Living with diabetes

When a child or young person is diagnosed with Type 1 Diabetes, some changes must take place in the way they live in order to make room for the diabetes. Living with diabetes can at times feel challenging, but finding the best way that it can fit into your family means that it does not have to control or restrict your life.

On this page:

Diet and diabetes

Food and  go hand in hand and you will meet your dietitian when you are diagnosed.  They can help you to think about your meal and snack routine and healthy eating.  It is good to see your dietitian at least once a year.

Click on the links below to find out more about food and diabetes.

For any further information contact your dietitian. 

Managing illness for type 1 diabetes

Managing illnesses at home

If a child with type 1 diabetes is unwell:

  • Never stop the insulin—more insulin may be needed for illness, even if they are not eating well
  • Check glucose more frequently
  • Check ketones in urine or blood (if your meter does this)
  • Encourage them to drink plenty. 
  • Give paracetamol or ibuprofen if needed for temperatures
  • Make sure they continue to take carbohydrates, if they do not want to eat try small snacks or replace food with a sweet drink or ice cream (and give insulin for this)

Insulin doses

Glucose levels are often higher if a child is unwell, and they may need extra insulin. Usually this is given as extra short acting insulin. If the glucose levels are high give additional fast acting insulin, (Novorapid or Humalog). If your child has an advisor meter give the correction calculated by the meter and consider increasing the dose by setting 10–20% extra under the health events setting. For children on insulin pumps give corrections as calculated by the pump and consider setting a temporary basal rate 10–20% higher.

If the glucose levels are low (for example during gastroenteritis) give sweet drinks to keep the glucose up and continue with insulin treatment.

Ketones

Ketones in urine or blood are usually a sign that not enough insulin has been given. They can be produced if the child has not eaten for a significant period.  If blood glucose and ketones are both high the child needs more insulin, consider giving a correction dose. If high ketone levels do not settle there is a risk of ketoacidosis and the child should be reviewed by a doctor.

Sick day rules chart

Please see the following chart to seek advice on what do with your child’s insulin according to the levels of blood glucose and ketones:

Managing high blood glucose levels (hyperglycaemia)

Why do we need to worry about high blood glucose levels

High blood sugars indicate that you haven’t got enough insulin on board.  This can make you feel unwell.  If you have lots of high blood sugars, this can lead to poor overall diabetes control and a high HbA1c. If this continues over time you will be more at risk of developing diabetes related complications.  Giving extra insulin or a “correction” dose when your blood sugars are high helps to ensure better diabetes control. 

What should blood glucose levels be?

The National institute for Clinical Excellence (NICE) have set recommendations for blood glucose targets:

  • A plasma glucose level of 4–7 mmol/litre before meals at other times of the day
  • A plasma glucose level of 5–9 mmol/litre after meals

Consider correcting a high blood sugar above 14.5mmol/L.

How much correction do I give?

To calculate a correction dose, you first have to calculate the ”insulin sensitivity factor” (ISF) or “correction factor”. This tells you how much 1 unit of novorapid will reduce your blood sugar.  You work this out using a standard equation:

  • 100 / total daily dose of insulin (this includes both long acting (eg Lantus or Levemir) and rapid acting insulin (eg Novorapid or Humalog)

Once the ISF is calculated, you can work out your correction dose using the equation below.

  • Blood glucose level – 10 / ISF

How sensitive a person is to the affects of novorapid differs among individuals. Correction doses can depend on a lot of things such as how high your blood sugar level is, if you are ill, how much exercise you have done and if you have any active insulin on board (this is the amount of insulin left in your body from a previous correction dose). Speak to your diabetes team for more information about this or if you need help calculating your ISF.

If you have a bolus advisor meter, this is programmed with your ISF and the meter will include correction doses in its calculations.

Managing low blood glucose levels (hypoglycaemia)

Hypoglycaemia, sometimes called as ‘hypo’ is defined as blood glucose less than 4mmol/l.  Below this level treatment is required to bring glucose levels up, even if the child feels well.

Symptoms of hypoglycaemia

Symptoms of hypoglycaemia can be non-specific. Most children especially older are aware of the symptoms when they have hypoglycaemia but should check their blood glucose to confirm. However when they have frequent hypoglycaemia, the sensitivity may be reduced and symptoms may not occur until the levels fall much lower. This is similar to when the body is used to having frequent high blood glucose levels and lowering the levels to normal can cause symptoms similar to hypoglycaemia. However, testing the blood glucose will show normal range in this situation.

