Type 1 diabetes is a disorder characterized by abnormally high levels of blood glucose, also called blood sugar. In this form of diabetes, specialized cells in the pancreas called beta cells stop producing insulin. Insulin controls how much glucose (a type of sugar) is passed from the blood into cells for conversion to energy. Lack of insulin results in the inability to use glucose for energy or to control the amount of glucose in the blood.

Type 1 diabetes can occur at any age, from early childhood to late adulthood. The first signs and symptoms of the disorder are caused by high blood glucose and may include frequent urination (polyuria), excessive thirst (polydipsia), fatigue, blurred vision, tingling or loss of feeling in the hands and feet, and weight loss. These symptoms may recur during the course of the disorder if blood glucose is not well controlled by insulin replacement therapy. Improper control can also cause blood glucose levels to become too low (hypoglycemia). This may occur when the body's needs change, such as during exercise or if eating is delayed. Hypoglycemia can cause headache, dizziness, hunger, shaking, sweating, weakness, and agitation.

Uncontrolled type 1 diabetes can lead to a life-threatening complication called diabetic ketoacidosis. Without insulin, cells cannot take in glucose. A lack of glucose in cells prompts the liver to try to compensate by releasing more glucose into the blood, and blood glucose can become extremely high. The cells, unable to use the glucose in the blood for energy, respond by using fats instead. Breaking down fats to obtain energy produces waste products called ketones, which can build up to toxic levels in people with type 1 diabetes, resulting in diabetic ketoacidosis. Affected individuals may begin breathing rapidly; develop a fruity odor in the breath; and experience nausea, vomiting, facial flushing, stomach pain, and dryness of the mouth (xerostomia). In severe cases, diabetic ketoacidosis can lead to coma and death.

Over many years, the chronic high blood glucose associated with diabetes may cause damage to blood vessels and nerves, leading to complications affecting many organs and tissues. The retina, which is the light-sensitive tissue at the back of the eye, can be damaged (diabetic retinopathy), leading to vision loss and eventual blindness. Kidney damage (diabetic nephropathy) may also occur and can lead to kidney failure and end-stage renal disease (ESRD). Pain, tingling, and loss of normal sensation (diabetic neuropathy) often occur, especially in the feet. Impaired circulation and absence of the normal sensations that prompt reaction to injury can result in permanent damage to the feet; in severe cases, the damage can lead to amputation. People with type 1 diabetes are also at increased risk of heart attacks, strokes, and problems with urinary and sexual function.

If you have type 1 diabetes, your pancreas doesn’t make insulin or makes very little insulin. Insulin helps blood sugar enter the cells in your body for use as energy. Without insulin, blood sugar can’t get into cells and builds up in the bloodstream. High blood sugar is damaging to the body and causes many of the symptoms and complications of diabetes.

Type 1 diabetes was once called insulin-dependent or juvenile diabetes. It usually develops in children, teens, and young adults, but it can happen at any age.

Type 1 diabetes is less common than type 2—about 5-10% of people with diabetes have type 1. Currently, no one knows how to prevent type 1 diabetes, but it can be treated successfully by:

• Following your doctor’s recommendations for living a healthy lifestyle.
• Managing your blood sugar.
• Getting regular health checkups.
• Getting diabetes self-management education and support.

For Parents

If your child has type 1 diabetes—especially a young child—you’ll handle diabetes care on a day-to-day basis. Daily care will include serving healthy foods, giving insulin injections, and watching for and treating hypoglycemia (low blood sugar). You’ll also need to stay in close contact with your child’s health care team. They will help you understand the treatment plan and how to help your child stay healthy.

What Causes Type 1 Diabetes?

Type 1 diabetes is thought to be caused by an autoimmune reaction (the body attacks itself by mistake). This reaction destroys the cells in the pancreas that make insulin, called beta cells. This process can go on for months or years before any symptoms appear.

Some people have certain genes (traits passed on from parent to child) that make them more likely to develop type 1 diabetes. However, many of them won’t go on to have type 1 diabetes even if they have the genes. A trigger in the environment, such as a virus, may also play a part in developing type 1 diabetes. Diet and lifestyle habits don’t cause type 1 diabetes.

Symptoms and Risk Factors

It can take months or years before symptoms of type 1 diabetes are noticed. Type 1 diabetes symptoms can develop in just a few weeks or months. Once symptoms appear, they can be severe.

Some type 1 diabetes symptoms are similar to symptoms of other health conditions. Don’t guess! If you think you could have type 1 diabetes, see your doctor to get your blood sugar tested. Untreated diabetes can lead to very serious—even fatal—health problems.

Risk factors for type 1 diabetes are not as clear as for prediabetes and type 2 diabetes. However, studies show that family history plays a part.

Testing for Type 1 Diabetes

A simple blood test will let you know if you have diabetes. If you were tested at a health fair or pharmacy, follow up at a clinic or doctor’s office. That way you’ll be sure the results are accurate.

If your doctor thinks you have type 1 diabetes, your blood may also be tested for autoantibodies. These substances indicate your body is attacking itself and are often found with type 1 diabetes but not with type 2. You may have your urine tested for ketones too. Ketones are produced when your body burns fat for energy. Having ketones in your urine indicates you have type 1 diabetes instead of type 2.

Managing Diabetes

Unlike many health conditions, diabetes is managed mostly by you, with support from your health care team:

• Primary care doctor
• Foot doctor
• Dentist
• Eye doctor
• Registered dietitian nutritionist
• Diabetes educator
• Pharmacist

Also ask your family, teachers, and other important people in your life for help and support. Managing diabetes can be challenging, but everything you do to improve your health is worth it!

