TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 1 MY TYPE 1 DIABETES GUIDE A picture-led handbook for children and families YOU CAN DO THIS Learn the steps. Practise with your diabetes team. Keep the emergency plan where everyone can see it. Name: __________________________ Diabetes team: __________________________TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 2 How to use this booklet Read one chapter at a time. Ask your diabetes educator to demonstrate each skill, then tick it when you can do it safely. Chapter What you will learn 1 What type 1 diabetes is 2 How to check a finger-prick glucose 3 How to complete a 7-point profile 4 Types of insulin 5 Giving, storing and rotating insulin 6 Food groups and carbohydrate counting 7 Recognizing and treating hypoglycemia 8 Hyperglycemia and ketones 9 Sick-day management IMPORTANT This booklet supports - but does not replace - your child’s written insulin, correction, ketone and sick-day plan. Insulin doses must be individualized by the diabetes team.TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 3 CHAPTER 1 1. What is type 1 diabetes? Food is broken down into glucose. Glucose travels in the blood and is a major fuel for the body. Insulin is the “key” that helps glucose move from the blood into cells. What normally happens What happens in type 1 diabetes What treatment does The pancreas releases insulin so glucose can enter cells. The immune system damages insulin- making beta cells. Injected or pumped insulin replaces the missing insulin. IT IS NOT YOUR FAULT Type 1 diabetes is not caused by eating sugar, being inactive, or anything a child or parent did. It cannot be prevented by diet alone. THE DAILY BUILDING BLOCKS Take insulin • check glucose • count carbohydrate • play and exercise safely.TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 4 CHAPTER 2 2. How to check blood glucose 1 Wash and dry hands Food or moisture on fingers can alter the reading. 2 Prepare Insert an unexpired strip and load a fresh lancet. 3 Prick the side of a fingertip Avoid the centre pad; rotate fingers. 4 Apply blood Let the strip draw in the drop. Avoid forceful squeezing. 5 Read, record and act Write the number, time, insulin, food, activity and symptoms. METER SAFETY Never share lancets or finger-pricking devices. Dispose of sharps in a puncture-resistant container. Confirm with a meter if symptoms do not match a CGM reading.TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 5 CHAPTER 3 3. The 7-point sugar profile A 7-point profile shows how meals and insulin affect glucose across one day. Use it on days advised by your diabetes team. Point Time Record beside it 1 Before breakfast Overnight/basal pattern 2 About 2 h after breakfast Breakfast and bolus effect 3 Before lunch Morning trend 4 About 2 h after lunch Lunch and bolus effect 5 Before dinner Afternoon trend 6 About 2 h after dinner Dinner and bolus effect 7 At 3 am Overnight safety EXTRA CHECKS Check additionally when symptoms occur, before/during/after exercise, during illness, after treating a low, and at 2-3 am when your team advises. CGM may reduce finger-pricks, but keep a meter available.TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 6 CHAPTER 4 4. Types of insulin Most children use a basal-bolus plan: background insulin plus meal insulin. Pumps use rapid-acting insulin continuously. Exact timing depends on the prescribed product. Type Main job Typical start / duration* Examples (generic) Ultra-rapid / rapid Meals and corrections ~5-20 min / ~3-5 h lispro, aspart, glulisine Short-acting Meals ~30 min / ~5-8 h regular/soluble insulin Intermediate Background; has a peak ~1-2 h / ~12-18 h NPH/isophane Long-acting Background ~1-2 h / up to ~24 h glargine U100, detemir Ultra-long Background varies / >24 h degludec, glargine U300 *Approximate profiles vary by dose, injection site, activity, age and product. Follow the label and your diabetes team. BASAL + BOLUS Basal insulin covers glucose made between meals and overnight. Bolus insulin covers carbohydrate eaten and may correct high glucose. Do not swap insulin types or concentrations without checking. CONCENTRATION WARNING Use only the device intended for that insulin concentration. Never withdraw insulin from a pen cartridge with a syringe.TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 7 CHAPTER 5 5. Giving insulin safely 1 Check Right child, insulin, concentration, dose and time. Check label and expiry. 2 Prepare the pen Attach a new needle. Prime according to device instructions. Dial the prescribed dose. 3 Choose healthy tissue Avoid lumps, scars, bruises and inflamed skin. Use clean, dry skin. 4 Inject into subcutaneous fat Use the needle length and skin-fold technique taught by your team. 5 Count slowly Keep the needle in place for the device- recommended time (often 10 seconds), then remove safely. 