Type 1 diabetes in children

Subject: Type 1 diabetes in children Tue Dec 28, 2010 7:03 pm

Type 1 diabetes in children is a condition in which your child's pancreas no longer produces the insulin your child needs to survive, and you'll need to replace the missing insulin using shots or an insulin pump. This type of diabetes used to be known as juvenile diabetes or insulin-dependent diabetes.

The diagnosis of type 1 diabetes can be overwhelming at first. Suddenly, you and your child — depending on his or her age — must learn how to give injections, count carbohydrates and monitor blood sugar.

Although type 1 diabetes requires consistent care, advances in blood sugar monitoring and insulin delivery have improved the daily management of type 1 diabetes in children. With proper treatment, children with type 1 diabetes can expect to live long, healthy lives.

Symptoms
The signs and symptoms of type 1 diabetes in children usually develop quickly, over a period of weeks. Look for:

Increased thirst and frequent urination. As excess sugar builds up in your child's bloodstream, fluid is pulled from the tissues. This may leave your child thirsty. As a result, your child may drink — and urinate — more than usual.
Extreme hunger. Without enough insulin to move sugar into your child's cells, your child's muscles and organs become depleted for energy. This triggers intense hunger.
Weight loss. Despite eating more than usual to relieve hunger, your child may lose weight — sometimes rapidly. Without the energy sugar supplies, muscle tissues and fat stores simply shrink. Unexplained weight loss is often the first symptom to be noticed.
Fatigue. If your child's cells are deprived of sugar, he or she may become tired and lethargic.
Irritability or unusual behavior. Children with undiagnosed type 1 diabetes may suddenly seem moody or irritable.
Blurred vision. If your child's blood sugar is too high, fluid may be pulled from the lenses of your child's eyes. This may affect your child's ability to focus clearly.
Yeast infection. A genital yeast infection may be the first sign of type 1 diabetes in a girl.
In babies and young children, the first indication of type 1 diabetes may be a yeast infection that causes a severe diaper rash that's far worse than the common red, puffy and tender skin rash. In young children and infants, lethargy, dehydration and abdominal pain also may indicate type 1 diabetes.

When to see a doctor
Talk to your child's doctor if you notice any of the signs or symptoms of type 1 diabetes — increased thirst and frequent urination, extreme hunger, weight loss, blurred vision or fatigue.

Causes
The exact cause of type 1 diabetes is unknown. Scientists do know that in most people with type 1 diabetes, the body's own immune system — which normally fights harmful bacteria and viruses — mistakenly destroys the insulin-producing (islet) cells in the pancreas. Genetics may play a role in this process, and exposure to certain viruses may trigger the disease.

Insulin key to sugar entering cells
Whatever the cause, once the islet cells are destroyed, your child will have little or no insulin. Normally, the hormone insulin helps glucose enter your child's cells to provide energy to the muscles and tissues. Insulin comes from the pancreas, a gland located just behind the stomach. When everything is working properly, once you eat, the pancreas secretes insulin into the bloodstream. As insulin circulates, it acts like a key by unlocking microscopic doors that allow sugar to enter the body's cells. Insulin lowers the amount of sugar in the bloodstream, and as the blood sugar level drops, so does the secretion of insulin from the pancreas.

The liver acts as a glucose storage and manufacturing center. When insulin levels are low — when you haven't eaten in a while, for example — the liver releases stored glycogen, which is then converted to glucose to keep your blood glucose level within a normal range.

Dangerous sugar level in bloodstream
In type 1 diabetes, none of this occurs because there's no insulin to let glucose into the cells. So instead of being transported into your child's cells, sugar builds up in your child's bloodstream, where it can cause life-threatening complications.

The cause of type 1 diabetes is different from the more familiar type 2 diabetes. In type 2, the islet cells are still functioning, but the body becomes resistant to insulin or the pancreas doesn't produce enough insulin.

