Type 1 Diabetes

Because our research informs our treatment, our diabetes team is known for our innovative treatments and science-driven approach. Children’s Hospital Boston is home to the world’s most extensive pediatric hospital research enterprise, and we partner with elite health care and biotech organizations around the globe. But as specialists in family-centered care, our physicians never forget that your child is precious, and not just a patient.

In dealing with your child’s diabetes, you probably want to know the basics about what diabetes is, and how type 1 diabetes differs from other forms of the disease.

What is diabetes?
 

Diabetes (diabetes mellitus) is a lifelong condition that occurs when the body doesn’t make enough insulin, or when the body doesn’t respond properly to the insulin it makes. There are many forms of diabetes mellitus, several of which have undergone name changes as the disease has become better understood.

• type 1 diabetes: Formerly known as “juvenile” or “insulin-dependent” diabetes,type 1 diabetes is caused by the immune system’s failure to recognize the beta cells as belonging to the body, so it attacks and destroys them. This is why type 1 diabetes is considered an autoimmune disease. Children with type 1 diabetes must take insulin injections every day.

• type 2 diabetes: Formerly known as “adult onset” or “non-insulin dependent” diabetes, type 2 diabetes typically occurs in people who are overweight, physically inactive and over age 40, although more and more children are developing type 2 diabetes, possibly because of childhood obesity. Some children need insulin; others can control their diabetes with healthful eating and exercise, or oral medicines (hypoglycemic agents).
   
• MODY (maturity onset diabetes of youth): a form of diabetes that has been diagnosed before the age of 35 years in at least three generations of family members. Doctors have identified many specific genetic defects (mutations) in such families. Some patients who have MODY need insulin. Others can effectively manage their condition with diet and/or oral medicines.

• secondary diabetes: This is a form of the disease in which the beta cells are destroyed, not by the body’s immune system, but by  cystic fibrosis (“secondary to cystic fibrosis”), pancreatic surgery or another cause.

Note: diabetes insipidus is a very different condition from diabetes mellitus.

Is there more than one form of type 1 diabetes?
 

There are two forms of type 1 diabetes:

• immune-mediated diabetes: an autoimmune disorder in which the body’s immune system destroys, or attempts to destroy, the cells in the pancreas that produce insulin. This is the most common form of type 1 diabetes, and it accounts for most cases.
   
• idiopathic type 1: refers to rare forms of the disease with no known cause

What is insulin?
 

Insulin is the hormone that allows glucose to enter the cells of the body to provide fuel in the form of glucose. Without insulin, glucose builds up in the bloodstream, starving the body’s cells. Children with type 1 diabetes must take daily insulin injections and must regularly monitor their blood sugar levels.

• Insulin is a protein hormone made by the beta cells of an area of the pancreas (an organ that lies behind the stomach).
• Insulin is needed to help glucose (sugar) enter the cells of the body.
  • When glucose enters the cells, it can be used to produce energy, or it can be stored in the liver and muscles (as glycogen) for later use.
• If the body doesn’t produce its own insulin, it must be injected so the body can function properly.
  • Insulin can’t be taken by mouth because the digestive system would destroy it.
• Insulin for injection comes from several sources.
  • Human insulin is the kind most commonly used today to treat diabetes. It’s made in special bacteria (by genetic engineering) so that it’s identical to the insulin the human body produces.

How do you diagnose diabetes?
 

Often, clues are when a child is very thirsty and has to urinate frequently. Your child’s doctor may also order blood and urine tests, including:

• glycated hemoglobin (A1C) test: This blood test indicates average blood sugar level for the past two to three months.
• random blood sugar test: A blood sample is taken at a random time.
• fasting blood sugar test: A blood sample is taken after an overnight fast.
• To distinguish between type 1 and type 2 diabetes, your child’s doctor may alsocheck for autoantibodies in the blood that are common in type 1 diabetes. Children’s diabetes team also tests for the presence of ketones (byproducts from the breakdown of fat) in the urine or blood, which when present, also suggest the child has type 1 diabetes.

