Type 1 Diabetes: Children Living With the Disease

	Topic Overview
	Health Tools
	Cause
	Symptoms
	What Happens
	What Increases Your Risk
	When To Call a Doctor
	Exams and Tests
	Treatment Overview
	Prevention
	Home Treatment
	Medications
	Surgery
	Other Treatment
	Other Places To Get Help
	Related Information
	References
	Credits

Is this topic for you?

This topic provides information for parents who have children age 11 years and younger with type 1 diabetes. Before reading this topic, you may want to read Type 1 Diabetes: Recently Diagnosed.

If this topic does not answer your questions, one of the following topics may meet your needs.

• Type 1 Diabetes, if you want to learn about type 1 diabetes but do not have the disease
• Type 1 Diabetes: Recently Diagnosed, if you have been told recently that you or your child has type 1 diabetes
• Type 1 Diabetes: Living with the Disease, if you or your adolescent has type 1 diabetes. If you have not read the topic Type 1 Diabetes: Recently Diagnosed, you may want to read it first.
• Type 1 Diabetes: Living with Complications, if you have complications, such as eye, kidney, heart, nerve, or blood vessel disease, caused by diabetes

What is type 1 diabetes?

Type 1 diabetes is a lifelong disease that develops when your child's pancreas stops producing enough insulin. Insulin lets blood sugar—also called glucose—enter the body's cells, where it is used for energy. Without insulin, glucose cannot be used for energy, and the amount of sugar in the blood rises above a safe level. It isn't easy for you or your child to cope with this disease, but knowing as much as possible about type 1 diabetes and its progression can help. Information can give you and your child the resources and coping skills you both need.

What will it be like for my child to live with type 1 diabetes?

Living with type 1 diabetes requires daily attention to what and how much your child eats, insulin injections, blood sugar monitoring, and physical exercise. These will always be a part of your child’s daily routine and are the most important part of your child’s diabetes treatment.

Taking care of your child’s diabetes takes a lot of time and energy. It will become a big part of your and your child’s life. But it will help your child feel better and have a good quality of life. You may worry about your child developing diabetic complications, such as eye, kidney, heart, blood vessel, and nerve diseases. For some reason, children seem protected from complications during childhood. However, persistent high blood sugar levels during childhood and adolescence increase the risk for having these complications in early adulthood. If your adolescent has diabetes, tight control of blood sugar levels can prevent complications from developing in early adulthood.

What symptoms should I watch for?

As your child lives with type 1 diabetes, you need to watch for signs of high and low blood sugar. If you are concerned about your child’s blood sugar, do a home blood sugar test—don't rely on symptoms alone.

• Low blood sugar (hypoglycemia) can develop when your child takes more insulin than needed, eats too little food, or is more active than usual. Low blood sugar usually develops within 10 to 15 minutes. Early symptoms include sweating, weakness, shakiness, and hunger; however, your child's symptoms may vary. Over time, your child may not notice these symptoms. If not treated, low blood sugar can get worse and lead to confusion, slurred speech, and loss of consciousness.
• High blood sugar (hyperglycemia) can develop when your child feels sick or stressed, misses an insulin dose, or eats more than usual. Early symptoms are increased thirst, increased urination, increased hunger, and blurred vision. High blood sugar usually develops slowly over a few days or weeks.

How often does my child need to see the doctor?

See your child's doctor at least every 3 to 4 months to evaluate how well the treatment is working. During these visits, the doctor will do some tests to evaluate your child's blood sugar control. Based on these results, your child's treatment plan could change.

When your child is 10 years old or starts puberty, he or she will start having screening exams and tests for diabetic complications. The timing varies depending on the type of test.

How will my child's treatment change over time?

Your child's insulin dose, possibly the types of insulin, and the way insulin is given (by injection or insulin pump) may change over time. Your child's nutritional needs will also vary, but spreading carbohydrate throughout the day will always be important. Carbohydrate is the nutrient that most affects blood sugar.

When your child enters puberty, his or her insulin requirements will alter dramatically. During this time of rapid growth and development, your child's treatment will change to keep pace with a changing body.

