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Column originally published Feb 27, 2018

Type 1 Diabetes

Question: I am worried about our twelve-year-old grandson. He got sick several weeks ago, and we thought he had the stomach flu. Instead of getting better, he got much worse. Our daughter took him to see the doctor, and found out that he has diabetes. Looking back, he was thirsty all the time, and went to bathroom a lot. My husband developed diabetes a few years ago, but he wasn’t like that. I am worried that he got diabetes at such an early age. How can we help as grandparents?


Most children develop what is called type 1 diabetes. The cells in the pancreas (an organ in our abdomen above the kidneys) stop producing insulin, an essential hormone that regulates blood sugar. Without insulin, sugar cannot be used by the cells. As a result, all the cells are starving and cannot function properly. Excess sugar passes into urine with water, causing dehydration in spite of him drinking lots of water.

At the same time, the body breaks down fat in an attempt to produce sugar that the cells need. The byproduct of this is ketone. Some can detect the sweet smell of ketone from diabetics who are sick. Tests will show elevated levels of sugar and ketone in his blood and urine.

Most adults develop what is called type 2, or adult-onset, diabetes. They still have a functioning pancreas that produces insulin. The body, however, does not respond to insulin as well as it should. That is why most of them can be treated with medicine that improves the function of insulin.

However, all type 1 diabetics require insulin injections. There are fast-acting insulins that work immediately, and long-acting ones that work for twelve to 24 hours. Most children, because of their activities and metabolism, usually require fast-acting insulin three to 4 times a day, and long-acting ones in morning and evening.

They need to monitor their blood sugar four times a day, before breakfast, lunch, supper, and bedtime, to determine the amount of each type of insulin to use. Insulin pumps can help to regulate blood sugar, but they require diligence and monitoring. His diabetes needs to be fairly well controlled before he can start using the pump.

Your grandson also needs to eat healthy and regular meals that include all food groups. The amount of carbohydrate in each meal is used to calculate the dose of fast-acting insulin. He also needs regular exercise to maintain his health.

As grandparents, you are key to support him and his parents. If he comes over for visit or sleepover, make sure he checks his blood sugar before each meal and bedtime, and gives himself insulin properly. You may want to learn how to inject insulin, if he needs to put it in hard-to-reach places (like his buttocks). Make sure he changes injection sites, otherwise fat will deposit, which will affect insulin absorption.

If you are used to spoil him with treats and candies, you will have to change. A lot of sitting activities is unwise. Staying up late at night and sleeping-in will affect the insulin schedule. Take him to the gym, the swimming pool, or go for a walk instead.

Be supportive, and understand that this is a big change for him and his family. If his parents are busy, you can take him to his appointments with his doctor and the diabetes team. You can also take him to the laboratory for regular blood tests. If the cost of insulin pump is too much for his family, this can be a great gift from you.