Risk factors
There aren't many known risk factors for type 1 diabetes, though researchers continue to find new possibilities. Some known risk factors include:

A family history. Anyone with a parent or siblings with type 1 diabetes has a slightly increased risk of developing the condition.
Genetics. The presence of certain genes indicates an increased risk of developing type 1 diabetes. In some cases — usually through a clinical trial — genetic testing can be done to determine if a child who has a family history of type 1 diabetes is at increased risk of developing the condition.
Possible risk factors for type 1 diabetes include:

Viral exposure. Exposure to Epstein-Barr virus, coxsackievirus, mumps or cytomegalovirus may trigger the autoimmune destruction of the islet cells, or the virus may directly infect the islet cells.
Low vitamin D levels. Research suggests that vitamin D may protect against type 1 diabetes. However, early intake of cow's milk — a common source of vitamin D — has been linked to an increased risk of type 1 diabetes.
Other dietary factors. Omega-3 fatty acids may offer some protection against type 1 diabetes, while drinking water that contains nitrates may increase the risk. Additionally, the timing of the introduction of cereal into a baby's diet may affect his or her risk of type 1 diabetes. One clinical trial found that between ages 3 and 7 months appears to be the optimal time for introducing cereal.
Some other possible risk factors include a young maternal age (less than 25), a mother with preeclampsia during pregnancy, and a baby with jaundice or a respiratory infection occurring just after birth.

Complications
Type 1 diabetes can affect nearly every major organ in your child's body, including the heart, blood vessels, nerves, eyes and kidneys. The good news is that keeping your child's blood sugar level close to normal most of the time can dramatically reduce the risk of these complications.

Long-term complications of type 1 diabetes develop gradually. Eventually, if blood sugar levels aren't well controlled, diabetes complications may be disabling or even life-threatening.

Heart and blood vessel disease. Diabetes dramatically increases your child's risk of various cardiovascular problems, including coronary artery disease with chest pain (angina), heart attack, stroke, narrowing of the arteries (atherosclerosis) and high blood pressure, later in life.
Nerve damage (neuropathy). Excess sugar can injure the walls of the tiny blood vessels (capillaries) that nourish your child's nerves, especially in the legs. This can cause tingling, numbness, burning or pain that may begin at the tips of the toes or fingers and gradually spread upward. Left untreated, your child could lose all sense of feeling in the affected limbs.
Kidney damage (nephropathy). The kidneys contain millions of tiny blood vessel clusters that filter waste from your child's blood. Diabetes can damage this delicate filtering system. Severe damage can lead to kidney failure or irreversible end-stage kidney disease, requiring dialysis or a kidney transplant.
Eye damage. Diabetes can damage the blood vessels of the retina (diabetic retinopathy). Diabetic retinopathy can cause blindness. Diabetes can also lead to cataracts and a greater risk of glaucoma. By adulthood, diabetes is a leading cause of blindness.
Foot damage. Nerve damage in the feet or poor blood flow to the feet increases the risk of various foot complications. Left untreated, cuts and blisters can become serious infections.
Skin conditions. Diabetes may leave your child more susceptible to skin problems, including bacterial infections, fungal infections and itching.
Osteoporosis. Diabetes may lead to lower than normal bone mineral density, increasing your child's risk of osteoporosis as an adult.

Preparing for your appointment
Your child's family doctor or pediatrician will probably make the initial diagnosis of diabetes, and possibly send your child straight to the hospital. There, the staff will stabilize his or her blood sugar levels, and you and your child will all learn about insulin delivery, carbohydrate counting and more. Diabetes education may also be done on an outpatient basis if your child's condition is stable.

Once your child is discharged from the hospital, his or her diabetes care will likely be handled by a doctor who specializes in metabolic disorders in children (pediatric endocrinologist). Your child's health care team will also generally include a nutritionist, a certified diabetes educator, and a doctor who specializes in eye care (ophthalmologist).

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to be well prepared for any appointments you have with your child's health care team. Here's some information to help you get ready for your appointment, and what you can expect from your doctor.

