C hildren 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.
Type-1 Diabetes
Type-2 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 blood glucose (sugar) get into the cells. The extra blood 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 blood glucose. Because of this, children with type-1 have to inject insulin to help move glucose into the cells.
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. Especially in older people. Type-2 diabetes in children may be caused by:
You may wonder what caused your child to get diabetes. There is no known cause. But it is thought that one or more of these have something to do with it: • a virus attacking 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
• 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 medicines (oral agents) • losing weight (some children who lose weight don’t need to take medicines)
Diabetes from a child’s point of view Children often see things in a different way than adults. Young children who have diabetes may think: • they “caught” diabetes from someone else • they will die because diabetes begins with “die” • diabetes is a punishment for something they did
M anaging diabetes For now, diabetes can’t be cured. But it can be managed. Learning how to manage diabetes is vital to your child’s growth and develoment. It can also help him or her develop good habits for the future. Keeping a balance between food and stress 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.
Management team 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. They will work closely to get your child’s diabetes under control. A Pediatrician is your child’s doctor who you see for check ups or when you are sick. A Pediatric Endocrinologist/ Diabetologist is a doctor specially trained to work with children who have diabetes. A Certified Diabetes Educator (CDE) or a Nurse Educator is a person who teaches you and your child all about diabetes and how to manage it. A Registered Dietitian (RD) is a person who will help you and your child plan meals and make healthy food choices. An Ophthalmologist is a doctor who specializes in diseases of the eyes. If diabetes is not managed, it can cause problems with the eyes. A Podiatrist is a doctor who specializes in care for the feet. If not managed, diabetes can cause problems with the feet. A Social Worker (SW) is a person who specializes in finding and giving information on diabetes related services.
E ating healthy 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 to grow and develop, 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.
C reate your plate Using a small dinner plate (no more than 9 inches) divide your child’s plate into halves, then divide one half into quarters. You will end up with 3 sections:
• 3 oz of meat = a deck of playing cards
• A scoop of ice cream = 1 ⁄2 cup
• One of the smaller sections is for protein. • The last section is for starches. Add a serving of fruit or a glass of milk or both if your meal plan allows.
Here are serving size guidelines:
• 1 slice of bread = a CD case
• The largest section should be non-starchy vegetables.
Meal Planning Try to involve your child in meal planning. The amount of planning depends on your child. An older child may be able to plan all of his or her meals everyday. Younger children may not be ready for this. They may also be picky eaters. So offer them a few different choices at mealtime and let them choose.
Serving Sizes
milk
• One ounce serving of cheese = a pair of dice The more active your child is, the more calories he needs. AND
starches
The less active your child is, the fewer calories are needed.
non-starchy vegetables proteins
My child needs _______________ calories per day.
Exercise and Activity 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 • being physically fit
You and your child’s doctor will decide which type of insulin your child should use. A member of the management team will teach you and/or your child:
• when it works its hardest • how long it lasts • how to inject it
• losing weight (more for type-2)
Injecting insulin
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.
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Some children who have diabetes need to take insulin. Like exercise, insulin lowers blood glucose levels. So balancing it with exercise and eating is very important.
• when it starts to work
• helping the body use insulin better (if it is used)
®
I nsulin
Product # 628
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.
C hecking blood glucose To check your child’s blood glucose level:
1. Wash your hands with soap and water. 2. Insert a test strip into your meter. 3. Prick the side of your child’s finger to get a drop of blood. 4. Put the drop of blood onto the testing strip. 5. After a few seconds, the meter shows the blood glucose level. 6. Record the test score. 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.
Healthy Blood Glucose Range 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, may become frustrated with managing their diabetes. This frustration may cause them to:
Hyperglycemia (or high blood glucose) High blood glucose (sugar) may be the result of:
• eat off schedule
• not following your eating plan
• not eat at all
• being sick
A urine test is the main way to test for ketones. Your child’s doctor can tell you how to do this.
Hypoglycemia (or low blood glucose)
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.
Low blood glucose is often caused by:
If diabetes is not managed, it can lead to: • heart problems
• not exercise
• stress
• eating off schedule
• not take their insulin
•n ot taking enough insulin or other oral medicine
• not eating enough
• stroke
• exercising a lot and not eating enough food
• visual problems
B lood 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:
yperglycemia H (hi-per-glie-see-mee-uh) high blood glucose Hypoglycemia (hi-poe-glie-see-mee-uh) low blood glucose
• t aking other medicines that affect blood glucose levels • not exercising enough
Ketones When there is a lack of insulin, there is a buildup of blood glucose (sugar) 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-toeacid-o-sis). This can be very serious.
• taking too much insulin or diabetes medicine
T reating hypoglycemia To treat low blood glucose, give your child 15 grams of a fast acting carbohydrate, such as: • 1 ⁄2 cup of juice or non-diet soda •3 -4 glucose tablets • 1 tablespoon of jelly or honey
our child has diabetes A parents guide for managing diabetes in children
• circulation problems • kidney problems
T aking diabetes to school Teach everyone who will look after your child 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. It may also be helpful to write a letter that explains: • what diabetes is •w hat to do about hyperglycemia, hypoglycemia and ketoacidosis •w hen your child should eat meals and have snacks • who to call in case of an emergency 628