Children and diabetes
With the right knowledge and support, children with diabetes can achieve everything they want to in life.15
About 29,000 children in the UK are living with Type 1 diabetes, an autoimmune condition in which the pancreas stops producing insulin.1
A small but growing number of children have Type 2 diabetes, which is linked to obesity and often develops more quickly and aggressively than in adults.2
Once diagnosed, all children with diabetes and their families should receive ongoing support, treatment and advice from a specialist care team. They’ll also have an individual health care plan (IHP) that can be shared with teachers and carers.3
What’s the treatment for diabetes in children?
All children with Type 1 diabetes need insulin to help control their glucose levels. They can take insulin by:4
- Multiple daily injections of different types of insulin (a basal-bolus regimen)
- Up to three daily injections of mixed types of insulin
- An insulin pump that releases a continuous supply of insulin under the skin.
Each method has pros and cons, and every child with diabetes is an individual, so deciding which option to go for should take their lifestyle and preferences into account. 4
Treatment for children with Type 2 diabetes usually starts with healthy eating, exercise, supervised weight loss and medication such as metformin.4
Being diagnosed with diabetes is life-changing for children and their families, so emotional support should be available to help cope with challenges and setbacks.4
How often should children with diabetes test their glucose?
Children with Type 1 diabetes are recommended to test their glucose at least five times a day and more often if they’re ill or when they’re exercising.4
Your diabetes care team will agree with you a target range for glucose levels on waking, and before and after meals.4 The aim of diabetes treatment is to keep glucose within this target range as often as possible, to avoid short-term and long-term health problems.4
You’ll also agree a target HbA1c – a measure of blood glucose levels over time, rather than the ‘snapshot’ of a single test. An HbA1c of 48mmol/mol is recommended as ideal to minimise the risk of long-term complications.4 Your diabetes clinic will measure HbA1c four times a year.4
To keep track of glucose levels at home and school, your child will need to learn how to test their glucose. There are several ways of doing this, including:
- A blood glucose meter
- Continuous glucose monitoring
- Flash glucose monitoring (the FreeStyle Libre system from Abbott*)
Your diabetes care team will advise on which method of glucose testing is likely to be best for your child, and will help your child and you learn how to carry out tests safely and accurately.
What if glucose is too high or too low?
Many different factors can make your child’s glucose level rise and fall. For example, being ill, having extra snacks or not taking enough insulin can make glucose rise, while missing a meal or being extra-active can make glucose fall.5
If untreated, glucose that’s too high or too low can lead to a medical emergency so it’s important that your child learns the signs that something’s wrong and what to do.
High glucose (hyperglycaemia)
Symptoms of hyperglycaemia are similar to untreated or undiagnosed diabetes and include feeling thirsty, urinating often, especially at night, and fatigue. Exercising or a small increase in insulin dose can bring down a high glucose level but it’s important to avoid bringing on a hypo.6
Low glucose (hypoglycaemia)
Hypoglycaemia (also called a hypo) means your child’s glucose level is low, usually below 4mmol/L. Typical warning signs of a hypo include trembling, sweating, feeling hungry or tired, or blurred vision.7
Older children may learn to recognise when they’re having a hypo and how to treat it, but others may need help. Information on how to treat a hypo should be in a child’s IHP for use at school.8
High glucose and blood ketones (ketosis)
A combination of high glucose and reduced supply of insulin – which can happen if, for example, your child’s ill or missed an insulin dose – can trigger the production of ketones. Ketones are acidic chemicals that the body produces when the liver breaks down fat to use for energy instead of glucose.9
Your healthcare team will advise on when to test your child’s blood or urine for ketones and what to do if they’re present.
It’s important not to ignore ketones as a build-up can lead to diabetic ketoacidosis, which is a life-threatening emergency.10
Sick day rules
When your child’s ill, especially if they have a fever, have sickness or diarrhoea or can’t face food, it can be much harder to manage glucose levels safely. It’s important to contact your child’s diabetes care team if you’re unsure what to do .11
Your diabetes care team can help you devise a sick day care plan for your child, which might include a set of ‘sick day guidelines’ to follow, to help your child manage their glucose until they feel better.11
What’s a healthy diet for children with diabetes?
All children need a healthy, balanced diet to help them grow and develop. Children with diabetes, Type 1 or Type 2, are no different,4 and the essentials of a healthy diet are the same for the whole family:12
- Plenty of vegetables and fruit (at least five portions a day)
- Carbohydrates, choosing high-fibre varieties and those with a low glycaemic index12
- Dairy products or non-dairy equivalents, choosing low-fat, low-sugar varieties
- Protein foods (pulses, beans, eggs, fish, meat or vegetable proteins)
- Small amounts of ‘healthy’ unsaturated fats such as rapeseed or vegetable oil
- Plenty of low-calorie drinks
There’s no need to buy special ‘diabetic foods’, or to give up sugar or sweets,13 although foods that are high in fat, sugar and salt aren’t needed in the diet and should be eaten as occasional treats.12
Children who treat their diabetes with insulin will need to balance the carbohydrates they eat with their insulin regime.4 Your diabetes care team might suggest a course for the family to learn about counting carbohydrates in foods and drinks and how they affect glucose levels.4
For children with Type 2 diabetes, healthy eating is an important part of treatment as it can help weight loss, which in turn can lower glucose levels and reduce the risk of cardiovascular disease.4
Can children with diabetes exercise and play sport?
