Your Child Has Diabetes Preview for AADE

Your child has

Diabetes A parent’s guide for managing diabetes in children

Introduction to your child has diabetes When you first found out that your child has diabetes, how did you feel? Scared? Angry? Sad? Guilty? Many parents have these feelings at first, and they are normal. Finding out your child has diabetes is tough. But did you feel this way because you didn’t think your child could live a normal life with diabetes? Well, that does not have to be the case.

Children with diabetes are just like other children.

They can grow up to lead happy and active lives. The only difference is children with diabetes have to keep their blood glucose (sugar) in a certain range to stay healthy. While children who don’t have diabetes don’t have to worry about their blood glucose at all.

You and your child will have to learn how to manage his or her diabetes. But this will take time. So you may have to take the lead in managing it. Learn as much about diabetes as you can. It can help you and your child cope with any negative feelings you may have. No matter how old your child is, learning about diabetes takes a team effort.

This book was written to teach you the basics about diabetes and managing it. It is not a substitute for what your doctor, nurse, certified diabetes educator (CDE) or any other healthcare professional advises you about your child’s diabetes.

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Children need energy Children need lots of energy to grow and be active. This energy comes from food. Once inside the body, food is changed into glucose. Then it goes into the blood and is carried to the cells of the body.

Insulin is a hormone that opens the cells to allow the glucose inside. Insulin is made in the pancreas (a gland near the stomach). There are certain cells in the pancreas called beta cells. These cells release insulin into the bloodstream to help glucose get into the body’s cells.

With diabetes, the body either does not make insulin, does not make enough insulin or the cells can’t use insulin the way they should. When there is not enough insulin, the cells don’t open up to use the glucose.

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types of

Diabetes The two most common types of diabetes are: Type-1 Diabetes Type-2 Diabetes

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Type -1 Diabetes With Type-1 diabetes, the beta cells in the pancreas make little or no insulin. This means there is not enough insulin to help glucose get into the cells. The extra glucose stays in the blood and does not get used.

Instead, it is dumped into the urine and the body gets rid of it. This can rob a child of energy and starve the body because the cells can’t get glucose. Because of this, children with Type-1 diabetes have to inject insulin to help move glucose into the cells. Most children have Type-1 diabetes but some have Type-2.

You may wonder what caused your child to get diabetes. There is no known cause. But it is believed that one or more of these have something to do with it: a virus attacks the pancreas problems with the body’s self defense system (auto-immune response) that damage the beta cells in the pancreas a family history of diabetes

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Type -2 Diabetes With Type-2 diabetes, the body makes insulin but it doesn’t make enough or the cells can’t use it the way they should.

Type-2 diabetes is much more common than Type-1. But most people who get it are 40 years old or older. However, children are now getting Type-2 diabetes more than ever before. This is often caused by: being overweight (can be caused by eating lots of fast food and “junk” food) lack of activity and regular exercise Some children with Type-2 diabetes have to inject insulin. But some can control it by: eating healthy meals exercising daily taking medicine (oral agents) losing weight (some children who lose weight don’t need to take medicine) If your child has Type-2 diabetes, now is the time to help him or her start and keep healthy habits.

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diabetes

From a child’s point of view Children often see things in a different way than adults. Your child may not understand why he or she has diabetes. Young children who have diabetes might think: they “caught” diabetes from someone else they will die because diabetes begins with “die” diabetes is a punishment for something they did Of course, none of this is true. So to help your child better understand diabetes, explain this to him or her. Older children may understand why they have diabetes, but still have a hard time dealing with it. They may get angry, depressed or you might notice other changes in their behavior. These feelings are normal at first. With your help, your child can learn more about diabetes and begin to manage it so that many of these feelings go away.

Learning about people with diabetes who have had successful lives can be helpful. You may want to tell your child about celebrities, sports figures or people you know who have diabetes. Some examples are Thomas Edison (famous inventor) and Nicole Johnson (Miss America 1999).

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Managingdiabetes For now, diabetes can’t be cured. But it can be managed.