Frequently Asked Questions

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	Preventing high blood sugar emergencies in children with diabetes

Type 1 diabetes develops when your child's pancreas stops producing enough insulin. Insulin lets blood sugar—also called glucose—enter the body's cells, where it is used for energy. Without insulin, the amount of sugar in the blood rises above a safe level. As a result, your child experiences high and low blood sugar levels from time to time. High blood sugar can damage blood vessels and nerves throughout the body and increases your child's risk of eye, heart, blood vessel, nerve, and kidney diseases.

Causes of high blood sugar

• Skipping a dose of insulin or eating more than usual
• Experiencing emotional stress or illness, such as the flu or an infection, especially if your child is not eating or drinking enough
• Taking certain medications that can raise blood sugar levels, such as medications that reduce swelling and inflammation (corticosteroids), growth hormone, and decongestants that contain beta-adrenergic agents, such as pseudoephedrine
• Experiencing the dawn phenomenon or the Somogyi effect, which causes high blood sugar in the morning

Causes of low blood sugar

• Taking too much insulin
• Skipping or delaying a meal or snack
• Being more physically active than usual without eating enough food
• Taking certain medications that may lower blood sugar levels, such as those that reduce fever and pain
• Entering puberty. Hormonal changes may affect how well insulin works.

Because your child has type 1 diabetes, he or she will experience high and low blood sugar levels from time to time. High blood sugar usually develops slowly over hours or days, so you can treat the symptoms before they become severe and require medical attention. On the other hand, your child's blood sugar level can drop to dangerously low levels in minutes.

Be alert for:

• Symptoms of low blood sugar, which include sweating, weakness, and hunger.
• Symptoms of high blood sugar, which include increased thirst and increased urination.

How can I tell the difference?

Sometimes it's hard to distinguish between high and low blood sugar symptoms, especially if your child is very young. Test your child's blood sugar whenever you think it may be high or low so that you can treat it appropriately. If your child has symptoms of very high blood sugar, such as a fruity breath odor, vomiting, and abdominal pain, seek emergency care. These symptoms may indicate diabetic ketoacidosis, which is a life-threatening emergency.

Every child experiences type 1 diabetes differently. What they do have in common is that having diabetes will not affect their learning ability or school performance.¹

The negative effects of diabetes are caused by blood sugar levels that are above or below a normal or near-normal range.

Low blood sugar

Very low blood sugar is a frightening experience for you and your child. However, if low blood sugar levels are treated quickly and appropriately, your child should have no lasting effects.

Young children cannot recognize low blood sugar symptoms as well as adults can, which puts them at risk for low blood sugar emergencies. Children who develop hypoglycemia unawareness or are trying to keep their blood sugar levels tightly within a target range are also at risk for low blood sugar emergencies. Make sure your child's caregivers watch for symptoms of low blood sugar, know how to do a home blood sugar test, and know what to do if your child's blood sugar level is low. Let your doctor know if your child is having frequent episodes of low blood sugar.

High blood sugar

Very high blood sugar puts your child at risk for diabetic ketoacidosis, a life-threatening emergency. Stress, illness, injury, and puberty can trigger high blood sugar. Since blood sugar levels usually rise slowly, you can treat symptoms early and, most often, prevent diabetic ketoacidosis.

High blood sugar can also lead to:

• Adjustment of the body to high levels. For example, if your child's blood sugar level is consistently at 250 milligrams per deciliter (mg/dL) and suddenly drops to 100 mg/dL, you or your child may think this level is too low when it is really not.
• Delayed growth and maturity. If your child has high blood sugar levels over a long period of time, he or she may grow and mature more slowly. During puberty, this can delay normal sex changes and the onset of menstruation.
• Developing complications from the disease (eye, kidney, heart, blood vessel, and nerve disease). Children seem to be protected from developing these complications during childhood. However, if their blood sugar levels are persistently high, children are more likely to show early signs of these complications, particularly eye and kidney disease. In addition, high blood sugar levels during childhood and adolescence put your child at risk for these diseases in early adulthood.

What can be done?

