For children with type 1 diabetes, insulin administered by syringe injection, insulin pen, jet injector or insulin pump is necessary. When diabetes occurs in infants, parents must learn how to test glucose (blood sugar) and administer insulin. They should also be aware of symptoms of hypoglycemia, or low blood sugar. Such symptoms include:

• Paleness
• Sweating
• Trembling or clumsiness
• Crankiness
• An unusual cry
• Clammy skin or a bluish tinge to the lips or fingers
• Hunger

Symptoms of hyperglycemia include:

• Excessive thirst (polydipsia)
• Frequent urination (polyuria)
• Fatigue

Youngsters in elementary and middle school can begin to take some responsibility in management of diabetes. Many can use a glucose meter by age 7, describe symptoms of high blood glucose by age 9 and give themselves injections by age 10. Concerns at this age include:

• Diabetes management in school. Administrators, teachers and coaches need to know about injections, insulin pumps, lancets and other diabetic equipment. There have been cases of uninformed school officials confiscating such devices.

• Education rights. Groups such as the American Diabetes Association (ADA) can inform parents and children with diabetes about their legal rights to accommodation in schools and other facilities, such as camps.
  

• Overnight visits with friends. Schoolmates’ parents and leaders of youth groups may need information about a child’s diabetes and emergency treatment plan (for example, if glucagon must be injected in case of severe hypoglycemia).

Adolescents may rebel in diabetes management as well as other ways. Parents may need to be more flexible in setting goals and learn to ask questions rather than confront. Concerns at this age include:

• Hormonal changes. Onset of pediatric diabetes often occurs around puberty. The release of growth hormones can lead to insulin resistance. Increased levels of estrogen and testosterone can cause fluctuations in glucose levels. Insulin and other medications may need to be adjusted.
  
  
• Alcohol. Binge drinking can increase the risk of hypoglycemia. Intoxication can mask symptoms of hypoglycemia, including confusion and trembling.
  
  
• Tobacco. Smoking increases risk of damage to the heart, blood vessels and circulation. Teens with diabetes need to know how smoking can worsen the condition and contribute to the development of complications.
  
  
• Eating disorders. Anorexia, bulimia and other conditions can affect glucose levels and have severe consequences with diabetes.
  
  
• Increased self-consciousness. The wish to avoid seeming different may reduce compliance with insulin, diet and other treatments. Peer groups can help teens as well as younger children.