Type 1 Diabetes in Children

Diagnosis

There are several blood tests used to diagnose type 1 diabetes in children and to help monitor their diabetes management. These tests help determine blood sugar levels and guide further evaluation.

Random blood sugar test. This is the primary screening tool for type 1 diabetes. A blood sample is taken at a random time. A level of 200 mg/dL (11.1 mmol/L) or higher along with symptoms suggests diabetes.

Glycated hemoglobin (A1C) test. This test shows your child’s average blood sugar level over the past 3 months. An A1C level of 6.5% or higher on two separate tests indicates diabetes.

Fasting blood sugar test. This test measures a blood sample taken after your child has fasted for at least 8 hours or overnight. A fasting blood sugar of 126 mg/dL (7.0 mmol/L) or higher suggests type 1 diabetes.

Additional tests

If blood sugar testing indicates diabetes, your health care provider may recommend further testing to distinguish type 1 diabetes from type 2 diabetes. These tests may include blood tests that check for antibodies commonly found in type 1 diabetes.

More Information
A1C test

Treatment

Treatment for type 1 diabetes focuses on managing blood sugar levels through lifestyle and medical care. Key components of treatment include:

• Taking insulin
• Monitoring blood sugar
• Eating healthy foods
• Exercising regularly

You will work closely with your child’s diabetes care team, including a health care provider, diabetes educator and registered dietitian. The goal is to keep your child’s blood sugar within a target range that will change as your child grows.

Insulin

Lifelong insulin therapy is required for anyone with type 1 diabetes. Various types of insulin can be used to manage blood sugar levels.

Rapid-acting insulin works within 15 minutes, peaks at about 60 minutes and lasts around 4 hours. Examples include lispro, aspart and glulisine.

Short-acting insulin begins working in about 30 minutes, peaks in 90 to 120 minutes and lasts 4 to 6 hours. Examples include human insulin.

Intermediate-acting insulin begins working within 1 to 3 hours, peaks at 6 to 8 hours and lasts 12 to 24 hours. Examples include NPH insulin.

Long- and ultra-long-acting insulin may provide coverage for 14 to 40 hours. Examples include glargine, detemir and degludec.

Insulin delivery options

Insulin can be delivered in different ways depending on your child’s needs and comfort.

• Fine needle and syringe
• Insulin pen with a fine needle
• Insulin pump with tubing and a catheter under the skin

A tubeless pump option is also available, using a small pod worn on the skin and a tiny catheter beneath the surface.

Blood sugar monitoring

You or your child will need to check and track blood sugar levels at least four times a day. Most children test before meals, at bedtime and sometimes during the night. More frequent testing may be needed if your child does not use a continuous glucose monitor. Checking often is the best way to ensure the blood sugar stays within the target range.

Continuous glucose monitoring (CGM)

CGM devices track blood sugar every few minutes through a temporary sensor placed under the skin. Some devices show readings continuously on a phone or smartwatch, while others require scanning the sensor. CGM helps identify patterns and prevent low or high blood sugar.

Closed loop system

A closed loop system connects a continuous glucose monitor with an insulin pump. It automatically delivers insulin based on blood sugar readings. Currently available hybrid systems require some user input, such as entering carbohydrate amounts. Fully automated systems are still being studied.

Healthy eating

A healthy diet plays an important role in diabetes care. Your child should regularly eat foods that are nutritious and low in fat and calories, including:

• Vegetables
• Fruits
• Lean protein
• Whole grains

A registered dietitian can help design a meal plan based on your child’s preferences and teach you how to count carbohydrates for proper insulin dosing.

Physical activity

Regular activity is important for all children, including those with type 1 diabetes. Activity can lower blood sugar and may continue to impact levels for hours afterward. You may need to adjust insulin or food intake on active days. Encourage your child to get at least 60 minutes of activity every day.

Handling challenges

Blood sugar levels can shift unexpectedly. More frequent testing can help you understand changes and adjust treatment. Your diabetes care team can help you manage challenges such as:

• Picky eating
• Illness and infections
• Growth spurts and puberty
• Sleep changes
• Unexpected schedule changes

Ongoing medical care

Regular checkups ensure your child’s diabetes is well managed. Your provider will review blood sugar patterns, insulin needs, eating habits and physical activity. A1C tests are done periodically, with a general goal of 7% or lower. Your child’s provider will also check:

• Blood pressure
• Growth
• Cholesterol
• Thyroid function
• Kidney function
• Feet
• Eyes

Signs of trouble

Some short-term complications need immediate care to prevent more serious problems. These include low blood sugar, high blood sugar and diabetic ketoacidosis.

Low blood sugar (hypoglycemia)

Hypoglycemia occurs when blood sugar falls below the target range. It may happen due to skipped meals, more activity than usual or too much insulin. Symptoms include:

• Pallor
• Shakiness
• Hunger
• Sweating
• Irritability
• Mood changes
• Difficulty concentrating
• Dizziness
• Slurred speech
• Loss of consciousness

Teach your child to recognize symptoms. If symptoms occur and no meter is available, treat for low blood sugar immediately and test afterward.

If blood sugar is low:

• Give 15 to 20 grams of fast-acting carbohydrate such as juice, glucose tablets or regular soda
• Retest in 15 minutes and repeat if needed
• After reaching the target range, follow with a snack or meal

If your child loses consciousness, a glucagon injection may be needed.

High blood sugar (hyperglycemia)

Hyperglycemia occurs when blood sugar rises above the target range. It can happen due to illness, eating too much or missing insulin doses. Symptoms include:

• Frequent urination
• Increased thirst
• Dry mouth
• Blurred vision
• Fatigue
• Nausea

If you suspect high blood sugar, test your child’s blood glucose and follow the treatment plan. If blood sugar exceeds 240 mg/dL (13.3 mmol/L), test for ketones.

Diabetic ketoacidosis (DKA)

A severe lack of insulin causes the body to break down fat for energy, leading to a buildup of ketones. High ketone levels can lead to diabetic ketoacidosis, a life-threatening condition.

Symptoms include:

• Thirst or dry mouth
• Increased urination
• Dry or flushed skin
• Nausea or vomiting
• Abdominal pain
• Fruity-smelling breath
• Confusion

If you suspect DKA, check for ketones. If levels are high, contact your child’s provider or seek emergency care.