The best way to help your child with type 1 diabetes live a long and healthy life is to keep his or her blood sugar levels within a normal to near-normal range. Two important studies, Diabetes Control and Complications Trial (DCCT) and its follow-up study, showed that keeping blood sugar levels in this range greatly decreases the chance of developing complications. Work with your child's doctor, and monitor blood sugar levels frequently.

Risk factors for very high or low blood sugar levels in a child with type 1 diabetes include:

• Age. Very young children and boys of all ages are at the greatest risk for very low blood sugar.²
• Tight blood sugar control. Although keeping your child's blood sugar level tightly within a normal or near-normal range is important, this puts him or her at risk for frequent low blood sugar levels.³
• Persistent high blood sugar levels. Children who have persistent high blood sugar, indicated by higher hemoglobin A_1c test results, are at greater risk for diabetic ketoacidosis than children with lower levels.²
• Puberty. Growth spurts and changing hormone levels that occur during puberty make it difficult to keep a child's blood sugar level within a target range.
• Psychiatric conditions. Children with depression, anxiety disorder, panic disorder, or eating disorders are at increased risk for frequent high and low blood sugar levels.²

Although children are protected from developing complications from diabetes (eye, kidney, heart, blood vessel, and nerve disease) during childhood, they are at risk for developing these diseases in adulthood. Risk factors for these complications include:

• Persistent high blood sugar over time. The higher your child's blood sugar levels and the longer they remain high, the greater his or her risk of developing complications in early adulthood.
• Length of time having the disease. The longer your child has diabetes, the more likely complications will develop, even if blood sugar levels are controlled.
  • Eye damage from diabetes, called diabetic retinopathy, is the most frequent cause of new cases of blindness in adults ages 20 to 74.⁴
  • Kidney damage, diabetic nephropathy, eventually occurs in 20% to 40% of all people with diabetes.⁵ Children who develop nephropathy usually show the first signs of the condition after puberty.
  • Nerve disease. Most people with diabetes develop some diabetic neuropathy over the years, but only about 13% to 15% have noticeable symptoms.⁶
• Having one complication. In adulthood, if children develop one complication, they are at risk for developing others.
• Smoking, high blood pressure, high cholesterol, and a family history of diabetic complications.

Call 911 or other emergency services immediately if:

• Your child with type 1 diabetes is becoming sleepy or lethargic and his or her blood sugar level is less than 60 mg/dL. Follow the emergency care for low blood sugar guidelines.
• Your child with type 1 diabetes is losing consciousness and you notice that his or her breath has a fruity odor. This can indicate diabetic ketoacidosis.

Call a health professional if:

• Your child's blood sugar level stays below his or her target range after you give him or her some quick-sugar food, especially if your child has nausea and/or vomiting.
• Your child's blood sugar level stays above a safe range after you follow the steps for high blood sugar.
• Your child's blood sugar level stays high after taking a missed dose of insulin or taking an extra dose of insulin, if prescribed by the doctor.
• Your child has frequent problems with high or low blood sugar levels.
• Your child continues with persistent high blood sugar levels even though you followed the recommended treatment.
• Your child is having problems following his or her treatment plan.
• Your child has high blood sugar, and a urine test for ketones shows more than 2+ or moderate or higher ketones.
• Your child is sick, unless it is a mild illness (such as a mild cold), and you don't know what to do.

Watchful Waiting

Watchful waiting is a period of time during which you and your health professional study your health without using medical treatment. Watchful waiting is not appropriate for a child with type 1 diabetes if blood sugar levels are frequently high or low. His or her treatment may need changing. Keeping your child's blood sugar levels within a normal or near-normal range helps prevent high blood sugar emergencies and long-term complications, such as eye, kidney, heart, blood vessel, and nerve damage.

