Diabetes
Treatment

Managing your child's diabetes is a group effort involving the whole family. At UCSF Children's Hospital, our team — including doctors, dietitians, nurses, educators and social workers — work closely with your family to provide treatment, information, support, guidance and help. Your doctor will help you and your child develop a daily diabetes treatment plan.

Diabetes management is designed to keep your child's blood sugar levels in a near-normal range and prevent erratic swings. The treatment plan will also promote your child's normal physical and emotional development.

Treatment typically involves following a healthy meal plan, getting regular exercise, checking blood sugar levels, participating in regular screenings for long-term complications of diabetes and taking insulin or oral medication as prescribed. The treatment plan is reviewed and revised as necessary. It's generally recommended that patients visit the Pediatric Diabetes Program every three months.

Meal Planning

Healthy meal planning is an essential part of your diabetes treatment. Family support in following the plan and setting up regular meal times is key to success, especially if your child or teen is taking insulin. A registered dietitian will work with you and your child to develop a healthy meal plan that:

• Maintains targeted blood sugar levels based on your child's diet, exercise and diabetes medications
• Controls your child's weight
• Provides proper nutrition to promote normal physical and emotional growth

Your doctor and dietitian also will discuss food tips for managing diabetes. These include:

• Learning which foods contain carbohydrates and how much carbs should be included at meals and snacks. Carbohydrate intake will raise your child's blood sugar levels, so the amount of carbohydrates eaten must be matched with exercise and insulin and other medications to balance blood sugar levels. For more information, please see Carbohydrates and Diabetes.
• Correctly reading food labels
• Establishing correct portion size and caloric intake based on your child's age, weight and activity levels
• Timing of meals, medications and physical activity
• Tracking dietary fat, cholesterol and sodium, as needed
• Preventing and treating hypoglycemia

Exercise

Regular physical activity is important for all children, especially those with diabetes. Exercise helps insulin work more efficiently, lowers blood sugar, burns calories and helps control weight. It also improves cholesterol levels, muscle tone and a person's sense of well-being.

If your child isn't used to regular physical activity, we recommend starting slowly and working up to 30 to 60 minutes each day. It's important that your child do something he or she likes, such as walking, dancing, swimming, sports or riding a bike. Before your child begins exercising, we suggest testing blood sugar. Ask your doctor if your child needs to test it during and after exercise as well, and if diabetes pills or insulin doses need to be reduced before beginning a regular exercise program.

Parents and family members can participate in a child's exercise program. It can be a great way for families to spend quality time together. Your diabetes educator can discuss ways to encourage exercise and participate in regular physical activity.

Blood Sugar Levels

All people with diabetes, including children and teens, need to regularly check blood sugar levels. Checking blood sugar levels tells us a number of important factors:

• The current state of your child's diabetes at a particular time
• How exercise, food and illness affects diabetes
• How well diabetes medication is working

You or your child should check blood sugar levels regularly with a blood glucose meter, preferably a meter with a built-in memory. We will teach you and your child how to use this meter. Blood glucose meter results indicate whether blood sugar levels are in the target range, too high or too low. Your child's diabetes team will recommend a target range for blood sugar and how often to test it.

We recommend that you or your child, depending on age, keep a journal or other records of blood sugar results to discuss with your doctor or nurse. You should bring your glucose meter or glucometer and written records to all clinic appointments. This information helps determine if we need to make any changes to your child's treatment plan. Keeping a written record makes it easier for you and your family to identify potential problems before your next scheduled visit. As soon as issues or problems are identified, you should discuss them with your doctor.

For more information on how to check your child's blood sugar levels and the American Diabetes Association's recommendations on age-specific blood sugar goal range, please see Tips For Checking Blood Sugar.

Medications

There are two kinds of diabetes medicines: insulin, which is taken by injection, and pills that are taken orally. For type 1 diabetes, a child or teen takes insulin shots at regular times each day. Some patients use an insulin pump to deliver insulin. Some children or teens with type 2 diabetes need pills or insulin shots or both. In all cases, medications should be balanced daily with food and activity. It's important that children or teenagers take all their diabetes medication as prescribed. Parents, caregivers, school nurses and others can help a child or teen learn how to take medications properly.

Insulin

Insulin, a hormone made by beta cells in the pancreas, lowers the blood sugar level and is injected under the skin. Until a cure is found, a person with type 1 diabetes must take insulin injections or wear an insulin pump. Injections are usually taken three or more times a day. A variety of insulin preparations are available that have different properties.

Most people use a combination of intermediate or long-acting insulin with short-acting insulin. Many children and teens receive insulin through insulin pumps that provide greater flexibility in diets and sleep schedules as well as freedom to pursue activities without worrying as much about their blood sugar levels. The insulin pump is a small device about the size of a pager or a deck of cards that can be clipped to the waistband. You, your child and your diabetes care team will decide if and when "the pump" is right for helping to manage your child's diabetes.

Oral Medications

Diabetes pills may be prescribed if you have type 2 diabetes. There are several types of oral medications:

• Sulfonylureas such as glipizide (Micronase), glyburide (Glucotrol) and glimepiride (Amaryl) — These medications help the pancreas release more insulin. Sulfonylureas usually are taken once or twice a day. They raise insulin levels for several hours. A low blood sugar is a possible side effect. People taking this medication should not skip meals. Mild weight gain, usually less than five pounds, may occur.
• Meglitinides such as nateglinide (Starlix) and repaglinide (Prandin) — These medications work in the same way as sulfonylureas, but don't last as long. They're taken right before a meal. People taking this medication should not skip meals. A low blood sugar is a possible side effect. Mild weight gain, usually less than five pounds, may occur.
• Starch Blockers such as acarbose (Precose) and miglitol (Glyset) — These medicines slow the digestion and absorption of starches and sugars. They're taken with the first bite of a meal. Gas and bloating are common side effects. When taking starch blockers, it's important that glucose tablets, not sugar candies, are used to correct a low blood sugar because starch blockers also block the absorption of sugar.
• Biguanide such as metformin (Glucophage) — This medication keeps the liver from releasing too much sugar. Metformin is usually taken twice or three times a day with a meal, although extended release forms are available that are taken only once daily. Metformin can cause diarrhea and stomach upset. To reduce diarrhea, metformin is taken with food. Diarrhea usually goes away over time.
• Thiazolidinediones (TZDs) such as pioglitazone (Actos) and rosiglitazone (Avandia) — Thiazolidinediones (TZDs) decrease insulin resistance and allow the body to use insulin better. They usually are taken once a day. TZDs can cause mild fluid retention, swelling and weight gain. A blood test to check liver function should be done every two months the first year of treatment and then every six to 12 months.

Reviewed by health care specialists at UCSF Children's Hospital.
Last updated March 10, 2010