What you can do

Write down any concerns you have about your child's well-being that you want to share with your doctor.
Ask a family member or friend to join you, if possible. Managing diabetes well requires you to retain a lot of information, and it can sometimes be difficult to soak up all the information provided to you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
Bring a notebook and a pen or pencil, to write down important information.
Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions that can help you clarify aspects of your child's care can be useful. List your concerns from most important to least important in case time runs out. Some of your concerns may be best addressed by a dietitian or a diabetes nurse educator. Ask your doctor for a referral. For type 1 diabetes in children, some topics you may want to address with your doctor, nutritionist or diabetes educator include:

The frequency and timing of blood glucose monitoring
Insulin therapy: types of insulin used, timing of dosing, amount of dose
Insulin administration: shots versus pumps
Low blood sugar: how to recognize and treat
High blood sugar: how to recognize and treat
Ketones: testing and treatment
Nutrition: types of food and their effect on blood sugar
Carbohydrate counting
Exercise: adjusting insulin and food intake for activity
Dealing with diabetes at school, summer camp and on special occasions, such as sleepovers
Medical management: how often to visit the doctor and other diabetes care specialists
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

How comfortable are you managing your child's diabetes?
Has your child had any low blood sugar episodes?
What's a typical day's diet like?
Is your child exercising? If so, how often?
On average, how much insulin are you using daily?
What you can do in the meantime
If your child's blood sugar isn't well controlled, or if you're not sure about what to do in a certain situation, don't hesitate to contact your child's doctor or diabetes educator in between appointments for advice and guidance.

Tests and diagnosis
If your child's doctor suspects diabetes, he or she will recommend a screening test. The primary test used to diagnose diabetes in children is the:

Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when your child last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes.
If your child's random blood sugar test results don't suggest diabetes, but your doctor still suspects it because of your child's symptoms, you doctor may do a:

Glycated hemoglobin (A1C) test. This blood test indicates an average blood sugar level for the past two to three months. It works by measuring the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher the blood sugar levels, the more hemoglobin that has sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates diabetes. A result between 6 and 6.5 percent is considered prediabetes, which indicates a high risk of developing diabetes.
Another test your doctor might use is a fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, your child will be diagnosed with diabetes.

If your child is diagnosed with diabetes, your doctor will also run blood tests to check for autoantibodies that are common in type 1 diabetes, and help doctors distinguish between type 1 and type 2 diabetes. The presence of ketones — byproducts from the breakdown of fat — in your child's urine also suggests type 1 diabetes, rather than type 2.

After the diagnosis
Once your child has been diagnosed with type 1 diabetes, he or she will regularly visit his or her doctor to ensure good diabetes management.

During these visits, the doctor will also check your child's A1C levels. Your child's target A1C goal may vary depending on his or her age and various other factors, but the American Diabetes Association generally recommends that A1C levels be below 7 percent, which translates to an estimated average glucose of 154 mg/dL (8.5 mmol/L). The American Diabetes Association recently developed a formula to translate the A1C into an estimated average glucose (eAG) because it more closely correlates with daily blood sugar readings.

Compared with repeated daily blood sugar tests, A1C testing better indicates how well your child's diabetes treatment plan is working. An elevated A1C level may signal the need for a change in your child's insulin regimen or meal plan.

In addition to the A1C test, the doctor will also take blood and urine samples periodically to check your child's cholesterol levels, thyroid function, liver function, kidney function and to test for celiac disease. The doctor will also examine your child to assess his or her blood pressure and growth, and will check the sites where your child tests his or her blood sugar and delivers insulin.

Treatments and drugs
Treatment for type 1 diabetes is a lifelong commitment of blood sugar monitoring, insulin, healthy eating and regular exercise — even for kids. And as your child grows and changes, so will his or her diabetes treatment plan. Over the years, your child may need different doses or types of insulin, a new meal plan or other treatment changes.

