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Diabetes - managing diabetes in childhood

insulin; sugar; blood; hypo; hypos; hypoglycaemia; diabetes; mellitus; glucose; blood; glucose; insulin-dependent; diabetes; ketoacidosis; insulin; pumps; type-1; cargbohydrates; glycaemic; index; glycemic;

Managing diabetes is more than just keeping blood glucose levels right. The aim is to make sure that a child or young person can do the things that others of their age can do, even though some aspects of life need to be more carefully 'controlled' than is usual.

Contents

Injecting insulin and measuring blood glucose, watching activity and food are daily 'facts-of-life', but children living with diabetes should be able to go to school, play, work, go to camps and parties.

Alert!

If a person who is known to have diabetes becomes confused, unwell, drowsy or unconscious, that person needs urgent help. She may have very low levels of blood glucose (hypoglycaemia), very high blood glucose (hyperglycaemia) or ketoacidosis. See the topic 'Diabetes in childhood' for more information about these problems.

Note: All children and young people who have diabetes should have their own diabetes management plan worked out with their doctor and their diabetes team.

Parenting a child with diabetes

  • Children may have difficulty understanding the changes that diabetes brings into their lives, and may have anger that they are 'different'.
  • They may feel that they are being punished for some reason, or feel ashamed or guilty about needing treatment. They may feel frightened that they will be very ill, or even die.
  • These feelings may lead them to be angry at times with their parents or diabetes team, and sometimes they may be very unwilling to cooperate with the treatment and limits on their lives.
  • The diabetes team will be aware of these feelings, and able to support parents and children. Linking children to other children with diabetes can be very useful and supportive.

Food

Children with diabetes do not have to have special foods - they need a healthy diet. Most families need to make some changes such as avoiding quick acting carbohydrates (high GI foods) and saturated fats.

If all family members go onto the same diet as the family member who has diabetes, it will be easier to manage for the family, and healthier too.

  • If children are on insulin they will need to have regular meals at regular times. Skipping meals (feeling too tired, being out, sleeping in) can lead to 'hypos' if insulin doses remain unchanged.
  • Carbohydrates are 'energy' foods and they are important in controlling diabetes. A person with diabetes will need to have a diet that contains the right carbohydrates.

There is more information on the Diabetes Australia website 'diabeteskidsandteens.com.au'  'Healthy eating'.

Food fads

  • Children's eating patterns go through cycles and fads.
  • While variety in foods is important, there are alternatives if a child refuses to eat vegetables for example.
  • Try not to worry too much if your child does not want a varied diet - just do the best you can.
  • Get advice from a dietitian if you are worried.
  • Punishment does not solve eating problems.
  • On the other hand you should be careful not to provide sweets, chips or soft drinks, which take away your child's appetite for other foods.

When kids refuse to eat!

  • Check that your child is not unwell. Many children will not eat if they feel sick. At these times it's important to make sure your child gets plenty of drinks, especially milk and fruit juice.
  • Make sure that your insulin management plan covers what to do when your child is not eating.

When kids binge

  • Check whether your child requires more food (growth spurt) or is just eating more. Insulin doses need to change during times of rapid growth, and your child may also need more food if he or she starts to do a lot more exercise. Check with your health professional.
  • If overeating does not seem related to growth or exercise, it may be a sign that your child is not managing all of the controls that are needed for living with diabetes. Many older children and young adolescents rebel against their disease, and may show their difficulties through changes in eating patterns.

Remember – it is important for someone with diabetes to eat at regular times.

  • When children are diagnosed with diabetes they will be referred to a dietitian who will work out an eating plan with the family that is tailor made to the needs of the child with diabetes and the family situation.
  • The use of force is not helpful to anyone's eating habits, so the days of rigid 'no glucose' enforcement have gone.
  • Above all you need to be honest with the dietitian - this will make it much easier for him/her to help you.
  • If your child has binged the dietitian is not going to be angry with you. Their job is to find a way to deal with the problem and they understand that chocolates and other 'sometimes foods' are tempting and it can be difficult for children to stick to a plan.

School

  • There should be no need to make special allowances at school for your child's dietary needs.
  • If your child's school is not serving and encouraging healthy eating in their canteen you need to talk to your child's class teacher, the principal or members of the group who manage the canteen.
  • School camps should serve healthy food suitable for diabetes but it is wise to check. Ask for the meal plan beforehand and suggest changes if necessary.

Managing insulin

As insulin is destroyed by the digestive juices in the stomach, it cannot be taken by mouth and must be injected. All children with type 1 diabetes will need insulin injections (some have insulin pumps).