Since test results should be confirmed with a second test on a different day, it’s likely that your child will have blood drawn more than once.

How do you treat diabetes?
 

Children with type 1 diabetes must have daily injections of insulin to keep their blood sugar levels within the normal range. After stabilizing your child, our diabetes team will help you to determine and balance your child’s insulin, food and exercise to keep her blood glucose levels in a safe and healthy range.

In addition to insulin injections, other ways of managing your child’s diabetes that her team may recommend include:

• eating a healthful diabetes diet (to manage blood sugar level)
• exercise (to lower—and help the body use—blood sugar)
• regular blood check (for blood sugar [glucose] levels)
• regular urine check (for ketone levels)

Our registered nutritionists and dietitians will work with you to develop a meal plan based on your child’s specific needs. And our diabetes nurse-educators will work with you to increase your knowledge of, and confidence in, how best to care for your child at home.

Who will be on my child’s diabetes team at Children’s?
 

Children’s multidisciplinary team members include:

• pediatric endocrinologists: medical doctors who specialize in the care of children with disorders that affect any of the body’s hormone-producing glands, such as diabetes mellitus. The endocrinologist supervises the work of the diabetes team and is responsible for your child’s care.
   
• diabetes nurse-educators: nurses who specialize in teaching families how to care for a child who has diabetes. The nurse educator, together with your child’s staff nurses, teach you about managing your child’s diabetes. After your child returns home, the nurse educator continues to teach and support you in our outpatient Diabetes Program, and is available by phone for urgent advice.
   
• staff nurses: nurses who help while your child in the hospital. The staff nurses also work closely with the nurse educator in the outpatient Diabetes Program. Together, they’ll make sure you and your child learn all the basics for caring for your child safely at home.
   
• registered nutritionists and dietitians: nutritional professionals who’ll help you develop a healthful diabetic meal plan that meets your child’s nutritional needs. After your child has left the hospital, she’ll have a follow-up appointment with the dietitian, who will also be available by phone to answer your questions.
   
• medical social workers: psycho-social specialists who help families deal with the difficult feelings around living with diabetes. Your social worker can offer guidance about your child’s behavior, provide you with information about community resources, and help with the transition from hospital to home.

How and when should I give insulin to my child?
 

Your child’s diabetes team will help you decide what types of insulin your child should use, and when you should give it.

• Your child’s nurse will teach you how to measure and inject the insulin.
   
• Your team will also give you tips for:
  • the best time(s) in the day to give insulin—the timing of meals, as well as the pre-meal blood glucose level, may affect the time you should give the injection
  • storing and transporting your child’s insulin

Does having type 1 diabetes put my child at risk for other conditions?
 

Unfortunately, children who have diabetes are also at risk for other autoimmune conditions such as autoimmune thyroid disease, celiac disease and, rarely, Addison’s disease.

What’s a  healthful diet for kids with type 1 diabetes?
 

Proper meal-planning is very important if your child has diabetes, since the type and amount of food your child eats affects her blood sugar levels. If she eats too much, her blood sugar may go up too high. If she skips meals, her blood sugar may go too low. Good blood sugar control requires a balance of food, exercise and medication. Healthy meals include foods that contain the right amounts of carbohydrates, protein and fat.

Carbohydrates (“carbs”) are an important source of energy for kids, and they affect the body's blood sugar the most since the body turns carbohydrates into blood sugar. If your child eats too many foods with carbs, her blood sugar can go too high. About half the calories your child eats should come from carbs, and a certain amount of carbohydrates should be included with each meal and snack. Your child’s dietitian can help you decide how much carbohydrate your child needs each day.

Sugar is a carbohydrate. It doesn’t affect your child’s blood sugar any differently from other carbs. Your child can eat sweets and sugars if they’re counted as part of her daily carbohydrate intake. (Sweets don’t have many vitamins or minerals, so your child should eat them only in small amounts.)

Proteins and fats don’t affect the body’s blood sugar level as much as carbs do. But the amount of protein and fat in your child’s diet may need to be counted, since it’s important for her to eat them in appropriate amounts. Too much fat can increase your child’s risk for heart disease and may make it difficult for her to maintain a healthy weight. Your child’s dietitian can help you decide how much protein and fat your child needs.

