Type 1 Diabetes 101

If you, a friend or a loved one recently had a child diagnosed with type 1 diabetes, you know how overwhelming this time can be. There is a lot to learn very quickly while coping with a big life change for the entire family.

One of the most important things I tell families of patients newly diagnosed with type 1 diabetes is that they are not alone, and I hope they’ll find friends, neighbors and family members who will support you when they find out what you’re going through. Many communities have a Juvenile Diabetes Research Foundation (JDRF) chapter and/or an American Diabetes Association (ADA) chapter that can help connect families of newly diagnosed patients to other families experiencing life with type 1 diabetes. Patient families can ask their diabetes healthcare team for information about health psychology which can help everyone cope with the new type 1 diabetes diagnosis and learn more about how this will affect their lives.

Here are some “nuts and bolts” about diabetes that may help families, friends, teachers and babysitters who want to learn more about diabetes and how they can help.

What is diabetes?

  • Diabetes mellitus is when the body can’t get energy normally because it has a problem with insulin. 
  • The name “diabetes mellitus” means urinating a lot (diabetes) of sweet (mellitus) urine.

What is insulin?

  • Insulin is a hormone the body needs to get carbohydrates/sugars into the body’s cells and transform them into energy.
  • Picture a cell in a body, and imagine it has a door to let sugar in. Insulin is the key that opens that door.
  • When insulin isn’t working, the sugar stays in the blood and eventually gets eliminated through urine rather than used for energy. This leads to frequent urination and the need to drink more fluids, so you don’t get dehydrated. 

What’s the difference between type 1 and type 2 diabetes?

Type 1 diabetes is when the pancreas doesn’t make insulin anymore, so there’s no insulin to let the body use sugar, leading to frequent urination, the need to drink more fluids, weight loss and tiredness. Think of this as having no keys available to open the cell doors and let sugar in.

  • The treatment for type 1 diabetes is insulin via injections 4-6 times daily (or sometimes through a device called an insulin pump).
  • When a child is diagnosed with diabetes, it is usually type 1 diabetes, which happens in about 1 in 250 children. It can run in families.
  • Type 1 diabetes is caused by the body’s own immune system inappropriately attacking the pancreas. This leads to the destruction of the pancreas so it can’t make insulin.
  • There is nothing we know that can prevent type 1 diabetes, and nothing anyone did that could have caused this to happen.
  • The blood tests that confirm a child has type 1 diabetes looks for antibodies, which are flags that the immune system makes to target the pancreas.

Type 2 diabetes is when the pancreas makes insulin, but the insulin doesn’t work very well. This is like having a lot of crooked keys that don’t open the cell doors very well.

  • Type 2 diabetes runs in families more frequently than type 1 diabetes.
  • Type 2 diabetes is treated with exercise, healthy eating, pills and sometimes insulin.
  • When an adult is diagnosed with diabetes, it’s often (but not always) type 2 diabetes.

What is blood sugar?

  • Blood sugar (blood glucose) is the amount of sugar in the blood. Most people with don’t have diabetes have blood sugars somewhere between 60-70 and 130-140.
  • Children with diabetes need their sugar checked 4-6+ times a day (before meals, at bedtime, if he/she’s feeling ‘off’ and sometimes in the middle of the night). Many children with diabetes have a continuous glucose monitor, a device that goes under their skin, that almost continuously checks sugar levels.
  • Beyond food, many things can change blood sugar levels: exercise/activity, illness, growth, puberty, excitement/stress, temperature and time of day.
  • Each child will have a target range for his/her blood sugar level. This range is something that may change depending on the day, his/her activity level, as he/she grows and just over time. For example, a target range might be between 70-80 and 140-150 but those ranges are unique to that person and may change over time.
  • Think of this target range as a target on a dartboard: it’s where to aim but not always achievable, and that’s ok.
  • There are no bad sugars. They are just the level of sugar in the blood. If there are patterns of a lot of highs or lows, then the insulin plan might need to change to try and get more sugar levels in the target range.

Treating high or low sugar:

  • If a sugar is higher than the target range, it’s high or hyperglycemia. Give fast-acting insulin.
  • If a sugar is lower than the target range, it’s low, or hypoglycemia. Give fast-acting carbs

What should I know about giving insulin?

  • Insulin is given with an injection via a syringe or pen device, or via an insulin pump device.
  • When a child is first diagnosed, insulin is given with an injection, most commonly with two kinds of insulin: Long-acting insulin once daily at bedtime and fast-acting insulin 4+ times a day.
  • When dosing insulin to cover carbohydrates, insulin is dosed before eating to mimic what the pancreas does. This allows insulin to kick-in as food goes through the digestive tract.
  • Insulin brings blood sugar down, so treat highs with insulin.
  • Expect that the child’s insulin plan will keep changing. At first, this will be directed by their diabetes team, but the child and their family/support team will become experts at managing the diabetes plan and will learn how to make safe adjustments.

What should you know about carbohydrates?

  • Carbohydrates (‘carbs’) in food get broken down to sugar; in fact, all nutrition eventually gets broken down to sugar. But, to be practical, you will count carbs in grams to estimate the amount of fast-acting insulin needed to cover food/drink intake.
  • Carbs bring blood sugar up, so treat lows with carbs.
  • Simple sugars like fruit juice, frosting, etc, bring sugar up faster than more complex carbs like wheat bread.

What is a typical day like for a child with diabetes?

  • Before each meal: 
    • Finger poke to check sugar before meals
    • Estimate grams of carbs in breakfast
  • Before eating:
    • Calculate and give a dose of fast-acting insulin – the sum of insulin needed for food (carbohydrate ratio) plus insulin needed if blood sugar is high (correction factor).
  • Check sugar during other times of the day (examples: if feeling shaky/weird/dizzy or before exercise/sports). If sugar is low, treat with 15 grams of carbs and recheck in 15 minutes.
  • Give insulin with snacks using individualized carbohydrate ratio
  • At bedtime:
    • Finger poke to check sugar and treat if high or low
    • Give long-acting insulin dose
  • Overnight:
    • Often, a finger poke to check sugar between midnight and 2 am

What are ketones?

  • Without insulin, a child can’t easily get energy, and if he/she goes too long without insulin, the body will make a back-up form of energy called ketones.
  • In small amounts, ketones don’t cause a problem (we all make them when we fast). But, if the ketones build up too much, they can make you very sick because they are an acid.
  • If the child has several sugars >250 in a row or if he/she has a fever or is ill, do a urine check for ketones. If there are ketones, he/she needs more insulin.
  • Learn more: What to Do When Sick or With Ketones

How to treat an emergency low blood sugar:

Unlikely but important to know: if a child is ever so ‘out of it’ that he/she’s not able to eat, or is having a seizure due to low blood sugar, give a glucagon injection (use this app to guide you through it).

  • Glucagon Emergency Kit for Persons with Diabetes in English and Spanish

Skills needed for diabetes care:

This collection of videos can help you learn about common procedures and practices related to diabetes.

Final thoughts…

The main thing you can do to help when a child has been diagnosed with type 1 diabetes is to be supportive because everyone is coping with this change.

Caring for a child with diabetes is a substantial undertaking. It affects almost every part of day-to-day life and requires everyone involved with their care to make thoughtful calculations and judgment calls throughout the day. It can be stressful and daunting to think about all the big-picture questions that often come to mind. Meanwhile, everyone is still juggling to manage the usual craziness of life and making sure this child still gets to be a kid, have fun, and do all the activities that bring them joy and help them grow.

Our UW Health pediatric diabetes team is here to offer help and support throughout this journey.