Diabetes in children and adolescents

Type 1 diabetes in children. Type 1 diabetes in children

If a child or teenager becomes ill with diabetes, then more than 85% of the chances are that this will be insulin-dependent type 1 diabetes. Although in the XXI century and type 2 diabetes is also very “younger”. Now they get sick obese children from the age of 10 years. If the child becomes ill with diabetes, then it is a severe lifelong problem for young patients and their parents. Before you study the treatment of type 1 diabetes in children, read our main article, "Diabetes in children and adolescents."

In this article you will learn everything you need about the diagnosis and treatment of type 1 diabetes in children. Moreover, we publish some important information in Russian for the first time. This is our “exclusive” wonderful way (low-carbohydrate diet) to control blood sugar well in diabetes. Now diabetics can maintain its normal values, almost like in healthy people.

First of all, the doctor should find out what type of diabetes the child has. This is called differential diagnosis of type 1 and type 2 diabetes. There are other options for this disease, although they are rare.

Symptoms of type 1 diabetes in children

This question is described in detail in the article “Symptoms of diabetes in children.” The typical symptoms of type 1 diabetes are different in infants, preschoolers, younger students and adolescents. This information is useful to parents and children's doctors. Doctors too often “record” the symptoms of diabetes for other diseases, until the child falls into a coma from high blood sugar.

Diabetes and Thyroid Disease

Type 1 diabetes is an autoimmune disease. It is caused by the failure of the immune system. Because of this failure, antibodies begin to attack and destroy the beta cells of the pancreas, which produce insulin. Not surprisingly, other autoimmune diseases are often found in children with type 1 diabetes.

Most often, the “behind the company” system with beta cells attacks the thyroid gland. This is called autoimmune thyroiditis. In most children with type 1 diabetes, it proceeds without symptoms. But for those unlucky, autoimmune thyroiditis causes a decrease in thyroid function. Even less often there are cases when he on the contrary increases its function, and hyperthyroidism occurs.

A child with type 1 diabetes, it is desirable to pass a blood test for antibodies of the thyroid gland. You also need to be examined every year if thyroid gland diseases have developed during this time. For this, a blood test for thyroid stimulating hormone (TSH) is performed. It is a hormone that stimulates the thyroid gland. If problems are found, the endocrinologist will prescribe pills, and they will greatly improve the health of the diabetic.

Treatment of type 1 diabetes in children

Treatment of type 1 diabetes in children consists of the following activities:

  • self-monitoring of blood sugar using a glucometer;
  • regular implementation of this self-control at home;
  • dieting;
  • insulin shots;
  • physical activity (sports and games - physical therapy for diabetes);
  • psychological help.

Each of these points is necessary for the treatment of type 1 diabetes in a child to be successful. They are performed, for the most part, on an outpatient basis, that is, at home or during the day at the doctor's office. If a child with diabetes has acute symptoms, it should be hospitalized in a hospital. Usually, children with type 1 diabetes are in the hospital 1-2 times a year.

The goal of treating type 1 diabetes in children is to maintain blood sugar as close to normal as possible. This is called “achieving good diabetes compensation.” If diabetes is well compensated by treatment, then the child will be able to develop normally and grow up, and complications will be postponed until a late date or not at all.

Objectives of diabetes in children and adolescents

What are the blood sugar levels in children with type 1 diabetes? Scientists and medical practitioners unanimously agree that the closer to normal blood glucose levels, the better. Because in this case, the diabetic lives almost like a healthy person, and he does not develop vascular complications.

The problem is that diabetic patients who receive insulin injections, the closer to normal blood sugar, the higher the risk of developing hypoglycemia, including severe. This applies to all patients with type 1 diabetes. And in children with diabetes, the risk of hypoglycemia is particularly high. Because they eat irregularly, and the level of physical activity in a child can be very different on different days.

Based on this, it is recommended not to reduce blood sugar in children with type 1 diabetes to the norm, but to maintain it at higher values. No longer the case. After the statistics had accumulated, it became obvious that the development of vascular complications of diabetes is more dangerous than the risk of hypoglycemia. Therefore, since 2013, the American Diabetes Association recommends maintaining glycated hemoglobin in all children with diabetes below 7.5%. Its higher value is harmful, not desirable.