Learning how to manage diabetes can help your child grow up healthy. It can also help him or her develop good habits for the future. Managing diabetes means checking blood glucose levels and balancing: the amount and type of food eaten exercise and activity levels insulin and/or oral medicines stress levels Food and stress raise blood glucose levels, while exercise, insulin and medicine lower it. Keeping a balance between all of these will help keep your child’s diabetes in check. Checking your child’s blood glucose will help you know if his or her management plan is working.

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Your child may feel he or she has to do a lot to manage diabetes. So be aware of this. You should stay involved in your child’s life and step in at times. But, once your child is able to handle it, he or she should be involved in his or her own care. Being involved can help your child: have more confidence and higher self-esteem feel like he or she reached a goal start good habits for the future become more responsible

For younger children, helping manage diabetes, little by little, will get them into the habit of good management.

Older children want to be independent, and letting them be in control is a good way to see if they can handle it. But try not to rush your child into doing things that he or she is not ready to handle. No matter how independent your child is with diabetes management, you should still be involved.

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management Team* Raising a child can be hard. Trying to manage diabetes can make it harder. When you learned your child has diabetes, you may have felt that you would have to deal with it on your own.

That is not the case. Your child’s diabetes management team can help you. The team will work closely to get your child’s diabetes under control.

You and your child are the most important members of the management team. You can teach your child to help out in his or her own care.

A Pediatric Endocrinologist/Diabetologist is a doctor specially trained to work with children who have diabetes.

My child’s endocrinologist/diabetologist is

.

A Certified Diabetes Educator (CDE) or a Nurse Educator is a person who is specially trained to work with children with diabetes. Your child’s CDE teaches you and your child all about diabetes and how to manage it.

My child’s CDE is

.

A Registered Dietitian (RD) is a person who will help you and your child plan meals and make healthy food choices.

My child’s RD is

. team members continue on next page

* Your child’s diabetes management team may or may not have all of these members. And you may have some people work with you who are not listed here.

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management Team* An Ophthalmologist is a doctor who specializes in diseases of the eyes. If diabetes is not managed, it can cause problems with the eyes. But with good management, this should not be a problem. Five years after diagnosis, your child should get his or her eyes checked every year.

My child’s Ophthalmologist is

.

A Podiatrist is a doctor who specializes in care for the feet. If not managed, diabetes can cause problems with the feet. But with good management, this may not be a problem.

My child’s podiatrist is

.

A Social Worker (SW) is a person who specializes in finding and giving information on diabetes related services that you and your child may need to better manage diabetes.

My child’s social worker is

.

Other members of my child’s diabetes management team:

* Your child’s diabetes management team may or may not have all of these members. And you may have some people work with you who are not listed here.

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Eatinghealthy meals and snacks Having diabetes does not mean your child can only have bland and boring meals. A healthy meal plan for a child with diabetes is almost the same as a healthy meal plan for a child who doesn’t have diabetes. This means your child can enjoy a variety of foods.

To have enough energy and to grow up healthy, a child’s meal plan needs the right mix of fats, proteins, carbohydrates, fiber, vitamins and minerals. Avoiding a meal plan high in fat, salt, cholesterol and sugar is also important. Work with a dietitian to come up with a healthy meal plan that your child will enjoy. Keep in mind that to balance meals and insulin, your child needs to: eat at about the same time each day

12 3 9 6

avoid skipping meals or snacks eat the right amount of foods at each meal

Meal Time!

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Meal Planning Try to involve your child in meal planning. The amount of planning depends on your child. An older child might be able to plan all of his or her meals everyday. Younger children may not be ready for this. They could also be picky eaters. So offer them a few different choices at mealtime and let them choose.

Sometimes, things come up that may not fit into your child’s meal plan. A group of friends want to go to a fast food restaurant after school. Or a friend is having a birthday party with lots of cake and ice cream.

What should you do?

While it is important that your child sticks with his or her management plan, it is also important to let a “child be a child.” If things happen from time to time it is OK. Explain that it helps to know about parties and other group activities in advance. Often, food from parties can be worked into the meal plan without too much trouble.