How can I monitor my child’s diabetes day-to-day?
 

Checking your child’s blood glucose (sugar) levels every day will tell you if she’s maintaining a good balance of insulin, food and exercise.

• Your child’s diabetes doctor or nurse educator will recommend the best goal or target range for your child’s blood glucose levels. If these levels are in the target range most of the time, this means that her diabetes is well controlled.
   
• It’s important to measure your child’s blood glucose levels at certain times during the day. Your diabetes team will give you specific recommendations on when and how often you should check her levels.
   
• You’ll use a blood glucose meter to measure the amount of glucose in a drop of your child’s blood, in order to check if her blood glucose levels are within her goal range. Your diabetes team member will recommend a meter for your child and teach you how to use it. These are small and simple to use—and involve just a tiny pinprick.

What about emergencies?


We’ll teach you how to cope with emergency situations in which you may need to administer extra insulin (“booster shot”) or check your child’s urine for ketones (toxins released by the body’s breakdown of fat caused by a lack of sugar to the cells of the body. We’ll help you recognize signs that your child may need emergency attention.

What about exercise for kids with type 1 diabetes?
 

Exercise is always important for growing children, regardless of diabetes. When exercise is combined with the right amounts of food and insulin, it will help keep your child healthy, and her blood glucose levels will remain in balance.

In general, exercise tends to lower blood glucose levels.

• When your child exercises, her muscles use glucose at an increased rate to provide energy.
• Exercise increases the body’s sensitivity to insulin.
  • The insulin has a greater effect on lowering blood glucose levels when a child is exercising, and even for some time after the exercise is over.

To avoid low blood glucose when exercising:

• Plan vigorous activities for roughly the same times each day.
• Plan activities to follow meals and snacks.
• Check your child’s blood glucose level before and after exercise.
• Add an extra snack before exercise.
• Plan activities and snacks according to when insulin starts to work, when its peak effect is reach and how long it works to lower blood glucose levels.

Your diabetes team will help you figure out how insulin works in your child; what types of snacks are most helpful before exercise; how to check your child’s glucose; and any other questions you may have—we’re here to help.

What are the dangers of not treating type 1 diabetes?
 

Uncontrolled type 1 diabetes can be dangerous. It can lead to serious, even life-threatening, problems such as:

• kidney damage (nephropathy)
• diabetic retinopathy
• poor circulation (especially of the feet)

What are some complications associated with diabetes?
 

People who have diabetes are also at risk for other autoimmune conditions such as autoimmune thyroid disease, celiac disease and, rarely, Addison’s disease.                                                     

Although type 1 diabetes can cause many different problems, there are several key complications that if uncontrolled, can cause emergencies.

• hypoglycemia (low blood sugar, “insulin reaction”):
  • occurs when blood sugar drops too low—so the body doesn’t have the source of energy it needs to function properly
  • can result from:
    • too high an insulin dose
    • a missed meal or snack
    • more physical activity than usual
    • sickness with vomiting and/or diarrhea
  • if unchecked, can result in a low blood glucose medical emergency with loss of consciousness or seizure
    • treated by injecting the hormone glucagon
  • common signs and symptoms include shakiness, sweating, weakness, blurry vision, rapid heartbeat
  • If your child has signs or symptoms of hypoglycemia, measure her blood glucose level (if possible) and give her a fast-acting carbohydrate, such as fruit juice, hard candy or raisins.
     
• hyperglycemia (high blood sugar):
  • occurs when blood sugar is too high
  • can be a sign that diabetes is not well controlled
  • caused by build-up of glucose in the bloodstream; possible causes:
    • not enough insulin—glucose can’t enter the body’s cells
    • too much food, wrong kinds of food
    • less physical activity than recommended
    • sickness
  • symptoms can resemble those of diabetes—excessive urination, bedwetting, weight loss, thirst, yeast infections, nausea and vomiting
  • If your child has signs or symptoms of hyperglycemia
    • measure her blood glucose level
    • check her urine for ketones
    • check with your diabetes team to see if you should administer a “booster shot” of extra insulin
  • If your child has signs or symptoms of hyperglycemia, PLUS a rapid heartbeat and deep, rapid breathing, call your doctor immediately, since she may be in the medical emergency called diabetic ketoacidosis.

