Parents and Kids
Special Concerns for Kids
Dealing with diabetes is difficult for all who have this chronic disease, but there are special concerns for the child with diabetes. Simple activities such as going to birthday parties, spending the night with friends, or playing sports must be carefully planned. It is important for children with diabetes to take their medications as prescribed and check their blood sugars several times a day. Young children may have difficulty understanding the sudden changes, glucose monitoring, insulin injections, food restrictions-that Type 1 diabetes brings to their lives. Some common reactions among children are as follows:
- A feeling they are being punished for disobedience
- Feelings of shame or guilt
- Fear of death because diabetes starts with the sound “die.”
- Show signs of depression or eating disorders
These reactions may prompt your child to act hostile towards you, feeling that somehow you have failed him or her. Because children think their parents are all powerful, your child may believe you can make the diabetes go away. Dealing with diabetes may also cause a child to experience emotional and behavioral challenges. Often times talking with a diabetes educator, psychologist, and/or social worker will help the child and his/her family learn how to adjust to the lifestyle changes required to stay healthy and happy.
The Key to Treatment
The key to successful treatment of childhood diabetes is teaching the child to become self-sufficient and to show the child that he or she must take an active roll in treating the disease. This point cannot be overstated: parents must get the child involved in self-care as soon as he or she is able to master self-management tasks and is emotionally ready. At the same time, supervision by caregivers must continue. In order to control diabetes and prevent further complications, blood glucose levels must be as close to the “normal” range as possible. Parents / caregivers should work closely with health care providers to ensure that a personal diabetes plan for the child is in place to keep the child’s diabetes under control.
Tools to help children / parents control their diabetes:
- Take all diabetes medication as prescribed by the healthcare provider. For children with type 1 diabetes insulin shots should be taken at regular times each day. Some children prefer to use an insulin pump to deliver their insulin. Children with type 2 diabetes may take oral medications, insulin shots, or both. In either situation, all medications should be balanced with food and activity daily.
- Get Regular Physical Activity. Children with diabetes need regular physical activity. Exercise helps to lower blood glucose levels. Exercise is also a good way to help children manage their weight. A child’s blood glucose should be checked before beginning a physical activity, and a child should never exercise if blood glucose levels are too low!
- Check blood glucose levels regularly. Children should have their blood glucose checked regularly. The child or his/her parents should keep a journal or other records of blood glucose results to discuss with his / her health care provider. This information helps the provider make any needed changes to the child's personal diabetes plan.
- Follow a Healthy Meal Plan. A child needs to follow a meal plan developed by a physician, diabetes educator, or a registered dietitian. A meal plan outlines proper nutrition for growth. A meal plan also helps keep blood glucose levels in the target range. Children or adolescents and their families can learn how different types of food - especially carbohydrates such as breads, pasta, and rice - can affect blood glucose levels. Portion size, the right amount of calories for the child's age, and ideas for healthy food choices at meal and snack time also should be discussed. Family support for following the meal plan and setting up regular meal times is a key to success, especially if the child or teen is taking insulin.
Hypoglycemia and Hyperglycemia
The goal of diabetes control is to keep blood glucose levels within the target range. However, extremes in blood glucose levels can occur for several different reasons. The parent or caregiver should talk with their health care provider about how to deal with these potential problems related to a child's diabetes.
Low Blood Sugar (< 70mg/dl)
Blood glucose levels can sometimes drop too low - a condition called hypoglycemia (low blood sugar). A child or teen can become nervous, shaky, and confused. When blood glucose levels fall low, the child may become nervous, shaky, confused, irritable and / or drowsy. In extreme cases of low blood sugar the child may lose consciousness or develop seizures. Talk to the child's or teen's health care provider about how to deal with this serious but manageable condition. Listed below are some causes of hypoglycemia in children and teens.