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Exchanges* and Carbohydrate Counting There are different meal planning methods. You and your child may decide that either exchanges or carbohydrate (carb) counting will work best. The exchange system places foods into three groups based on the number of carbohydrates, proteins and fats they have. These groups are called exchanges because you can trade any food in a group for a different food in the same group.

Counting carbs is another way to help plan meals. Carbs break down into glucose quickly. So, monitoring the number of carbohydrates in your child’s diet can help control blood glucose levels. Talk to your child’s doctor or dietitian about carb counting.

How Carb Counting Helps By spreading your child’s carbs out over the course of the day, you can keep his or her blood glucose from getting too high or too low.

To do this, you need to know how many carbs to let your child have at each meal or snack. In the side chart, ask your child’s diabetes educator or RD to fill in how many carb grams your child should have each day.

Breakfast Snack Lunch Snack Dinner Snack

_______ _______ _______ _______ _______ _______

Total

_______

* You can contact the American Diabetes Association (ADA) for an exchange list.

The exchange list servings may differ from those suggested with the pyramid.

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Food Pyramid

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Visit www.mypyramid.gov for more information.

at Me

s ean B &

Milk

Oils

Fruits

Veget ables

Gra ins

The food pyramid helps create a meal plan that keeps your child’s blood glucose in a healthy range. The pyramid is divided into groups of food types. How much of each type your child needs each day is based on the number of calories needed for a healthy weight at different activity levels for both boys and girls.

Grains — include all foods made from wheat, rice, oats, cornmeal or barley. At least half of all grains eaten should be from high-fiber whole grains.

Vegetables — include all fresh, frozen, canned or dried vegetables and vegetable juices. Vegetables are sub-divided into dark green, orange, legumes (beans), starches and all others. A variety of vegetable types should be eaten each week. Canned vegetables and vegetable juice have a lot of sodium, so eat less of them.

Fruits — include all fresh, frozen, canned or dried fruits and fruit juices. Fresh and frozen is best. Canned or dried fruit and juices contain a lot of added sugar, which can affect blood sugar.

Oils — include fats from many different plants, fish and fats that are liquid at room temperature, such as canola, corn, olive, soybean and sunflower oil. Some foods are naturally high in oils, like nuts, olives, fish and avocados. Other foods that are mainly oil include mayonnaise, some salad dressings and soft margarine.

Milk — include all fluid milk products, yogurt and cheese. Other foods made from milk like, cream cheese, cream and butter, are not part of the group (they have little to no calcium in them). Choose fat-free or low-fat.

Meat and Beans — includes 1 oz of lean meat, poultry or fish, 1 egg, 1 Tbsp peanut butter, 1⁄4 cup cooked dry beans or 1⁄2 oz of nuts or seeds (equal to 1 oz of meat or beans).

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Calories

1,000

1,200

1,400

1,600

1,800

2,000

Grains

3 oz

4 oz

5 oz

5 oz

6 oz

6 oz

Vegetables

1 cup

1 cup

11⁄2 cups

2 cups

21⁄2 cups

21⁄2 cups

Fruits

1 cup

1 cup

11⁄2 cups

11⁄2 cups

2 cups

2 cups

Oils

3 tsp

4 tsp

4 tsp

5 tsp

5 tsp

6 tsp

Milk

2 cups

2 cups

2 cups

3 cups

3 cups

3 cups

2 oz

3 oz

4 oz

5 oz

5 oz

51⁄2 oz

Meat & Beans

How many calories are right How many calories your child needs are based on activity levels by gender. Activity levels are: I = inactive; M= moderately active; A = active

Calories

Boys age

activity level

1,000

2 3

1,200

Girls age

activity level

I, M, A I

2–3

I, M, A

3 4–5

M, A I

4–7

I

1,400

4–5 6–8

M I

4 5–6 8 – 10

M, A M I

1,600

4–5 6–8 9 – 10

A M I

5–6 7–9 11 – 13

A M I

9 – 10 11 – 12

M I

7–9 10 – 11 14 – 18

A M I

8–9 11 13 – 14

A M I

10 – 11 12 – 18

A M

1,800

2,000

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Exercise and Activity To help know your child’s activity level, follow these rules: Inactive means your child gets less than 30 minutes of physical activity each day. This includes riding a bike (less than 10 mph), hiking, yard work or walking briskly (over 31⁄2 miles an hour), etc.

