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Treatments and drugs of Type 1 Diabetes in Children - Part I

Treatment for type 1 diabetes is a lifelong commitment of blood sugar monitoring, insulin, healthy eating and regular exercise — even for kids. And as your child grows and changes, so will his or her diabetes treatment plan. Over the years, your child may need different doses or types of insulin, a new meal plan or other treatment changes.

If managing your child's diabetes seems overwhelming, take it one day at a time. Some days you'll manage your child's blood sugar perfectly. Other days, it may seem as if nothing works well. Don't forget that you're not alone. You'll work closely with your child's diabetes treatment team — doctor, diabetes educator and registered dietitian — to keep your child's blood sugar level as close to normal as possible.

 

Blood sugar monitoring

Depending on what type of insulin therapy your child needs, you may need to check and record your child's blood sugar at least three times a day, but probably more often. This requires frequent finger sticks. Some blood glucose meters allow for testing at other sites. Frequent testing is the only way to make sure that your child's blood sugar level remains within his or her target range — which may change as your child grows and changes. Your child's doctor will let you know what your child's blood sugar target range is. Your doctor may ask you to keep a log of the blood glucose readings, or he or she may download that information from the blood glucose meter.

 

Continuous glucose monitoring (CGM)

CGM is the newest way to monitor blood sugar levels, and may be most helpful for people who have developed hypoglycemia unawareness. CGM attaches to the body using a fine needle just under the skin that checks blood glucose level every few minutes. CGM isn't yet considered as accurate as standard blood sugar monitoring, so it's not considered a replacement method for keeping track of blood sugar, but is used as an additional tool.

 

Insulin and other medications

Anyone who has type 1 diabetes needs insulin treatment to survive. Because stomach enzymes interfere with insulin taken by mouth, oral insulin isn't an option for lowering blood sugar.

 

Many types of insulin are available, including:

 

  • Rapid-acting insulin, such as insulin lispro (Humalog) and insulin aspart (NovoLog), starts working in five to 15 minutes and peaks 30 to 90 minutes later.
  • Short-acting insulin, such as human insulin (Humulin R, Novolin R, others), starts working 30 to 60 minutes after injection and generally peaks in two to four hours.
  • Long-acting insulin, such as insulin glargine (Lantus) and insulin detemir (Levemir), has almost no peak and may provide coverage for as long as 20 to 26 hours.
  • Intermediate-acting insulin, such as NPH insulin (Humulin N, Novolin N), starts working one to three hours after it's taken and peaks in eight hours. NPH insulin is similar in effectiveness to long-acting types of insulin, but may be more likely to cause low blood sugar. Using NPH insulin allows for less flexibility with mealtimes, as well as in the amount of carbohydrates your child can eat.

 

Depending on your child's age and needs, the doctor may prescribe a mixture of insulin types to use throughout the day and night.

 

Insulin delivery options

Often, insulin is injected using a fine needle and syringe or an insulin pen — a device that looks like an ink pen, except the cartridge is filled with insulin.

 

An insulin pump also may be an option for some children. The pump is a device about the size of a cell phone worn on the outside of the body. In most cases, a tube connects the reservoir of insulin to a catheter that's inserted under the skin of the abdomen. A wireless pump that uses small pods filled with insulin is another option that's now available. The pump is programmed to dispense specific amounts of insulin automatically. It can be adjusted to deliver more or less insulin depending on meals, activity level and blood sugar level.

 

Healthy eating

Contrary to popular perception, there's no diabetes diet. Your child won't be restricted to a lifetime of boring, bland foods. Instead, your child will need plenty of fruits, vegetables and whole grains — foods that are high in nutrition and low in fat and calories. Your child's dietitian will likely suggest that your child — and the rest of the family — consume fewer animal products and sweets. In fact, it's the best eating plan for the entire family. Sugary foods are OK, once in a while, as long as they're included in your child's meal plan.

 

Yet understanding what and how much to feed your child can be a challenge. A registered dietitian can help you create a meal plan that fits your child's health goals, food preferences and lifestyle. Certain foods, such as those with a high sugar or fat content, may be more difficult to incorporate into your child's meal plan than healthier choices. For example, high-fat foods — because fat slows digestion — may cause a spike in blood sugar several hours after your child has eaten. Unfortunately, there's no set formula to tell you how your child's body will process different foods. But, as time passes, you'll learn more about how your child's favorites affect his or her blood sugar, and then you can learn to compensate for them.

 

Physical activity

Everyone needs regular aerobic exercise, and children who have type 1 diabetes are no exception. Encourage your child to get regular physical activity. Sign up for a sports team or dance lessons. Better yet, exercise together. Play catch in the backyard. Walk or run through your neighborhood. Visit an indoor climbing wall or local pool. Make physical activity part of your child's daily routine.

 

But remember that physical activity usually lowers blood sugar, and it can affect blood sugar levels for up to 12 hours after exercise. If your child begins a new activity, check your child's blood sugar more often than usual until you learn how his or her body reacts to the activity. You might need to adjust your child's meal plan or insulin doses to compensate for the increased activity.

 

Flexibility

Even if your child takes insulin and eats on a rigid schedule, the amount of sugar in his or her blood can change unpredictably. With help from your child's diabetes treatment team, you'll learn how your child's blood sugar level changes in response to:

 

  • Food. What and how much your child eats will affect your child's blood sugar level. Food can pose a particular challenge for parents of very young children with type 1 diabetes. That's because young children are notorious for not finishing what's on their plate, and that's a problem if you've given the child an insulin injection to cover more food than he or she ate. If you know this will be an issue, let your child's doctor know so that he or she can work with you to come up with an insulin regimen that works for your family.
  • Physical activity. Physical activity moves sugar from your child's blood into his or her cells. The more active your child is, the lower his or her blood sugar level. To compensate, you might need to lower your child's insulin dose before unusual physical activity, or your child may need to have a snack before exercise.
  • Medication. Your child needs insulin to lower his or her blood sugar. But any other medications your child takes may affect his or her blood sugar level as well — sometimes requiring changes in your child's diabetes treatment plan.
  • Illness. During a cold or other illness, your child's body will produce hormones that raise his or her blood sugar level. In addition, a fever increases your child's metabolism. As a result, your child may need to take more frequent or larger doses of insulin. If your child has an illness that's causing vomiting and he or she can't keep any food down, his or her body still needs insulin to cover the glucose produced in the liver. Ask your doctor about coming up with a sick-day management plan.
  • Growth spurts and puberty. Just when you've mastered your child's insulin needs, he or she shoots up 2 inches seemingly overnight and suddenly isn't getting enough insulin. Hormones also can affect insulin requirements, particularly for teenage girls as they begin to menstruate.
  • Sleep. Depending on your child's insulin regimen, he or she may be at risk of low blood sugar during the night. For that reason, your child's blood sugar levels should be slightly higher before bed than they are during the day. For children younger than age 6, a good pre-bedtime level is 110 to 200 mg/dL (6.1 to 11.1 mmol/L), while a child between ages 6 and 12 should be in the 100 to 180 mg/dL (5.6 to 10 mmol/L) range. Teenagers' blood sugar levels should be between 90 and 150 mg/dL (5 to 8.3 mmol/L) before bed.