If managing your child's diabetes seems overwhelming, take it one day at a time. Some days you'll manage your child's blood sugar perfectly. Other days, it may seem as if nothing works right. Don't forget that you're not in it alone. You'll work closely with your child's diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your child's blood sugar level as close to normal as possible.

Blood sugar monitoring
Depending on what type of insulin therapy your child needs, you may need to check and record your child's blood sugar at least three times a day, but probably more. This requires frequent finger sticks. Some blood glucose meters allow for testing at other sites. Frequent testing is the only way to make sure that your child's blood sugar level remains within his or her target range — which may change as your child grows and changes. Your child's doctor will let you know what your child's blood sugar target range is. Your doctor may ask you to keep a log of the blood glucose readings, or he or she may download that information from the blood glucose meter.

Continuous glucose monitoring (CGM)
CGM is the newest way to monitor blood sugar levels, and may be most helpful for people who have developed hypoglycemia unawareness. CGM attaches to the body using a fine needle just under the skin that checks blood glucose level every few minutes. CGM isn't yet considered as accurate as standard blood sugar monitoring, so it's not considered a replacement method for keeping track of blood sugar, but an additional tool.

Insulin and other medications
Anyone who has type 1 diabetes needs insulin treatment to survive. Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar.

Many types of insulin are available, including:

Rapid-acting insulin, such as insulin lispro (Humalog) and insulin aspart (NovoLog), starts working in five to 15 minutes and peaks 30 to 90 minutes later.
Regular insulin, such as human insulin (Humulin R, Novolin R, others), starts working about 30 minutes after injection and generally peaks in 60 to 90 minutes.
Long-acting insulin, such as insulin glargine (Lantus), has almost no peak and may provide coverage for as long as 24 hours.
Intermediate-acting insulin, such as NPH insulin (Humulin N, Novolin N), starts working two to four hours after it's taken and peaks in four to 12 hours. NPH insulin is similar in effectiveness to long-acting types of insulin, but may be more likely to cause low blood sugar. Using NPH insulin allows for less flexibility with mealtimes, as well as in the amount of carbohydrates your child can eat.
Depending on your child's age and needs, the doctor may prescribe a mixture of insulin types to use throughout the day and night.

Insulin delivery options
Often, insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin.

An insulin pump also may be an option for some children. The pump is a device about the size of a cell phone worn on the outside of the body. In most cases, a tube connects the reservoir of insulin to a catheter that's inserted under the skin of the abdomen. A wireless pump that uses small pods filled with insulin is another option that's now available. The pump is programmed to dispense specific amounts of insulin automatically. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.

Healthy eating
Contrary to popular perception, there's no diabetes diet. Your child won't be restricted to a lifetime of boring, bland foods. Instead, your child will need plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories — and fewer animal products and sweets. In fact, it's the best eating plan for the entire family. Even sugary foods are OK once in a while, as long as they're included in your child's meal plan.

Yet understanding what and how much to feed your child can be a challenge. A registered dietitian can help you create a meal plan that fits your child's health goals, food preferences and lifestyle. Certain foods, such as those with a high sugar or fat content, may be more difficult to incorporate into your child's meal plan than healthier choices. For example, high-fat foods — because fat slows digestion — may cause a spike in blood sugar several hours after your child has eaten. Unfortunately, there's no set formula to tell you how your child's body will process different foods. But, as time passes, you'll learn more about how your child's favorites affect his or her blood sugar, and then you can learn to compensate for them.

Physical activity
Everyone needs regular aerobic exercise, and children who have type 1 diabetes are no exception. Encourage your child to get regular physical activity. Sign up for a sports team or dance lessons. Better yet, get in the act together. Play catch in the backyard. Walk or run through your neighborhood. Visit an indoor climbing wall or local pool. Make physical activity part of your child's daily routine.

But, remember that physical activity usually lowers blood sugar, and it can affect blood sugar levels for up to 12 hours after exercise. If your child begins a new activity, check your child's blood sugar more often than usual until you learn how his or her body reacts to the activity. You might need to adjust your child's meal plan or insulin doses to compensate for the increased activity.

