Goals in treating children with diabetes include avoiding the dangers of high glucose (blood sugar) and low glucose, maintaining normal growth and development, and avoiding complications such as kidney disease. Because children are more prone to more illnesses than adults are, it is especially important for young diabetic patients to have a sick-day management plan.

Some of the same therapies used in adults with diabetes are appropriate for children. Researchers are still testing use of some antidiabetic agents with children and working on alternatives. Hormonal changes and growth are two factors that can affect insulin, glucose and medication dosage in children.

Treatment options for diabetic children include:

• Glucose monitoring. Keeping track of glucose levels is important whether insulin is being administered or not. Ways to help children maintain correct levels of glucose include:
  
  
• • Explaining diabetes, glucose and insulin to everyone in the family
    
    
  • Trying the glucose meter under supervision of a physician or diabetes educator

The family should understand the plan developed by the physician to define, detect and treat irregular glucose levels (hyperglycemia and hypoglycemia). For example, the treatment plan for severe hypoglycemia may be an injection of glucagon administered by a parent, school nurse or other trained person.

The physician may also recommend regular ketone tests to help avoid diabetic ketoacidosis. Ketones are waste products produced when the body burns stored fat instead of glucose for energy and are of particular concern to people with type 1 diabetes.

• Exercise. Children with type 2 diabetes can help control the disease by losing weight through increased activity. Exercise can also help children with type 1 diabetes feel better and avoid double diabetes. Ways to get children more active include:
  
• • Setting an example, such as walking or bicycling more
    
    
  • Involving the whole family
    
    
  • Starting slowly, such as one family walk a week
    
    
  • Increasing activity levels as early goals become easy

• Diet. This is another lifestyle change that can help control type 2 diabetes and benefit children with type 1 diabetes. Ways to improve children’s eating habits include:
  
  
• • Getting nutrition counseling
    
    
  • Reducing portion sizes
    
    
  • Planning several small meals a day rather than fewer heavy ones
    
    
  • Introducing more vegetables, fruits and high-fiber whole grains
    
    
  • Limiting saturated fats, starches and sugars
    
    
    
  • Keeping healthful snacks on hand, such as yogurt and sliced vegetables
    
    
  • Showing children how to shop for food and read labels
    
    
  • Urging officials to make school meals more nutritious
    
    
• Insulin. Children with type 1 diabetes or Wolfram syndrome need to take insulinby syringe injection, insulin pen, jet injector or pump. Some children with type 2 diabetes or other forms of diabetes also require insulin therapy. The U.S. Food and Drug Administration (FDA) has approved inhaled insulin for diabetic adults but not children. Ways to help children take insulin include:
  
  
• • Alternating the test on different fingers
    
    
  • Pricking the side rather than the top of the fingertip
    
    
  • Having the child, if old enough, record the results in the logbook

• Oral medications (antidiabetic agents). The FDA has approved pediatric use of biguanides (metformin) and a sulfonylurea (glimepiride) for type 2 diabetes. Antidiabetic agents being assessed in clinical trials for use by children include thiazolidinediones, including rosiglitazone.