Treatment of Diabetes in Children

The treatment of diabetes in children is more complex than in adults because young patients cannot cooperate in the same way as adults. In toddlers, therapy is carried out entirely by the parents. As cognitive abilities increase, responsibility for therapy is gradually transferred to the children themselves. Against the background of children’s social development in kindergarten, school, and leisure activities, difficult situations often arise that repeatedly pose challenges for the children, their parents, and their environment. For parents and physicians, finding the right balance between too much and too little involvement in therapy is a major challenge.

In the past, treatment of type 1 diabetes in children was mostly carried out using intensified conventional insulin therapy. In recent years, there has been a strong shift toward insulin pump therapy. Almost all toddlers today receive an insulin pump, as it allows very small insulin doses to be administered and adjusted with great precision. With the additional option of continuous glucose monitoring (CGM), nocturnal hypoglycemia can be avoided, and parents can be relieved from nighttime blood glucose measurements. Even during growth phases, the insulin pump is the best way to regulate fluctuating insulin requirements throughout the day.

Transition in Adolescents with Diabetes

The transition from pediatric care to adult medicine is referred to as “transition.” It usually takes place between the ages of 16 and 21. This decision is not easy for young people with diabetes. On the one hand, there is often a strong personal bond with the pediatrician due to many years of intensive care. On the other hand, adolescents no longer want to sit in the waiting room with much younger patients. In addition, the transition often coincides with adolescence, a period in which diabetes management is particularly challenging. Good cooperation between pediatricians and adult diabetologists is helpful in this context. Transitional clinics or joint consultation hours, in which both specialists initially care for the patient together, are also recommended.

Specific Characteristics

The treatment of type 1 diabetes in children has several specific characteristics that distinguish it from treatment in adults:

  1. Age-dependent responsibility
    In young children, diabetes management is carried out entirely by the parents or caregivers. As the child grows and cognitive abilities develop, responsibility is gradually transferred to the child or adolescent. This transition must be carefully guided and supervised.
  2. Variable insulin requirements
    Children have highly variable insulin needs due to growth, changing activity levels, illnesses, and hormonal influences, especially during puberty. Insulin doses often need frequent adjustment.
  3. Risk of hypoglycemia
    Children, particularly young ones, are at higher risk of hypoglycemia and may not be able to recognize or communicate symptoms. Preventing low blood glucose levels is therefore a central goal of therapy.
  4. Use of insulin pumps and CGM
    Insulin pump therapy is commonly used in children because it allows very precise delivery of small insulin doses. Continuous glucose monitoring (CGM) is especially valuable, as it helps detect glucose fluctuations early and reduces the risk of nocturnal hypoglycemia.
  5. Impact of growth and puberty
    Growth phases and puberty significantly affect insulin sensitivity and metabolic control. During puberty, insulin resistance increases, making glycemic control particularly challenging.
  6. Psychosocial aspects
    Diabetes management must be integrated into the child’s daily life, including kindergarten, school, sports, and social activities. Psychological support for both the child and the family is often essential.
  7. Education and training
    Structured education for children and their parents is a key component of treatment. This includes training in insulin administration, blood glucose monitoring, nutrition, and management of acute situations.
  8. Long-term focus
    The goal is not only good short-term metabolic control but also the prevention of long-term complications while ensuring normal physical, emotional, and social development.

Overall, type 1 diabetes treatment in children requires an individualized, family-centered, and multidisciplinary approach.