Flexibility
Even if your child takes insulin and eats on a rigid schedule, the amount of sugar in his or her blood can change unpredictably. With help from your child's diabetes treatment team, you'll learn how your child's blood sugar level changes in response to:

Food. What and how much your child eats will affect your child's blood sugar level. Blood sugar is typically highest one to two hours after a meal.

Food can pose a particular challenge for parents of very young children with type 1 diabetes. As any parent knows, toddlers are notorious for being picky eaters and not finishing what's on their plate, which becomes a problem if you've given the child an insulin injection to cover 20 grams of carbohydrate and your child has consumed only 5 grams. If you know this will be an issue, let your doctor know so that he or she can work with you to come up with an insulin regimen that works for you.

Physical activity. Physical activity moves sugar from your child's blood into his or her cells. The more active your child is, the lower his or her blood sugar level. To compensate, you might need to lower your child's insulin dose before unusual physical activity, or your child may need to have a snack before exercise.
Medication. Your child needs insulin to lower his or her blood sugar. But any other medications your child takes may affect his or her blood sugar level as well — sometimes requiring changes in your child's diabetes treatment plan.
Illness. During a cold or other illness, your child's body will produce hormones that raise his or her blood sugar level. In addition, a fever increases your child's metabolism. As a result, your child may need to take more frequent or larger doses of insulin. If your child has an illness that's causing vomiting and he or she can't keep any food down, his or her body still needs insulin to cover the glucose produced in the liver. Ask your doctor about coming up with a sick-day management plan.
Growth spurts and puberty. Just when you've mastered your child's insulin needs, he or she shoots up two inches seemingly overnight, and suddenly isn't getting enough insulin. Hormones can also affect insulin requirements, particularly for teenage girls as they begin to menstruate.
Sleep. Depending on your child's insulin regimen, he or she may be at risk of low blood sugar during the night. For that reason, your child's blood sugar levels should be slightly higher before bed than they are during the day. For children under 6, a good pre-bedtime level is 110 to 200 mg/dL (6.1 to 11.1 mmol/L), while a child from 6 to 12 should be in the 100 to 180 mg/dL (5.6 to 10 mmol/L) range. Teenagers' blood sugar levels should be between 90 and 150 mg/dL (5 to 8.3 mmol/L) before bed.
Investigational treatments

Pancreas transplant. With a successful pancreas transplant, your child would no longer need insulin. But pancreas transplants aren't always successful — and the procedure poses serious risks. Your child would need a lifetime of potent immune-suppressing drugs to prevent organ rejection. These drugs can have serious side effects, including a high risk of infection and organ injury. Because the side effects can be more dangerous than the diabetes, pancreas transplants in children are unusual.
Islet cell transplantation. Researchers also are experimenting with islet cell transplantation, which provides new insulin-producing cells from a donor pancreas. Although this experimental procedure has met with problems in the past, new techniques and better drugs to prevent islet cell rejection may hold promise for the future. However, islet cell transplantation still requires the use of immune-suppressing medications, and just as it did with its own natural islet cells, the body often destroys transplanted islet cells, making the time off insulin short-lived.
Signs of trouble
Despite your best efforts, sometimes problems will arise. Certain short-term complications of type 1 diabetes require immediate care. Left untreated, these conditions can cause seizures and loss of consciousness (coma).

Low blood sugar (hypoglycemia). If your child's blood sugar level drops below his or her target range, it's known as low blood sugar. Ask your doctor what's considered a low blood sugar level for your child. Blood sugar levels can drop for many reasons, including skipping a meal, getting more physical activity than normal or injecting too much insulin. Hypoglycemia occurs more frequently with intermediate-acting insulin, such as NPH.

