Although healthy social and emotional development are key goals in managing a child's diabetes, you've probably heard your child's doctors or health care providers talk the most about "diabetes control." They're usually referring to how close the blood sugar, or glucose, is kept to the desired range.

When Diabetes Isn't Under Control

Too much or not enough sugar in the bloodstream can lead to short-term problems that need to be treated right away, like hypoglycemia, hyperglycemia, or diabetic ketoacidosis. Too much sugar in the bloodstream can also cause long-term damage to the vessels that supply blood to vital organs, which can increase the risk of heart disease and stroke, kidney disease, vision problems, and nerve problems in people with diabetes.

These problems don't usually show up in kids or teens with diabetes who have had the disease for only a few years. However, these health problems can occur in adulthood in people with diabetes, particularly if they haven't managed or controlled their diabetes properly.

Children with diabetes who don't control their blood sugar levels may also have problems with growth and development and can even experience a delay in the onset of puberty.

Avoiding frequent and/or severe episodes of hypoglycemia (low blood sugar) is also an important part of good long-term control of diabetes. Having lots of low blood sugar reactions can interfere with a child's participation in school and other activities. This may make it difficult for them to cope with their diabetes and live the kind of life that leads to a healthy, happy childhood and adulthood.

Controlling diabetes means keeping blood sugar levels as close to normal as possible. It's a three-way balancing act: Your child's medications (such as insulin or other diabetes medicines), food, and activity level all need to be balanced to keep your child's blood sugar levels under control. If any one of these is off, blood sugar levels will be, too.

In general, problems controlling blood sugar levels can be due to one or more of the following:

• not taking medications as prescribed
• not following the meal plan (like eating too much or not enough food without adjusting medications)
• not getting regular exercise or not making the necessary adjustments in the diabetes treatment plan when there is a significant change in physical activity level
• illness or stress
• not monitoring blood sugar levels closely enough, so that changes in blood sugar levels can be recognized and addressed promptly

The Benefits of Good Control

The complications associated with diabetes can seem frightening, but the good news is that studies have shown that people with diabetes who keep their blood sugar levels as close to normal as possible have a much lower likelihood of developing diabetes complications.

One large study showed that people with type 1 diabetes who checked blood sugar levels four or more times a day — and adjusted the amounts of insulin and other diabetes medicines, diet, and exercise based on their blood sugar level readings — had a reduced risk of developing eye disease, kidney problems, nerve damage, and high cholesterol levels (a major risk factor for heart disease).

How to Know if Your Child's Diabetes Is Under Control

How do you find out if your child's in control? First, your child's diabetes health care team will let you know what your child's blood sugar levels should be. They may refer to this as a "target" range. Your child's target blood sugar level range will be based on factors such as your child's age and medical condition. The target range may also be written down in your child's diabetes management plan.

Day to day, the only way to know if your child's blood sugar level is close to his or her target range is to measure blood sugar levels several times a day with a glucose meter. Your child's diabetes health care team will recommend how and when to test your child's blood sugar level based on his or her treatment plan. If you and your child check blood sugar levels regularly and keep an organized and accurate record of the results, you and your child's diabetes health care team will have the information needed to adjust your child's diabetes management plan.

In addition to daily checks with a glucose meter that tells you what your child's blood sugar level is at the moment you test, another type of blood sugar test, the glycosylated hemoglobin (hemoglobin A1c or HbA1c) test, can be used to let you know your child's blood sugar levels over a longer period of time. The HbA1C test will give you and your child's diabetes health care team information about your child's blood glucose control over the 2 to 3 months prior to doing the test.

Helping Your Child Control Diabetes

Helping your child achieve good blood sugar control will no doubt be challenging at times. However, there are some things you can do to help your child keep blood sugar levels in a healthy range:

• Make sure your child takes his or her insulin or other diabetes medicines as prescribed.
• Provide meals and snacks that fit into your child's meal plan.
• Encourage your child to engage in regular physical activity.
• Check your child's blood sugar levels often and make changes in the treatment plan with guidance from the diabetes health care team.
• Make sure your child gets regular medical checkups.
• Learn as much as possible about diabetes.

Working with your child's diabetes health care team will help you better understand and manage the challenges faced by children with diabetes and help your child avoid many of the problems associated with the disease.

Reviewed by: Steven Dowshen, MD
Date reviewed: September 2007