6 Dispose and record Remove the needle from the pen and place it in a sharps container.TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 8 CHAPTER 5 5. Storage, rotation and precautions DO AVOID Keep unopened insulin refrigerated at 2-8°C; store it in the main compartment. Never freeze insulin or place it beside the freezer plate. Write the opening date on in-use insulin; follow its leaflet for time and temperature limits. Avoid direct sun, heat, parked cars, expired insulin or unexpected clumps/discolouration. Travel with insulin in an insulated pouch and keep it with you. Do not let insulin touch ice or a frozen pack directly. ROTATE, DO NOT RANDOMLY JUMP Use one region consistently for the same time of day, but move each injection at least one finger-width. Examine sites regularly. Injecting into lipohypertrophy makes absorption unpredictable. CHECK THE LEAFLET In-use temperature limits and discard times differ between products (often around 28 days, but not always). Follow the manufacturer’s leaflet and your team’s written instructions.TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 9 CHAPTER 6 6. Food groups and the healthy plate Children with type 1 diabetes need normal growth, variety and family meals - not a “diabetic diet”. Match insulin to carbohydrate using the individualized insulin-to-carbohydrate ratio. Half the plate One quarter One quarter Add Non-starchy vegetables: leafy vegetables, beans, carrot, cucumber Protein: dal, pulses, paneer, egg, fish or chicken Carbohydrate: roti, rice, bhakri, idli, poha or other grain Water; fruit or dairy as planned Count carbohydrate in grains, potato/corn, fruit, milk/yogurt, dal/beans, sweets and sweet drinks. Most non-starchy vegetables, eggs, fish and chicken contain little carbohydrate. QUALITY STILL MATTERS Prefer whole grains, pulses, vegetables, fruit and unsweetened dairy. Limit sugary drinks, highly processed snacks and excess saturated fat. Do not unnecessarily restrict carbohydrate in a growing child.TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 10 CHAPTER 6 6. Carbohydrate counting Carbohydrate counting estimates the grams of carbohydrate in a meal. Use household measures, food labels and a digital kitchen scale while learning. 1 List carbohydrate foods Example: chapati + dal + milk. 2 Measure the portion Use the same cup, bowl or scale. 3 Find carbohydrate grams Use your approved exchange list or nutrition label. 4 Add the grams This is the meal’s total carbohydrate. 5 Calculate meal insulin Use only the insulin-to-carbohydrate ratio prescribed for that time of day. Approximate 15 g carbohydrate exchange Portion from the supplied diet guide Chapati 1 Cooked rice ⅓ cup Bread 1 slice Roasted chana ⅓ cup Apple 1 small Banana 1 small Milk 250 mL Dhokla 2 pieces VERIFY PORTIONS Recipes, bowl sizes and brands vary. These are learning estimates from the supplied diet booklet, not universal values. Check labels and review portions with your dietitian.TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 11 CHAPTER 7 7. Hypoglycemia (low sugars) Hypoglycemia or low sugar is sugar level below 70 mg/dL (3.9 mmol/L). Treat promptly. A child may have low sugars even before a meter result if typical symptoms occur. Body warning signs Brain/behaviour signs Shaking, sweating, hunger, paleness, fast heartbeat Irritability, headache, confusion, poor concentration Tingling, weakness, dizziness Unusual behaviour, drowsiness, blurred vision Nightmares or restless sleep Seizure or unconsciousness = severe hypoglycemia IF CONSCIOUS AND ABLE TO SWALLOW Give rapid glucose: ISPAD recommends about 0.3 g/kg, usually not more than 15 g. Examples include measured glucose tablets/gel or glucose dissolved in water. Recheck in 15 minutes and repeat if still below 70 mg/dL. Follow with the planned meal/snack when appropriate. IF UNCONSCIOUS, SEIZING OR UNABLE TO SWALLOW Do not give food or drink by mouth. Place on the side, give prescribed glucagon immediately, call emergency services, and recheck glucose. Family and school staff should practise the glucagon plan.TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 12 CHAPTER 8 8. Hyperglycemia and ketones Hyperglycemia means glucose is above the child’s target. Common causes include missed or insufficient insulin, illness, stress, inaccurate carbohydrate counting, spoiled insulin, injection-site problems, or pump/set failure. High-glucose symptoms Danger signs of DKA Thirst, frequent urination, tiredness, blurred vision Vomiting or severe abdominal pain Dry mouth, headache, poor concentration Deep/rapid breathing or fruity-smelling breath Often no symptoms - check glucose Increasing drowsiness, confusion or dehydration When to check ketones Whenever the child is unwell, especially with fever, vomiting, abdominal pain or unusual tiredness - even if glucose is not very high. When glucose is persistently high (commonly ≥300 mg/dL / 14.2 mmol/L, or the threshold in your written plan). When a pump or infusion-set problem is suspected. What to do 1 Check Confirm glucose; check blood ketones if available, or urine ketones. 