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For Parents
When you come to know that your child has been diagnosed with diabetes, it can be
very frightening and overwhelming. Children and their families have to go through
a tremendous learning experience to help the child manage his or her diabetes. But
children are adaptable and children with diabetes can have very normal childhoods
with preparation and understanding.
Five major areas that parents need to focus on when their child is diagnosed
with type1 diabetes.
1. Insulin Dosing
Because your child's body can no longer make insulin, it must be replaced throughout
the day, usually by injecting it. There are several methods of insulin dosing:
Fixed doses of intermediate and rapid-acting insulins: With fixed doses of
insulin your child must have meals at the time of insulin peak action. Meals should
be as close as possible to the same time every day with the same proportions of
carbs, fats and proteins. Children who take long acting insulins such as Lantus
(Glargine) still need to take rapid acting insulin doses at meals. The amount of
rapid acting insulin is calculated depending on the carbohydrate content of the
meal.
In Pakistan, insulin pumps are new, but a lot of type 1 diabetics in other countries
(USA, European countries) are using these pumps effectively. An insulin pump is
a computerized device that delivers insulin into your body. It is about the size
of a cell phone and you can attach it to a belt, or keep it in a pocket. Insulin
pump contains three-day body requirement of short-acting insulin. When programmed
to do so, a plunger inside the device pumps out a measured amount of insulin through
a thin tube (called a catheter). The tip of the tube, called the cannula, is placed
just under your skin.
2. Blood Glucose Testing
Your child's blood glucose should be tested before meals and at bedtime.
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Age less than six years
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100-200 mg/dl before every meal and bedtime
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Age six to twelve years
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80-180 mg/dl before every meal and bedtime
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Age more than twelve years
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80-140 mg/dl before every meal
Less then 160 mg/dl after two hours of each meal
100-160 before bed.
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Reference: Staged diabetes management, Module 2
They vary by age group and may be adjusted depending on your child's individual
experiences with hypoglycemia. The recommended levels may seem high compared to
levels for adults with diabetes. The reason behind the higher numbers is because
children, especially young children, are at an increased risk for hypoglycemia.
Keep a record of meals and blood glucose numbers, times and physical activities
to get the big picture of how to manage your child's diabetes. That way, you'll
get a feel for the fluctuations in your child's blood glucose and be able to
keep it at a more even level.
3. Low Blood Sugar
Also known as hypoglycemia, low blood sugar is a common problem for children with
type 1 diabetes. Symptoms include:
- Irritability
- Shakiness, trembling or weakness
- Lack of coordination
- Drowsiness or confusion
- Headache
- Dizziness
- Double vision
- Convulsions or unconsciousness
- Blood glucose level below 70
Sometimes children, especially younger children, can't tell that they're
becoming hypoglycemic or can't express what is wrong.
If your child's blood sugar is too low, have your child drink or eat a concentrated
amount of sugar (approx. 10 to 15 grams) to raise the blood glucose value to greater
than 80 mg/dl. Some examples of this would be:
- Two teaspoon of glucose dissolved in some water
- One small cube of cake
- Two to four pieces of candy
- One-half cup of orange juice (or sugarcane juice).
- One to two tablespoons of honey
It's a good idea to keep a small bag in your car packed with 15-gram portions
of quick sugar sources such as the above.
Keep one or two kits ready and waiting before a hypoglycemic emergency happens.
Practice using the kit. Your doctor or diabetes educator might be able to provide
you with a practice kit, so that you are comfortable using it before you need to.
If your child loses consciousness then your child will need to go to the hospital
immediately. It's a medical emergency.
4. Nutrition
A registered dietitian, nutritionist, diabetes educator or other healthcare professional
should help you develop a plan of eating that is balanced so that blood glucose
levels don't fluctuate too much, and also meets the needs of your growing child.
There are also good resources on the internet to help you gather information about
nutrition and supplement your child's eating plan. The internet should not be
your only source of information, however. You still need the support of healthcare
providers who will get to know your child and his or her particular nutritional
needs.
5. Exercise
Physical activity lowers blood glucose levels. Children with diabetes should get
regular daily exercise. Parents need to be aware that hypoglycemia can occur during
exercise so children should check their blood glucose levels before they start to
exercise. If their blood glucose is low, they should have a carbohydrate snack and
sit out until their blood glucose returns to a normal level (over 80 mg/dl).
Parents should make Physical training teachers aware of their child's diabetes
and about the possibility of hypoglycemic reactions.
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