- Taking too much diabetes medicine
- Missing a meal or snack
- Exercising too much
High Blood Sugar (>240mg/dl)
Blood glucose levels can sometimes become too high - a condition known as hyperglycemia (high blood sugar). Over time, hyperglycemia can lead to serious health problems and cause damage to the eyes, kidneys, nerves, blood vessels, gums, and teeth. Listed below are some causes of hyperglycemia in children and teens.
- Forgetting to take medicines on time
- Eating too much
- Getting to little exercise
- Being ill
- Stress (due to social environments, exams, sickness, etc…)
Parents
For most people, parent hood is a challenge in and of itself. Adding the tasks of diabetes care to normal parenting responsibilities makes the job of parenting even more challenging. Most people need help along the way to manage it all. This help can come in many forms: through a wonderful medical team; from family and friends; and through learning as much as you possibly can about diabetes.
There are 2 types of Diabetes: Type 1 and Type 2, Type 1 Diabetes can develop at any age, however, it usually develops in children and young adults before the age of 30. Over the past few years we are seeing more children diagnosed with Type 2 diabetes due to poor diet and obesity.
Type 1 Diabetes is a lifelong disease that occurs because the pancreas stops producing insulin. Insulin is a hormone that enables sugar (glucose) to move from the blood into the body's cells, where it can be used for energy. If sugar cannot move from the blood into the cells, the person's blood sugar rises (hyperglycemia) and the cells cannot function properly.
Often symptoms of Type 1 Diabetes are first noticed after an illness, such as the flu or a major surgery. Listed below are early warning signs of Type 1 diabetes:
- Frequent urination.
- Extreme thirst.
- Fruity breath
- Tiredness / Irritability
- Increased hunger.
- Weight loss.
The treatment goal for individuals with Type 1 diabetes is to keep their blood sugar level within a safe range. This is done by taking insulin injections, eating a balanced diet, and getting regular exercise.
Type 2 Diabetes is often called non-insulin dependant diabetes. Although the complications of type 1 and type 2 diabetes are similar, the diseases arise from different circumstances. In type 2 diabetes, high blood glucose arises despite the fact that the pancreas produces an adequate supply of the hormone insulin. Individuals with type 2 diabetes have high levels of insulin yet their body’s cells are resistance to the actions of the insulin. With the progression of the disease they can develop a deficiency of insulin similar to people with type 1 diabetes. Listed below are early symptoms of Type 2 Diabetes:
- Increased thirst
- Increased hunger (especially after eating)
- Dry mouth
- Nausea and occasionally vomiting
- Frequent urination
- Fatigue (weak, tired feeling)
- Blurred vision
- Numbness or tingling of the hands or feet
- Frequent infections of the skin, urinary tract or vagina
Understanding Insulin
Insulin is a hormone normally secreted by the pancreas. When you eat food it stimulates the pancreas to secrete insulin. The amount of insulin secreted is proportional to the amount / type of food consumed at that particular meal.
The primary role of Insulin is to move sugar (glucose) into the cells of the body's tissues. The body then uses the sugar as a source of energy to run a variety of important processes for the body.
The different types of insulins are categorized according to how fast they begin to work (onset) and how long they continue to work (duration). The types now available include rapid-acting, short-acting, intermediate-acting, and long-acting insulin.