Who To See

Health professionals who may care for a child with type 1 diabetes include:

• A pediatrician, a family medicine doctor, or a general practitioner.
• A nurse practitioner or a physician assistant.
• A pediatric endocrinologist.
• A certified diabetes educator (CDE).
• A registered dietitian, to help develop a daily meal plan for your child and your family.
• A psychologist, to help with emotional or family issues that might affect your child's treatment.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

A child with type 1 diabetes needs to visit his or her doctor at least every 3 to 4 months. During these visits, the doctor reviews your child's blood sugar level records and asks about any problems you and your child may have. Your child's blood pressure is checked, and growth and development evaluated. A health professional will examine your child for signs of infections, especially at injection sites. Your child will usually have the following tests at office visits:

• A hemoglobin A_1c or similar test (glycosylated hemoglobin or glycohemoglobin) to check your child's blood sugar control over the previous 2 to 3 months
• A blood glucose test. This is a good time to check the accuracy of your child's blood sugar meter.
• A blood test to check kidney functions and electrolyte levels.

Your child's doctor will do a cholesterol (LDL and HDL) test as soon as your child's blood sugar levels are under control. If the LDL cholesterol is less than 110 mg/dL (2.60 mmol/L) and there is no family history of high cholesterol, the doctor will repeat this test every 5 years.

Diabetes increases your child's risk for dental problems. Experts suggest dental checkups every 6 months.

Children's nutritional needs change as they grow and develop. See a registered dietitian at least once a year to review your child's meal plan.

5 years after diagnosis

Your child should have an initial dilated eye exam (ophthalmoscopy) by an ophthalmologist or an optometrist within 3 to 5 years of the diabetes diagnosis to check for signs of diabetic retinopathy. Thereafter, your child should have yearly eye exams. You child should also begin having annual microalbumin urine tests. This test helps detect diabetic nephropathy.

Other tests

Your child may need a thyroid-stimulating hormone (TSH) test at some point. This test checks for thyroid problems, which are common among people with diabetes.

The goal of your child's treatment for type 1 diabetes is to always keep his or her blood sugar levels within a target range; a normal or near-normal range reduces the chance of diabetes complications. Daily diabetes care and regular medical checkups will help you and your child accomplish this goal.

Daily care

Your child's daily care includes:

• Exercise. Encourage your child to have at least 1 hour of exercise or physical play time every day. Try to have at least 15 minutes of that time spent in a fast-paced activity.
• Home blood sugar monitoring.
• Preparing and giving insulin injections or using an insulin pump.
• Counting carbohydrates.
• Dealing with low blood sugar levels.
• Preventing high blood sugar levels.

Some problems you may encounter include:

• Changing appetite and "picky eating." A registered dietitian can help you develop a flexible meal plan to meet your child's appetite needs and allow for special events, such as parties and school activities. If you use rapid-acting insulin, you can give the insulin dose after a meal based on what your child ate. Some tips for mealtimes with young children include having alternative meal choices.
• Illness. Follow the sick-day guidelines that you and your child's doctor set up to prevent high blood sugar emergencies when your child is ill. Talk with the doctor before giving your child any nonprescription medication.
• Exercise. If your child is not very active, limit his or her time playing video games, watching TV, or using the computer. Plan some activities to do along with your child, such as in-line skating or bicycling. Keep your child safe during exercise by:
  • Checking his or her blood sugar levels before and after vigorous activity.
  • Having a quick-sugar food on hand at all times.
  • Giving the coach a copy of the symptoms of low blood sugar and instructions about what to do if it occurs.

You will also want to:

• Always have your child wear medical identification to let medical personnel know that he or she has diabetes. You can buy medical-identification bracelets, necklaces, or other forms of jewelry at a pharmacy.
• Have your child wear shoes that fit properly at all times, even in the house. Use the checklist for foot exams to check your child's feet every day for signs of injury or infection. Teach your child how to wash and dry his or her feet thoroughly. If you notice a foot problem, even a minor one, talk with your child's doctor before treating it.
• Keep your child's day care or school plan for diabetes care up to date. Have written instructions for your babysitter and other caregivers.
• Help your child care for his or her skin and teeth and gums. Make sure your child has a dental checkup every 6 months.
• Keep your child's immunizations up to date. For more information, see the topic Immunizations.
• Participate in a support group for parents of children with diabetes. These groups can be very helpful, especially the first few years after diagnosis. Local groups are available in most areas.
• Encourage your child to attend camps for children with diabetes. Diabetes camps are a good learning experience for your child, and they will allow you some time to yourself.
• Allow your child with diabetes to help with the treatment, given his or her age and experience with the disease.

