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   DIABETES MELLITUS

 

Your Child has Type 1 Diabetes. What you should know

"Your child has diabetes." Many parents who hear these words feel dazed, shocked, afraid, or guilty. It's natural to have such feelings.

Children with diabetes usually have type 1 diabetes, in which the pancreas doesn't make insulin. They need daily insulin shots to help their bodies to use food. Type 1 diabetes is one of the most common chronic diseases in children. Nearly one child out of every 600 develops it. Diabetes can run in families, and researchers are still studying how and why it happens.

Although diabetes cannot be cured, it can be treated. With family support, daily care and treatment, your child with diabetes can lead a healthy, active, and fun-filled life.

High Blood Sugar (hyperglycemia)- When blood sugar levels get too high, the body gets too little insulin or too much food.

Symptoms of high blood sugar are:
              excessive thirst
              frequent urination
              fatigue
              blurred vision

High blood sugar is treated by checking sugar levels and giving your child insulin. Untreated, high blood sugar may develop into ketoacidosis, a very serious condition.

Ketoacidosis is caused by very high levels of ketones in blood and urine. Ketones are waste products that build up when the body burns fat for energy. Check with your doctor about when to do ketone tests, especially when your child is sick.Call your doctor immediately if your child has ketones in their urine or any of the following symptoms:

              dehydration
              vomiting
              drowsiness, labored breathing
              abdominal pain
              fruity smelling breath

Unless treated promptly Ketoacidosis can lead to a diabetic coma.  Ketoacidosis should be treated in a hospital

Low Blood Sugar (hypoglycemia) - When blood sugar levels get too low - the body gets too much insulin or too little food. It is the most common problem in children with diabetes. Symptoms include:

              trembling
              dizziness
              hunger
              crying
              sleepiness
              clumsiness
              pale skin
              headaches

Low blood sugar can be treated by giving the child carbohydrates, such as sugar cubes, a chocolate bar, hard candy, fruit juice, regular soda, followed by a snack of crackers  with cheese or peanut butter, half a sandwich, cereal with milk.

Treating Diabetes

The goals of diabetes treatment for children are:

1 to maintain normal growth and development
2 to keep blood sugar levels within a target range (not too high, not too low) as much as possible
3 to promote emotional well-being

Keeping blood sugar levels in a target range means balancing insulin, food, and exercise. Remember: food raises blood sugar levels, while insulin and exercise lower them.

A good diabetes treatment plan includes:

  eating healthy and on schedule
  checking blood sugar levels regularly
  adjusting insulin as blood sugar levels and activities warrant
  exercising regularly

Ideas about how to treat diabetes have changed a lot in recent years. Diabetes treatment plans are more flexible than they used to be. Treatment is geared to the needs of the individual child and his or her family.

Insulin shots/injections

Most children manage diabetes with two or three insulin shots a day. However, some need four or more shots. Insulin is usually given at regular times each day. Different kinds of insulin work harder at different times. Most children take more than one kind of insulin. The kinds of insulin your child takes and the times it is taken will depend on your child's needs. There is no strict rule about when (ie. what age) children can give their own insulin injections. It depends on the child. Some children and teenagers with diabetes use an insulin pump. The pump delivers a continuous flow of insulin to the body. Working closely with an expert team of health care providers helps to ensure safe pump use.

Blood Glucose Checking

Regular checking of blood sugar levels gives information about how well the diabetes care plan is working. Checking is done by taking a drop of blood, usually from a finger (a "fingerstick"). The blood is placed on a special test strip in a glucose meter.

Blood sugar levels are measured in mM. A normal blood sugar level is between 4 mM and 8 mM.

However, keeping blood sugar levels within the target range isn't always possible. Especially in children, blood sugar levels may be out of range for no apparent reason. It's important that children are never made to feel it's their fault if their blood sugar level is out of range.

Meals and Snacks

Eating meals at about the same time every day helps keep blood sugar levels in the target range. Children with diabetes often need to eat snacks during the day and before, during, or after exercise, for example crackers with peanut butter or cheese, pretzels, or apples.

You will want to know in advance about any special activities that will change your child's usual meal times. Meal planning for children with diabetes is fairly flexible these days. A schedule change can usually be dealt with by adjusting your child's meal plan or insulin dose.

Parties

Many party foods are high in sugar and fat. Generally, children with diabetes need to limit eating these foods. A child with diabetes can occasionally eat birthday cake or other special foods. He or she may need to take more insulin than usual to prevent high blood sugar. Playing an energetic game can also be a good way of lowering blood sugar levels after eating sweets. Discuss special events with your health care team.

Sports and Exercise

Children with diabetes can -- in fact, they should -- play games and sports with their friends. Exercise helps to lower blood sugar levels. In addition, taking part in gym class and team sports can help your child make friends and feel like "one of the gang." Getting regular exercise is important for children with diabetes because of the need to balance the effect of exercise with food and insulin. Because children's lives involve a lot of unplanned activity, it's a good idea for your child to always carry snack foods like pretzels or crackers with cheese or peanut butter. Youngsters should also carry sugar cubes, hard candy, glucose tablets, or another form of carbohydrate to treat low blood sugar. The timing of exercise may affect your child's meal plan and need for insulin. It's a good idea to ask your child's school to notify you in advance if a game or sports event will change your child's meal time.

Your child should not exercise if he or she is having symptoms of low blood sugar.

Age related issues

Preschoolers. Preschool-age children with diabetes often have not learned to recognize the symptoms of low blood sugar, or they aren't able to tell others when they are feeling "low." For this reason, it's important that they have frequent blood sugar checks. Preschoolers who are frightened by fingersticks and insulin shots often try to avoid or delay them. If this happens with your preschooler, it can help to say: "Yes, I know it hurts" and "You're being very brave." Stickers and stars can help to encourage a child to have a fingerstick or a shot.

Young children with diabetes can go through the same fussy eating phases as other children. It's usually best not to force a fussy child to eat. Have a variety of foods available. If the child rejects one food, offer something else, or offer juice or milk instead.

School-age children. School-age children want to be like their peers. It's not unusual for children with diabetes to feel "different" because they need insulin shots, check blood sugar regularly, and use a meal plan.

Talk with your doctor about how to help your child. Some children are comfortable openly talking about their diabetes care while others prefer to keep it private.

Teenagers. For the teenager with diabetes, having to take insulin, check blood sugar, and use a meal plan is bothersome. Diabetes often adds to the normal difficulties of growing up. It is not unusual for a teen with diabetes to ease up on diabetes care and try to act "like everyone else." Many teenagers rebel.

Staff at your child's school need to know about your child's diabetes. At the beginning of the school year, ask for a conference with your child's teachers,  the principal, and other school staff. This way, everyone hears the same information at the same time and questions can be answered.

Work with your child's school to prepare a written plan. it should include information such as:

when to check blood sugar and take insulin
meal and snack times
preferred snacks and party foods
usual symptoms of low blood sugar
preferred treatment for low blood sugar

 


 

Copyright of Lee Chung Horn Diabetes & Endocrinology 2009