If you have type 1 diabetes, you’ll need to take insulin shots (or wear an insulin pump) every day. Insulin is needed to manage your blood sugar levels and give your body energy. You can’t take insulin as a pill. That’s because the acid in your stomach would destroy it before it could get into your bloodstream. Your doctor will work with you to figure out the most effective type and dosage of insulin for you.

You’ll also need to do regular blood sugar checks. Ask your doctor how often you should check it and what your target blood sugar levels should be. Keeping your blood sugar levels as close to target as possible will help you prevent or delay diabetes-related complications.

Stress is a part of life, but it can make managing diabetes harder. Both managing your blood sugar levels and dealing with daily diabetes care can be tougher to do. Regular physical activity, getting enough sleep, and exercises to relax can help. Talk to your doctor and diabetes educator about these and other ways you can manage stress.

Healthy lifestyle habits are really important too:

• Making healthy food choices
• Being physically active
• Controlling your blood pressure
• Controlling your cholesterol

Make regular appointments with your health care team. They’ll help you stay on track with your treatment plan and offer new ideas and strategies if needed.

Hypoglycemia and Diabetic Ketoacidosis

These 2 conditions are common complications of diabetes, and you’ll need to know how to handle them. Meet with your doctor for step-by-step instructions. You may want to bring a family member with you to the appointment so they learn the steps too.

Hypoglycemia (low blood sugar) can happen quickly and needs to be treated quickly. It’s most often caused by:

• Too much insulin.
• Waiting too long for a meal or snack.
• Not eating enough.
• Getting extra physical activity.

Talk to your doctor if you have low blood sugar several times a week. Your treatment plan may need to be changed.

Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. DKA develops when you don’t have enough insulin to let blood sugar into your cells. Very high blood sugar and low insulin levels lead to DKA. The two most common causes are illness and missing insulin shots. Talk with your doctor and make sure you understand how you can prevent and treat DKA.

Get Diabetes Education

Meeting with a diabetes educator is a great way to get support and guidance, including how to:

• Develop and stick to a healthy eating and activity plan
• Test your blood sugar and keep a record of the results
• Recognize the signs of high or low blood sugar and what to do about it
• Give yourself insulin by syringe, pen, or pump
• Monitor your feet, skin, and eyes to catch problems early
• Buy diabetes supplies and store them properly
• Manage stress and deal with daily diabetes care

Ask your doctor about diabetes self-management education and support services and to recommend a diabetes educator. You can also search this nationwide directory for a list of programs in your community.

Get Support

Tap into online diabetes communities for encouragement, insights, and support. Check out the American Diabetes Association’s Community page and JDRF’s TypeOneNation. Both are great ways to connect with others who share your experience.

Type 1 diabetes occurs in 10 to 20 per 100,000 people per year in the United States. By age 18, approximately 1 in 300 people in the United States develop type 1 diabetes. The disorder occurs with similar frequencies in Europe, the United Kingdom, Canada, and New Zealand. Type 1 diabetes occurs much less frequently in Asia and South America, with reported incidences as low as 1 in 1 million per year. For unknown reasons, during the past 20 years the worldwide incidence of type 1 diabetes has been increasing by 2 to 5 percent each year.

Type 1 diabetes accounts for 5 to 10 percent of cases of diabetes worldwide. Most people with diabetes have type 2 diabetes, in which the body continues to produce insulin but becomes less able to use it.

The causes of type 1 diabetes are unknown, although several risk factors have been identified. The risk of developing type 1 diabetes is increased by certain variants of the HLA-DQA1, HLA-DQB1, and HLA-DRB1 genes. These genes provide instructions for making proteins that play a critical role in the immune system. The HLA-DQA1, HLA-DQB1, and HLA-DRB1 genes belong to a family of genes called the human leukocyte antigen (HLA) complex. The HLA complex helps the immune system distinguish the body's own proteins from proteins made by foreign invaders such as viruses and bacteria.

Type 1 diabetes is generally considered to be an autoimmune disorder. Autoimmune disorders occur when the immune system attacks the body's own tissues and organs. For unknown reasons, in people with type 1 diabetes the immune system damages the insulin-producing beta cells in the pancreas. Damage to these cells impairs insulin production and leads to the signs and symptoms of type 1 diabetes.

HLA genes, including HLA-DQA1, HLA-DQB1, and HLA-DRB1, have many variations, and individuals have a certain combination of these variations, called a haplotype. Certain HLA haplotypes are associated with a higher risk of developing type 1 diabetes, with particular combinations of HLA-DQA1, HLA-DQB1, and HLA-DRB1 gene variations resulting in the highest risk. These haplotypes seem to increase the risk of an inappropriate immune response to beta cells. However, these variants are also found in the general population, and only about 5 percent of individuals with the gene variants develop type 1 diabetes. HLA variations account for approximately 40 percent of the genetic risk for the condition. Other HLA variations appear to be protective against the disease. Additional contributors, such as environmental factors and variations in other genes, are also thought to influence the development of this complex disorder.

You may have found out you have type 1 diabetes from a routine blood test. Or you may have had sudden and severe symptoms that led to a trip to the doctor or even the emergency room.

Either way, getting the diagnosis can be overwhelming, and you’re likely to have lots of questions. Did you somehow cause type 1 diabetes? What will life be like now? Is there a cure, or is type 1 forever?

Managing a chronic (long-term) health condition like diabetes takes work, but you won’t have to do it alone. Your health care team will help you learn about day-to-day care and let you know about all the tools available to make it easier. Type 1 diabetes is very treatable. Let’s take it one step at a time.

Anyone Can Get Type 1 Diabetes

It isn’t completely clear what causes type 1 diabetes, but we know that diet and lifestyle habits don’t. Type 1 is thought to be the result of an autoimmune response, where your body attacks the cells in your pancreas that make insulin. Insulin is a hormone that acts like a key to let blood sugar into your body’s cells for use as energy. Sometimes infection with a virus seems to trigger the autoimmune response. Many people with type 1 diabetes have family members with type 1, but most don’t.