Regular medical checkups

Your child needs to see his or her doctor every 3 to 4 months. During these checkups, the doctor will evaluate and adjust your child's treatment. The doctor will do a hemoglobin A_1c or similar test (glycosylated hemoglobin or glycohemoglobin) to check your child's blood sugar control over the previous 2 to 3 months, and a blood glucose test.

If your child's LDL cholesterol is less than 110 mg/dL (2.60 mmol/L) and there is no family history of high cholesterol, the doctor will do a cholesterol (LDL and HDL) test every 5 years.

When your child has had diabetes for 5 years, the doctor will start yearly screening tests for protein in the urine, which indicates diabetic nephropathy. At that same time, your child needs to see an ophthalmologist for yearly dilated eye exams (ophthalmoscopy) to check for signs of diabetic retinopathy.

Treatment for high blood sugar emergency

If your child does not take enough insulin, has a severe infection or other illness, or becomes severely dehydrated, his or her blood sugar level may rise very high and lead to diabetic ketoacidosis. Diabetic ketoacidosis is usually treated in a hospital, often in the intensive care unit, where caregivers can watch your child closely and give him or her frequent blood tests for glucose and electrolytes. Insulin is given through a vein (intravenous, or IV) to bring blood sugar levels down. Fluids are given through the IV to correct the electrolyte imbalance. Your child may stay in the hospital for a few days until blood sugar levels are back in a safe range.⁷

What To Think About

A 10-year study, and its follow-up study, showed that keeping blood sugar levels within a normal or near-normal range helps decrease the chances of developing diabetes complications, such as eye, kidney, heart, blood vessel, and nerve damage. As a result of this study, experts recommend that people with diabetes carefully control their blood sugar levels. This is often called strict or tight blood sugar control.

When a child has diabetes, keeping blood sugar levels within a normal or near-normal range helps the child grow and develop normally; however, it increases the risk for frequent low blood sugar episodes. Your health professional will figure the safest range for your child's blood sugar level.

For some children, using an insulin pump helps keep their blood sugar levels within a target range.⁵

If your child has frequent low blood sugar levels, especially at night (nocturnal hypoglycemia), the doctor may suggest continuous ambulatory blood glucose monitoring. This means your child wears a special monitor that tests his or her blood sugar level continuously for 24 to 72 hours. The monitor stores the results, allowing you to look for patterns of high or low blood sugar levels.⁸

Scientists are looking for pain-free ways to give insulin and test blood sugar levels. Under development are inhaled insulin, improved insulin pumps, and better needles and lancets. An inhaled insulin (Exubera) was recently approved by the U.S. Food and Drug Administration (FDA) for use in adults but is still being studied for use in children. In the future, glucose monitors may be worn continuously and be able to signal insulin pumps when the rate of insulin needs to be changed. Scientists are also studying ways to prevent or decrease complications from diabetes. If you're interested, talk to your child's doctor about participating in any of these studies.

Your child with type 1 diabetes will have high and low blood sugar levels from time to time. You can help avoid many immediate problems and long-term complications, such as eye, kidney, heart, blood vessel, and nerve disease, by:

• Helping your child develop a healthy attitude toward having diabetes. As your child grows and develops, let him or her assume appropriate responsibility for treatment.
• Encouraging and supporting your child to keep blood sugar levels within a normal or near-normal range. Starting tight control of blood sugar levels as soon as possible after diagnosis of diabetes gives your child the greatest chance of avoiding complications from diabetes later on in life.
• Checking your child's blood sugar level several times a day and whenever you think it may be high or low.⁹
• Recognizing and treating high and low blood sugar quickly. Make sure everyone who cares for your child knows how to treat high and low blood sugar episodes.
• Discussing the dangers of smoking, drinking alcohol, and using other drugs. Smoking affects the blood vessels and can lead to developing diabetes complications later on in life.¹⁰ Alcohol and other drugs can mask symptoms of low blood sugar, which may lead to an emergency situation.
• Keeping your child's immunizations up to date. Diabetes affects the immune system, increasing the risk of developing a severe illness.
• Keeping your child's doctor aware of behavior changes in your child. Emotions and behavior can affect how well you and your child manage diabetes treatment.⁵

