Diabetes is a life-long disease that can be effectively treated with good management. The most common form of diabetes in children is Type 1, although cases of Type 2 diabetes in children are now becoming more common.

Proper management includes lifestyle changes such as being more careful about when and what your child eats and appropriately monitoring blood glucose levels. Such changes will place new needs on you and your child, and it is important that the two of you work together toward better management.

Many parents worry about how their child will cope at school which is understandable. Your child should have the right type of foods to treat a low blood glucose or hypo with them at all times. They also need a blood glucose meter and any medicines.

Filling in their diary might be a good way of communicating with the teachers if you can’t get to speak to them every day. Communication with the school and teachers is important, with support from you and the healthcare team, the school staff will be able to look after your child.

Controlling diabetes is essential to avoiding potential future complications that are often linked to diabetes, such as damage to the heart, eyes, or kidneys. Positive management comes from communication between you, your child, and your healthcare team.

If your child, together with your support, learns to manage their diabetes well using a combination of diet, exercise and medication and/or insulin they can lead a long and fulfilling life. Certainly, however old they are, they will always need your support and guidance and it can be very worrying for a parent when a child leaves home to go away to university or to go travelling.

How to lead a healthier lifestyle

You can help your child to lead a healthier lifestyle in various ways and you may already be doing some of those things already such as :

• Prepare meals that are low in saturated fat and sugar
• Assist in keeping their calorie intake constant (fluctuations can affect blood glucose)
• Encourage regular physical activity
• Help to ensure that glucose testing is regular
• Make sure that insulin is being injected appropriately
• Be a positive force

This final point is vital as it is common for people to experience feelings of depression soon after being diagnosed with diabetes. Your child may have problems articulating his or her emotions so it is good to continue to be supportive and be on the lookout for signs of depression. Some of these may include:

• Mood changes
• Inability to concentrate
• Changes in behaviour
• Being constantly tired (either from too much or too little sleep)

If these signs become extreme and are more than you can handle on your own, it's a good idea to talk to a member of your diabetes healthcare team. Taking the right medication at the right time is important too of course, so remember, your healthcare team are there to help and support you too.

Controlling and testing blood glucose

It is important that your child learns to test their blood glucose regularly - your Healthcare Professional will give you guidance on this. The best way for your child to ensure steady glucose levels is for him or her to test blood glucose 3 to 4 times a day.

Recommended testing times are before and, less frequently, after meals. This way, if glucose levels alter greatly, you will know right away and be able to act accordingly. Generally, 4-7 mmol/L before meals and no more than 10 mmol/L after meals is recommended, but this varies with individuals and your child should aim for the levels agreed with your healthcare professional.

As everyone is different, testing is also a good way for your child to begin to read his or her body and how it reacts to different blood glucose levels.

Feeling better

If blood glucose is well controlled, people often find that they feel fitter and have more energy. If your child's glucose has been high for some time, then a lower level may not immediately improve matters as the body can take a while to adjust to the new level. Some people, however, may feel better almost immediately.

Hyperglycaemia

A blood glucose level above 10 mmol/L is usually defined as hyperglycaemia. When a person with diabetes has hyperglycaemia, he or she is more likely to develop ketoacidosis.

This results when the body releases ketones into the blood in response to the high blood glucose levels. Ketoacidosis is more likely to occur when your child is sick so it's best to look out for signs and symptoms at this time. Signs and symptoms include nausea/ vomiting, blurred vision, deep and fast breathing, and their breath smelling of pear drops. At this point, it's best to contact your healthcare team and have your child drink lots of fluids.

If blood glucose climbs very high because it is not being controlled then there is a danger of slipping into a coma. Good control of blood glucose makes this very unlikely.

Is your child at risk of ketoacidosis?

Testing your child's blood ketones may help you spot problems before they get too serious.

Here are a few suggestions to help you decide if a blood ketone test is needed:

• When your child feels ill , especially if they have an infection and a temperature or if they have been sick.
• If they are suffering from any of the symptoms of ketoacidosis , such as being thirsty all the time, going to the toilet more often than usual, feeling or being sick, blurred eyesight, dry or flushed skin, finding it hard to breathe, feeling tired and / or confused.
• If their blood glucose levels rise to 16.7 mmol/L or higher.

Ketones should be tested every 2 to 4 hours until they get better.

Normal blood ketone levels are slightly different from person to person. This table will help you decide whether you need to do anything and what you should do.

Ketones are serious, but good blood glucose management takes care of ketones as well.

Reducing the risk of future health problems

Over time, a high blood glucose level can damage the body, affecting a number of organs. The best way to prevent this is to keep blood glucose well controlled.

You will find that hypos are much more common and both hypoglycaemia and hyperglycaemia can usually be avoided with regular testing and good management of glucose levels. For more information on hypoglycaemia and hyperglycaemia, speak to a member of your diabetes healthcare team.