Moderately active means your child gets between 30 and 60 minutes of physical exercise each day.

Active means your child gets 60 or more minutes of physical activity each day. This includes running, riding a bike (more than 10 mph), swimming laps, etc.

Exercise is good for everyone – especially children with diabetes.

Exercise helps the heart pump more blood with less effort, it improves circulation and keeps muscles strong and toned. For children with diabetes, exercise offers added benefits such as: lowering blood glucose levels helping the body use insulin better (if it is used) losing weight* (if needed) being physically fit

* Most children with Type-2 diabetes are overweight.

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Since exercise lowers blood glucose levels most of the time, extra steps have to be taken to avoid hypoglycemia (low blood glucose)*. This means: regular blood glucose checks before and after exercise prepare for longer exercise periods with a snack glucose checks during longer exercise periods Children don’t always plan out their activities, they just like to go out and play or hang out with their friends. But when a child has diabetes, making a habit of checking blood glucose before activity and always carrying a sugar source snack will help him or her avoid problems.

* see pages 33-35

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Insulin Some children who have diabetes need to take insulin. Like exercise, insulin lowers blood glucose levels. So balancing it between exercise and eating is very important.

You and your child’s doctor will decide upon which type of insulin your child should use. A member of the management team will teach you and/or your child: when it starts to work when it works hardest how long it lasts how to inject it

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Talk to your child’s doctor or nurse about the type of insulin your child needs. Use the chart below to fill in this information.

Type of insulin your child uses: How many units your child needs: How many times your child should inject per day: How long after injecting before the insulin begins to work: How long it takes for the insulin to work its hardest: How long the insulin lasts:

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Injecting insulin One of the first things you may have to learn is how to inject insulin. This may seem a bit scary – for both you and your child. Try to be positive when you inject the insulin. A young child will not really understand why you are sticking him or her with a needle. You may feel bad or guilty about doing it. But it has to be done for your child’s health.

At some point, you or your child’s diabetes educator will have to teach your child how to inject insulin. Each child is different. Don’t force a child to learn to inject insulin before he or she is ready. An older child may learn how to do it quickly.

It might take a bit longer to teach a younger child how.

Your child may need several injections each day. Or, two types of insulin may need to be mixed and injected to make sure your child has enough for a full day.

It all depends on your child’s needs.

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Insulin Pumps An insulin pump is another way for your child to get insulin. The pumps: are about the size of a beeper must be programmed (You will have to learn how to do this. Your child may also have to learn this, depending on his or her age.) give a steady flow of insulin have to be worn at all times (except for bathing and swimming) may allow more flexible meal times may allow your child to exercise or do other activities without worrying about glucose levels going too low Insulin pumps do not check blood glucose. So, regular blood glucose checks are still very important. And, following a healthy meal plan is still needed with a pump.

Talk with your doctor or nurse about the pump. Your management team can help you decide if it may be right for your child. Pumps can be expensive. So check with your insurance carrier to see if an insulin pump would be covered.

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Medicines oral agents In addition to insulin and exercise, oral agents may be used to lower blood glucose in children who have Type-2 diabetes.

Oral agents are not the same as insulin. There are several types of oral agents and they work differently. Some: cause the pancreas to make more insulin slow down the breakdown of carbohydrates keep the liver from releasing too much glucose make the muscle cells more sensitive to insulin Oral agents can be given alone or used with other oral agents or insulin. But they still have to be balanced with meals and exercise. Talk with your child’s doctor about oral agents. Together you will decide if your child needs to take an oral agent. If so, fill in the chart below.

