Managing diabetes in children is a team effort. When a child or teenager is diagnosed with type 1 diabetes (T1D), the best management plan usually involves family, healthcare professionals, a school-care team, and all other caregivers working together. This group also includes counselors, therapists, and other mental health support for patients and caregivers.

It’s also important to know that people are not alone when it comes to managing diabetes in a child or teenager. There are a wide range of resources, online groups, and an active social media community that many people find extremely supportive.

When a child is diagnosed with T1D — an autoimmune condition where the body doesn’t produce enough, or any, insulin — there can be a lot of questions.

• How do you manage diabetes in children?
• What about diabetes at school?
• What about type 1 diabetes and sports?
• What are the signs and symptoms of T1D that should be monitored?

Here are some first steps and resources to start the conversation.

Educate Children and Teens to Understand what the Measurements Mean

The first step towards managing type 1 diabetes in children is understanding blood glucose levels and what the numbers mean.

There are two sets of numbers that are particularly important when it comes to managing diabetes. Those are A1c and blood glucose range.

An A1c blood test, also called a hemoglobin A1c or HbA1c test, can give an average of what glucose levels were over an approximate two- to three-month period. This measurement is a strong indicator for “big picture” diabetes management. The American Diabetes Association recommends most children aim for less than 7% for their HbA1c level. For context, an A1c of 7% corresponds to an average blood sugar of 154 mg/dL (milligrams per deciliter).

Blood glucose levels can fluctuate throughout the day, so constant monitoring is essential to make sure there aren’t highs or lows. A recommended goal range is to keep at least 70% of readings between 70-180 mg/dL.

Managing diabetes in children is about understanding these numbers. Recognizing the signs and symptoms of hypoglycemia (when glucose levels get too low) and hyperglycemia (when glucose levels get too high) is essential for teens and children managing diabetes.

Diabetes and School

The idea of managing diabetes in school can be stressful for parents and children. Communication with the school-care team is an important first step. There are also lots of great resources available through government websites and private companies, including this comprehensive Back to School section from Tandem Diabetes Care.

All students have the right to a free and appropriate public education, which means schools must accommodate students with special needs, including students living with diabetes.

There are two forms of accommodations:

• A 504 plan allows for accommodations but tends to be less formal (a child with diabetes, for example, may be able to check their glucose levels on their smartphone during class).
• An Individualized Education Plan (IEP) is more formal and provides specialized instruction. The American Diabetes Association has some excellent information about IEPs.

A school-care professional will want to know the extent to which the child or teenager can manage their diabetes. Some questions the school-care team might have for a child, teenager, or parent include:

• Are they able to accurately count carbohydrates?
• Can they identify the symptoms of hyperglycemia and hypoglycemia?
• If they use an insulin pump, are they able to independently navigate it?
• Can they independently change an infusion set?
• Are they comfortable discussing their insulin pump with classmates?

Some questions a parent might have for a school-care professional include:

Remember — managing diabetes in children is a team effort. Keep the lines of communication open.

Diabetes and Sports

Managing type 1 diabetes doesn’t mean a child or teenager can’t play sports. In fact, there are many athletes who have been living with type 1 diabetes for years.

Physical activity is very important for people of all ages and, in children, can promote healthy development by strengthening muscles and bones. Exercise has also been known to improve mental health in children by relieving stress and bolstering self-confidence.

Before a child living with T1D starts a sport, it is important to consult with a healthcare professional to make a plan and understand how physical activity can impact blood glucose levels. During exercise, blood sugar levels will often drop, which will require adjusting insulin doses and carbohydrate intake. In some people, and for some forms of exercise, glucose levels go up before coming down. It is important to check glucose levels before, during, and after exercise.

Before starting a team sport, consult with the coaching staff to make sure they have an understanding of how to manage diabetes in a child or teenager. Consider asking similar questions to those of a school-care team member.

It is also important to understand symptoms of high and low blood sugar during exercise. While sweating and fatigue are common during physical exertion, managing diabetes means being aware of other symptoms at all times.

Possible symptoms of low blood sugar during exercise could be:

• Shaking
• Confusion
• Hunger
• Headache
• A lightheaded or “woozy” feeling

These could be signs of low blood sugar, which is called hypoglycemia.

It is normal to feel thirsty during physical activity. But be aware of possible signs of high blood sugar during exercise, including:

• Excessive thirst
• Frequent urination
• Impaired vision

These could be possible signs of hyperglycemia.

Note: The above symptoms may or may not be associated with hyperglycemia or hypoglycemia. Always consult with a healthcare professional before taking medical action and to understand symptoms.

Knowing how blood glucose levels can fluctuate during physical activity is an important first step towards managing diabetes in children playing sports. Certain insulin pumps can account for increased physical activity. For example, the t:slim X2 pump with Control-IQ technology has an Exercise Activity feature and has been approved by the FDA for children as young as 6.

Unless otherwise noted, all medical information was provided by Jordan Pinsker, MD, and Molly McElwee Malloy, RN, CDCES of Tandem Diabetes Care, Inc.