Regular exercise is good for all children, and children with diabetes can take part in all kinds of exercise and sport if they want to.4
Exercise is beneficial to long-term health, but in the short term it can affect glucose levels, increasing the risk of spikes (hyperglycaemia) and lows (hypoglycaemia).4
Testing glucose before and after exercising can help children learn how their body responds to different types of exercise, and spot when they may need an extra snack or to adjust an insulin dose.4
It’s a good idea to involve teachers and sports coaches, so they’re aware of your child’s IHP and how to help them if they need it.14
Tips for exercising safely include:4
- Have a snack if glucose is 7mmol/L or lower before starting to exercise
- Have carbohydrate snacks handy during and after exercise
- Be aware that a hypo may be delayed, so test glucose levels regularly for up to 24 hours after exercise.
*For children aged 4-12, a caregiver at least 18 years old is responsible for supervising, managing, and assisting them in using the FreeStyle Libre system and interpreting its readings
1. JDRF 2019, Type 1 diabetes facts and figures, accessed 7 April 2019,<https://jdrf.org.uk/information-support/about-type-1-diabetes/facts-and-figures/>.
2. Diabetes UK 2018, Position statement: Type 2 diabetes in children and young people, accessed 23 March 2019,<https://www.diabetes.org.uk/resources-s3/2018-08/Our%20position%20on%20Type%202%20diabetes%20in%20children%20and%20young%20people.pdf>
3. Diabetes UK 2019, Diabetes in schools: the IHP, accessed 23 March 2019, <https://www.diabetes.org.uk/guide-to-diabetes/your-child-and-diabetes/schools/ihp-a-childs-individual-healthcare-plan>.
4. National Institute of Health and Care Excellence 2017, NG18: Diabetes (Type 1 and Type 2) in children and young people: diagnosis and management, accessed 23 March 2019, <https://www.nice.org.uk/guidance/ng18/chapter/1-Recommendations>.
5. American Diabetes Association 2019, Factors affecting blood glucose, accessed 23 March 2019, <http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/factors-affecting-blood-glucose.html>.
6. NHS 2018, Hyperglycaemia, accessed 23 March 2019, <https://www.nhs.uk/conditions/high-blood-sugar-hyperglycaemia/>.
7. NHS 2018, Hypoglycaemia (hypos), accessed 23 March 2019,<https://www.nhs.uk/conditions/type-1-diabetes/hypoglycaemia-hypos/>
8. Diabetes UK 2019, Diabetes Complications, Information for School Staff, accessed 16 April 2019,<https://www.diabetes.org.uk/guide-to-diabetes/your-child-and-diabetes/schools/school-staff/complications/>
9. Diabetes Education Online 2019, Ketones, University of Southern California, San Francisco, accessed 7 April 2019, <https://dtc.ucsf.edu/types-of-diabetes/type2/understanding-type-2-diabetes/how-the-body-processes-sugar/ketones/>.
10. Diabetes UK 2019, Diabetic ketoacidosis (DKA), accessed 21 March 2019, <https://www.diabetes.org.uk/guide-to-diabetes/complications/diabetic_ketoacidosis>.
11. Buckinghamshire Healthcare NHS Trust 2017, Sick day guidelines for a child with diabetes, accessed 16 April 2019, <https://www.buckshealthcare.nhs.uk/Downloads/Patient-leaflets-diabetes-folder/Sick%20day%20guidelines%20for%20a%20child%20with%20diabetes.pdf/>.
12. NHS 2019, The Eatwell Guide, accessed 23 March 2019, <https://www.nhs.uk/live-well/eat-well/the-eatwell-guide/>.
13. Diabetes UK 2019, I have Type 1 diabetes; what can I eat?, accessed 23 March 2019, <https://www.diabetes.org.uk/diabetes-the-basics/food-and-diabetes/i-have-type-1-diabetes>
14. Diabetes UK 2019, Teachers’ responsibilities, accessed 23 March 2019, <https://www.diabetes.org.uk/guide-to-diabetes/your-child-and-diabetes/schools/school-staff/responsibilities-teachers#trips>
15. American Diabetes Association 2019, Recently Diagnosed, Living with Type 1 diabetes, accessed 16 April 2019, <http://www.diabetes.org/living-with-diabetes/recently-diagnosed/living-with-type-1-diabetes.html/>.