Name of oral agent

Time your child should take it

Amount your child should take

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checking

Blood Glucose Exercise, diet and medicine (insulin and oral agents) have to be balanced to keep your child’s blood glucose within a normal range. These levels have to be checked often every day. This means measuring the amount of glucose in your child’s blood.

Your child’s doctor or diabetes educator can help you choose a blood glucose testing kit. This kit may include: a lancet (a finger stick device) testing strips a meter that reads the test strip to tell the blood glucose level each time a booklet to write down each reading other reading materials about diabetes

meter blood sample test strip

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To check your child’s blood glucose level: 1.

Wash your hands with soap and water.

2. Prick his or her finger with the lancet to get a drop of blood (it may hurt less if you prick the side of the finger).

3.* Put the drop of blood onto the testing strip.

4.* Insert the test strip into the meter.

5. After a few seconds, the meter shows the blood glucose level.

6.

Record the test score in the booklet.

The prick may scare a young child. Be honest. Say that the prick will hurt. But also explain that the prick will help keep him or her healthy. This may ease your child’s fears. As your child gets older, he or she will need to learn how and when to test blood glucose levels. * Steps 3 and 4 may be reversed depending on your child’s meter.

Follow the meter instructions.

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Healthy Blood Glucose Range Despite good management, your child may have blood glucose levels that are high or low from time to time. When this happens, you might think you did something wrong. If your child checks it, you may think he or she did something wrong. But this may not be the case.

Emotions and hormones can sometimes cause high or low blood glucose levels. This is often the case with teenagers who are going through puberty.

But sometimes high or low blood glucose levels occur because children, especially teenagers, become frustrated with managing their diabetes. This frustration could cause them to: eat off schedule not eat at all not exercise not take their insulin

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Knowing your child’s normal blood glucose range can help both of you know if you are managing diabetes well. Fill in the box below so you or your child can refer to it when needed.

You can’t be with your child every minute of every day. So, remind your child why managing diabetes is so important. And encourage your child to follow the plan.

You may need the team to work more closely with you and your child during unstable times.

healthy blood glucose range child’s name

‘s target blood glucose range is:

name

Before meals: 2 hours after meals: At bedtime:

_________ to _________ _________ to _________ _________ to _________

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blood glucose

Problems Problems with blood glucose will come up from time to time.

Sometimes they are caused by not following the management plan. But even with good management, high or low blood glucose levels may happen. You and your child (if old enough) need to know the symptoms of these and how to treat them to avoid complications. The two main problems that can happen with blood glucose are: Hyperglycemia (hi-per-glie-see-mee-uh) high blood glucose Hypoglycemia (hi-poe-glie-see-mee-uh) low blood glucose

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Hyperglycemia (or high blood glucose) The symptoms of high blood glucose often include: being very thirsty going to the bathroom a lot being tired a lot Teach your child these symptoms and what causes them so he or she can avoid high blood glucose. Also teach anyone who will look after your child (teacher, coach, babysitter, etc.) about the symptoms and what to do about them.

29

High blood glucose may be the result of: over eating being sick not taking enough insulin taking other medicines that affect blood glucose levels not exercising enough stress

30

High blood glucose may be a result of two or more of these.

Ketones When there is a lack of insulin, there is a buildup of glucose in the blood. If the cells can’t get enough energy, they may start to break down fat for energy. When fats are broken down, the body produces acids called ketones. Ketones are passed out of the body through the urine. But quite often the body can’t get rid of them all.

When ketones are in the body for too long, it can lead to ketoacidosis (key-toe-acid-o-sis). This can be very serious.

A urine test is the main way to test for ketones. Your child’s doctor can tell you how to do this.

When large amounts of ketones are present in the body, they can be poisonous and can lead to: lethargy (tired all the time) being very weak coma (this normally only happens to children who have type 1 and have really high blood glucose levels)

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Ketones are measured in 3 levels: small, moderate and large. Ask when you should call the doctor or nurse about ketones. Many only want to be called if the ketones are moderate or large.

Poor diabetes management can lead to ketones.