2 Give fluids Use small frequent sips. Choose sugar-free or carbohydrate-containing fluids according to glucose and the sick-day plan. 3 Give correction insulin Use the written correction/ketone plan. With pump failure, correction may need injection by pen/syringe. 4 Recheck Repeat glucose and ketones in 1-2 hours or as directed. GET URGENT HELP Moderate/large urine ketones, blood ketones ≥1.5 mmol/L, persistent vomiting, breathing difficulty, severe abdominal pain, dehydration, drowsiness, or rising ketones despite insulin require urgent diabetes-team/emergency assessment.TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 13 CHAPTER 9 9. Sick-day management THE GOLDEN RULE Never stop basal insulin. Illness may increase insulin needs even when the child eats less. Contact your diabetes team early for individualized dose advice. 1 Monitor more often Check glucose every 2-4 hours, including overnight if advised. Confirm unexpected CGM values with a meter. 2 Check ketones Check every 2-4 hours while ill and whenever glucose is high; follow blood- or urine- ketone instructions. 3 Continue insulin Continue basal insulin and give meal/correction/ketone insulin according to the written plan. 4 Prevent dehydration Offer frequent small sips. If glucose is high, use sugar-free fluids; if low/normal and not eating, use carbohydrate-containing fluids as advised. 5 Treat the illness Use age-appropriate medicines advised by the child’s clinician. Check labels for sugar and interactions.TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 14 CHAPTER 9 9. Sick-day action sheet Every 2-4 hours record Result / action Time ____________________________ Glucose ____________________________ Blood or urine ketones ____________________________ Insulin given ____________________________ Fluids / carbohydrate taken ____________________________ Temperature and symptoms ____________________________ Call the diabetes team urgently if Ketones are moderate/large, blood ketones are ≥1.5 mmol/L, or ketones are rising/not clearing. The child cannot keep fluids down, has repeated vomiting or has signs of dehydration. Glucose stays high despite correction insulin, or repeated hypoglycemia occurs. You are unsure how much insulin or fluid to give. Go to emergency care now if Breathing is deep/rapid, the child is very drowsy/confused, has severe abdominal pain, or looks seriously unwell. There is a seizure, unconsciousness, severe hypoglycemia not responding to glucagon, or you cannot safely manage at home. KEEP READY Meter + strips • blood/urine ketone strips • insulin and delivery supplies • glucagon • rapid glucose • thermometer • oral rehydration fluids • diabetes-team and emergency numbersTYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 15 My individualized diabetes plan Plan item Write the child-specific instruction Usual glucose target ________________________________________ Low-glucose treatment amount ________________________________________ Glucagon product and dose ________________________________________ When to check ketones ________________________________________ Correction factor / plan ________________________________________ Ketone insulin plan ________________________________________ Sick-day contact number ________________________________________ Emergency number ________________________________________TYPE 1 DIABETES • FAMILY GUIDE Education guide • Follow your child’s individualized diabetes plan Page 16 Sources and clinical note This family education booklet was developed from the supplied “Diabetes Information Booklet” and “Diet in Type 1 DM” materials, then clinically aligned with current ISPAD consensus guidance. Core references ISPAD Clinical Practice Consensus Guidelines 2024: Glycemic Targets. ISPAD Clinical Practice Consensus Guidelines 2024: Glucose Monitoring. ISPAD Clinical Practice Consensus Guidelines 2024: Insulin and Adjunctive Treatments in Children and Adolescents with Diabetes. ISPAD Clinical Practice Consensus Guidelines 2024: Diabetes Technologies - Insulin Delivery. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes Education in Children and Adolescents. ISPAD Clinical Practice Consensus Guidelines 2022: Nutritional Management in Children and Adolescents with Diabetes. ISPAD Clinical Practice Consensus Guidelines 2022: Assessment and Management of Hypoglycemia in Children and Adolescents with Diabetes. ISPAD Clinical Practice Consensus Guidelines 2022: Sick Day Management in Children and Adolescents with Diabetes. Prepared as an educational draft • August 2026