Did You Know?

The peak age for being diagnosed with type 1 diabetes is around 13 or 14 years, but people can be diagnosed when they’re much younger (including babies) and older (even over 40).

Living With Type 1 Diabetes

You need insulin to live, so you’ll need to take it every day by injecting it or using an insulin pump. You’ll also check your blood sugar levels throughout the day to make sure you’re staying in your target range as much as possible. Your health care team will help you understand what your target range is and how to stay within it.

Get diabetes education

Type 1 diabetes requires your attention every day. To learn what you need to know, ask your doctor to refer you to diabetes self-management education and support (DSMES) services. There you’ll find out how to balance insulin, food, and physical activity and get tips on how to cope with the emotional side of living with diabetes. All these things can affect your blood sugar levels.

Over time, having high blood sugar can cause serious health problems, such as heart disease, vision loss, and kidney failure. But you can lower your risk for those health complications and others. You’ll need to understand how food, activity, and other factors in your life affect your blood sugar and make changes to improve your blood sugar levels.

Be an experimenter. See what works best for you by trying different things. Prepare a healthier version of a favorite dish or take a walk after you eat, and keep track of your blood sugar results. This information can help you take charge of your diabetes instead of feeling like it’s in charge of you. Your diabetes educator can suggest ideas for you to try that have worked for other people with type 1.

Managing Blood Sugar

Time in range

Time in range is how long your blood sugar stays in your target range throughout the day. Most people with diabetes aim for 70% time in range, or between 16 and 17 hours out of 24.

High and low blood sugar

Blood sugar levels change often during the day. You’ll need to notice if your blood sugar drops too low (hypoglycemia) and be prepared to treat it right away.

If your blood sugar spikes very high and your insulin is low, you can develop diabetic ketoacidosis (DKA), a serious complication of diabetes that can be life-threatening. You’ll need medical care immediately if you develop DKA.

Your health care team will let you know how to identify and treat high and low blood sugar and related health problems. Be sure to get in touch with your doctor or diabetes educator if you have any questions.

How managing blood sugar helps now

Keeping your blood sugar levels on target can help you avoid serious health problems like heart disease and nerve damage down the road. But did you know avoiding ups and downs in blood sugar can help you feel better right away?

Steady blood sugar levels can help you have more energy, better sleep, an easier-to-manage appetite, better focus, and stable moods. If you’re having trouble meeting your target, talk to your doctor or diabetes educator about making changes to your treatment plan so you can stay in range longer and feel better.

Doctor Visits

Your diabetes care team

It takes a health care team to help you manage diabetes. And you’re the most important member of the team because you’re the one managing diabetes every day. And it really is a team—a group of dedicated, focused health care experts to assist you in feeling good and living a long, healthy life.

Your team will include your primary care doctor, endocrinologist (a doctor who treats diabetes and other hormone problems), foot doctor, eye doctor, dentist, pharmacist, nurse, dietitian, and diabetes educator. They specialize in helping you manage every aspect of diabetes, and you’ll schedule regular visits with them to ensure your treatment plan is on track. Ask your primary care doctor for referrals to these specialists to begin building your team.

Parents: Diabetes Care Tips

If you have a young child or teen who is newly diagnosed, they will need help with everyday diabetes care especially at first, such as checking blood sugar, taking insulin, and adjusting levels if they use an insulin pump. Your child’s health care team will give you detailed information about managing your child’s diabetes, but here are some highlights:

• If your insurance and finances allow, have your child use an insulin pump to lower the risk of low blood sugar and help keep blood sugar levels in range. Your diabetes educator will need to train you and your child on using the pump.
• Also have your child use a continuous glucose monitor (CGM), if possible, for around-the-clock blood sugar readings. Your child will still need twice-daily finger sticks to ensure the CGM is measuring blood sugar levels accurately.
• Talk to your child about healthy eating and being active. Both have a big impact on blood sugar levels and on feeling well in general.

Get Support

Family members

With support from your family, you can feel more empowered and less overwhelmed by this new life with diabetes. Ask your loved ones for the help you need to make diabetes more manageable, such as going to doctor appointments with you or making healthy food together.

DSMES

Diabetes self-management education and support (DSMES) can help you learn to solve problems, cope with the emotional side of diabetes, and lower your risk for other health problems. And not just when you’re first diagnosed. Have your doctor refer you to DSMES if you’re feeling stressed or if a life change such as a job loss or a new health condition is affecting your diabetes self-care. You can also find out about the latest treatment options and get answers to any questions you have.

Support groups

Connect with others to share experiences and learn tips and techniques for living well with diabetes. Visit the American Diabetes Association’s Community page, the Association of Diabetes Care & Education Specialists’ Diabetes Online Community, and JDRF’s TypeOneNation Community Forum. If you’d like to connect in person, this directory will help you find a diabetes support group near you.

Can Type 1 Diabetes Be Cured?

Currently, there isn’t a cure for type 1 diabetes. However, what we know about the condition is constantly evolving, new technologies and medicines are being developed, and researchers are making important breakthroughs. Right now, people of all ages are leading full, healthy lives with type 1 diabetes. You can too!

Regular blood sugar monitoring is the most important thing you can do to manage type 1 or type 2 diabetes. You’ll be able to see what makes your numbers go up or down, such as eating different foods, taking your medicine, or being physically active. With this information, you can work with your health care team to make decisions about your best diabetes care plan. These decisions can help delay or prevent diabetes complications such as heart attack, stroke, kidney disease, blindness, and amputation. Your doctor will tell you when and how often to check your blood sugar levels.

Most blood sugar meters allow you to save your results and you can use an app on your cell phone to track your levels. If you don’t have a smart phone, keep a written daily record like the one in the photo. You should bring your meter, phone, or paper record with you each time you visit your health care provider.