The daily care for your child with type 1 diabetes can seem overwhelming, leading to conflicts between you and your child. Here are some tips that may help:

Make mealtimes less stressful

Mealtimes can become a battleground when you want your child to get a certain amount of carbohydrate. You can:

• Meet regularly with a registered dietitian. A registered dietitian can help set up a flexible meal plan to meet your child's appetite needs and allow for special events, such as parties and school activities. Some tips for mealtimes with young children include having alternative meal choices.
• Use rapid-acting insulin so you can give the insulin dose after a meal based on what your child ate.
• Count carbohydrate grams.

Make giving insulin less difficult

Your child may take several insulin injections each day or use an insulin pump. You may need help with:

Preparing and giving an insulin injection.

Keep monitoring reasonable

If you test several times a day (before breakfast, with meals, and at bedtime), you can tell how well your child's blood sugar levels stay within a target range. You need to test more often when your child is sick. Follow the sick-day guidelines that you and your child's doctor set up, or call for help. Do not give your child nonprescription medications without talking with the doctor.

Home blood sugar monitoring

Encourage physical activity

Encourage your child to have at least 1 hour of physical activity a day. Try to have at least 15 minutes of energetic activity during that time. Check your child's blood sugar levels before and after active play, and have some quick-sugar food (hard candy, fruit juice, honey) on hand at all times. If your child participates in organized sports, give the coach a copy of the symptoms of low blood sugar and instructions about what to do if it occurs.

If your child has a tendency to be inactive, you may need to:

• Limit his or her time playing video games, watching TV, or using the computer.
• Plan some activities to do along with your child, such as skating or bicycling.

Catch the ups and downs

Because blood sugar levels can drop to dangerous levels very quickly:

• Have your child always wear medical identification so medical personnel can give the right care. You can buy medical-identification bracelets, necklaces, or other forms of jewelry at a pharmacy.
• Make sure everyone who cares for your child knows how to treat low blood sugar quickly.

  For more information, see:

  Dealing with low blood sugar.

High blood sugar levels develop more slowly, over a period of hours. For more information, see:

Preventing high blood sugar emergencies.

Keep your child healthy and safe

With planning and care, your child can live a safe and healthy life. Here are some suggestions:

• Don't let your child go barefoot. If you notice a foot problem, even a minor one, talk with a doctor before treating it.
• Keep your child's day care or school plan for diabetes care up to date.
• Have written instructions for your babysitter and other caregivers.
• Keep your child's immunizations up to date.
• Help your child care for his or her skin and teeth and gums. Make sure your child has a dental checkup every 6 months.

Keep your balance

It's difficult to deal with such a demanding disease as diabetes. You can:

• Allow children with diabetes to participate in their treatment to the extent they can.
• Join a support group for parents of children with diabetes. These groups can be very helpful, especially the first few years after diagnosis. Local groups are available in most areas.
• Encourage your child to attend camps for children with diabetes. It's a good learning experience for your child and will give you some time to yourself.

Insulin is the only medication that can treat type 1 diabetes, and your child is most likely taking more than one type of insulin. Your child may take several injections a day or use an insulin pump. The insulin pump provides insulin with fewer injections and is as effective as multiple daily injections for maintaining normal or near-normal blood sugar levels.

The amount and type of insulin your child takes will likely change over time, depending on changes that occur with normal growth, physical activity level, and hormones (such as during adolescence). Your child may also need higher doses of insulin when feeling sick or stressed.

• Know the dose of each type of insulin your child takes, when your child should take the doses, how long it takes for each type of insulin to start working (onset), when it will have its greatest effect (peak), and how long it will work (duration).
• Don't let your child skip a dose of insulin without a doctor's advice.