Target values ​​of blood glucose, depending on the age of a child with type 1 diabetes

Age groupThe degree of compensation of carbohydrate metabolismGlucose in blood plasma, mmol / lGlycated hemoglobin HbA1C,%
before eatingafter mealbefore bed / night
Preschoolers (0-6 years)Good compensation5,5-9,07,0-12,06,0-11,0 7,5)
Satisfactory compensation9,0-12,012,0-14,0 11,08,5-9,5
Bad compensation> 12,0> 14,0 13,0> 9,5
Schoolchildren (6-12 years old)Good compensation5,0-8,06,0-11,05,5-10,0< 8,0
Satisfactory compensation8,0-10,011,0-13,0 10,08,0-9,0
Bad compensation> 10,0> 13,0 12,0> 9,0
Teenagers (13-19 years old)Good compensation5,0-7,55,0-9,05,0-8,5< 7,5
Satisfactory compensation7,5-9,09,0-11,0 8,57,5-9,0
Bad compensation> 9,0> 11,0 10,0> 9,0

Note the glycated hemoglobin numbers in the last column of the table. This is an indicator that reflects the average level of glucose in the blood plasma over the past 3 months. A blood test for glycated hemoglobin is taken once every few months in order to assess whether the patient's diabetes was well compensated for over the past period.

Can children with type 1 diabetes maintain normal sugar?

For your information, the normal values ​​of glycated hemoglobin in the blood of healthy people without obesity are 4.2% - 4.6%. The table above shows that medicine recommends maintaining blood sugar in children with type 1 diabetes at least 1.6 times higher than normal. This is associated with an increased risk of hypoglycemia in young diabetics.

Our site was created to spread knowledge about low-carbohydrate diets for type 1 and type 2 diabetes. A diet with carbohydrate restriction in the diet allows adults and children with diabetes to maintain blood sugar almost at the same level as in healthy people. For details, see below in the section "Diet for type 1 diabetes in children."

The most important question: is it worth while treating type 1 diabetes in a child to strive to lower his blood sugar to normal? Parents can do this “at their own risk.” Remember that even one episode of severe hypoglycemia can cause irreversible brain damage and make the child disabled for the rest of his life.

On the other hand, the less carbohydrates a child eats, the less insulin it will need. And the less insulin, the lower the risk of hypoglycemia. If the child goes on a low-carbohydrate diet, the dosage of insulin will be reduced several times. They can become literally insignificant compared to how much insulin was pricked earlier. It turns out that the probability of hypoglycemia is also much reduced.

In addition, if a child quickly turns to a low-carbohydrate diet after the discovery of type 1 diabetes, the “honeymoon” phase will last longer. It can take several years to stretch, and if it is especially lucky, even for the rest of her life. Because the carbohydrate load on the pancreas will decrease, and its beta cells will not collapse so quickly.

Conclusion: if a child with type 1 diabetes, starting at the “kindergarten” age, switches to a low-carbohydrate diet, then this has significant advantages. Blood sugar can be maintained at the same level as in healthy people. The risk of hypoglycemia will not increase, but will decrease, because insulin dosages will be reduced several times. The “honeymoon period” can last much longer.

However, parents who choose this type of treatment for type 1 diabetes in their child act at their own peril and risk. Your endocrinologist will take it "in hostility" because it is contrary to the instructions of the Ministry of Health, which are now in force. We recommend, first of all, to make sure that you are using an accurate blood glucose meter. In the first few days of the "new life" measure blood sugar very often, monitor the situation literally continuously. Be prepared to stop hypoglycemia at any time, including at night. You will see how the blood sugar level of a child depends on changes in its diet, and make your own conclusions as to which diabetes treatment tactics are most appropriate.

How to prick insulin to a child with diabetes

To understand how type 1 diabetes in children is treated with insulin, you first need to study the articles:

  • How to measure blood sugar with a glucometer painlessly;
  • Dose calculation and insulin administration technique;
  • Insulin regimens;
  • How to dilute insulin to accurately prick low doses.

In young children, short and ultrashort insulin lowers blood sugar levels faster and more strongly than older children and adults. In general, the younger the child, the higher his insulin sensitivity. In any case, it must be determined individually for each patient with type 1 diabetes. How to do this is described in the article “Dose Calculation and Insulin Injection Technique”, the link to which is given above.

Insulin Pump for Diabetes in Children

In recent years, in the West, and then with us, more and more children and adolescents use insulin pumps to treat their diabetes. This is a device that often allows you to automatically inject subcutaneously high-speed ultrashort insulin, in very small doses. In many cases, switching to an insulin pump for type 1 diabetes in children can improve blood sugar control and the quality of life of the child.

Insulin pump in action

Read about the advantages and disadvantages of switching to an insulin pump here. See also the video.

Features of insulin treatment if a diabetic child follows a low-carbohydrate diet

Together with meals, it is better to use not ultrashort analogs, but ordinary “short” human insulin. In the transition from a normal to a low-carb diet, there is a high risk of hypoglycemia. This means that you need to carefully monitor blood sugar with a glucometer up to 7-8 times a day. And the results of these measurements drastically reduce the dosage of insulin. It can be expected that they will be reduced by 2-3 times or more.