Make Friends With Your Numbers

Sometimes having high blood sugar can feel like a test you didn’t pass. But numbers are just numbers. Think of them instead as information. Did a certain food or activity make your levels go up or down? Armed with that knowledge, you can make adjustments and get closer to your target range more often.

How to Use a Blood Sugar Meter

There are different kinds of meters, but most of them work the same way. Ask your health care team to show you the benefits of each. In addition to you, have someone else learn how to use your meter in case you’re sick and can’t check your blood sugar yourself.

Below are tips for how to use a blood sugar meter.

1. Make sure the meter is clean and ready to use.
2. After removing a test strip, immediately close the test strip container tightly. Test strips can be damaged if they are exposed to moisture.
3. Wash your hands with soap and warm water. Dry well. Massage your hand to get blood into your finger. Don’t use alcohol because it dries the skin too much.
4. Use a lancet to prick your finger. Squeezing from the base of the finger, gently place a small amount of blood onto the test strip. Place the strip in the meter.
5. After a few seconds, the reading will appear. Track and record your results. Add notes about anything that might have made the reading out of your target range, such as food, activity, etc.
6. Properly dispose the lancet and strip in a trash container.
7. Do not share blood sugar monitoring equipment, such as lancets, with anyone, even other family members. For more safety information, please see Infection Prevention during Blood Glucose Monitoring and Insulin Administration.
8. Store test strips in the container provided. Do not expose them to moisture, extreme heat, or cold temperatures.

Recommended Target Ranges

The following standard recommendations are from the American Diabetes Association (ADA) for people who have diagnosed diabetes and are not pregnant. Work with your doctor to identify your personal blood sugar goals based on your age, health, diabetes treatment, and whether you have type 1 or type 2 diabetes.

Your range may be different if you have other health conditions or if your blood sugar is often low or high. Always follow your doctor’s recommendations.

Below is a sample record to discuss with your doctor.

Getting an A1C Test

Make sure to get an A1C test at least twice a year. Some people may need to have the test more often, so follow your doctor’s advice.

A1C results tell you your average blood sugar level over 3 months. A1C results may be different in people with hemoglobin problems such as sickle cell anemia. Work with your doctor to decide the best A1C goal for you. Follow your doctor’s advice and recommendations.

Your A1C result will be reported in two ways:

• A1C as a percentage.
• Estimated average glucose (eAG), in the same kind of numbers as your day-to-day blood sugar readings.

If after taking this test your results are too high or too low, your diabetes care plan may need to be adjusted. Below are ADA’s standard target ranges:

Questions To Ask Your Doctor

When visiting your doctor, you might keep these questions in mind to ask during your appointment.

• What is my target blood sugar range?
• How often should I check my blood sugar?
• What do these numbers mean?
• Are there patterns that show I need to change my diabetes treatment?
• What changes need to be made to my diabetes care plan?

If you have other questions about your numbers or your ability to manage your diabetes, make sure to work closely with your doctor or health care team.

Many types of insulin are used to treat diabetes. Although available choices may seem a bit overwhelming at first, this guide can help you discuss your treatment with your doctor.

Insulin is classified by how fast and how long it works in your body.

Terms To Know

• Onset – How quickly insulin lowers your blood sugar.
• Peak Time – When insulin is at maximum strength.
• Duration – How long insulin works to lower your blood sugar.

Your doctor will prescribe the best insulin or insulins for you based on several factors:

• How active you are.
• The food you eat.
• How well you’re able to manage your blood sugar levels.
• Your age.
• How long it takes your body to absorb insulin and how long it stays active. (This is different for different people.)

If you have type 1 diabetes, you’ll likely take a combination of insulins. Some people with type 2 diabetes will also need to take insulin.

Different brands of insulin vary in onset, peak time, and duration, even if they’re the same type, such as rapid acting. Be sure to check the dosing information that comes with your insulin and follow your doctor’s instructions.

For more information about types of insulin and when to take them, talk to your doctor or diabetes educator.

How and when to take insulin is different for each person and can change over time.

You may take just one type of insulin or different types throughout the day depending on your lifestyle, what you eat, and your blood sugar levels.

Ask your doctor to refer you to diabetes self-management education and support (DSMES) services when you start using insulin.

Your diabetes educator will make sure you feel comfortable managing your insulin routine, including how and where to inject and how to program an insulin pump if you’re using one.

Terms To Know

Bolus Insulin

Short- or rapid-acting insulin taken at or before mealtimes to control blood sugar levels.

Basal Insulin (background insulin)

Intermediate- or long-acting insulin taken to keep blood sugar levels steady between meals and overnight.

Basal-Bolus Regimen

Rapid-acting insulin taken at mealtimes and long-acting insulin taken once or twice a day.

Syringe or Pen

Syringes and insulin pens deliver insulin through a needle. Pens may be more convenient, and children may find them more comfortable than syringes.

Syringe

Your doctor will tell you how much insulin you need per dose. Smaller-capacity syringes are easier to use and more accurate.

• If your largest dose is close to the syringe’s maximum capacity, buy the next size up in case your dosage changes.
• If you need doses in half units, choose a syringe with half-unit markings.

Insulin pen

Some pens use cartridges that are inserted into the pen. Others are pre-filled and discarded after all the insulin is used. The insulin dose is dialed on the pen, and the insulin is injected through a needle.

If you inject insulin near the same place each time, hard lumps or fatty deposits can develop. Both problems can be unsightly and make insulin less reliable.

Advantages of syringes and pens

• Injections require less training than a pump.
• Injections may cost less than a pump.
• Pens are more portable and easier to use than syringes.
• Needles in pens are small, thin, and more comfortable.

