Diabetes Education

Children with Diabetes
Special considerations for children with Type 1 diabetes

Having a child diagnosed with a chronic illness such as diabetes can be devastating for a parent. One day the world is perfect and the next, your entire family is thrown into a whirlwind of doctor's visits, testing, maintenance, and lifestyle change.

When the initial shock has worn off, the attitude must become one of action. Diabetes can be treated and diabetic children can live very normal lives. The key to living as normal a life as possible is to educate all involved—yourself, your family, your child's school, and your child. Through education, a collaborative action plan can be enacted, and medical care becomes a commonplace occurrence.

Type 1 diabetes is the most common form affecting children

Most children have type 1 diabetes (formerly referred to as Juvenile Diabetes). In type 1 diabetes patients, the pancreas does not produce insulin. Therefore, insulin must be injected for the body to survive. Insulin aides the body by helping blood sugar (glucose) enter cells of the body where it is used as energy. When there is not insulin to accompany glucose into the body's cells, blood sugars build up and body function suffers.

Type 2 diabetes is less common in children, however, as the obesity epidemic among children increases, so does the incidence of Type 2 diabetes in youth. When a person has type 2 diabetes they either do not produce enough insulin or their bodies are unable to efficiently use the insulin produced (insulin resistance). A sedentary lifestyle and obesity increases the prevalence of insulin resistance in children.

Diabetes can develop at any age

Diabetes can present in children at any time. Even children younger than one year old can develop diabetes, but the symptoms in children so young are often mistaken for other health problems, or dismissed as normal, passing infections. This is why it is important to learn the symptoms associated with diabetes, and report even seemingly small abnormalities to your pediatrician.
Symptoms of diabetes

Look for the same symptoms in children as in adults for detection of diabetes. These symptoms include:

  • Frequent urination
  • Excessive thirst
  • Rapid weight loss (especially when unexplained or accompanied by increased food intake)
  • Excessive feelings of hunger
  • Dizziness
  • Itchy or dry skin
  • Vision difficulty
  • Tingling/numbness in extremities
  • Moodiness
  • Tiredness/fatigue
  • Difficulty Healing
  • Frequent Infections

In young children, additional or different symptoms may present, including:

  • Failure to grow or gain weight (often dubbed 'Failure to Thrive')
  • Dehydration
  • Severe diaper rash (unresponsive to treatment)
  • Persistent vomiting, especially when accompanied by weakness/drowsiness

Diagnosis of diabetes in children

Doctors diagnose diabetes in children by running thorough blood and urine tests. Levels of glucose will be checked, as well as other diabetic markers. Expect your doctor to collect blood and urine for testing. Urine collection in very small children is done by placing a special collection bag over the penis or vaginal opening. Sticky-tape backed wings around the mouth of the collection bag hold it in place in the child's diaper until voiding occurs.

Caring for a child with diabetes

Children diagnosed with type 1 diabetes are immediately treated to combat the buildup of sugars in the blood and prevent further complications. Injections of insulin will be started so that blood sugars can be metabolized and reduced. If necessary, intravenous fluids will be administered to re-hydrate the child. When IV fluids are not needed and complications are not present, new diabetes patients are not usually hospitalized.

Your pediatrician will arrange for thorough diabetes education for you and your child (when age permits), as well as siblings. Diabetes education covers all aspects of controlling and maintaining the disease. Practical procedures such as how to administer insulin injections and blood testing will be discussed, as well as coping with the disease and all the associated emotions.

The dietary needs of children with type 1 diabetes are the same as children without the disease. It is important, however, to pay particular attention to good nutrition, and most importantly, eating frequently. Diabetic children cannot miss meals, as the insulin injected is calibrated to process dietary sugars, and when there is no source of sugar from the child's diet, the insulin will metabolize everything available in the blood. This results in a condition known as hypoglycemia (low blood sugar) and serious complications can occur. Maintaining blood sugar at adequate levels is a balancing act which leaves no room for children to miss meals. Mealtimes should remain constant, given in relatively same sized portions and at the same time of day. Special 'diabetic' foods are unnecessary. Simply following a normal diet plan as advised by your doctor or dietician is the best course for all children.

