🥬 Type 1 Diabetes in Children
The three polys plus weight loss, sick day rules, and why a sudden behavior change means check the glucose.
🧬 How it presents
Type 1 is autoimmune destruction of the beta cells. There is no insulin at all, so glucose cannot get into cells — the body is starving in a sea of sugar.
Polyuria, polydipsia, polyphagia AND weight loss. A child eating more and losing weight has type 1 until proven otherwise.
💧 The clue parents actually notice
New bedwetting in a previously dry child, or a toddler soaking through diapers. Also constant thirst, tiredness, irritability, and blurred vision.
Many present already in DKA: Kussmaul breathing, fruity breath, vomiting, and abdominal pain that can be mistaken for appendicitis.
| Type 1 | Type 2 | |
|---|---|---|
| Onset | Sudden, weeks | Gradual |
| Body habitus | Often thin, recent weight loss | Usually overweight |
| Insulin | Always required | Diet, metformin, sometimes insulin |
| Ketones | Common at diagnosis | Uncommon |
| Acanthosis nigricans | No | Yes — dark velvety neck creases |
🚨 Hypoglycemia — act first
In a young child, low blood sugar often looks like a sudden change in behavior — irritable, tearful, silly, or unusually quiet.
Also: shaky, sweaty, pale, hungry, headache, confused.
When you cannot tell high from low, treat as LOW. Hypoglycemia kills in minutes; hyperglycemia takes hours.
⭐ The Rule of 15
15 g of fast carbohydrate → wait 15 minutes → recheck. Repeat until above 70, then a snack with protein.
15 g looks like: 4 oz juice 3 glucose tabs 1 tbsp honey (over 12 months)
If the child is unconscious or cannot swallow, nothing goes in the mouth. IM glucagon or IV dextrose.
🏃 Exercise
Exercise lowers glucose, sometimes for hours afterwards.
- Snack before sport; carry fast sugar at all times
- Check before, during and after prolonged activity
- Sport is encouraged, not restricted — it improves control
- Tell coaches and the school nurse what to do
🩺 Living with it
✅ Sick day rules — the teaching that prevents admissions
- NEVER stop insulin, even when not eating. Illness RAISES glucose because stress hormones do.
- Check glucose every 2–4 hours
- Check ketones whenever glucose is above 250, or with any vomiting
- Push sugar-free fluids to stay hydrated
- Call for: persistent vomiting, moderate or large ketones, glucose that will not come down, or drowsiness
| Insulin | Onset | Peak | Duration |
|---|---|---|---|
| Lispro / aspart | 15 min | 1 h | 3–4 h |
| Regular | 30 min | 2–3 h | 5–8 h |
| NPH | 1–2 h | 4–12 h | 12–18 h |
| Glargine | 1–2 h | No peak | ~24 h |
Peak time is when hypoglycemia happens — that is the only reason to memorize these.
Glargine is never mixed with another insulin. When mixing NPH and regular: clear before cloudy.
Rotate injection sites to prevent lipohypertrophy, which makes absorption unpredictable.
🧠 By developmental stage
- Toddler / preschool — parents manage everything; expect resistance to finger sticks. Offer limited choices: which finger, which site
- School age — can start checking their own glucose; give them real jobs; involve the school
- Adolescent — wants independence but control often worsens. Expect some omitted doses; approach without blame, and watch for diabetes burnout and eating-disorder behavior
Screening: HbA1c every 3 months; annual eye, kidney, lipid and thyroid checks.
🎯 NCLEX traps
- Three polys + weight loss + new bedwetting = type 1
- Treat low before high; when unsure, treat as low
- Never stop insulin when ill
- Peak time = when hypoglycemia happens
- Clear before cloudy; glargine never mixed
- Sudden behavior change → check the glucose