Disadvantages of syringes and pens

• Syringes are less discreet than pens.
• Not all types of insulin can be used with a pen.
• Pens are more expensive than syringes and may not be covered by insurance.

Insulin Pump

An insulin pump is about the size of a small cell phone. It gives you a basal dose of short- or rapid-acting insulin per hour. When you eat or when blood sugar is high, you calculate the dose, and the insulin in the pump delivers the bolus.

The pump delivers insulin through a thin plastic tube placed semi-permanently into the fatty layer under your skin, usually in the stomach area or back of the upper arm. Your doctor or health education specialist will show you how and where to place the tube.

Advantages of insulin pumps

• Have been shown to improve A1C.
• Deliver insulin more accurately.
• Deliver bolus insulin easier.
• Eliminate unpredictable effects of intermediate- or long-acting insulin.
• Provide greater flexibility with meals, exercise, and daily schedule.
• Can improve physical and psychological well-being.

Disadvantages of insulin pumps

• May cause weight gain.
• Can be expensive.
• May cause infection.
• May cause diabetic ketoacidosis (very high blood sugar) if the system is stopped or stops working correctly.
• Can be a constant reminder of having diabetes.
• Training is necessary.

Insulin Inhaler

Inhaled insulin is taken using an oral inhaler to deliver ultra-rapid-acting insulin at the beginning of meals. Inhaled insulin is used with an injectable long-acting insulin.

Advantages of insulin inhalers

• Is not an injection.
• Acts very fast and is as effective as injectable rapid-acting insulins.
• Can be taken at the beginning of meals.
• Could lower risk of low blood sugar.
• Could cause less weight gain.
• Inhaler device is small.

Disadvantages of insulin inhalers

• Might cause mild or severe coughing.
• May be more expensive.
• Still requires injections or a pump for basal insulin.
• Dosing isn’t as precise.

Make sure to talk to your doctor and diabetes educator when your lifestyle or needs change. They will know about the latest devices and have tips to make taking insulin and all aspects of diabetes easier to manage.

In type 1 diabetes, your body mistakenly attacks and destroys certain cells in your own pancreas. These cells normally make a molecule called insulin. Without insulin, the sugar glucose builds up in your blood. This can cause serious health problems.

Current treatments for type 1 diabetes include frequent testing of blood glucose and insulin injections. But researchers have been working on a new approach called artificial pancreas systems. These automated systems contain a blood glucose monitor and an insulin pump. The monitor provides constant feedback to the pump. The pump then supplies insulin to the body when needed.

Past studies showed that such systems work well in adults and older children. Scientists tested an artificial pancreas system in 68 children, ages 2 to 5, with type 1 diabetes. They compared their blood glucose levels with those of 34 children receiving standard care.

After three months, children with the artificial pancreas showed more stable blood glucose levels than the kids getting standard care. They had about three more hours per day of better blood glucose control. The benefits were greatest during the night, when kids would be sleeping.

“Artificial pancreas systems have the potential to improve all-day blood glucose control in these young patients,” says NIH diabetes expert Dr. Guillermo Arreaza-Rubín. “This could help ease concerns about the long-term effects of type 1 diabetes on children’s health.”

More study is needed to see how well the artificial pancreas system works in young kids over long periods of time.

For people with diabetes, making the right food choices can sometimes feel complicated or confusing. And while individual dietary needs should always be carefully discussed with your doctor or nutritionist, there are a few go-to diabetes-friendly foods – sometimes called “diabetes superfoods” – that will not only come to the nutritional rescue but may also help make meal planning and snacking a little easier.

A great place to start is with fruits and vegetables. Dried, canned, frozen, or fresh all contain the same overall nutritional benefits and will hit the spot when you need a quick snack, or can even fill you up when you’re ready for a meal. Here are just a few reasons to put fruit and veggies at the top of your list:

• Fruits and veggies are packed with nutrients that can boost your energy levels.
• They provide a solid dose of fiber which helps fill you up and keeps your digestive system happy!
• Low calories and lots of color and texture to add to your plate.
• Eating more fruits and veggies may lower your risk for many diseases including some types of cancer, high blood pressure, and even heart disease.
• Fruits and veggies have low glycemic indexes which help keep blood sugar levels steady.

There are, of course, a few standout fruit and veggie superstars that you’ll want to have on-hand whenever possible:

• Dark leafy greens like spinach and kale are bursting with so much good stuff, you simply can’t eat too much!
• Citrus fruit like lemons, limes, grapefruit, and oranges will give you your daily supply of vitamin C and soluble fiber.
• Berries of all types are delicious little powerhouses packed with antioxidants, vitamins, and fiber making them a sweet treat anytime.

In addition to fruit and vegetables, there are some other nutrient-rich-good-for-your-health-diabetes-friendly and delicious foods to keep in mind when you are planning your menu:

• Beans are a great source of fiber, magnesium, potassium, and protein. In fact, just a 1/2 cup of beans gives you as much protein as an ounce of meat without the saturated fat.
• Sweet potatoes can be baked, mashed, roasted, or chunked and added to all kinds of dishes. Versatile and packed with fiber and Vitamin A they are a yummy addition to your plate.
• Tomatoes are another standout food that can be enjoyed raw, cooked, pureed, as a sauce or soup, and are bursting with vital nutrients like Vitamins C and E.
• Fish – any fish high in Omega-3 fatty acids (like salmon) is an excellent addition to your menu. Try it baked, grilled, or broiled twice a week and you’ll be well on your way to meeting the US Dietary Guidelines recommendation of 8 ounces of seafood per week.
• Whole grains are loaded with magnesium, B vitamins, chromium, iron, and folate. Check the label to make sure the first ingredient listed uses the word “whole” (like “whole wheat” for example). Brown rice, wheatberries, oats, and oatmeal are also “whole” grains.
• Nuts and seeds can be a hunger-buster when the munchies come calling. Just an ounce will go a long way toward controlling your appetite and as an added bonus will give you a nice dose of magnesium and fiber.
• Milk and yogurt (fat-free or low-fat varieties) contain calcium and many fortified products are a good source of vitamin D as well. Combine with your favorite fruits and veggies for a perfect filling snack.