• diabetic ketoacidosis (diabetic coma):
  • loss of consciousness due to untreated or under-treated diabetes
    • lack of sugar to the cells of the body cause the body to break down fats, releasing toxins (ketones) into the bloodstream faster than the kidneys can get rid of them
  • Diabetic ketoacidosis is a serious condition that requires immediate medical attention; children become very sick; call your doctor if your child has ketones in her blood.

Insulin, food and exercise: How do we find the right balance?
 

Many factors can affect your child’s blood sugar level, including:

• exercise
• some foods
• some medications (non-diabetic)
• illness, fever

The key to maintaining your child’s blood sugar in a normal range is to balance your child’s insulin dosage, type and amount of food intake and level of exercise. Your diabetes team will help you determine a healthful regimen for your child that balances these key elements.

How do we cope with traveling and vacationing?
 

Traveling with a child who has diabetes requires some advance planning—but it is doable, and your child’s condition doesn’t have to slow up the family’s plans. Joseph Wolfsdorf, MD, associate chief of Children’s Division of Endocrinology, has written a helpful article called Traveling with Diabetes. Wolfsdorf’s article offers tips for packing, airline travel, spending time outdoors, dining out, transporting insulin, wearing an ID bracelet, packing an emergency kit and lots more.

Your diabetes team will give you a great deal of helpful information about helping your child manage other kinds of stays outside your home when you’re not around—such as sleepovers, school, day care and summer camp (including diabetes camp programs). Here, too, some planning and communication smooth the way.

Will my child be OK?
 

With proper attention to maintaining the balance among your child’s insulin, food and exercise, she should not only be OK—she should be able to maintain good general health. But untreated diabetes can be dangerous, and can lead to damage to nerves, blood vessels, heart, eyes, kidneys and circulation.

What new research is Children’s doing on type 1 diabetes?
 

Clinical trial. Children’s Hospital Boston’s Diabetes Program is participating in the Diabetes Prevention Trial-Type 1 (DPT-1)—a nationwide clinical trial to determine whether type 1 diabetes can be prevented or delayed in people at risk for developing the disease.

Diabetes research initiatives. Because diabetes requires lifelong management, researchers at Children’s are investigating the earliest stages of the disease in order to understand how it develops and how it can be treated.

Tracking study for type 1 diabetes. In addition to developing a hospital registry, researchers are also working with the Commonwealth of Massachusetts to track the growing incidence of type 1 diabetes in the state.

Autoimmune disease research collaboration. Children’s is collaborating with the Immune Disease Institute, a non-profit research and educational institution, to accelerate groundbreaking research in immunology and inflammation—and to translate basic discoveries into the clinical setting. This research is focusing on discovering what controls the interaction of immune cells with each other, and on understanding how genetic variation contributes to autoimmunity.

For more on Children’s diabetes research, see Research & innovation.

FAQ
 

Q: What is type 1 diabetes?

A: Type 1 diabetes is an autoimmune disease—more specifically, a disorder of carbohydrate metabolism—in which the immune system attacks and destroys the insulin producing-cells of the pancreas (called beta cells).

Q: What causes diabetes?

A: The exact cause of type 1 diabetes is still not known. It’s currently thought that previous infections and substances in the environment may trigger the immune system to destroy the beta cells that make insulin. Genetic (inherited) factors increase a child’s risk of developing diabetes. Type 1 diabetes is not caused by obesity or by eating too many sweets, and it’s not contagious.

Q: If my child has diabetes, will she be OK?

A: With proper attention to maintaining the balance among your child’s insulin, food and exercise, she should not only be OK—she should be able to maintain good general health. But untreated diabetes can be dangerous, and can lead to damage to nerves, blood vessels, heart, eyes, kidneys and circulation.

