Important Facts

Below are a list of variables that can affect blood sugar levels in people under the age of 18 with Type 1 Diabetes (T1D):

Biological Factors

Insulin Dosing:

Amount, timing, and type of insulin (rapid-acting, long-acting, basal-bolus).

Growth Hormones:

Puberty and growth spurts cause insulin resistance, making blood sugar unpredictable.

Illness/Infection:

Fever or infections (e.g., colds, flu) often raise blood sugar levels.

Menstruation (in females):

Hormonal changes during the menstrual cycle can cause fluctuations.

Hydration Levels:

Dehydration can lead to higher blood sugar levels.

Stress (Emotional or Physical):

Stress hormones like cortisol and adrenaline can raise blood sugar levels.

Thyroid Disease:

Undiagnosed or unmanaged thyroid disease can lead to significant blood sugar fluctuations, especially during sleep.

Dietary Factors

Carbohydrate Intake:

Type and amount of carbohydrates consumed, including high glycemic index foods.

Meal Timing:

Irregular meal times or skipped meals can cause fluctuations.

Fat and Protein:

High-fat meals can delay digestion, leading to delayed blood sugar spikes.

High-protein meals may raise blood sugar slightly, depending on insulin levels.

Activity and Lifestyle Factors

Physical Activity:

Exercise can lower blood sugar levels, but the effect varies based on intensity, duration, and timing.

Anaerobic activities (e.g., weightlifting) may temporarily increase blood sugar due to adrenaline release.

Sleep Patterns:

Lack of sleep or irregular sleep schedules can affect blood sugar regulation.

Screen Time and Sedentary Behavior:

Prolonged inactivity can lead to higher blood sugar levels.

Medication and Treatment Factors

Insulin Absorption:

Injection site and technique (e.g., abdomen vs. thigh) can impact absorption.

Lipohypertrophy (buildup of fat at injection sites) can interfere with insulin delivery.

Medications:

Other medications, such as steroids, can raise blood sugar levels.

Environmental Factors

Temperature:

Hot weather can increase insulin absorption, potentially causing low blood sugar.

Cold weather can slow absorption.

Altitude:

High altitudes may impact blood sugar due to changes in oxygen levels and physical activity.

Behavioral and Psychological Factors

Adherence to Treatment:

Missing insulin doses or not regularly checking blood sugar can cause variability.

Mental Health:

Conditions like anxiety, depression, or eating disorders can affect management.

Other Factors

Dawn Phenomenon:

Early morning blood sugar rise due to overnight hormone release (e.g., growth hormone, cortisol).

Somogyi Effect:

Rebound hyperglycemia following nighttime hypoglycemia.

Alcohol or Substance Use (in older teens):

Alcohol can lower blood sugar hours later due to its effects on the liver.

For people with Type 1 Diabetes (T1D), blood sugar control can be challenging at any age, but younger and older individuals face different obstacles due to physiological and lifestyle factors.

Question: How many days, on average, can a Type 1 Diabetic live or not go into a coma without insulin?

A person with Type 1 diabetes cannot survive long without insulin. Insulin is essential for life because it allows glucose to enter cells for energy and prevents dangerous ketone buildup.

What happens without insulin: Without insulin, the body rapidly develops diabetic ketoacidosis (DKA) — a life-threatening condition.

Typical progression (can vary by person, age, illness, hydration, etc.):

Time without insulin - What is happening physiologically

4–8 hours - Blood glucose rises sharply (hyperglycemia). Body begins breaking down fat for fuel.

8–24 hours - Ketones accumulate → blood becomes acidic. Dehydration worsens. Nausea, vomiting, abdominal pain, heavy breathing may start.

24–48 hours - Full DKA likely. Severe dehydration, electrolyte imbalance, confusion, rapid deep breathing (Kussmaul respirations).

48+ hours - High risk of coma, organ failure, and death without emergency treatment. Some people deteriorate faster (especially children).

Average time to coma or death

There is no safe “average” number of days, but medically:

• DKA can begin in less than 24 hours

• Coma can occur within 1–3 days 

• Death may follow soon after without IV fluids, insulin, and hospital care

• Some individuals decline in under a day, particularly if they are sick, dehydrated, or young

Important distinctions

This is different from Type 2 diabetes.
A Type 1 diabetic has little to no insulin production, so insulin is as essential as oxygen or water.

Emergency warning signs (call 911 / ER immediately)

• Fruity or nail-polish smell on breath
  
  

• Rapid, deep breathing
  
  

• Severe vomiting or inability to keep fluids down
  
  

• Confusion or extreme drowsiness
  
  

• Blood glucose persistently over ~300 mg/dL with ketones present
  
  

Bottom line

A person with Type 1 diabetes generally cannot go more than about a day or two without insulin before life-threatening DKA develops. Survival beyond that without medical treatment is unlikely.