If your child or teen has been diagnosed with type 1 diabetes, the next step is to create a treatment plan that allows your child to manage the condition and stay healthy and active. Doctors or members of your child's diabetes health care team may call this a diabetes management plan.

Treatment plans for type 1 diabetes should be based on your child's needs and the suggestions of your child's diabetes health care team. Treatment approaches differ in, among other things, the types of insulin given and the schedules for giving insulin given each day. The advantages and disadvantages of each plan should be considered for each individual child.

Type 1 Diabetes Treatment Basics

The blood glucose level is the amount of glucose in the blood. Glucose is a sugar that comes from the foods we eat, and it's also formed and stored inside the body. It's the main source of energy for the cells of our body, and it's carried to each cell through the bloodstream. Insulin is a hormone that allows the glucose to get into the cells. In type 1 diabetes, the body can no longer make insulin, so the glucose can't get into the body's cells. This causes the blood glucose level to rise.

For children with diabetes, the goals of treatment are to control the condition in a way that helps minimize symptoms and prevent short- and long-term health problems, while making sure a child has normal physical, mental, emotional, and social growth and development. To do this, parents and kids should aim for the goal of keeping blood sugar levels as close to normal as possible.

In general, kids with type 1 diabetes need to:

• take insulin as prescribed
• eat a healthy, balanced diet, paying special attention to the amount of carbohydrates in each meal and the diabetes meal plan
• monitor blood sugar levels several times a day
• get regular physical activity

Following the treatment plan can help your child stay healthy, but treating diabetes isn't the same as curing it. Right now, there's no cure for diabetes, so kids with type 1 diabetes will need treatment for the rest of their lives. But with proper care, they should look and feel healthy and go on to live long, productive lives, just like other kids.

Take Insulin as Prescribed

Children and teens who have type 1 diabetes must take insulin as part of their treatment plan. Insulin is the only medicine that can keep blood sugar levels in a healthy range in kids with type 1 diabetes.

Taking insulin as prescribed allows kids and teens with type 1 diabetes to use the glucose in their blood for energy. When glucose is entering and being used by the cells properly, its level in the blood generally remains within a healthy range. Unless they are using an insulin pump, most children with type 1 diabetes require two or more injections every day to keep blood sugar levels under control. Usually, children inject a combination of different types of insulin to handle the sugar that circulates in the blood both after eating and in between meals. The acids and digestive juices in the stomach and intestines can break down and destroy insulin if it is swallowed, so it can't be taken in a pill. The only way to get insulin into the body right now is by injection with a needle or with an insulin pump.

There is no-one-size-fits-all insulin schedule — the types of insulin used and number of daily injections your child needs will depend on your child's diabetes management plan. Also, you can't turn off the action of insulin once it's been injected, so insulin doses need to be adjusted to handle the rise in blood sugar that occurs with meals and provide the amounts of insulin the body needs between meals and overnight. Eating meals at regular times generally makes this easier to accomplish. Although eating on schedule may work well for younger children, sticking to a routine may be a bigger challenge for older kids, whose school, sleep, and social schedules may not be as routine. Your child's diabetes health care team can help you work through any problems your child may be having with scheduling meals and insulin injections.

Getting insulin injections today is nearly painless, thanks to smaller needles. Insulin pumps, which deliver insulin through a small tube that is placed just under the skin, cut down on the number of injections a child needs to take.

Insulin is usually injected into the fatty layer under the skin of the abdomen, hips/buttocks, or thighs. Your child's diabetes health care team will teach you when and how to give your child insulin, as well as the best sites in which to inject it, based on your child's weight, age, and activity patterns.

Eat a Healthy, Balanced Diet and Follow a Meal Plan

Eating a balanced diet and following a meal plan are important components of your child's treatment for type 1 diabetes. Kids with diabetes benefit from the same kind of healthy diet as people without diabetes — one that includes a variety of nutritious foods that help the body grow and function properly.

Kids with diabetes also have to balance the type and timing of the food they eat with the amount of insulin they take and with their activity level. That's because eating some foods will cause blood sugar levels to go up more than others, whereas insulin and exercise will make blood sugar levels go down.

How much the blood sugar level goes up after eating depends on the type of nutrients the food contains. The three main types of nutrients found in foods are carbohydrates (carbs), proteins, and fats, which all provide energy in the form of calories. Foods containing carbohydrates cause blood sugar levels to go up the most. Foods that contain mostly protein and/or fat don't affect blood sugar levels nearly as much.

