your family's) daily schedules.

Chances are that your child will have to interrupt her activities regularly to have a snack. She may have to come home after school to check her blood glucose before she meets her friends or takes part in after-school activities. Your child will have to wake up early enough to take insulin and then eat a full breakfast on schedule. This schedule will be part of her life whether she's at home or away at camp, on a sleepover, or, later, in a college dorm.

Children with diabetes learn to prick their fingers to test for blood-glucose levels. Eventually, most learn how to inject themselves each day with insulin.

Special Programs

Many camping programs are specially designed for children with diabetes. They usually combine diabetes education, support and treatment with camping, sports and recreation.

The goals of most camp programs are to help children:

  • Learn about themselves
  • Gain self-confidence
  • Better understand the challenges of diabetes
Many are run by adults who have diabetes themselves. The other campers also have diabetes. This gives your child the opportunity to make friends and establish a support network that can last a lifetime.

Many such programs are tailored for young adults, too. They may offer group discussions, role-playing and dances as well as age-appropriate camp activities. Most camps involve the families at some point. Some offer weekend retreats throughout the school year. Ask your child's doctor for information about camps in your area.

Emotional And Psychological Support

Living with any chronic illness presents special challenges for children and families. Finding support and guidance from others in the same situation can make a world of difference. Many parents find it helpful to join a support group. There, they can talk with other parents of children with diabetes, or speak with a mental health professional.

Finally, the Juvenile Diabetes Foundation (JDF) provides support as well as funds for research. The foundation is a nonprofit, voluntary health agency. State and local chapters offer support groups and other activities for families affected by diabetes.

For more information, contact:

Juvenile Diabetes Research Foundation International
120 Wall St.
New York, NY 10005-4001
Toll-Free: (800)533-CURE (2873)
E-Mail: info@jdrf.org
www.jdrf.org

American Diabetes Association
ATTN: National Call Center
1701 N. Beauregard St.
Alexandria, VA 22311
Toll-Free: (800) 342-2383
E-Mail: AskADA@diabetes.org
www.diabetes.org

National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892-3560
Phone: (301) 654-3327
Toll-Free: (800) 860-8747
E-Mail: ndic@info.niddk.nih.gov
www.niddk.nihgov/health.diabetes/ndc

Joslin Diabetes Center
One Joslin Place
Boston, MA 02215
Phone: (617) 732-2400
www.joslin.org/education/library

Last updated February 25, 2014




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