So you have to make sure your child is following his or her management plan. If your child is following the plan and ketones are present, changes may have to be made to the plan. Talk with your child’s team about making changes in the plan when needed. If your child is not following the plan, see why this is happening. You may need to step in.

32

Hypoglycemia (or low blood glucose) The symptoms of low blood glucose often include: feeling irritable, nervous or shaky being hungry feeling dizzy sweating too much feeling weak being confused or not thinking clearly having trouble seeing seizures

33

Low blood glucose is often caused by: eating off schedule not eating enough exercising a lot and not eating enough food taking too much insulin not eating a snack during exercise

34

Treating hypoglycemia Low blood glucose needs to be treated right away. If untreated, it can lead to seizures or passing out. To treat low blood glucose, give your child 15 grams of a fast acting carbohydrate, such as: 1⁄ 2

cup of juice (apple juice, orange juice, grape juice, etc.)

1⁄ 2

cup of regular (non-diet) soda 3-4 glucose tablets Re-check your child’s blood glucose levels after 15 minutes. If it is still low: give him or her another 15 grams of a fast acting carbohydrate (juice or non-diet soda) if your child is not going to eat for a while, give him or her a long acting carbohydrate like crackers Your child’s doctor or diabetes educator can tell you about other ways to help your child avoid low blood glucose problems.

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when diabetes

Is not managed Now you know that managing diabetes involves a balance of diet, exercise and medicine (insulin or oral agents) as well as daily blood glucose monitoring. If this balance is kept, it can help your child delay or avoid long-term problems caused by diabetes.

If diabetes is not managed, it can lead to: heart problems

circulation problems

stroke

kidney problems

visual problems

meals

exercise

medicine

Balance is the key

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taking diabetes to

School Being a child can be hard. Learning new things at school, making friends and trying to fit in are all parts of growing up. But having diabetes may make these things harder.

Teach everyone who will look after your child (teacher, coach, principal, bus driver, babysitter) about your child’s diabetes. It may be helpful to schedule a meeting at the beginning of the school year to talk about your child’s diabetes and to let them ask any questions they may have. It may also be helpful to write a letter* that explains: what diabetes is what to do about hyperglycemia, hypoglycemia and ketoacidosis when your child should eat meals and have snacks who to call in case of an emergency *See sample letter on page 39

37

Explain to teachers that your child may need to eat snacks through the day and check his or her blood glucose. This is especially true before any activity (recess or gym class) or whenever your child feels his or her blood glucose is low.

Also tell them that your child may need to take medicine during class time (inject insulin or take an oral agent). Teachers also need to know that your child may need to use the restroom more often than other children. If a teacher knows about this ahead of time, it might be easier for your child to stick to his or her management plan. And, it may prevent jealousy among the other students who may think your child is getting special treatment.

Keep in mind that under section 504 of the Rehabilitation Act of 1973, your child has a right to education. Your child also has the right to a discrimination free environment. If you have any questions about this Act, talk to your child’s team about it.

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sample

Letter _____ ,

______ r ______

betes. ype ___ dia T s a h , _ _ ___ _______ plan includes: _ _ _ _ _ , d ment My chil . etes manage b ia d ’s d g oral agents) il h in c k a t My r o n li g insu ither injectin kes is: (e e in ic d e m hild ta .

1. Taking edicine my c _____________ m f o pe y t e _ Th _______ _______ each day. e im t e m sa e s at th ls and snack a e m g in t a E 2. everyday.

3. Exercising . blood glucose 4. Checking . ild to do this h c ble, y m r o f e tim nervous, irrita g n li e e f e Please allow d s inclu The symptom To treat low blood sugar: r. u c c o n a c ry. ar Low blood sug , weak, sweaty and hung 1⁄ 2 cup of juice or e ik d (l se e ill sourc dizzy, confu acting sugar fter 15 minutes. If it is st st a f a f o s 15 gram lucose a all me.

