• Helping Your Child Manage Type 1 Diabetes

    HCA image for kids type 1 diabetes As any parent knows, raising kids is not easy. Parents of children with type 1, or insulin-dependent diabetes , face all the usual challenges of child-rearing plus the unique issues that come with their child’s disease. Even the simplest activities, like birthday parties or playing ball, can be stressful if they are not carefully planned.
    Children with diabetes need to keep their blood glucose under control to maintain normal growth and development as well as a normal lifestyle. While doctors and dietitians provide the specific treatment your child needs, the following tips can help you teach your child how to live with this disease.

    Helping Your Child Adjust to Living With Diabetes

    As your child gets older, she will have plenty of questions about the disease. But it’s important to remember that while diabetes is a big part of your child’s life, it’s only one part. Here are some pointers to help you instill both knowledge and a positive attitude in your child, in any stage of her young life.

    Infants and Toddlers

    Children under the age of two are too young to understand what’s going on. Stay calm and try to test blood and inject insulin quickly. Comfort and reassure the child afterward.

    Preschool Children

    Explain diabetes-related terms and what you are doing to treat the disease, simply and often. Make sure your child knows she didn’t do anything to cause the disease.

    Children 5-12 Years Old

    Slowly let your child take on more diabetes-related tasks such as meal planning and doing blood sugar checks, but stay involved. Use your child’s maturity, skills, readiness, and interest to help you determine how much she is ready for and when. Also, answer any questions your child has and make sure she can talk comfortably about the disease. This will help her peers feel comfortable with diabetes too.

    Teenagers

    Help your teenager through this time by being honest, sensitive, and supportive. Teach teens the facts about diabetes and how the choices they make will affect them. Get help from teachers or counselors if necessary. Don’t forget, the teenage years can be a time of rebellion and experimentation. Try to anticipate teenage temptations such as alcohol and give your teenager the tools she needs to address these temptations without creating diabetic disasters.

    Keep Blood Glucose at a Healthy Level

    Blood glucose (the main type of sugar found in the blood, which is used by the body as the primary source of energy) needs to be kept at a healthy level—in the range of about 70-120 mg/dl (milligrams per deciliter) [3.9-6.7 mmol/L (millimoles per liter)]. Keeping blood sugar well-controlled is important to prevent and/or slow down disease-related problems.
    Parents and children might have difficulty recognizing when blood sugar is low. Hypoglycemia (low blood sugar) can cause significant problems for children. Be sure that you work with your doctor and diabetes educator to assure that episodes are recognized and treated promptly.

    Blood Glucose Monitoring

    Blood glucose monitoring is the primary tool used to keep track of blood glucose levels. It is done by taking a drop of blood (usually from the finger) and testing it in a glucose meter. Your child’s pediatrician will tell you when and how often your child should check her blood glucose and what the appropriate range is. Most doctors recommend that blood be tested at different times during the day: sometimes before, and sometimes after a meal.

    Insulin

    Because children with type 1 diabetes cannot produce insulin on their own, they must receive insulin injections. Most children need no less than two, and sometimes three or more shots of insulin a day. These shots should be spaced appropriately throughout the day and be given at the same time each day. Doctors try to design an insulin schedule for each child that will closely mimic the normal insulin response to meals and snacks. Some children may be able to use an insulin pump, which delivers a continuous flow of insulin to the body and usually eliminates the need for daily insulin injections.
    Because each child is different, there is no strict rule about when children can administer their own insulin injections. By age 14, most children can (but should not be required to) give their own injections. Talk to your child’s doctor about what’s right for her.
    In addition to measuring blood glucose and giving insulin, your child should keep a log of the results from their blood glucose tests. This will allow your child’s doctor, dietitian, or nurse to work with you and your child in making any necessary changes in the diabetes management plan.