Meal planning doesn’t have to be a chore when you start with a list of diabetes-friendly foods. And don’t forget: 1/2 of your plate should be fruits and vegetables, 1/4 protein (beans or lean meat), and 1/4 should be whole grains.

Blood sugar levels change often during the day. When they drop below 70 mg/dL, this is called having low blood sugar. At this level, you need to take action to bring it back up. Low blood sugar is especially common in people with type 1 diabetes.

Knowing how to identify low blood sugar is important because it can be dangerous if left untreated. Read more about what causes low blood sugar and common symptoms.

Causes of Low Blood Sugar

There are many reasons why you may have low blood sugar, including:

• Taking too much insulin.
• Not eating enough carbs for how much insulin you take.
• Timing of when you take your insulin.
• The amount and timing of physical activity.
• Drinking alcohol.
• How much fat, protein, and fiber are in your meal.
• Hot and humid weather.
• Unexpected changes in your schedule.
• Spending time at a high altitude.
• Going through puberty.
• Menstruation.

Symptoms of Low Blood Sugar

How you react to low blood sugar may not be the same as how someone else with low blood sugar reacts. It’s important to know your signs. Common symptoms may include:

• Fast heartbeat
• Shaking
• Sweating
• Nervousness or anxiety
• Irritability or confusion
• Dizziness
• Hunger

Hypoglycemia Unawareness

If you’ve had low blood sugar without feeling or noticing symptoms (hypoglycemia unawareness), you may need to check your blood sugar more often to see if it’s low and treat it. Driving with low blood sugar can be dangerous, so be sure to check your blood sugar before you get behind the wheel.

You may not have any symptoms when your blood sugar is low (hypoglycemia unawareness). If you don’t have symptoms, it will be harder to treat your low blood sugar early. This increases your risk of having severe lows and can be dangerous. This is more likely to happen if you:

• Have had diabetes for more than 5-10 years.
• Frequently have low blood sugar.
• Take certain medicines, such as beta blockers for high blood pressure.

If you meet one or more of the above and you have hypoglycemia unawareness, you may need to check your blood sugar more often to see if it’s low. This is very important to do before driving or being physically active.

Types of Low Blood Sugar

Nighttime low blood sugar

While low blood sugar can happen at any time during the day, some people may experience low blood sugar while they sleep. Reasons this may happen include:

• Having an active day.
• Being physically active close to bedtime.
• Taking too much insulin.
• Drinking alcohol at night.

Eating regular meals and not skipping them can help you avoid nighttime low blood sugar. Eating when you drink alcohol can also help. If you think you’re at risk for low blood sugar overnight, have a snack before bed.

You may wake up when you have low blood sugar, but you shouldn’t rely on that. A continuous glucose monitor (CGM) can alert you with an alarm if your blood sugar gets low while you’re sleeping.

Severe low blood sugar

As your low blood sugar gets worse, you may experience more serious symptoms, including:

• Feeling weak.
• Having difficulty walking or seeing clearly.
• Acting strange or feeling confused.
• Having seizures.

Severe low blood sugar is below 54 mg/dL. Blood sugar this low may make you faint (pass out). Often, you’ll need someone to help you treat severe low blood sugar.

People with diabetes may experience low blood sugar as often as once or twice a week, even when managing their blood sugar closely. Knowing how to identify and treat it is important for your health.

When too many ketones are produced too fast, they can build up in your body and cause diabetic ketoacidosis, or DKA. DKA is very serious and can cause a coma or even death. Common symptoms of DKA include:

• Fast, deep breathing.
• Dry skin and mouth.
• Flushed face.
• Frequent urination or thirst that lasts for a day or more.
• Fruity-smelling breath.
• Headache.
• Muscle stiffness or aches.
• Nausea and vomiting.
• Stomach pain.

If you think you may have DKA, test your urine for ketones. Follow the test kit directions, checking the color of the test strip against the color chart in the kit to see your ketone level. If your ketones are high, call your health care provider right away. DKA requires treatment in a hospital.

DKA happens most in people with type 1 diabetes and is sometimes the first sign of type 1 in people who haven’t yet been diagnosed. People with type 2 diabetes can also develop DKA, but it’s less common.

Goodbye, summer. Hello, homework. And guess what—the first assignment isn’t for kids. Parents, make a game plan to ensure all the bases are covered for your child’s diabetes care at school.

Getting back into the routine of school takes a little more preparation for kids with diabetes, but it pays off over and over as the weeks and months go by. And since kids spend nearly half their waking hours in school, reliable diabetes care during the school day really matters.

Some older students will be comfortable testing their blood sugar, injecting insulin, and adjusting levels if they use an insulin pump. Younger students and those who just found out they have diabetes will need help with everyday diabetes care.

In a perfect world, all teachers and other school staff would understand how to manage diabetes so they could support your child as needed. But here in the real world, you’ll want to provide information to the school and work with staff to keep your son or daughter safe and healthy, no matter what the school day brings.

Make a Diabetes Management Plan

No two kids handle their diabetes exactly the same way. Before the year begins, meet with your child’s health care team to develop a personalized Diabetes Medical Management Plan (DMMP). Then visit the school and review the DMMP with the principal, office secretary, school nurse, nutrition service manager, teachers, and other staff who may have responsibility for your son or daughter during the day and after school.