Insulin is used by the body more quickly during times of increased physical activity, so children should eat more frequently when they are active as well. Additionally, diabetic children should have a supply of foods at the ready when symptoms of hypoglycemia (low blood sugar) arise. Snacks such as fruit, peanut butter, granola bars, yogurt and pudding are a few good food supplies to keep nearby.

Diabetic children of all ages should be schooled in the control of their disease and recognition of complications to the extent their age allows. Education and involvement gives children a measure of control and helps them to alert caregivers when they are feeling poorly. Even very young children can be given the control of choosing where to test or inject insulin, all the while taking steps towards independent control of the disease they will live with.

Older children are encouraged to take an active role in their treatment and disease maintenance. Children as young as eleven can test their own blood and administer insulin injections with adult supervision. As parents, you may feel ill at ease with this, but treating diabetes as part of mainstream living helps children cope with their disease without anxiety, and hence they go on to lead full and normal lives unhindered.

School and Daycare

Children with diabetes can participate normally in school and daycare, but it is important to inform the school and work with the school nurse to educate teachers and aides working closely with your child. School and daycare personnel need to know a diabetic child's need for frequent snacks and meals, and accommodations must be made for the child to eat more frequently than regularly planned if necessary.

The rights of diabetic children are protected under federal law. Section 504 of the Rehabilitation Act of 1973, the Individuals with Disabilities Act, and the Americans with Disabilities Act of 1992 are three federal laws that protect the rights of children with diabetes in school and daycare settings (among others). Under these laws, diabetic children cannot be discriminated against and schools (or daycares) may be required to make necessary accommodations for your diabetic child if need be. These laws also mandate accommodations to seamlessly assimilate diabetic children into everyday school life and activities.

A very important part of educating school and childcare personnel in the control of diabetes is educating them to the warning signs of hypoglycemia and emergency responses. Drive home the importance of preventing low blood sugar with frequent snacking. Provide educators with written meal and actions plans, and emergency response procedures. Make sure this information is conveyed to transportation providers as well. Bus drivers are every bit as important a link in the chain of response and prevention.


Blood sugar testing to determine blood glucose levels is essential in effective diabetes control for children with diabetes. On their own, symptoms are not enough to be relied on for necessary medication and dietary adjustment. Testing is important to determine how close (or far from) normal glucose levels diabetes patients are. When testing reveals blood sugar levels that are too high or too low, insulin and food intake can be adjusted to return sugar to normal ranges.

Your child's doctor will regularly monitor results and order in-depth testing as necessary, but the majority of your child's diabetes testing will be done at home with a blood glucose monitor. How often your child's blood glucose levels need to be tested will be tailored to your child's situation. Your pediatrician will work with you to determine the frequency of testing and teach you how to interpret the results, but generally speaking, diabetes patients need to test blood glucose levels four or more times a day.
Target levels for blood glucose monitoring are as follows:

  • Before meals: 90 to 130 mg/dL
  • Two hours after a meal: under 180 mg/dl
  • Bedtime: 100 to 140 mg/dl

Typically, your child's blood should be tested before meals and at bedtime, and one to two hours after a meal.

Your child's doctor will instruct you as to proper testing procedures. Before you begin, you and your child should wash your hands thoroughly so as not to throw off the results of blood glucose monitoring. Collect the amount of blood needed to test with the equipment you have chosen. Generally, a finger stick is all that is needed, and this will be applied to a test strip inserted in the glucose meter. When results seem inaccurate, double check with a second test or a backup glucose meter. Clean your equipment as recommended by the manufacturer to keep it in good working order.