After the transition to a low-carbohydrate diet, the need for insulin is reduced by 2-7 times. And if you're lucky, you can completely refuse injections.

Most likely, you can easily do without an insulin pump. And accordingly, do not take on the additional risks that its use carries. You will be perfectly able to compensate for diabetes with low doses of insulin, which are injected with traditional syringes or syringe pens in increments of 0.5 U.

Diet for type 1 diabetes in children

Official medicine recommends a balanced diet for type 1 diabetes, in which carbohydrates make up 55-60% of the caloric intake. Such a diet leads to significant fluctuations in blood sugar levels, which cannot be controlled by insulin injections. As a result, periods of very high glucose concentrations are replaced by periods of low sugar.

Broad "jumps" of glucose in the blood lead to the development of vascular complications of diabetes, as well as provoke episodes of hypoglycemia. If you eat less carbohydrates, this reduces the amplitude of sugar fluctuations. In a healthy person at any age, the normal level of sugar is about 4.6 mmol / l.

If in type 1 diabetes you limit the carbohydrates in the diet and use small, carefully selected doses of insulin, you can maintain your sugar at the same level, with deviations of no more than 0.5 mmol / l in both directions. This will completely avoid the complications of diabetes, including hypoglycemia.

See the articles for more details:

  • Insulin and carbohydrates: the truth you need to know;
  • The best way to reduce blood sugar and keep it normal.

Does a low-carb diet hurt the growth and development of a child's body? Far from it. There is a list of essential amino acids (proteins). It is also necessary to consume natural healthy fats, especially omega-3 fatty acids. If a person does not eat proteins and fats, then he will die of exhaustion. But you will not find anywhere else a list of essential carbohydrates, because they simply do not exist. At the same time, carbohydrates (except dietary fiber, i.e. fiber) are harmful in diabetes.

From what age can a child be transferred to a low-carbohydrate diet in type 1 diabetes? You can try to do this when he begins to eat the same food as adults. By the time of transition to a new diet you need to prepare and provide the following:

  1. Understand how to stop hypoglycemia. Keep sweets on hand in case you have to do it.
  2. In the transitional period, blood sugar should be measured with a glucometer before each meal, 1 hour after it, and also at night. It turns out at least 7 times a day.
  3. According to the results of blood glucose control - boldly reduce the dosage of insulin. You will see that they can and should be reduced several times. Otherwise there will be hypoglycemia.
  4. During this period, the life of a child with diabetes should be as calm as possible, without stress and strong physical exertion. Until the new regime becomes a habit.

How to convince a child to stick to a diet

How to convince a child to stick to a healthy diet and give up sweets? When a child with type 1 diabetes follows a traditional “balanced” diet, he has the following problems:

  • due to the "jumps" of sugar in the blood - consistently feeling unwell;
  • hypoglycemia sometimes happens;
  • various chronic infections may occur.

At the same time, if a diabetic carefully adheres to a low-carbohydrate diet, then within a few days he will receive great benefits:

  • blood sugar is stably normal, and because of this, the state of health improves, energy becomes more;
  • the risk of hypoglycemia is extremely low;
  • many chronic health problems are receding.

Let the child experience “in his own skin,” how different is his state of health, if he adheres to the regime and if he violates it. And then he will have a natural motivation to control his diabetes and resist the temptations to eat “forbidden” products, especially in the company of friends.

Many children and adult patients with type 1 diabetes do not even suspect how well they can feel on a low-carbohydrate diet. They have become accustomed and resigned to the fact that they have constant fatigue and malaise. The more persistent supporters of low-carbohydrate food, they will, as soon as they try it and feel the wonderful results of this method.

Answers to frequent questions from parents

Son 6 years old, type 1 diabetes for almost a year. The last 2 months we measure sugar 6-7 times a day, intensive insulin therapy with calculating HE. Sugar keeps from 4.0 to 7.5. At the same time, HbA1C is still growing. It was 5.5%, recently passed again - 6.6%. Why is it growing despite careful treatment?

Glycated hemoglobin grows because it is impossible to compensate for diabetes normally, while the diet remains “balanced”, i.e. overloaded with carbohydrates. No matter how carefully you consider bread units, there will be little confusion. Go to the low-carb diet that our site preaches. Read the interviews with parents of a 6-year-old child with type 1 diabetes who achieved complete remission and jumped off insulin. I do not promise that you will get the same thing, because they immediately began to be treated correctly, and did not wait a whole year. But in any case, the compensation of diabetes will improve.

6-year-old child, 2 years experience of type 1 diabetes, on an insulin pump. With the beginning of summer, the need for insulin has dropped 3 times. Is this normal or should something be examined?