Teach your child the symptoms of low blood sugar, and that when in doubt, he or she should always do a blood sugar test. Early signs and symptoms of low blood sugar include:

Sweating
Shakiness
Hunger
Dizziness
Nausea
Pale skin
Rapid or irregular heart rate
Fatigue
Difficulty concentrating
Headaches
Later signs and symptoms of low blood sugar, which are sometimes mistaken for alcohol intoxication in teens and adults include:

Lethargy
Confusion
Behavior changes, sometimes dramatic
Crying
Poor coordination
Convulsions
If your child develops hypoglycemia during the night, he or she might wake with sweat-soaked pajamas or a headache. Thanks to a natural rebound effect, nighttime hypoglycemia might cause an unusually high blood sugar reading first thing in the morning.

If your child has a low blood sugar reading, give him or her fruit juice, glucose tablets, hard candy, regular (not diet) soda or another source of sugar. Then retest his or her blood sugar in about 15 minutes to make sure it has gone up into the normal range. If it's not in the normal range, re-treat with more sugar (juice, candy, glucose tablets or another source of sugar) and then retest in another 15 minutes. Keep doing this until you get a normal reading. It's a good idea to have your child eat another snack, this one containing a mixed food source, such as peanut butter and crackers, to help stabilize the blood sugar.

If a blood glucose meter isn't readily available, treat for low blood sugar anyway if your child has symptoms of hypoglycemia, and then test as soon as possible.

Make sure your child always carries a source of fast-acting sugar with him or her.

Left untreated, low blood sugar will cause your child to lose consciousness. If this occurs, he or she may need an emergency injection of glucagon — a hormone that stimulates the release of sugar into the blood. Be sure your child always has a glucagon emergency kit available — at home, at school, during sports, on sleepovers — and make sure it hasn't expired.

High blood sugar (hyperglycemia). As with low blood sugar, your child's blood sugar can rise for many reasons, including eating too much, eating the wrong types of foods, not taking enough insulin or illness.

Watch for:

Frequent urination
Increased thirst
Blurred vision
Fatigue
Nausea
Irritability
Hunger
Difficulty concentrating
If you suspect hyperglycemia, check your child's blood sugar. You might need to adjust your child's meal plan or medications. If your child's blood sugar is higher than his or her target range, you'll likely need to administer a "correction" using an insulin shot or through an insulin pump. A correction is an additional dose of insulin that should bring your child's blood sugar back into the normal range. High blood sugar levels don't come down as quickly as they go up. Ask your doctor how long to wait until you recheck. If your child uses an insulin pump, you may need to change the pump site.

If your child has two consecutive blood sugar readings above 250 mg/dL (13.9 mmol/L), have your child test for ketones using a urine test stick. Don't allow your child to exercise if his or her blood sugar level is high or anytime ketones are present. If only a trace or small ketones are present, have your child drink extra fluids to flush out the ketones.

If your child's blood sugar is persistently above 300 mg/dL (16.7 mmol/L), call your child's doctor or seek emergency care.

Increased ketones in your child's urine (diabetic ketoacidosis). If your child's cells are starved for energy, your child's body may begin to break down fat — producing toxic acids known as ketones.

Signs and symptoms of this serious condition include:

Loss of appetite, weight loss
Nausea
Vomiting
Stomach pain
A sweet, fruity smell on your child's breath
If you suspect ketoacidosis, check your child's urine for excess ketones with an over-the-counter ketones test kit. If your child has large ketones in his or her urine, call your child's doctor right away or seek emergency care. Also, call your doctor if your child has vomited more than once in a four-hour period and has ketones in his or her urine.

Lifestyle and home remedies
Type 1 diabetes is a serious disease. Helping your child follow his or her diabetes treatment plan takes round-the-clock commitment, and will initially require some significant lifestyle changes. But your efforts are worthwhile. Careful management of type 1 diabetes can reduce your child's risk of serious — even life-threatening — complications.

As your child gets older:

Encourage him or her to take an increasingly active role in diabetes management.
Stress the importance of lifelong diabetes care.
Teach your child how to test his or her blood sugar and inject insulin.
Help your child make wise food choices.
Encourage your child to remain physically active.
Foster a relationship between your child and his or her diabetes treatment team.
Make sure your child wears a medical ID tag.
Above all, stay positive. The habits you teach your child today will help him or her enjoy an active and healthy life with type 1 diabetes.