Medication Choices

Insulin

What To Think About

The new rapid-acting insulin is given with a meal or immediately afterward. The dose is based on what your child actually ate, not what the meal plan required. If your child is a "picky eater," this provides flexibility that may reduce mealtime battles.

Scientists are looking at new types of insulin and better ways to give it.

Surgery is not a routine treatment for type 1 diabetes, and children do not meet the criteria for the surgeries that are available. Surgeries for type 1 diabetes are:

• Surgery to replace the pancreas (pancreas transplant), possibly while receiving another organ, such as a kidney.
• Surgery to insert working pancreas cells (islet cell transplant). This procedure is still experimental.

You'll hear about products that promise a “cure” for type 1 diabetes. Avoid them. No such cure exists. Also, avoid products for diabetes that are advertised only by "satisfied customers." These products or remedies may be harmful and costly. They also might cause you to delay or avoid getting treatment for your child that really works. If you have questions about a product for diabetes, check with your local American Diabetes Association office, your doctor, or a diabetes educator.

Other types of meal plans

You may hear of people with diabetes following other types of meal plans or using low glycemic index foods to prevent high blood sugar levels after meals. Talk with a registered dietitian before trying a new meal plan.

Complementary therapies

Complementary therapies such as relaxation techniques may help relieve stress and muscle tension and improve your child's overall well-being and quality of life. None of these complementary therapies are proven to effectively treat diabetes. However, children may benefit from safe, nontraditional therapies that complement their current treatment.

Do not use complementary therapies alone to treat your child's diabetes.

Talk with your child's doctor if you are using any of the following or other complementary or alternative therapies to treat your child's diabetes:

• Acupuncture
• Biofeedback
• Chiropractic therapy
• Herbal medicines and natural substances, such as antioxidants, vanadium, magnesium, or chromium. Studies indicate that soluble fiber may help you keep blood sugar levels within a target range.
• Osteopathy

Online Resource

Organizations

• Diabetic Nephropathy
• Diabetic Neuropathy
• Diabetic Retinopathy
• Type 1 Diabetes: Living With Complications
• Type 1 Diabetes: Living With the Disease
• Type 1 Diabetes: Recently Diagnosed
• Type 2 Diabetes in Children

Citations

1. McCarthy AM, et al. (2002). Effects of diabetes on learning in children. Pediatrics, 109(1). Available online: http://www.pediatrics.org/cgi/content/full/109/1/e9.

2. Rewers A, et al. (2002). Predictors of acute complications in children with type 1 diabetes. JAMA, 287(19): 2511–2518.

3. Allen C, et al. (2001). Risk factors for frequent and severe hypoglycemia in type 1 diabetes. Diabetes Care, 24(11): 1878–1881.

4. Begg IS, et al. (2001). Eye disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 396–428. Hamilton, ON: BC Decker.

5. American Diabetes Association (2006). Standards of medical care in diabetes. Clinical Practice Recommendations 2005. Diabetes Care, 29(Suppl 1): S3–S42.

6. Zochodne DW (2001). Peripheral nerve disease. In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 466–487. Hamilton, ON: BC Decker.

7. American Diabetes Association (2004). Hyperglycemic crises in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S94–S102.

8. American Diabetes Association (2004). Tests of glycemia in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S91–S93.

9. Levine BS, et al. (2001). Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes. Journal of Pediatrics, 139(2): 197–203.

10. American Diabetes Association (2004). Smoking and diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74–S75.

Other Works Consulted

• American Diabetes Association (2004). Diabetes care in the school and day care setting. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S122–S128.

• Ludwig DS (2002). The glycemic index: Physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA, 287(18): 2414–2423.

• Pickup J, Keen H (2002). Continuous subcutaneous insulin infusion at 25 years. Diabetes Care, 25(30): 593–598.

• Powers SW, et al. (2002). Parent report of mealtime behavior and parenting stress in young children with type 1 diabetes and in healthy control subjects. Diabetes Care, 25(2): 313–318.

Author:	Nancy Bateman	Last Updated February 8, 2005
Medical Review:	Michael J. Sexton, MD - Pediatrics Alan C. Dalkin, MD - Endocrinology
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