The pancreas is one of those organs you might call an unsung hero. It plays a vital role in digestion and making enzymes to break down the foods we eat, among other things. Yet we don’t pay it much attention—until, of course, there’s a problem.

One of the most common problems with the pancreas involves a very important natural hormone called insulin. Produced in the pancreas, insulin helps regulate the amount of glucose, or sugar, in the blood. Without it, the body can’t process glucose effectively. So sugar builds up in the blood and, over time, can damage blood vessels causing heart attack, stroke, blindness and other serious side effects.

Insulin and Diabetes

When insulin is deficient or isn’t used properly in the body, the result is diabetes. Children with type 1 diabetes are considered insulin deficient because they make little to no insulin. Children with type 2 diabetes have insulin resistance, which means their body doesn’t use insulin efficiently.

If your child has type 1 diabetes, insulin therapy, or replacement insulin, will be necessary throughout their lives to regulate blood glucose levels. Without it, these kids may experience serious complications, including kidney damage and blindness. Children with type 2 diabetes, however, may not need therapy if their condition can be managed through diet and other methods.

Injection alternatives

Insulin cannot be taken by mouth because it’s a protein that is destroyed during digestion. This is why it is typically given by injection. However, there are also newer alternatives that make therapy easier for kids to manage, such as the continuous infusion pump, a computerized device that attaches to the body and is programmed to deliver the medication under the skin.

Insulin therapy is customized for each child based on a number of factors that affect how insulin works and how long it lasts. Your doctor will evaluate how your child’s body responds to exercise, stress, the foods they eat and more before determining the right type of insulin, as well as how much and how often to give it.

“As a child grows older and their body changes, their insulin therapy changes as well,” says Andrew Muir, MD, Medical Director, Endocrinology and Diabetes at Children’s Physician Group.

Common types of insulin

There are a few key types of insulin, and each can be used for different reasons. Some kids will only need one type, while others may need a combination of these.

• Rapid-acting (Novolog, Humalog, Apidra)
• Taken with meals and some snacks, it’s also used to correct a spike in blood sugar.
• Works best if taken right before eating—up to 10 minutes before a meal or with the first bite of food.
• Small children and picky eaters can take this insulin after the first bite of food. They can also take it 15 to 30 minutes after starting a meal.
• For kids who are managing diabetes by counting carbohydrates or using an insulin pump, this insulin may be referred to as bolus insulin.

• Short-acting (Regular)
• Taken 30 minutes before eating.

• Intermediate-acting and long-acting (NPH, Levemir, Lantus, Toujeo, Tresiba, Basaglar)
• Works between meals.
• Given at the same time each day.
• Also known as basal insulin.

• Mixed
• Contains both rapid-acting and long-acting insulin. Because it contains rapid-acting insulin, kids should eat right away.
• Taken twice a day.
• A cloudy insulin, the bottle must be gently rolled between the hands to mix it before it’s taken.

When a child has diabetes, their blood sugar levels go up and down a lot. Over time, you’ll be able to recognize patterns in these blood sugar changes; the highs and lows often occur at the same time of day like mealtime or bedtime. Testing regularly and taking note of these patterns will help you more effectively manage their therapy—giving the right dose at the right time—and help keep blood sugar levels in check.

When to adjust your child’s insulin

Your child’s body is constantly changing, so their requirements will vary, particularly when they’re sick, stressed or change their routine. Signs that your child may need an adjustment to their insulin dosage include:

• Hypoglycemia, or low blood sugar (headache, rapid heartbeat, dizziness, fatigue)
• Hyperglycemia, or high blood sugar (frequent urination, excessive thirst, vomiting)
• Ketones (acid) in the urine

Make sure to repeat high or low blood sugar readings throughout the day.

If you are ever uncertain about how to manage your child’s levels, talk to your doctor or care team. Don’t stop giving insulin without physician approval even if your child is taking small doses or appears not to need it.

A lack of sufficient insulin can lead to diabetic ketoacidosis (DKA), which means that there is a high level of ketones (acid) in the blood. If not treated, DKA can be life-threatening.

There are several methods for monitoring and administering the correct dosage. Use the tools below to help you stay on track.