Rapid Acting Insulins:
- NovoLog (insulin aspart)
Onset: 10-20 minutes
Maximum effect: 1-3 hours
Duration: 3-5 hours - Humalog (insulin lispro)
Onset: 15-30 minutes
Maximum effect: 30 minutes to 2 1/2 hours
Duration: 3-5 hours
Short Acting Insulins:
Onset: within 30 minutes
Maximum effect: 1-3 hours
Duration: 8 hours
- Novolin R (regular novolin)
- Humulin R (regular humulin)
Intermediate Acting Insulins:
Onset: within 1.5 hours
Maximum effect: 4-12 hours
Duration: 24 hours
- Novolin N (novolin NPH)
- Humulin N (humulin NPH)
Long Acting Insulins:
- Lantus
- Ultra Lente
Premixed Rapid and Intermediate-acting Insulins:
- Novolin 70/30 (70% Novolin NPH and 30% Novolin R)
- Humulin 70/30 (70% Humulin NPH and 30% Humulin R)
- NovoLog Mix 70/30 (70% insulin aspart protamine and 30% insulin aspart)
- Humalog Mix 75/25 (75% insulin lispro protamine and 25% insulin lispro)
Parents and Diabetes
The Diabetes Foundation of Mississippi has established two support groups for families and children with diabetes. A dedicated group of parents and the staff of the Foundation inaugurated these groups. The first of these groups, the Teens and Young Adults with Diabetes support group, met for the first time in June 2000. In August of 2000, the Sweeties With Diabetes support group, which is aimed at younger children with diabetes and their parents, gathered for the first time for a “Back to School” picnic. Each support group meeting features a discussion of a topic of concern and a presentation by guest speakers covering topics such as nutrition, school and daycare programs, advocacy issues, and general question and answer sessions. The meetings also include activities geared for the children, including skating, swimming, and theme parties. Contact The Diabetes Foundation of Mississippi for more information on these support groups.
The School and Special Concerns
Taking Diabetes to School: DFM National Diabetes Month Tips
Because the school-aged child spends over half of his/her waking hours in school, school personnel are almost as important to the care of the child with diabetes as the parents or guardians. It is important that the school personnel understand and recognize the necessary accommodations, which are needed for children with diabetes. The education of a child with diabetes is dependent upon the cooperative responsibilities of the parents or guardians, school personnel, health care personnel, and the child. This support system assures assistance in managing the child’s blood sugar levels.
It must be understood that the parent is responsible for seeing that this child’s needs are met by the school system. And, the school’s administrators must be willing to take the extra steps to meet these needs. Diabetes Foundation of Mississippi, Inc. can help with a free training program available upon request. DFM volunteers will go to your school or daycare center to present an in-service program called "It's Not a Sweet Subject". The presentation lasts about 30 minutes with additional time provided for questions. We will provide an emergency “box” with a blood glucose meter to the school or daycare if they have enrolled children with diabetes.
Responsibility Guidelines
A child’s ability to deal with diabetes varies with age, but age alone does not tell you when a child is ready to assume tasks. Children develop at different rates. The Diabetes Foundation of Mississippi has developed a list of general guidelines for helping your child cope with diabetes.
Daycare
The child may begin to cooperate with diabetes-related tasks but is unable to perform them independently. Normally, young children with diabetes do not recognize symptoms of low blood glucose, or they aren’t able to communicate to others when they are feeling “low.” Therefore, it’s extremely important to check your child’s blood glucose level often. Oftentimes young children are frightened by finger sticks and insulin shots and may try to avoid or delay getting them.
Elementary School
The child is learning how to recognize low blood sugar symptoms and can cooperate with all diabetes-related tasks. Young children (ages 5-7) should be able to: draw up insulin of one type, give themselves shots under close supervision, and perform blood glucose testing with assistance. In some cases children with diabetes view their disease as a punishment for something they did wrong; diabetes camps and support groups will help the child work through these feelings.
Middle School or Junior High School
The child should recognize symptoms of high and low blood sugar and know when to monitor it. Unless he is newly diagnosed, he should be able to administer his own insulin, and keep a blood glucose log book. Changes in dosage require adult supervision. Children 12 years or older should discuss their diabetes directly with their doctor and work with healthcare professionals in developing a diabetes management plan.
High School
For the teenager with diabetes, having to take insulin, check blood glucose, and follow a meal plan is tiresome and can compound the normal difficulties of being a teen. It is normal for a teen with diabetes to ease up on diabetes care and try to act like everyone else.
The teen years are a time of testing limits, so don't be surprised if your teen tests his/her diabetes limits at some point. Teens may refuse to adhere to their eating plan, skip insulin injections, or stop checking their blood glucose. In some cases, the natural consequences of these actions (serious hypoglycemic reactions or hospitalization for DKA) discourage teens from continuing these habits.
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