The DMMP explains everything about diabetes management and treatment, including:

• Target blood sugar range and whether your child needs help checking his or her blood sugar
• Your child’s specific low blood sugar (hypoglycemia) symptoms (see the list on this page) and how to treat low blood sugar
• Insulin or other medication used
• Meal and snack plans, including for special events
• How to manage physical activity/sports

The DMMP works with your child’s daily needs and routine. Make sure to update it every year or more often if treatment changes.

You may want to work with the school to set up a 504 plan [PDF – 325 KB] that explains what the school will do to make sure your son or daughter is safe and has the same education opportunities as other students. The 504 plan makes the school’s responsibilities clear and helps avoid misunderstandings. A new plan should be set up each school year.

Team Up With School Staff

Work with teachers and other staff to make sure all the bases are covered for a safe and successful year.

The school nurse is usually the main staff member in charge of your student’s diabetes care, but may not always be available when needed. One or more backup school employees should be trained in diabetes care tasks and should be on site at all times during the day, including after-school activities. The 504 plan [PDF – 325 KB] explains how this works.

Make sure to visit the classroom(s). Some teachers may have had kids with diabetes in class before, but there’s still a learning curve because every student is unique—and so is every teacher.

This is a great time to talk about class rules. Are students allowed to leave the room without asking? Should they raise their hand? The more your child and teacher understand each other’s needs, the less disruptive and awkward self-care activities will be. You may want to ask if the teacher could talk to the class about diabetes—what it is and isn’t, what happens, and what needs to be done every day—without pointing out that your child has diabetes.

Also let the teacher know specific signs to look for if your son or daughter’s blood sugar is too low. Does he or she get irritable or nervous? Hungry or dizzy? The teacher may notice the signs before your child does and can alert him or her to eat an appropriate snack or get help.

Check in with nutrition services (school cafeteria) to get menus and nutritional information to help your child plan insulin use. Some students bring lunch from home because it’s easier to stick to their meal plan.

Kids with diabetes need to be physically active just like other kids. In fact, physical activity can help them use less insulin because it lowers blood sugar. Talk with the physical education instructor about what your kid needs to participate fully and safely.

And as the school year gets into full swing, get familiar with the daily school schedule, including any after-school activities. You’ll want to know where and when you can find your child if needed. Some parents use a free smartphone app to help them stay informed and in touch with their child.

Make a Diabetes Checklist

• Create a backpack checklist you and/or your child can use every day to be sure all necessary supplies are packed:
  • Blood sugar meter and extra batteries, testing strips, lancets
  • Ketone testing supplies
  • Insulin and syringes/pens (include for backup even if an insulin pump is used)
  • Antiseptic wipes
  • Water
  • Glucose tablets or other fast-acting carbs like fruit juice or hard candy (about 10 to 15 grams) that will raise blood sugar levels quickly
• Put together a “hypo” box (see sidebar) with your child’s name on it for the school office in case of low blood sugar

Also make sure your child:

• Wears a medical ID necklace or bracelet every day. Many options are available.
• Tests blood sugar according to schedule; older students can set phone reminders.
• Knows where and when to go for blood sugar testing if help is needed.
• Knows who to go to for help with low blood sugar.

Make a "Hypo" Box

In case of low blood sugar, keep a go-to box of supplies in the school office or nurse’s office (and another in the classroom if possible). Label it with your child’s name and remember to keep it stocked!

• Glucagon
• Test strips
• Lancets
• Blood sugar monitor
• Glucose tablets
• Juice boxes
• Crackers

Important: Treating Low Blood Sugar

Low blood sugar can happen quickly and needs to be treated immediately. It’s most often caused by too much insulin, waiting too long for a meal or snack, not eating enough, or getting extra physical activity. Low blood sugar symptoms vary, so school staff should be familiar with your child’s specific symptoms (see the DMMP), which could include:

• Shakiness
• Nervousness or anxiety
• Sweating, chills, or clamminess
• Irritability or impatience
• Dizziness and difficulty concentrating
• Hunger or nausea
• Blurred vision
• Weakness or fatigue
• Anger, stubbornness, or sadness

If your child has low blood sugar several times a week, visit his or her health care provider to see if the treatment plan needs to be adjusted.

Stay Well All Year

• Make sure your child has had all recommended shots, including the flu shot. Kids with diabetes can get sicker from the flu and stay sick longer. Being sick can make blood sugar monitoring harder.
• Regular hand washing, especially before eating and after using the bathroom, is one of the best ways to avoid getting sick and spreading germs to others.

Teens face lots of new challenges after they finish high school and move on to the next stage of life, including how to manage money, college, relationships, and work. And if they’re moving away from home for the first time, they’ll face those challenges with less help from parents and less structure in their day. This has even more impact for teens with diabetes.

Parents usually had the main role in diabetes care at first, especially for young children. They took their child to doctor’s appointments, picked up medicines, and provided nutritious food. They helped their child navigate school, after-school activities, birthday parties, and other social events.

It’s only natural that teens on their way to becoming adults want more independence and control. But more control over their lives can often mean less control of their diabetes. No curfew, no comments on what they’re eating, no one else setting their schedule. Diabetes care often suffers when teens and young adults begin to make complicated decisions on their own:

• Managing day to day, from eating well to taking insulin
• Finding health care providers
• Scheduling and keeping appointments
• Having supplies on hand

Young people need help to successfully balance their new independence with diabetes self-care. They’ll need to know how to deal with the practical side of diabetes: how to fill a prescription and pay for it, order supplies, contact their doctors, make health care appointments, and handle sick days. And they’ll also have the everyday problems that come with life on their own:

• Limited time
• Limited money
• Irregular schedules
• Food choices
• Concerns about low blood sugar (hypoglycemia), which can lead to overeating
• Less support

They may also be tired of the daily work of having diabetes and decide to ignore it. This can be very dangerous, especially when parents aren’t there to notice.

