Type 1 diabetes living in children

Overview

Type 1 diabetes is a condition where the body's immune system attacks the cells in the pancreas that make insulin. Insulin is a hormone that helps sugar (glucose) from food get into your cells to be used for energy. Without insulin, sugar builds up in the blood, which can cause serious health problems. Children with type 1 diabetes need to take insulin every day to stay healthy.

Type 1 diabetes is less common than type 2 diabetes, but it is one of the most common chronic conditions in children. In the UK, about 1 in 400 children and young people have type 1 diabetes. The number of new cases is increasing each year.

Type 1 diabetes can develop at any age, but it often starts in children and young adults. It affects boys and girls equally. It is more common in children of certain ethnic backgrounds, such as those of Northern European descent. A family history of type 1 diabetes increases the risk.

Symptoms

Common symptoms

• Increased thirst (polydipsia)
• Frequent urination, especially at night (polyuria)
• Unexplained weight loss
• Extreme hunger (polyphagia)
• Fatigue and tiredness
• Blurred vision
• Slow-healing cuts or infections

Symptoms in children

• Bedwetting in a child who was previously dry at night
• Irritability or mood changes
• Yeast infections (in girls)
• Fruity-smelling breath (a sign of high ketones)
• Rapid breathing or deep sighing breaths

Causes

Main causes

• Type 1 diabetes is an autoimmune disease. The body's immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas.
• The exact trigger is unknown, but it may involve a combination of genetic susceptibility and environmental factors, such as a viral infection.

Risk factors

• Family history: having a parent or sibling with type 1 diabetes increases the risk
• Certain genes (HLA types) that make the immune system more likely to attack the pancreas
• Being of Northern European descent
• Age: most common in children and adolescents

When to see a doctor

See a doctor urgently if:

• Any symptoms of diabetic ketoacidosis (DKA) – vomiting, fruity breath, deep rapid breathing, confusion
• Blood sugar readings that are very high (above 14 mmol/L) and not coming down
• Severe low blood sugar (hypoglycemia) that does not respond to treatment
• Any illness that makes it hard to eat or drink

Book a routine appointment if:

• If your child has increased thirst, urination, or unexplained weight loss – see your GP as soon as possible
• If your child has been diagnosed with type 1 diabetes, attend all follow-up appointments with the diabetes team
• Regular eye and foot checks as recommended by your healthcare provider

Diagnosis

Type 1 diabetes is diagnosed with a blood test that measures your child's blood sugar level. Doctors will also check for autoantibodies – proteins that indicate an autoimmune attack on the pancreas. These tests help confirm type 1 diabetes and rule out other forms of diabetes.

Tests that may be done

• Fasting blood glucose test: measures blood sugar after not eating for at least 8 hours
• Random blood glucose test: a high result (above 11.1 mmol/L) with symptoms suggests diabetes
• HbA1c test: shows average blood sugar over the past 2-3 months
• Autoantibody tests: detect antibodies against the pancreas (e.g., GAD, IA-2, insulin autoantibodies)
• C-peptide test: measures how much insulin the pancreas is still making (low or absent in type 1)

What to expect at your appointment

If your child is diagnosed with type 1 diabetes, the healthcare team will explain everything you need to know. Your child will need to learn how to check blood sugar levels, give insulin injections or use an insulin pump, and count carbohydrates. The team will include a diabetes specialist nurse, dietitian, and doctor. You will receive a written care plan and be taught how to recognise and treat high and low blood sugar. It may feel overwhelming at first, but the support and education will help you and your child become confident in managing diabetes.

Treatment

Treatment for type 1 diabetes focuses on replacing the missing insulin and keeping blood sugar levels as close to normal as possible. This involves daily insulin therapy, regular blood sugar monitoring, healthy eating, and physical activity. The goal is to prevent short-term emergencies (like DKA or severe hypos) and long-term complications.

