Being told that your child has diabetes can be very traumatic and the impact the diagnosis has on everyday family life can be significant. It’s important to remember that every child and their family will cope with the diagnosis differently.
The condition doesn't have to take away your child's freedom or end your usual family life. What it does mean is that you have to carefully manage your child's condition as part of daily life.
Types of diabetes
Type 1 diabetes
In type 1 diabetes, the insulin-producing cells in the pancreas are destroyed by the immune system and so can’t produce insulin. The exact cause of the immune system attacking these cells isn’t clearly understood. Unlike type 2 diabetes, which is usually slow to develop, type 1 comes on very quickly, often within days or weeks.
Type 2 diabetes
In type 2 diabetes, the pancreas either produces inadequate amounts of insulin, or the body is unable to use the insulin that’s produced (insulin resistance). It’s typically slow to develop, with some people being unaware of the condition for many years.
In recent years cases of type 2 diabetes have become more common in young adults, teens and children. It’s been connected to increasing levels of obesity as it’s strongly associated with excess body weight and lack of physical activity, an dit's the one you're most likely to have heard about recently in the press.
The signs and symptoms for type 1 and type 2 are very similar. But, this may not be as obvious in type 2, as the onset of type 2 is much more gradual than type 1.
Diagnosis for diabetes usually follows your child displaying classic symptoms. Diabetes UK has launched a campaign identifying these symptoms as the ‘four T’s’:
Toilet: As a result of producing excess urine - going to the toilet a lot, bed wetting by a previously dry child or heavier nappies in babies.
Thirsty: Being really thirsty and not being able to quench the thirst.
Tired: Feeling more tired than usual.
Thinner: Losing weight or looking thinner than usual.
A child with undiagnosed type 1 diabetes will appear extremely unwell, with severe deterioration of the above four T’s. A single blood glucose reading (not a finger-prick sample) in combination with such symptoms is sufficient to diagnose the condition. The HbA1c test isn’t used to test for diabetes in children.
Sometimes, a child with type 1 diabetes can display significant changes in their normal behaviour before their diagnosis is confirmed. This condition is called diabetic ketoacidosis.
This is when you have high blood glucose levels (higher than about 15mmol/l) and when you’re ill, your body may start to produce ketones.
Ketones make your blood very acidic, hence the term ketoacidosis.
What support is available?
As a newly diagnosed diabetic you and your child will be introduced to a diabetic team consisting of the following people;
- a consultant paediatrician who specialises in diabetes
- a children's diabetes specialist nurse
- a dietitian who is familiar with the needs of children
These people will visit you and your child, either whilst your child is an in-patient in hospital or once you’ve returned home.
The diabetic team will offer you practical sessions on how and when to test your child's blood glucose level using the finger-prick test, and how you and they can give them their medication, which may be tablets, a pump, or insulin injections. Your child won’t be expected to administer medication or inject themselves until they’re ready. This will depend on their age and circumstances.
A dietician will assess your child's diet and discuss how the family diet can be adapted to support your child with diabetes. A diabetic doesn’t need specific diabetic food. This can be overpriced and often unnecessary if you make simple adjustments to your child and the family’s diet.
The diabetic team will need to check on your child every couple of weeks. Then your child will receive a yearly review with the Consultant and a three or six month check up with the Diabetic Nurse.
They’ll make sure that you have a good understanding of how food and exercise affect your child's blood glucose level, and how to manage this with insulin.
The three month review with your diabetic team will involve checking injection sites, blood glucose levels, height and weight.
From the age of 12, these visits should include a comprehensive health check at least once a year. Your child will be checked for signs of damage to their eyes, feet, circulation and kidneys.
Medication will vary depending on the type of diabetes that your child is diagnosed with.
A child with type 1 diabetes will need insulin injections.
A child with type 2 diabetes may start with advice about diet but may progress to need oral medications and may need insulin after some time.
Your child will start on a regime, prescribed and directed by the Paediatric Consultant and supported by the Specialist Nurses.
This may consist of injections twice or four times a day of a medication called insulin.
The image above shows where the injections need to be given. The blue areas represent the injection sites.
These sites need to be rotated. This means that your child doesn’t inject in the same place all the time which prevents the buildup of fatty tissue.
Fatty tissue will inhibit the absorption of insulin getting into the bloodstream. The insulin won’t be able to work effectively and your blood glucose levels will be unstable.
Hint: Long acting insulin is given every 24 hours, keep one place that is only for the long acting injection site.
School and diabetes
Your child should have a sharps bin in their school so that they can change their needles regularly and dispose of them safely.
The school, diabetic team and diabetic child’s parents will need to establish the needs of the individual child and make appropriate arrangements.
Key subjects to discuss that a school aged child will need:
- Your school should help you with diabetes. You should have a safe place to keep emergency insulin, and your school should give you somewhere private to test blood glucose and use insulin injections.
- Your school will need to understand about diabetes, and they might need to ask you about your condition. Your Doctors and nurses can give your school more information about diabetes.
- Young people with diabetes should be able to eat snacks, whether they are in the middle of a lesson or not.
- Young people with diabetes should be allowed to go to the toilet whenever they need to, without any questions.
- Key people in the school should know how to recognise and treat hypoglycemia.
- Taking part in sports or gym shouldn’t be affected, but adequate precautions should be taken and blood glucose levels should be monitored.
- Diabetic children should be issued with an identity card to allow them to access school dinners earlier if required.
For further information about school and diabetes visit Diabetes UK.
Body image, identification and jewellery
It’s important that children and adolescents can be identified as diabetic if necessary; but young people are very image conscious. So companies have developed imaginative ways to overcome this.
Below are some examples of the ways to identify your child as diabetic and links to their websites.
If you want to find out more about diabetes, Diabetes UK has a comprehensive website that will answer nearly all of your questions and offer support groups for you and your child.
Our own diabetes hub also contains information and tips for those living with diabetes, or if you have a specific query about managing your Type 1 or Type 2 diabetes, we’re here to help. You can contact our team of nurses at any time of the day or night via our Ask the Expert service.