Q: How does Children’s treat diabetes?

A: Children with type 1 diabetes must have daily injections of insulin to keep their blood sugar levels within the normal range. After stabilizing your child, our diabetes team will help you to determine and balance your child’s insulin, food and exercise to keep her blood glucose levels in a safe and healthy range. In addition to insulin injections, other ways of managing your child’s diabetes that her team may recommend include:

• a healthful diabetes diet (to manage blood sugar level)
• exercise (to lower—and help the body use—blood sugar)
• regular blood check (for glucose [blood sugar] levels)
• regular urine check (for ketone levels)

Our registered nutritionists and dietitians will work with you to develop a meal plan based on your child’s specific needs. And our diabetes nurse-educators will work with you and your family to increase your knowledge of, and confidence in, how best to care for your child.

Q: What are the signs and symptoms of diabetes?

A:

• increasing thirst
• increasing frequency of urination
  • waking to urinate in the night
  • bed-wetting in children who’ve been toilet trained
• weight loss or inability to gain weight despite increasing or extreme hunger
• blurred vision
• nausea, vomiting and abdominal pain
• more apparent or increasing weakness and fatigue
• irritability and mood changes
• strange odor to breath—smells like fruit-flavored gum or nail polish remover
• yeast infections, including diaper rash, ringworm, athlete’s foot
• dry, itchy skin

Q: If my child has diabetes, what should I ask her doctor?

A: Some of the questions you may want to ask include:

• What type of diabetes does my child have?
• Are other tests needed to confirm the diagnosis?
• What actions might you take after you reach a diagnosis?
• What can we do at home? What should we change about our lifestyle?
• Is there a danger of emergencies? What should we do in an emergency?
• Will there be long-term effects?

Q: How is diabetes usually diagnosed?

A: The presence of extreme thirst and frequent urination is often a clue. Your child’s doctor may also order blood and urine tests including:

• glycated hemoglobin (A1C) test: indicates average blood sugar level for the past two to three months
• random blood sugar test
• fasting blood sugar test: taken after an overnight (eight-hour) fast
• check for autoantibodies in the blood common in type 1 diabetes (vs. type 2)
• check for the presence of ketones (byproducts from the breakdown of fat in children without enough insulin) in the urine or blood

Since test results should be confirmed with a second test on a different day, it’s likely that your child will have blood drawn more than once.

Your child will be diagnosed with diabetes if her:

• blood glucose is higher than 126 mg/dL first thing in the morning before eating or drinking (fast for at least eight hours)

-or-

• blood glucose is greater than 200 mg/dL (more than once) after a meal or snack

Q: What’s the long-term outlook for a child who has type 1 diabetes?

A: With proper attention to maintaining the balance among your child’s insulin, food and exercise, she should not only be OK—she should be able to maintain good general health. But untreated diabetes can be dangerous, and can lead to damage to nerves, blood vessels, heart, eyes, kidneys and circulation. Your child’s diabetes team is committed to helping you control and manage her type 1 diabetes—so that she, you and your whole family can thrive.

Q: What is Children’s experience treating diabetes?

A: Children’s Hospital Boston’s Diabetes Program provides children and families with a multidisciplinary diabetes team of pediatric endocrinologists, diabetes nurse-educators, staff nurses, registered nutritionists and medical social workers.

Ranked second in the nation for diabetes care by U.S. News & World Report for 2010-11, we are known for our comprehensive services for infants, children, adolescents and young adults with all types of diabetes. This includes type 1 diabetes, type 2 diabetes, cystic fibrosis-related diabetes, steroid-induced diabetes, post-pancreatectomy diabetes and other rare forms of diabetes.

Causes
 

The exact cause of type 1 diabetes is still not known. It’s currently thought that previous infections and substances in the environment may trigger the immune system to destroy the beta cells that make insulin. Genetic (inherited) factors contribute to the risk of developing diabetes. Type 1 diabetes is not caused by obesity or by eating too many sweets, and it’s not contagious.