Give my child Check his or her blood g st acting sugar. Please c ). a g to non-diet soda ild another 15 grams of f s include goin sugar, m o h pt c m y sy m r a e g od su low, giv blood ccur. High blo ling tired. To treat high o o ls a n a c r e ga High blood su a lot, being thirsty and fe m o f the bathro ater. Please call me. e symptoms o ut. h T w s. si d o il h id c c ing o ketoa give my ketones and smelling breath and pass t away. o t d a le n a c y righ ruit gar High blood su clude heavy breathing, f ll me or my child’s doctor a in ketoacidosis ws signs of ketoacidosis, c o If my child sh _ _______ _ _ _ _ _ _ _ My name __ _______ _ _ _ _ _ _ r e _ My work numb _______ _ _ _ _ _ r e b _______ _ _ _ _ _ My home num _ _ ___ r I may be at _______ _ Other numbe _ _ _ e m __ ctor’s na _______ _ My child’s do _ _ _ _ r e e numb Doctor’s offic

Dea

* You can use this letter or make your own.

39

other

Helpful Tips Keep in mind that managing diabetes is a team effort. You, your child and your whole family should work together.

Even though managing diabetes is a lot of work, let your child be a child.

A child with diabetes needs lots of attention.

If you have other children, they may be jealous of this attention. Talk to your other children and maybe involve them in the management so they don’t feel left out. Make time for them too.

Always make sure your child carries extra snacks, especially when traveling.

Look into sending your child to a camp for children with diabetes. At these camps, your child will learn how others deal with diabetes. Your child will also learn that they are not alone.

If your child has high or low blood glucose because of something he or she did, try not to be too hard on him or her. But remind your child how important it is to balance food, exercise and medicine.

Having your child wear Medic Alert® ID can also be helpful. This will let people know about your child’s diabetes in case of an emergency. Help your child choose the type of ID that works best for him or her.

40

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PRITCHETT & HULL ASSOCIATES, INC. 3440 OAKCLIFF RD NE STE 110 ATLANTA GA 30340-3079 Write for our catalog of product descriptions and prices.

Copyright Š 2002, 2005

by Pritchett & Hull Associates, Inc. All rights reserved. No part of this book may be photocopied, reprinted or otherwise reproduced without written permission from Pritchett & Hull Associates, Inc.

Throughout this book, where Pritchett & Hull Associates, Inc. was aware of names of products for which a trademark has been claimed, such names have been printed in initial capital letters (for example, Medic Alert).

Published and distributed by: Pritchett & Hull Associates, Inc. Printed in the U.S.A.

Resources American Association of Diabetes Educators

Juvenile Diabetes Foundation International

100 West Monroe Street 4th Floor Chicago, IL 60603-1901 (800) 338-3633 www.aadenet.org

120 Wall Street New York, NY 10015-4001 (212) 785-9500 www.jdfcure.org

American Diabetes Association 1701 Beaureguard Street Alexandria, VA 22311 (800) 232-3472 www.diabetes.org

American Dietetic Association 216 West Jackson Boulevard Chicago, Il 60606-6995 (800) 877-1600 www.eatright.org

National Diabetes Information Clearinghouse 1 Information Way Bethesda, MD 20892-3560 (301) 654-3372 www.niddk.nih.gov

Canadian Diabetes Association National Office 15 Toronto Street, Suite 800 Toronto, Ontario Canada M5C 2E3 (800) BANTING (416) 363-3373 www.diabetes.ca

Reviewers: Erin Cooper, RD Talbert Medical Group Thanks to previous reviewers:

Janet Haas, RN, CDE Lisa Waller, RN, CDE Wynola N. Wayne, RN

W

e believe that you have the right to know as much as you can about your health. Our goal is to give you enough facts to get the main points clearly in mind. We do this with medical accuracy, warmth and humor. The result for you: less tension, more healing and a good idea of what to ask your doctor, nurse or others.

ÂŽ



Pritchett & Hull Associates, Inc. 3440 Oakcliff Road, NE, Suite 110 Atlanta, GA 30340-3079 1-800-241-4925

We also have other health information materials on a variety of topics. Call for a free catalog of product descriptions.

ISBN 0-939838-98-2