The child grows and develops not smoothly, but in jumps. When there is a rapid growth, the need for insulin increases significantly, because hormonal changes. Perhaps you have just the next phase of active growth is over, so the need for insulin falls. Well, in the summer of insulin requires less, because it is warm. These effects overlap each other. You probably have nothing to worry about. Watch your sugar carefully, conduct total glucose self-monitoring. If you notice that insulin does not cope with the compensation of diabetes, then increase its dosage. Read here about the shortcomings of the insulin pump compared to good old syringes.

My 11-year-old daughter recently discovered type 1 diabetes. Excluded from the food sweet, flour, potatoes, all fruits. Thanks to this, they were able to completely abandon insulin, and sugar is still normal. But the child periodically eats sweets, then the sugar jumps to 19. And she wants to prick insulin, just not so strictly follow a diet. What do you advise?

I think you can’t keep her from “sins”, and not only from food ... Adolescence begins, typical conflicts with parents, the struggle for independence, etc. You will not be able to ban everything. Instead, try to act by conviction. Show examples of adults with type 1 diabetes who are now suffering from complications and repent that they were such idiots as a teenager. But generally accept it. In this situation, you really can not affect. Try wisely to accept. Get yourself a dog and get distracted by it. Other than jokes.

A child of 12 years old, is now being examined in the hospital for the diagnosis of diabetes. At hospitalization, blood sugar was 15.0. Received test results from the laboratory: HbA1C - 12.2%, C-peptide - 0.89 at a rate of 0.9-7.10, glucose (serum) - 12.02 mmol / l, insulin - 5.01 at a rate of 2.6-24.9. What does it mean? HbA1C is high and C-peptide is low - does it mean type 1 diabetes? But why then insulin in the blood in the normal range?

The insulin level in the blood jumps very strongly. Look at the spread in the norms - almost 10 times. Therefore, a blood test for insulin does not play a special role in the diagnosis. Your child, unfortunately, has 100% type 1 diabetes. Quickly begin to compensate for the disease with insulin injections and low-carbohydrate diet. Doctors may take time, but it is not in your interest. The later you begin to heal normally, the more difficult it will be to succeed. Prick insulin and follow a strict diet - little pleasure. But in adolescence to become disabled due to diabetes complications - the enemy does not want. So do not be lazy, and carefully treated.

My son is 4 years old; he got sick with type 1 diabetes 3 weeks ago, was in hospital. Learned to count XE, we inject insulin as prescribed in the hospital. We want to achieve the perfect compensation for diabetes. How to do it?

Achieving perfect compensation is a typical desire of parents who have recently experienced type 1 diabetes in their children. On all other sites you will be assured that this is impossible, and you need to put up with sugar jumps. But I have good news for you. Read the interviews with parents of a 6-year-old child with type 1 diabetes who achieved complete remission. Their child has consistently normal blood sugar, without insulin injections at all, thanks to a low-carbohydrate diet. With type 1 diabetes, there is a honeymoon period. If you do not allow carbohydrates to overload the pancreas, you can extend it for several years, and even for life.

A child of 5 years old, presumably type 1 diabetes. We’ll wait another 11 working days for analyzing antibodies. Excluded from the diet fast carbohydrates on the recommendation of a doctor. Now, sugar on an empty stomach is normal, rises after eating, and then drops to normal in 3-4 hours. Ate soup and a little barley porridge - after 2 hours, sugar turned out to be a high 11.2 mmol / l. What should I do if insulin is not prescribed?

What to do - first of all, you need to go on a low-carbohydrate diet. For a complete list of permitted and prohibited foods, read here, there are also dietary compliance rules. Exclude from the diet, flour, sweets and potatoes - this is a half measure, which is not enough. Read what is the honeymoon period for type 1 diabetes. Perhaps with the help of a low-carbohydrate diet, you will be able to extend it for several years, or even for a lifetime. Here is an interview with the parents of a 6-year-old child who got it. They do without insulin at all and keep stable normal sugar, like in healthy people. Their child did not like insulin so much that he was ready to follow a diet, if only there were no shots. I do not promise that you will achieve the same success. But in any case, a low-carb diet is the cornerstone of diabetes treatment.

Type 1 diabetes in children: conclusions

Parents should accept that a child with type 1 diabetes at the age of 12-14, or even older, will not give a damn about the development of vascular complications. The threat of these long-term problems will not make him control his diabetes more seriously. The child is only interested in the current moment, and at a young age this is normal. Be sure to read our main article "Diabetes in children and adolescents".

So, you learned what features of type 1 diabetes in children. These children need to be regularly examined whether their thyroid gland is working normally. In many children with type 1 diabetes, using an insulin pump helps to better control blood sugar. But if a child follows a low-carbohydrate diet, then most likely you will be able to maintain normal sugar with the help of traditional insulin shots.

Watch the video: Management of Type 1 Diabetes in Children (December 2019).