Signs and symptoms
 

Even though type 1 diabetes affects a child gradually, it often appears to come on quite suddenly. In children, the symptoms can resemble the flu, and while each child may experience symptoms differently, some of the most common include:

• increasing thirst
• increasing frequency of urination
  • waking to urinate in the night
  • bed-wetting in children who’ve been toilet trained
• weight loss or inability to gain weight despite increasing or extreme hunger
• blurred vision
• nausea, vomiting and abdominal pain
• more apparent or increasing weakness and fatigue
• irritability and mood changes
• strange odor to breath—smells like fruit-flavored gum or nail polish remover
• yeast infections, including diaper rash, ringworm, athlete’s foot
• dry, itchy skin (in combination with other signs)

When to seek medical advice


 

Consult your pediatrician immediately if your child shows signs of the following:

• increasing thirst
• increasing frequency of urination
  • waking to urinate in the night
  • bed-wetting in children who’ve been toilet trained
• weight loss or inability to gain weight despite increasing or extreme hunger
• blurred vision
• nausea, vomiting and abdominal pain
• more apparent or increasing weakness and fatigue
• irritability and mood changes
• strange odor to breath—smells like fruit-flavored gum or nail polish remover
• yeast infections, including diaper rash, ringworm, athlete’s foot
• dry, itchy skin (in combination with other signs)

Questions to ask your doctor
 

If your child is diagnosed with diabetes, you may feel a bit overwhelmed. It can be easy to lose track of the questions that occur to you. Lots of parents find it helpful to jot down questions as they arise—that way, when you talk to your child’s doctors, you can be sure that all your concerns are addressed.

Some of the questions you may want to ask include:

• What type of diabetes does my child have?
• Are other tests needed to confirm the diagnosis?
• What actions might you take after you reach a diagnosis?
• What can we do at home? What should we change about our lifestyle?
• Is there a danger of emergencies? What should we do in an emergency?
• Will there be long-term effects?

Who’s at risk
  

Type 1 diabetes can affect a child at any age, and usually affects children or teens before they’re 20 years old. About one in 250 people in the United States have type 1 diabetes, with the incidence somewhat higher among Caucasians than Blacks. Boys are equally likely to get the disease as girls.

For teens
 

If you’re a teen with diabetes, you have a lot to cope with. Besides the typical issues any teenager faces—from social acceptance to body changes and more—you also have to deal with medical appointments, taking your insulin, and learning how to strike a balance with your insulin, food and exercise.

Even if you’ve been very cooperative until now, you might be feeling lots of pressure to fit in with your classmates, so you may be tempted to neglect the daily steps you need to take to manage your diabetes. Try to resist this temptation. If you neglect your care, you could become very ill. If you follow your regular care regimen, you’ll be able to do most everything your peers can do.

If you feel down, angry or anxious through this important time in your life, speak to your doctor or counselor to get help. And remember: your parents are your partners in managing your diabetes. Trust that they have your best interests at heart; remain “interdependent” with your folks, and keep the lines of communication open.

For parents
 

Regardless of your child’s age, a diagnosis of diabetes can be devastating.

If your child is very young, she may not quite understand all the life changes that may come with a diagnosis of type 1 diabetes. Your child may experience feelings of:

• vulnerability
• anger
• difference from peers (“Why me?”)

If your child is  a teen with diabetes, the normal challenges of the teenage years can even more intense. Teens want to belong, and being different in any way from one’s peers can be emotionally stressful.

Even a teen who previously complied very well with her diabetes management plan may now:

• become rebellious and refuse to comply
• experience denial of the disease
• become aggressive in reaction to the stress of managing diabetes

Helping your teenager with her blood sugar control is especially hard. Researchers believe the growth hormone produced during adolescence that stimulates bone and muscle growth may also act as an anti-insulin agent. Blood sugar levels become harder to control—resulting in blood sugar levels that swing from too low to too high. This lack of control over blood sugar levels can be very frustrating for your teen.

Although a child who’s diagnosed with type 1 diabetes needs supervised medical care, the ideal relationship between parents and child is one of interdependence—with family members working together as a team to help the child live normally and happily. With your encouragement and our diabetes team’s guidance, your child will learn how to take care of her diabetes—and her increasing independence will improve her self-esteem.