    Diabetes and Diet

    People with diabetes have the same nutritional needs as anyone else. Unlike what many people think, children with diabetes can eat just about anything. Children who take insulin, however, do need to determine how much they are going to eat at a given meal. They must also balance their carbohydrate intake with the amount of insulin injected. Diet and insulin requirements may change with factors such as weight, amount of exercise, age, and medical conditions. Your best bet is to develop an eating plan based on your child’s class, lunch, gym, and afternoon activity schedule, and help your child follow it as closely as possible.
    In general, to eat right, a child with type 1 diabetes ought to:
    • Eat a diet that is low in saturated fat and includes a variety of whole grains, low-fat dairy products, and plenty of fruits and vegetables.
    • Eat about the same amount of food each day.
    • Eat meals and snacks at about the same time each day (without skipping any).
    • Eat soon after taking insulin, especially if very fast-acting insulin is prescribed.
    • Be ready for emergencies. Children, their teachers, or the school nurse should have a doctor-recommended treatment for hypoglycemia readily at hand in case it is needed. In most cases this treatment will be a form of sugar, but in some cases an injectable form of the hormone glucagon might be recommended. (Send your child off with healthful snacks such as fruit or nuts and money in case she needs to buy food.)
    • Learn to read food labels, so she can identify carbohydrates, fats, and other nutrients plus proper serving sizes.
    While you don’t need to ban “empty calorie” snacks like cookies and cake or prohibit your child from buying school lunches, you should encourage her to make healthy choices. At times when you know your child will be eating something extra sugary, such as at a party, she may have to take more insulin. Plan ahead for such events. Contact your child’s teacher or parents of friends for help reinforcing healthy eating habits away from home.

    Diabetes and Exercise

    Taking part in gym class and team sports is especially important for children with diabetes. It not only boosts esteem and improves overall health, but can also help control weight and lower blood sugar levels.
    Talk to your child and her doctor (or diabetes educator) about planning an exercise program. Your doctor will likely recommend a combination of aerobic exercise, stretching, and toning. Be sure your child starts out slowly and then gradually increases the intensity and length of her sessions. Also, teach your child (and physical education instructors and coaches) to watch out for signs of hypoglycemia, such as sweating, headache, heart racing, and confusion.
    To prevent low blood glucose reactions, your child should:
    • Drink plenty of fluids before, during, and after exercise.
    • Exercise at about the same time each day. (Your child should carry snack foods like pretzels or crackers with cheese or peanut butter in case of unplanned activity.)
    If your child becomes hypoglycemic, she should stop exercising and follow your doctor’s advice about what to do in this situation.

    Diabetes and School

    Once children reach school age it is important that parents make a good connection with the school health nurse so that she can assist with challenges in the school setting. As with any child, it is important for parents to keep in close contact with their child’s teachers to detect and respond to concerns.

    RESOURCES

    American Diabetes Association http://www.diabetes.org/

    Joslin Diabetes Center http://www.joslin.org/

    CANADIAN RESOURCES

    Canadian Diabetes Association http://www.diabetes.ca/

    Sick Kids http://www.sickkids.ca/

    References

    Eating healthy. American Diabetes Association website. Available at: http://www.diabetes.org/ . Accessed July 2, 2003.

    Exercise for the health of it. Joslin Diabetes Center website. Available at: http://www.joslin.org/Beginners%5Fguide%5F643.asp . Accessed July 2, 2003.

    Frequently asked questions about exercise. American Diabetes Association website. Available at: http://www.diabetes.org/ . Accessed July 2, 2003.

    Gonder-Frederick L, Zrebiec J, Bauchowitz A, et al. Detection of hypoglycemia by children with type 1 diabetes 6 to 11 years of age and their parents: a field study. Pediatrics . 2008;121(3):e489-95.

    McCarthy AM, Lindgren S, Mengeling MA, Tsalikian E, Engvall JC. Effects of diabetes on learning in children. Pediatrics . 2002 Jan;109(1):E9.

    Should I count calories or use exchanges for my meal planning approach? Joslin Diabetes Center website. Available at: http://www.joslin.org/managing%5Fyour%5Fdiabetes%5F699.asp . Accessed July 2, 2003.

    Type 1 Diabetes. American Academy of Family Physicians, Family Doctor.org website. Available at: http://familydoctor.org/online/famdocen/home/common/diabetes/basics/480.html . Updated May 2009. Accessed November 15, 2010.

    What I need to know about eating and diabetes. National Institute of Diabetes & Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/eating%5Fez/eating.pdf . Accessed July 2, 2003.

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