Gap in Care

Teens also need to make the leap from seeing a pediatrician to seeing an adult health care provider, usually without a clear road map for how to do so. When several changes happen at the same time, like getting new doctors and moving away from home, young people are more likely to miss appointments or drop out of care completely.

Other barriers can make it harder for teens and young adults to switch to adult health care:

• Being unhappy about leaving their pediatrician
• Getting a referral and contact information for a new doctor
• Trouble getting an appointment
• Competing life priorities
• Having insurance problems

But good care during this time is very important. Teens and young adults with diabetes have a much higher risk of early health problems, even early death, than those without diabetes. Major causes include hypoglycemia (low blood sugar) and diabetic ketoacidosis (DKA).

Staying close to recommended blood sugar goals helps them avoid these health problems and others down the road. But as teens and young adults with diabetes transition from pediatric to adult care, the risk of not meeting those goals more than doubles.

Get Ready To Make the Leap

Help teens get prepared to manage their diabetes care successfully before they’re out on their own. Parents, teen, and pediatrician can work together to coordinate care with new doctors and create a plan to address needs over the next year or two. Parents can share practical tips, such as how to fill prescriptions and make doctor’s appointments. They can also make sure their teen or young adult has this basic checklist before they leave home:

• Keep supplies on hand to manage low blood sugar (and healthy snacks to guard against high blood sugar).
• Keep supplies organized so you know what you have and can get to them easily.
• Keep contact information for your health care team and prescription information in a handy place.
• Tell people close to you that you have diabetes and how to help you if needed.
• Have a plan for sick days.
• Ask for help if you need it.
• Stay in touch with your health care team and let them know if you have questions or concerns.

Bridge the Gap

Family support is the strongest predictor that teens and young adults will stick with their diabetes treatment plan. Parents can serve as the “home team” to help them stay on track as they become more self-reliant by:

• Respecting their new independence, but staying connected. Ask how you can help.
• Helping your teen understand how their insurance plan works as well as its benefits and limitations.
• Reminding teens about short-term benefits of managing their diabetes, not just focusing on long-term health problems. They’re more motivated to take care of themselves if it helps them feel better physically and take part in normal activities with their friends.
• Asking about any life issues that may be getting in the way of good self-care, such as trouble making and keeping doctor’s appointments.
• Encouraging your teen to ask their health care provider for a referral to diabetes self-management education and support (DSMES) services. Diabetes education is strongly linked to better blood sugar management!

Life is bound to change in many ways when your child is diagnosed with type 1 diabetes. It can all seem overwhelming at first, but it will get easier with time and knowledge. Try these approaches to help make daily diabetes care more manageable from day 1.

1. Learn Everything You Can

Treatment options, blood sugar highs and lows, carb counting, ketones, dealing with sick days, how to manage diabetes at school. Read books, join support groups and online forums, talk to your child’s health care team and other parents.

Important things to know will include these items:

• When your child needs to take insulin, what types of insulin, and in what combination.
• What device they’ll use to take insulin and how to use it.
• How and when to check for high and low blood sugar and ketones.
• What items to have on hand, including glucagon, gels, snacks, and drinks for low blood sugar.
• Signs of low blood sugar (they’re different for every child).
• How to make a diabetes management plan for school.
• When to contact your health care team.
• Where to go for help and support.

Ask your child’s doctor to refer you to diabetes self-management education and support services when your child is first diagnosed. You’ll meet with a diabetes education and care specialist to learn how to use knowledge, skills, and tools to build confidence and emotional strength to manage diabetes. They’ll help your child to learn too—one example is having them practice using a needle with a stuffed animal.

Your diabetes education and care specialist can be your biggest ally. They’re aware of the latest developments and breakthroughs that can help make managing diabetes simpler and safer. They’ll work with you to fit diabetes care into all parts of life. And you’ll learn ways to get support from your family, friends, community, and health care team.

2. Expect Change

Just when you’ve got day-to-day diabetes management figured out, along comes more change, like a new school year or new activities.

As your child gets older and more independent, they will probably want to manage more of their own diabetes care. That can be a relief but can also come with its own worries. What if they don’t eat properly or take insulin as needed? Will they notice the signs of hypoglycemia if they happen?

It’s not just their attitude that changes. Blood sugar is harder to manage during puberty because your teen’s body is changing, which can increase their need for insulin. Your teen may feel different from their friends and want a more carefree lifestyle than their diabetes allows. Even when they follow their treatment plan, they might feel frustrated if natural body changes make their diabetes harder to handle. But managing diabetes effectively during the teen years is crucial to ensuring healthy growth into adulthood and reducing the chance of long-term health problems.

Taking insulin is a necessary part of treating type 1 diabetes, but it can be delivered in different ways—by syringe, insulin pen, or insulin pump. A diabetes education and care specialist can help you understand the pros and cons of different devices and which options may make the most sense for your child.

3. Stay Connected

Keep the lines of conversation open. Let your child know that you understand diabetes is a lot to handle. Reinforce that small choices now can lead to better results later. You’re there to help them make those choices and build healthy habits as they grow.

Call on your health care team for help with medical issues, but also to connect you to other resources like support groups, summer camps, and community forums. Support for living with diabetes is so important for the whole family.

People of any age with diabetes are more likely to have mental health issues, such as depression and anxiety. And sometimes the pressures and demands of managing a long-term condition like diabetes can seem like too much, a state known as diabetes distress or burnout. Keep an eye out for any changes in your child’s behavior or trouble sticking to their treatment plan. Those can signal distress or another emotional problem. Get in touch with your child’s health care team, who can connect you with a mental health counselor or other support if needed.

Having a child with diabetes may seem overwhelming at times, but you’re not alone. If you have questions or concerns, reach out to your child’s health care team. They’re there to help!