The common symptoms are:

  • Feeling sick
  • Sweatiness, trembling
  • Hunger
  • Irritability, difficult behaviour, tantrums, anxiety
  • Nightmares and odd behaviour at night
  • Headache, drowsiness, confusion, difficulties with vision
  • Convulsions and loss of consciousness (in severe hypoglycaemia)

Causes of hypoglycaemia

Blood glucose levels drop when there is an imbalance between insulin levels and glucose available in the blood for insulin to act. This can be caused by:

  • Not eating enough: Forgetting meals or snacks while having insulin can cause blood glucose levels to drop. Not having a snack at bedtime sometimes causes hypoglycaemia in the night especially if the bedtime levels are on the lower side.
  • Too much insulin: Injecting too much of insulin for the food eaten causes hypoglycaemia. This may be caused by inaccurate carbohydrate counting.
  • Exercise: Doing exercise increases insulin sensitivity helping insulin to act more effectively. Hence a smaller dose of insulin will be as effective and unless a snack is eaten or the amount of insulin reduced, hypoglycaemia can occur. This happened either during or after exercise and blood glucose monitoring is recommended.
  • Alcohol: Alcohol causes hypoglycaemia a combination of not eating, and being less aware of the symptoms by reduced level of consciousness.

How do I treat hypoglycaemia?

Younger children up to and around 30 kg should have 10g carbohydrate, and older children/adolescents around 50 kg, 15g carbohydrate. Follow the flowchart below for appropriate management.

The above treatment provides simple glucose in the pure form and can be easily absorbed.  Fruit juice may be suitable for smaller children if Lucozade is not liked, but you often need more of it because the source of carbohydrate (fructose) is more slowly absorbed.  Talk to your dietitian for advice.  Initial treatment with chocolate bars or biscuits is not recommended as the fat slows down the absorption of carbohydrate.

When to come to Children’s A&E

You can discuss with the children’s diabetes team (discuss with the paediatric diabetes nurses during office hours or ring 020 3315 3399 out of hours). Come to the children’s A&E (emergency department) if:

  • the ketones are high and the child has vomited more than two times
  • Your child is drowsy, floppy or short of breath
  • You cannot get the glucose to settle with normal management
  • The child is unwell and get the child to eat or drink anything

Adolescence

Adolescence is a significant time of ‘transition’ and change for families. Often at this time diabetic control becomes less easy to maintain for a range of reasons.

This could be due to:

  • Hormonal and growth changes impacting on insulin efficacy
  • Feeling that there are other things that take priority such as exams or friends
  • Negotiating independence and testing boundaries

It is also the time when young people get to decide what kind of adult they want to be.  This might mean experimenting with different ways of being an adult, learning about relationships and substance use.

Some of these will have an impact on your diabetes, and we hope you will feel able to seek information from the team if you have any adolescence specific questions.

Psychological support

Psychological wellbeing and good diabetes control can go hand in hand.  Research has shown that having access to psychological support can help children, young people and their families to manage diabetes well.

Our paediatric psychologist has two main roles:

  • to support a family’s psychological wellbeing and offer support in living with diabetes
  • to help children, young people and families think and explore their thoughts and expectations around insulin pump therapy

The times you will be able to see the paediatric psychologist are:

  • on admission when you are newly diagnosed
  • any other inpatient admissions
  • when you or the diabetes team feel that you may benefit from someone to talk to about your thoughts, feelings or behaviours related to living with diabetes
  • if you are interested in insulin pump therapy

You should also have contact with the psychologist as part of your annual review.

If you would like to be seen by the paediatric clinical psychologist, please ask any member of the team to make a referral on your behalf.  Once a referral is received, the psychologist will get in touch to ask you to contact them to make an appointment.  Appointments are about an hour long. In our first appointment, we will decide together the number and frequency of your appointments.

Things that the paediatric psychology clinical psychologist might be able to support you with include:

  • adjusting to diagnosis
  • managing treatment
  • discussing school and life stresses that are made more difficult by living with diabetes 

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