Prevention
 

There’s no way to prevent type 1 diabetes, since this is an autoimmune condition. But you and your child can help prevent emergency spikes and dips in her blood sugar levels by paying careful attention to maintaining the balance of your child’s insulin, food and exercise. Your child’s diabetes team is committed to helping you control and manage her type 1 diabetes—so your whole family can thrive.

Long-term outlook
 

With proper attention to maintaining the balance among your child’s insulin, food and exercise, she should not only be OK—she should be able to maintain good general health. But untreated diabetes can be dangerous, and can lead to damage to nerves, blood vessels, heart, eyes, kidneys and circulation. Your child’s diabetes team is committed to helping you control and manage her type 1 diabetes—so that she, you and your whole family can thrive.

Diabetes glossary
 

• autoimmune disease: a disorder in which the body’s immune system reacts against itself and produces antibodies to attack its own healthy cells and tissue

• carbohydrates: an important source of energy for kids, and they affect the body's blood sugar the most since the body turns carbohydrates into blood sugar. But if your child eats too many foods with carbs, her blood sugar can go too high.

• The Center for Families at Children’s: dedicated to helping families find the information, services and resources they need to understand their child’s medical condition and take part in their care

• diabetes (diabetes mellitus): a lifelong condition that occurs when the body doesn’t make enough insulin, or when the body doesn’t respond properly to the insulin it makes. There are many forms of diabetes mellitus, including type 1 diabetes, type 2 diabetes, MODY and secondary diabetes.

• diabetes diet: Good blood sugar control requires a balance of food, exercise and medication. Healthy meals include foods that contain an appropriate balance of carbohydrates, protein and fat.
   
• diabetic ketoacidosis (diabetic coma): loss of consciousness due to untreated or under-treated diabetes; a lack of sugar to the cells of the body cause the body to break down fats, releasing toxins (ketones)

• (blood) glucose: Found in foods, glucose is an important source of immediate energy for the body. Glucose can also be stored as other forms in the liver and muscles for later use. Excess glucose is converted to fat. Glucose is the main source of fuel for the brain, and is especially important for babies and young children. Complex hormonal and neurologic mechanisms regulate the amount of glucose between meals.
   
• hyperglycemia: condition in which the body’s blood sugar level is too high

• hypoglycemia: a condition in which the body’s blood sugar level drops too low

• insulin: the hormone that allows glucose to enter the cells of the body to provide fuel in the form of glucose. Without insulin, glucose builds up in the bloodstream, starving the body’s cells. People with type 1 diabetes must take daily insulin injections and must regularly monitor their blood sugar levels.
   
• ketones: toxins that are released when alack of sugar to the cells of the body causes the body to break down fats

• MODY (mature onset diabetes of youth): a form of diabetes has been diagnosed before the age of 35 years in at least three generations of family members. Many specific genetic defects (mutations) have been identified in such families. Some patients who have MODY need insulin. Others can effectively manage their condition with diet and/or oral medicines.

• pancreas: a large gland behind the stomach that plays a key role in digestion. Beta cells in the pancreas create insulin.

• secondary diabetes: a form of the disease in which the beta cells are destroyed, not by the body’s immune system, but by  cystic fibrosis (“secondary to cystic fibrosis”), pancreatic surgery or another cause

• type 1 diabetes: Formerly known as “juvenile” or “insulin-dependent” diabetes,type 1 diabetesis caused by the immune system’s failure to recognize the beta cells as belonging to the body, so it attacks and destroys them. This is why type 1 diabetes is considered an autoimmune disease. People with type 1 diabetes must take insulin injections every day.

• type 2 diabetes: Formerly known as “adult onset” or “non-insulin dependent” diabetes, type 2 diabetes typically occurs in people who are overweight, physically inactive and over age 40, although it’s affecting more and more children, possibly because of childhood obesity. Some patients need insulin; others can control their diabetes with diet and exercise, or oral medicines (hypoglycemic agents).