Type 1 Diabetes Mellitus, Diagnosis, Pediatric

Type 1 diabetes (type 1 diabetes mellitus) is a long-term, or chronic, disease. It occurs when the cells in the pancreas (beta cells) that make a hormone called insulin are destroyed. Normally, insulin allows blood sugar, also called glucose, to enter cells in the body. The cells use glucose for energy. Lack of insulin causes excess glucose to build up in the blood instead of going into cells. As a result, high blood glucose, or hyperglycemia, develops.

There is currently no cure for this condition, but it can be managed with insulin therapy and lifestyle changes.

What are the causes?

The exact cause of type 1 diabetes is not known.

What increases the risk?

Your child may be more likely to develop this condition if he or she has a family member who has type 1 diabetes. Other factors may also make your child more likely to develop type 1 diabetes, such as:

Having a gene for type 1 diabetes that is passed from parent to child (inherited).
Having autoimmune disorders. These are conditions in which the body's disease-fighting system (immunesystem) attacks itself.
Having started solid foods before age 4 months or after age 6 months.
Being exposed to certain viruses.
Having cystic fibrosis.
Living in an area with cold weather conditions.

What are the signs or symptoms?

Symptoms may develop slowly over days or weeks, or they may develop suddenly. Symptoms may include:

Increased thirst or hunger.
Increased urination, or increased urination during the night (nocturia). Bedwetting may be a sign of nocturia.
Sudden or unexplained weight changes.
Irritability or behavior changes.

Less common symptoms include:

Nausea or vomiting.
Pain in the abdomen.
Tiredness (fatigue) or weakness.
Vision changes, such as blurry vision.

How is this diagnosed?

This condition is diagnosed based on your child's symptoms and medical history, a physical exam, and your child's blood glucose level. Your child's blood glucose may be checked with one or more of these blood tests:

A fasting blood glucose (FBG) test. Your child will not be allowed to eat (he or she will fast) for 8 hours or longer before a blood sample is taken.
A random blood glucose test. This checks blood glucose at any time of day no matter when your child ate.
An A1C (hemoglobin A1C) blood test. This gives information about blood glucose control over the last 2–3 months.

Your child may be diagnosed with type 1 diabetes if his or her:

FBG level is 126 mg/dL (7 mmol/L) or higher.
Random blood glucose level is 200 mg/dL (11.1 mmol/L) or higher.
Hemoglobin A1C level is 6.5% or higher.

These blood tests may be repeated to confirm your child's diagnosis. Your child may also need urine tests or other blood tests.

If your child develops symptoms of diabetes, he or she may first be evaluated in the emergency room. This is because your child may need a hospital stay at the start of treatment.

How is this treated?

Your child's treatment may be managed by a specialist called a pediatric endocrinologist. You can help your child manage his or her diabetes by following instructions from the health care provider about:

Giving insulin daily. This helps keep your child's blood glucose levels in the healthy range.
Checking your child's blood glucose as often as told.
Encouraging your child to make diet and lifestyle changes. Your child may need to:
- Follow an individualized nutrition plan that is developed by a registered dietitian.
- Exercise regularly. Exercise can lower your child's blood glucose. It is especially important to check blood glucose before and after exercise. Your child may need to eat a snack before exercising to help prevent low blood glucose.
Giving medicines to help prevent complications from diabetes.
Making a written care plan (504 plan) for managing your child's diabetes at school.
Having your child's blood tested by a health care provider every year to check for conditions that are associated with type 1 diabetes.

Your child's health care provider will set individualized treatment goals for your child based on age and any other conditions your child has.

Follow these instructions at home:

Questions to ask your child's health care provider

Consider asking the following questions:

Do my child and I need to meet with a certified diabetes care and education specialist?
Where can I find a support group for children with diabetes?
What equipment will I need to manage my child's diabetes at home?
What diabetes medicines does my child need, and when should I give them?
How often should I check my child's blood glucose?
What number can I call if I have questions?
When is my child's next appointment?

General instructions

Give over-the-counter and prescription medicines only as told by your child's health care provider.
Keep all follow-up visits as told by your child's health care provider. This is important.

Where to find more information

American Diabetes Association (ADA): diabetes.org
Association of Diabetes Care and Education Specialists (ADCES): diabeteseducator.org
International Diabetes Federation (IDF): idf.org

Contact a health care provider if:

Your child's blood glucose is out of his or her healthy range. Your child's health care provider will tell you when you should contact a health care provider in these cases.
Your child has been sick or has had a fever for 2 days or more, and he or she is not getting better.
Your child cannot eat or drink.
Your child has nausea or vomiting.
Your child has diarrhea.

Get help right away if:

Your child's blood glucose is below 54 mg/dL (3 mmol/L).
Your child becomes confused or has trouble thinking clearly.
Your child has trouble breathing.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

Summary

Type 1 diabetes (type 1 diabetes mellitus) is a long-term, or chronic, disease. It occurs when the cells in the pancreas (beta cells) that make a hormone called insulin are destroyed. There is currently no cure for this condition.
The exact cause of type 1 diabetes is not known.
This condition is treated by giving insulin and other medicines to help prevent complications from diabetes. Diet and lifestyle changes are also part of treatment.
Your child's health care provider will set individualized treatment goals for your child based on age and any other conditions your child has.

This information is not intended to replace advice given to you by your health care provider. Make sure you discuss any questions you have with your health care provider.