There is information about use of insulin on the Diabetes Australia website 'Diabeteskidsand teens.com.au' 'Insulin'

Monitoring diabetes control

In order to control diabetes well enough to avoid the health problems of diabetes mellitus type 1, blood glucose levels must be measured. Glucose levels in urine are not good enough for showing blood glucose levels.

There is information about monitoring diabetes control on the Diabetes Australia website  'Diabeteskidsandteens.com.au' 'Monitoring'

Exercise

  • Why is exercise so important if you have diabetes?
    • Muscles have only just enough useable stored energy in their cells to do the simplest movements. Like a car, they need constant supplies of fuel that can be made into energy to make the muscles work.
    • Glucose is an easy-to-use fuel, and muscles can use glucose even if insulin levels are low.
    • So, exercise is very good for using up glucose quickly and in some ways it has similar effects to insulin.
    • There is also a long-term benefit as muscles that have been exercised can take up glucose more quickly for a number of hours and even up to several days after the exercise.
    • Exercise and insulin work on the glucose in different ways, and if you use both together they do even more good.
    • Regular exercise is also very important for your health in other ways.
  • There is more about exercise on the Diabetes Australia website 'Diabeteskidsandteens' 'Physical Activity'

School and diabetes

  • Tell the school staff if your child has diabetes so that they can make sure your child is safe and coping well.
  • Staff will also be able to help with any problems with other children and help your child to feel good about himself.
  • You will need to give the school details of emergency help, your doctor and health cover.

Some of the issues you will need to raise with staff are:

  • how to recognise and deal with hypos
  • the need to avoid delays to meal and snack times especially during school excursions
  • the need for privacy for injections and blood testing
  • the need to provide suitable drinks (eg diet cordial) and healthy food at school functions and in the canteen.

Note: check that after hours sports coaches and after school care staff can also recognise and deal with a hypo.

There is more information on diabeteskidsand teens.com.au website 'Teachers and schools'

Dental health

  • You will need to tell the dentist that your child has diabetes.
  • If there is good blood glucose control the risk for dental decay is the same as for those without diabetes, but if blood glucose control is poor the risk of dental decay is increased.
  • More glucose in the saliva and less saliva mean that germs causing dental decay can grow more easily.

Parties and special occasions

There is no need for children to miss out because they have diabetes.

  • Talk to your child about what type of food to choose beforehand. The following foods may be OK for a party (although most are high in fats and salt, and are not good as part of a regular diet):
    • corn chips
    • popcorn
    • chips
    • fairy bread
    • nuts and party pies.
  • Make sure that low-glucose soft drinks or cordial are available.
  • Dinner can be missed after a party if your child has high blood glucose levels and poor appetite. However test before bedtime and get her to have supper.
  • If your child has been very active at a party it is important to have a good supper before going to bed to avoid overnight hypos.
  • Parties should be part of your child's diabetes management plan too.

Travel

For long car, train or bus trips you and your family will need to plan ahead, so that there are regular meal breaks. You will not be able to take the risk of food not being available, so carrying food will be necessary.

There is more information about travel on the Diabetes Australia website  'Diabeteskidsandteens.com.au' 'Travel'.

Resources

South Australia

  • Diabetes Australia - South Australia (DA-SA) is an independent, not for profit, charitable organisation providing a range of services and products designed to meet the needs of people with diabetes.
    159 Sir Donald Bradman Drive, Hilton SA 5033
    - telephone: 1300 136 588
    http://www.diabetessa.com.au
  • The Queen Elizabeth Hospital Diabetes Centre
    http://www.diabetes.org.au

Australia

  • Diabetes Australia:
    1300 136 588
    http://www.diabetesaustralia.com.au
  • National Diabetic Services Scheme (NDSS) is funded by the Australian Commonwealth Government and administered in South Australia by DA-SA. It provides an easy, low cost way for people with diabetes to buy essential diabetic supplies. Lifetime registration is free. You need to fill in a registration form, get it signed by your doctor and return it to DA-SA.
    http://www.ndss.com.au/
  • Juvenile Diabetes Research Foundation in Australia
    A non-profit organisation dedicated to finding a cure for diabetes and preventing its complications through research
    - telephone 1300 363 126
    http://www.jdrf.org.au

International

References

Diabetes Australia 
 http://www.diabeteskidsandteens.com.au/index.asp

Juvenile Diabetes Research Foundation (Australia)
http://www.jdrf.org.au

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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