How can Type 1 Diabetes/ Pediatric Diabetes present?
  • Classic triad –
    • Polyuria
    • Polydipsia
    • Weight loss
  • General malaise/ Weakness/ Loss of energy
  • Headache
  • Pain abdomen
  • Irritable/ ill-tempered
  • Bed wetting
  • Blurring of vision
  • Leg cramps
  • Infections
  • Genital itching (Girls)
  • Altered consciousness/ Coma
  • Symptoms of Diabetes + Random Plasma Glucose of 200mg/dl or higher
  • The fasting Blood Glucose >126mg/dl OR
  • Plasma glucose of 200mg/dl or higher at 2 hours during an OGTT.
  • Regular Blood Glucose monitoring
  • Insulin administration
  • Lifestyle management (Diet & Exercise)
  • Eliminate diabetic symptoms
  • Prevention of Acute Complications: DKA & hypoglycemia
  • HbA1C < 8%
  • BG
    • 80-120mg/dl fasting
    • 100-140mg/dl before meal
    • 100-200mg/dl after meals
  • Normal growth & puberty
  • Early detection of associated diseases
  • Prevention of Chronic Vascular Complications
  • Ideally BG should be checked 5 times/day -
    • Morning- before breakfast (fasting)
    • Afternoon- before lunch
    • Evening- before dinner
    • 5-3 hrs post dinner
    • Late night- 3 am
  • It is essential to check BG and give Insulin injection before giving 3 major meals - Breakfast/ Lunch/ Dinner
  • Insulins should not be exposed to temperatures > 25ºC or frozen
  • No sunlight exposure
  • Pens, unused vials and cartridges should be stored in the door of refrigerator
  • Pen should be “Primed” with every needle/ cartridge change.
  • Yes, diet is based on taste of individuals, kids can have normal diet as non-diabetics
  • Avoid simple sugars like- table sugar, honey, candy, sweets, fruit juices etc.
  • Eat balanced meals with inclusion of variety of vegetables, whole grains and pulses.
  • Consistency in timing and amount of food consumed is important.
  • Meals should be timed according to the insulin schedule
  • Total caloric intake is divided into 3 meals and 2-3 mid-meal snacks
  • If peak time of insulin is over and child is hungry, FREE FOODS (carbohydrate < 5 grams) can be given to the child before next meal –
    • Lemonade (salted)
    • Buttermilk
    • Paneer/tofu
    • Soya
    • White portion of egg
    • Salad (no salad dressing)
    • Soups (veg/ chicken)- avoid adding cream/butter/corn/corn starch
    • Popcorn (prepared at home)
    • Roasted chana- murmura
    • Nuts- almonds and walnuts (4-5)
    • Roasted Makhana
  • Site of insulin injection should be changed regularly to avoid lipohypertrophy/ atrophy.
  • All Type 1 Diabetes kids should exercise and participate in all kinds of sports regularly.
  • Gives a sense of well being
  • Improves glycemic control
  • Improves the CV risk factors: lipids, BP
  • Helps maintain desirable body weight
  • Give ½ - 1 teaspoon of sugar to the child (depending on child’s age)– Repeat BG check after 20 mins
  • Other options – honey/glucose water/2-3 sips coke/ juice
  • DO NOT give chocolates/biscuits/toffees- as these contain fat, so they do not increase blood sugar immediately.
  • Injection GLUCAGON – to be used only in case of hypoglycaemic emergency
  • Increase insulin dosage
  • Change your insulin vial
  • Check for KETONES in urine (ketodiastix)
  • Make your child drink more water
  • Contact your doctor
  • DO NOT STOP INSULIN !!!
  • Take frequent blood glucose readings (every 2-4 hours), especially at night-time.
  • In sickness, ketones should be checked even if blood sugar readings are normal or mildly elevated.
  • Avoid strenuous exercise if BG> 250mg/dl or ketones are moderate-large.
  • Try to eat a normal diet.
    • Small frequent meals of easily digestible foods like- soups, crackers, toast, milk, tea, breakfast cereal etc.
    • Close contact with the diabetes team!!!
  • Very young age (< 2 years)
  • Fever> 100.5 for > 2 days / increasingly sick child
  • Persistent Vomiting & diarrhea
  • Moderate to large ketones in urine
  • Patient becomes drowsy/ unconscious
  • Child shows any symptoms of DKA- fruity breath, dehydration, dry lips, difficulty in breathing, stomach cramps etc.
  • All children should be attending school
  • Academic expectations should be the same
  • Teachers and school nurse should be informed about general rules and emergency situations
  • Written material about diabetes should be handed out to school staff
  • A close communication should exist between home and school
  • Appointment with your doctor 4–6 weeks before travel
  • Family should be capable of treating hypo- and hyperglycaemic episodes
  • Parents should know about sick-day management
  • Make sure that travel health insurance is valid
  • Whenever you travel, you should carry following things with you -
    • Insulin pens (with ice packs)
    • Extra cartridges
    • Glucometer with strips
    • Something sweet – sugar sachet/candy/juice
    • A snack
    • If travelling for more than a day – ketone sticks and Inj. Glucagon
  • Follow-up every 3 months for adjustment of insulin doses and physical check up
  • To check injection sites
  • BG log should be brought along with Glucometer at every visit
  • HbA1C checked every 3 months
  • Yearly investigations