Our bodies need all of these nutrients — in varying amounts — to function normally. So you and the diabetes health care team will create a diabetes meal plan that incorporates foods with all of the essential nutrients. Meal plans typically consist of breakfast, lunch, and dinner with scheduled between-meal snacks. The diabetes meal plan won't restrict your child to eating specific foods, but it will guide you in selecting choices from the basic food groups to achieve a nutritious balance. A meal plan is based on your child's age, activity level, schedule, and food likes and dislikes. It should also be flexible enough to accommodate special situations like parties and holidays. The meal plan should make it easier to keep your child's blood sugar within his or her goal range.

Awareness of the amount of carbohydrates in meals and snacks will help you determine how much insulin to give your child. Mismatching carbs and insulin can result in either high or low blood sugar levels.

Your child's diabetes meal plan may also recommend limiting extra fat and "empty" calories (foods that contain lots of calories but few nutrients like vitamins and minerals). Everyone should limit these foods anyway because eating too much of them can lead to excess weight gain or long-term health problems like heart disease, for which people with diabetes are already at risk.

Monitor Blood Sugar Levels

Another part of treating type 1 diabetes involves checking blood sugar levels regularly and responding to the results. Controlling blood sugar levels helps kids with diabetes feel well, and grow and develop normally, and it reduces the risk of long-term diabetes complications. Your child's diabetes treatment plan will recommend how many times a day your child's blood sugar levels should be checked. It's the only way to know how your child is doing with blood sugar control on a day-to-day basis.

Your child's diabetes health care team will also let you know what your child's target blood sugar levels should be. In general, kids with type 1 diabetes should test their blood sugar levels with a blood glucose meter at least twice a day, but preferably three or four times a day. Depending on your child's diabetes management plan and the need to troubleshoot problems that may come up, blood sugar levels may need to be tested even more often at times.

The blood glucose meter 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 give an indication of what your child's blood sugar levels have been like over the past few months.

Get Regular Physical Activity

Exercise is good for everyone — adults and children — with or without diabetes. Getting regular physical activity is also an important part of diabetes treatment. It helps control blood sugar levels and may reduce the risk of other chronic illnesses, like heart disease. In addition to helping keep blood sugar levels under control, exercise can help kids with diabetes:

• maintain a healthy body weight
• keep blood lipids and blood pressure under control
• get and keep their heart, lungs, and blood vessels in good shape
• feel more normal by doing things that kids without diabetes can

Encouraging a child with diabetes to exercise may make parents uneasy, but exercise actually helps insulin work better in the body. Although some adjustments of meals and insulin may be needed, kids with diabetes can and should exercise.

All exercise is great — from walking the dog or riding a bike to playing team sports. Encourage your child to exercise (set 60 minutes daily as a goal) to get the most benefits. Like any other part of a healthy lifestyle, new exercise habits might be hard for kids to adopt at first, but feeling the benefits of exercise can help kids stick to their program.

To help avoid problems during exercise, kids with diabetes may need to:

• have an extra snack prior to activity
• carry snacks, water, and supplies with them when they exercise
• check their blood sugar levels before, during, or after exercise
• wear a medical identification bracelet (should be worn always, but even more important when exercising)
• make sure their coaches know about their diabetes and what to do if problems occur

Your child's diabetes health care team will offer specific suggestions to help your child get ready for exercise or join a sport. They'll also give you instructions to help you and your child respond to any diabetes problems that may occur during exercise, like hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar).

Putting It All Together

Treating and managing diabetes may seem overwhelming at times. But your child's diabetes health care team is there for you. Your child's diabetes management plan should be easy to understand, detailed, and written down for easy reference. You should also have the names and phone numbers of your child's diabetes health care team members in case of emergencies, or if you have questions about how to take care of your child's diabetes.

In addition to the diabetes treatments mentioned above, you may also hear about alternative or complementary treatments for diabetes, such as herbal remedies and vitamin or mineral supplements. Not enough studies have been done to prove their effectiveness, although research is presently being done to study their possible benefits. Aside from being potentially ineffective, these practices can even be dangerous for kids and teens with type 1 diabetes, especially if they are used to replace medically recommended treatments. Talk to your child's diabetes health care team if you have questions.

Each day, researchers all over the world are working to find a cure for diabetes, and many treatment advances have occurred to make treatment easier and more effective. Insulin may soon be available in pill, patch, and spray forms, and scientists continue efforts to improve results of pancreas or islet cell transplants. Versions of an artificial pancreas — a device that senses blood sugar and gives insulin — are currently being tested also. Although these new developments are exciting, all of them still need extensive testing — especially for use in children — before they become available.

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