Record the results of each blood glucose metering, and have school and childcare personnel do the same. Use a log book to keep a record of the glucose level, and include the foods eaten with the time of the test. Include in your record the amount and time of insulin injections and any other medications your child has been taking. Glucose levels help with short term adjustments, but the predominant use is to determine a long term plan of action for your child to keep blood sugars maintained at good, normal (or very close) levels.

Blood Glucose Monitoring Systems

Medical professionals will help you explore glucose monitoring equipment that is right for accurately testing your child's blood sugar. A variety of testing equipment and supplies are available, and advancing technology is changing the field regularly. There are several factors to consider when choosing blood glucose testing equipment.

Traditional glucose monitors test a small amount of blood collected by pricking a finger. The test strip is placed into the meter and then it absorbs the small drop of blood – like a straw. Within seconds, the blood sugar reading appears. Different meters have varying requirements for accuracy in filling target areas on a test strip and so some meters are easier to use than others.

Glucose meters are also available to test at alternative sites of the body. Sample blood may be taken from the arm, thigh, or palm of your hand. While these meters minimize trauma to the fingertips caused by repeated testing, it should be noted that alternative testing sites detect changes in blood sugar at different levels. When sugar levels change quickly, it will first be detected in the fingertips, and so a fingertip meter may still be required for some testing; during symptoms of hypoglycemia, a traditional fingertip meter should be used for maximum accuracy.

Laser blood collection systems have been approved for glucose monitoring as well. A small laser light beam draws blood to the surface, replacing finger sticks with the less painful alternative.
Continuous blood glucose monitoring systems are emerging. Some devices place a tiny catheter into the abdomen and taken continuous readings for up to seventy-two hours. The benefit to these glucose measuring systems is being able to see a graph of glucose readings throughout the day without having to prick your fingers, only to calibrate the machine.

Advancements towards pain-free glucose monitoring are progressing, however, there is no current replacement for traditional systems. There are, however, some things to consider when choosing the right testing system for your child. Compare several meters and consider display options, size, portability, speed, and ease of use (including how difficult applying blood to the target area is). Cost will factor into your decision a great deal, but remember an unreliable, inexpensive pump that needs to be frequently replaced may cost you more in the long run. Also, include the cost of test strips and local availability in your calculations. Your child's doctor and local pharmacist can help you decipher the varied testing systems and their features.

Doctor's Visits

As your child's diabetes falls under control and doctor's visits diminish in frequency, accurate recordkeeping will become more important in the maintenance of your child's disease. Bring your recorded results and logs with you to your child's doctor's visits. Note any abnormalities, illnesses, changes in health, emergency measures, and questions you or your child have. This will be an important tool to make adjustments in your child's treatment.

The relationship between you, your child, and your child's treating physician should be one of trust and respect. Together, you are all working towards the same goal: healthy control of your child's diabetes. Choose pediatricians that are knowledgeable in your child's disease and with whom you are comfortable working with frequently over long periods of time.

Living with Diabetes

A diagnosis of diabetes in a child is overwhelming. Use every resource available to you and your child to learn as much as you can about controlling and maintaining childhood diabetes. Educate your child, make them an active partner in managing their disease. Educate those around you- friends, family, teachers- and make living with diabetes an accepted part of your child's life. When diabetes is dealt with as a straightforward task met head-on, and proper care and education are learned, living with diabetes becomes a controllable, if unfortunate, fact of your child's life, vastly diminishing anxiety and subsequent complications.

Marci Sloane, MS, RD, LD/N, CDE

Article was reviewed by Marci Sloane, a registered and licensed dietitian/nutritionist and certified diabetes educator. Marci graduated with a degree in Nutrition and Physiology from Teachers College at Columbia University. Marci manages a Diabetes and Nutrition Education Center in South Florida and is the author of The Diet Game: Playing for Life! More about Marci Sloane

The goal of Destination Diabetes is to be a useful and credible resource for the more than 20 million children and adults who have diabetes in the U.S. and their families. Destination Diabetes provides information on a wide range of diabetes health and wellness topics. Articles are written or reviewed by diabetes advisors who have experience in diabetes education.