School and diabetes
Along with at-home care, you'll also need to work with your child's school nurse and teachers to make sure they know what the symptoms of high and low blood sugar levels are, and in some cases, the school nurse may need to administer insulin or check your child's blood sugar levels. Federal law protects children with diabetes, and schools must make reasonable accommodations to ensure that your child gets a proper education.

Coping and support
Living with type 1 diabetes isn't easy — for you or for your child. Good diabetes management requires a lot of time and effort, especially in the beginning.

Your child's emotions
Diabetes can affect your child's emotions both directly and indirectly. Poorly controlled blood sugar can directly affect your emotions by causing behavior changes, such as irritability. And, if that happens at a birthday party because your child forgot to take insulin before having a piece of cake, he or she could end up fighting with friends.

Another way diabetes can take a toll on your child's emotions is by making him or her feel different from other kids. Most of the time, children don't want to be different and having to draw blood and give themselves shots definitely sets kids with diabetes apart from their peers. Getting your child together with other children who have diabetes may help make your child feel less alone.

Mental health and substance abuse
People with diabetes have an increased risk of depression and anxiety, which may be why many diabetes specialists regularly include a social worker or psychologist as part of their diabetes care team.

Teenagers, in particular, may have a particularly hard time dealing with diabetes. A child who has been very good about sticking to his or her diabetes regimen may rebel in the teen years by ignoring his or her diabetes care. Teens may also have a harder time telling friends or boyfriends or girlfriends that they have diabetes because they want to fit in. They may also experiment with drugs or alcohol, behaviors that can be even more dangerous for someone with diabetes. Eating disorders and forgoing insulin to lose weight are other problems that can occur more often in the teen years.

Talk to your teen, or ask your teen's doctor to talk to your teen, about the effects of drugs and alcohol on someone with diabetes. If you notice that your child or adolescent is persistently sad or pessimistic, or if you notice dramatic changes in his or her sleeping habits, friends or school performance, talk to your doctor or a therapist to have your teen assessed for depression. Additionally, let your child's doctor know if you notice that your son or daughter is losing weight or doesn't seem to be eating well.

Support groups
Talking to a counselor or therapist may help your child or you to cope with the dramatic lifestyle changes that come with a type 1 diabetes diagnosis. Your child may find encouragement and understanding in a type 1 diabetes support group for children. Support groups for parents also are available. Although support groups aren't for everyone, they can be good sources of information. Group members often know about the latest treatments and tend to share their own experiences, or helpful information, such as where to find carbohydrate counts for your child's favorite take-out restaurant. If you're interested, your doctor may be able to recommend a group in your area.

Or, you can visit the American Diabetes Association or Juvenile Diabetes Research Foundation to check out local activities for people with type 1 diabetes. The American Diabetes Association also offers diabetes camp programs. And, both groups offer online information and forums for children and teens.

Putting information in context
Because complications from poorly controlled diabetes can be so frightening, it's important to remember that many studies — and therefore, a lot of literature you may be reading — were completed before many advances in diabetes care occurred. And that means, many of those scary statistics probably don't apply to your child. If you and your child work with your child's doctor and do your best to control blood sugar levels, your child with likely live a long and normal life.

Prevention
There's nothing you or your child could have done to prevent type 1 diabetes; there is currently no known way to prevent type 1 diabetes.

Researchers are working on preventing type 1 diabetes in people who have a high risk of developing the disease, and others are working on preventing further destruction of the islet cells in people who are newly diagnosed. Ask your doctor if your child might be eligible for one of these trials, but carefully weigh the risks and benefits of any treatment available in a clinical trial. You can find more information on the types of research being done from TrialNet, a collaboration of diabetes researchers. TrialNet is also conducting a natural history study to check for diabetes genes in parents, offspring and siblings of people with type 1 diabetes.

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