Self-care at home

• Check blood sugar levels multiple times a day (before meals, before bed, and sometimes overnight)
• Give insulin as prescribed – this may be by injections (multiple daily injections) or through an insulin pump
• Count carbohydrates in meals to match insulin doses
• Keep a log of blood sugar readings, insulin doses, and carbohydrate intake
• Always carry a fast-acting sugar source (like glucose tablets, juice, or candy) for low blood sugar
• Wear a medical alert ID (bracelet or necklace) to let others know your child has type 1 diabetes
• Teach your child about diabetes as they grow older – involve them in their own care when appropriate

Medical treatments

Insulin is the only medicine used to treat type 1 diabetes. There are different types of insulin: rapid-acting, short-acting, intermediate-acting, and long-acting. The healthcare team will create an insulin plan that fits your child's needs. Some children use an insulin pump, which gives a steady stream of rapid-acting insulin. Others use multiple daily injections. Continuous glucose monitors (CGMs) can help check blood sugar without finger pricks. The choice of insulin and delivery method depends on the child's age, lifestyle, and preferences. No specific brand names are mentioned here – your diabetes team will recommend what is best for your child.

When is surgery considered?

Surgery is not a treatment for type 1 diabetes. However, children with type 1 diabetes may need special care if they have surgery for other reasons. The diabetes team will adjust insulin and blood sugar monitoring before, during, and after surgery to keep levels safe.

Living with this condition

Managing type 1 diabetes becomes part of daily life for the whole family. Your child will need help with blood sugar checks, insulin doses, and meal planning, especially when young. As they grow older, they can take on more responsibility with your guidance. It is important to have a plan for school, including informing teachers and having a diabetes kit always available. Physical activity, sports, and parties can all be enjoyed with proper planning – checking blood sugar before and after exercise and adjusting insulin or snacks as needed.

Lifestyle tips

• Eat regular, balanced meals and snacks – include carbohydrates, protein, and healthy fats
• Encourage regular physical activity – at least 60 minutes of moderate exercise daily, as recommended for all children
• Establish a consistent daily routine for blood sugar checks, insulin, and meals
• Get enough sleep – poor sleep can affect blood sugar control
• Manage stress – high stress can raise blood sugar; teach your child relaxation techniques

Diet and exercise

A healthy, balanced diet is important for everyone, and children with type 1 diabetes can eat the same foods as their peers – they just need to match insulin doses to the carbohydrates they eat. It is helpful to learn about carbohydrate counting. Physical activity is encouraged, but it can lower blood sugar. Check blood sugar before, during, and after exercise, and have a snack ready if needed. Always carry a fast-acting sugar source. With careful planning, children can participate in all sports and activities.

Mental health and emotional wellbeing

Living with a chronic condition can be challenging. Children may feel different from their friends, worry about blood sugar levels, or feel frustrated with the daily demands. It is common for children (and parents) to experience stress, anxiety, or even depression. Talk openly with your child about their feelings. Involve a mental health professional if needed – many diabetes clinics have psychologists or counselors. Remind your child that diabetes does not define them, and they can achieve everything they want in life.

Prevention

Type 1 diabetes cannot be prevented. It is an autoimmune condition that happens when the body attacks its own insulin-making cells. There is no known way to stop this from happening. Research is ongoing into ways to delay or prevent type 1 diabetes, but currently there are no proven methods.

Vaccines

There is no vaccine to prevent type 1 diabetes. However, children with type 1 diabetes should receive all routine childhood vaccines, including the flu vaccine and COVID-19 vaccines, because infections can make blood sugar harder to control.

Screening programmes

Routine screening for type 1 diabetes is not recommended for the general population. However, if your child has a close family member with type 1 diabetes, research studies may offer screening for autoantibodies. This can identify children at high risk before symptoms appear. Speak to your doctor if you are interested in such studies.

Complications

If left untreated

• Diabetic ketoacidosis (DKA) – a life-threatening condition where the body produces high levels of ketones, causing acid buildup in the blood
• Severe low blood sugar (hypoglycemia) – can cause seizures, unconsciousness, and brain damage if not treated
• Long-term damage to blood vessels: eye problems (retinopathy leading to blindness), kidney disease (nephropathy), and nerve damage (neuropathy)
• Increased risk of heart disease and stroke
• Foot problems (including infection and amputation) due to poor circulation and nerve damage

Long-term outlook

The outlook for children with type 1 diabetes is very good. With careful management, children can live long, healthy lives and achieve everything they want – school, sports, careers, and families. Modern technologies like insulin pumps and continuous glucose monitors make it easier to keep blood sugar in range. The key is to work closely with the healthcare team, keep up with regular check-ups, and teach your child to take good care of themselves. There is reason for hope: research continues to improve treatments and one day find a cure.

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