Type 1 Diabetes Mellitus, Self-Care, Pediatric

• Insulin.
• Nutrition.
• Exercise.
• Other medicines, if needed.
• Support from your child's team of health care providers and others.

It is important for you to have an active role in your child's diabetes care. The following information explains what you need to know to manage your child's diabetes at home.

What are the risks?

Having diabetes can put your child at risk for other long-term (chronic) conditions. These include thyroid disease, celiac disease, high cholesterol, heart disease, and kidney disease. These problems can get worse if you do not keep your child's blood glucose within the target range.

How to monitor blood glucose

• Check blood glucose levels frequently by using either a blood glucose meter or a continuous glucose monitor or as told by your child's health care provider.
• Have your child's A1C (hemoglobin A1C) level checked as often as told by the health care provider.
• The health care provider will set individualized blood glucose target ranges and hemoglobin A1C treatment goals for your child. It is important that the target ranges are adjusted as your child grows and develops.

Follow these instructions at home:

Medicines

• Give over-the-counter and prescription medicines only as told by your child's health care provider.
• Give your child insulin and other medicines every day as told.
• Do not let your child run out of insulin or other medicines. Plan ahead so you always have these available.
• Adjust your child's insulin delivery system (insulin pump) or dosage based on how physically active your child is and what foods he or she eats. Your child's health care provider will tell you how to do this.

Eating and drinking

What your child eats and drinks affects his or her blood glucose and insulin dosage. Helping your child make good choices helps to control your child's diabetes and prevent other health problems. A healthy meal plan includes eating lean proteins, complex carbohydrates, fresh fruits and vegetables, low-fat dairy products, and healthy fats.

Make an appointment to see a registered dietitian to help you create an eating plan that is right for your child. Make sure that:

• You and your child follow instructions from the health care provider about what your child may eat and drink.
• Your child drinks enough fluid to keep his or her urine pale yellow.
• You monitor how many grams of carbohydrates your child eats. You and your child can do this by learning how to carbohydrate count, by reading food labels, and by learning the standard serving sizes of food.
• Your child follows his or her sick-day plan whenever he or she cannot eat or drink as usual. Make this plan in advance with your child and his or her health care provider.

Your child should always have a 15-gram rapid-acting carbohydrate snack available to treat low blood sugar (hypoglycemia).

Activity

• Have your child exercise regularly, as told by your child's health care provider. This may include:
  • Stretching and doing strength exercises, such as yoga or weight lifting, 3 or more times a week.
  • Doing 60 minutes of moderate-intensity exercise each day. Moderate-intensity exercise includes brisk walking, running, and certain sports.
• Your child may need more carbohydrates before, during, and after physical activity. It is important for your child to have a rapid-acting carbohydrate snack available before, during, and after exercise. This helps to prevent or treat hypoglycemia.
• If your child's blood glucose level is below normal, your child should have a 5–15 gram carbohydrate snack before physical activity. Your child should have another 5–15 gram carbohydrate snack for every 30 minutes of continued activity.
• If your child plays a sport, tell the coach that your child has diabetes.
• Talk with the health care provider before your child starts a new exercise or activity. Work with the health care provider to adjust insulin, medicines, or food intake as needed.
• Frequent blood glucose monitoring before, during, and after physical activity is important. This can help check for high blood sugar (hyperglycemia) or hypoglycemia.

Care for your child's body

• Keep your child's immunizations up to date.
• Schedule an eye exam for your child when he or she is age 11 or older and has had diabetes for 3–5 years. After the first exam, your child should have an eye exam every 2 years.
• Check your child's skin and feet for cuts, bruises, redness, blisters, or sores.
• After your child begins puberty or is older than 10 years, he or she should have a complete foot exam done by a health care provider. After the first exam, your child should have a foot exam every year.
• Have your child:
  • Brush his or her teeth and gums two times a day.
  • Floss one or more times a day.
  • Visit the dentist one or more times every 6 months.
• Have your child's blood tested by a health care provider every year. If your child has not had a blood test in more than one year, ask the health care provider if blood tests are needed.
• Remember that growth spurts and puberty can affect blood glucose levels and the amount of insulin that your child needs.

General instructions

• Share your child's diabetes management plan with your child's caregivers, including people in your child's school and household.
• Family members and caregivers should:
  • Learn the symptoms of hypoglycemia.
  • Understand how to treat hypoglycemia.
• Check your child's urine for ketones:
  • When your child is ill.
  • As told by the health care provider.
  • When your child's blood glucose is above 240 mg/dL (13.3 mmol/L) for 2 tests in a row. Contact the health care provider if this happens and your child has moderate or large ketone levels in his or her urine.
• Have your child carry a medical alert card or wear medical alert jewelry.
• Teach your child to avoid alcohol and tobacco.
• Keep all follow-up visits. This is important.

Questions to ask your child's health care provider

• 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?
• Does my child need to have an emergency glucagon kit available?

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

Get help right away if:

• Your child's blood glucose level is below 54 mg/dL (3 mmol/L).
• Your child has moderate or large ketone levels in his or her urine.

These symptoms may be an emergency. Do not wait to see if the symptoms will go away. Get help right away. Call 911.

Summary

• Caring for your child with type 1 diabetes (type 1 diabetes mellitus) means keeping your child's blood sugar (glucose) within the target range. You can do this with a balance of insulin and other medicines, nutrition, exercise, and support from others.
• Check your child's blood glucose frequently.
• Share your child's diabetes management plan with your child's caregivers.
• Keep all follow-up visits. This is important.