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Experts in the field of Medicine
Shireen Khan
GP Paediatrician
Paediatrics, Neonatology, Child rights/Child Abuse, Immunization, Clinical Research
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Article by Shireen Khan...
Children with Diabetes

Learning about diabetes is a lot of work for both the parents and the child. But learning about how the body functions, giving insulin injections, controlling diet and measuring the blood glucose levels, will all help to restore family life and the child's life, back to normal.

Diabetes is a disease caused when the body either does not make enough insulin, or cannot correctly use the insulin it makes. There are several types of diabetes. The type that affects children is type I diabetes. (Young adults less than 30 years old are also affected by this type.) Type I diabetes occurs when the body stops making insulin. It develops quickly, sometimes within days. Children are most often affected between the ages of 11 and 14.

Insulin drives glucose, or blood sugar, into body cells so they can do their job. The foods we eat become glucose. When the body stops making enough insulin, glucose builds up in the blood instead of getting into the body cells.

Low blood sugar can also be a problem for children with diabetes. The symptoms of low blood sugar can come on quickly and must be treated promptly by eating something sweet to raise the blood sugar level to normal.

Knowing the signs of high or low blood sugar is helpful for caring for the condition. Medical care is vital to children with diabetes. Daily injections of insulin are needed to maintain normal body functions. Parents and the child can learn how and when to give the injections. It is important to keep the level of blood glucose as near normal as possible. Eating healthy foods, exercising, and daily monitoring of the child's blood and urine sugar levels with self-testing kits does this.

Parents can help their child control diabetes, rather than letting the disease control the child. A doctor can teach them how to manage the disease with proper record keeping of key information. Family, friends, and teachers must know how to help the child with any problems that may arise.

Below are a few frequently asked questions that are asked of the doctors treating children with diabetes:

Why must a young child have so many shots of insulin a day and test blood sugar so often?

Blood sugar levels can vary widely in young children and adolescents because of variations in such factors as level of activity, food intake, amount of sleep, childhood illnesses, etc. To maintain blood sugar levels within an appropriate range for a child, frequent testing and frequent injections are often necessary.

Must I wake my child in the middle of the night to test blood sugar?

A frequent dilemma for children with diabetes is that of running high blood sugars in the morning. You may occasionally need to test your child's blood sugar in the middle of the night. This testing will, in conjunction with measurements of your child's blood sugar level on waking, tell you whether blood sugar levels are going up or down during the night.

Whose fault is it my child has diabetes: my child's or mine?

Diabetes isn't anyone's fault. Research has shown that many factors may be responsible for the onset of diabetes-viruses, which may trigger an autoimmune response, genetic predisposition, and environmental factors.

What can happen if I give my child with diabetes an extra snack?

It's all right for your child occasionally to have an extra snack. Just make sure to monitor his or her blood glucose levels regularly so that the insulin dosage can be adjusted as necessary.

Does my child's activity change the insulin dosage needed at a particular time?
A higher level of activity can reduce the need for insulin. It is important that blood glucose levels be checked before and after rigorous activity so that insulin dosage can be adjusted as necessary.

Can I allow my child to play in someone else's home, not only ours?

Letting your child play in someone else's home is fine as long as the attending adult is aware of your child's needs for managing diabetes.

Should I let the school know where I can be reached and, if I am unavailable, who
should be called?

Yes. Parents should always let the child's school know where they can be reached and when they are available. In the event that the parent(s) are not available, a second person-a responsible adult who is aware of the child's needs-should be on call.

Children also ask questions, and it is imperative that they should know how to take care of themselves, especially when they are in school, or otherwise away from home. They should be aware of the signs & symptoms of low or high blood sugars, and let their parents, teachers or any other responsible adult know immediately. The following points are addressed to children:

General Care - Look Out For Your Future!

  • You should weigh yourself once a week and maintain a log of your weight.

  • Talk to a dietitian to help you plan which foods are best to eat.

  • Keep your body clean by using good personal hygiene.

  • Brush your teeth after each meal and at bedtime to avoid tooth and gum infections (Rinse well with water if brushing is not possible). Visit your dentist regularly, at least twice a year.

  • See your eye doctor at least once a year for eye checkups.

  • See your diabetes doctor regularly, even if you are doing well so he or she can assess you.

Be Aware - Look Out For Your Future!

  • Tell your teachers and others from your school that you have diabetes, so they know what to do in case you need help.

  • Always try to wear a tag or bracelet that says, "I have diabetes."

  • Keep your parents informed of any changes in your school schedule.

  • Report to your teacher any insulin or blood sugar changes that might affect you in school.

  • Stress makes your sugar go up. You can relieve stress by laughing, walking, riding your bike, playing a game, talking to a friend or your parents.

How often do I check my blood sugar?

  • Check your blood sugar 4 times a day (before breakfast, lunch, dinner and bedtime snack) and when you are not feeling well so you know whether you are high or low and what to do. You do not need to check before lunch if at school.

  • Keep a log of daily blood sugar results to bring with you to your doctor's appointment.

  • Many machines are available for checking your blood sugar - follow direction for use of the machine selected for you.

  • Normal blood sugar is between 80 - 120.

    What are causes of low blood sugar?
    • Too much insulin
    • Too little food
    • Waiting too long between insulin injections and eating
    • Too much exercise

    What are signs and symptoms of low blood sugar?

    • Weakness, no energy
    • Irritability
    • Nervousness, trembling
    • Sweating
    • Problem with your eyes, such as not seeing clearly
    • Fainting

    What can I do about low blood sugar?
    • Eat or drink something with sugar, such as orange juice, colas, glucose tablets etc. right away. It can get bad very fast, and if you don't treat it in time, you could pass out.

    • Milk is also good when your sugar is low, it has sugar and protein which will hold you until your next meal.

    • If you do not feel better, call your doctor.

    • Tell an adult you are feeling like your blood sugar is low.

    • Always keep an extra snack or sugar (glucose) tablets in your schoolbag, pocket, etc.

    • Give your teacher a special box to keep in her desk with sugar (glucose) tablets, juices, raisins or biscuits, etc.

    • Your best friends should know to give you sugar or juice if your blood sugar is low.

    • If it is near the time of your next meal, eat as soon as you can.

      What are the causes of high blood sugar?

      • Eating too much
      • Infection
      • Emotional problems
      • Not taking insulin
      • If it is near the time of your next meal, eat as soon as you can.

      What are the signs and symptoms of high blood sugar?

      • Frequent urination
      • Weakness, irritability
      • Headache, dizziness
      • Fruity odor in breath
      • Difficulty concentrating
      • Fainting or Sleepiness

      • What can I do about high blood sugar?

        • Check your blood sugar and log the result in your book.
        • Call your doctor right away.
        • Drink plenty of water or any sugarless (diet) drink.
        • Lay down if dizziness or weakness occurs.

          When do I check for urine ketones?
          You need to check your urine for ketones only if your blood sugar is greater than 250.

          How do I check my urine for ketones?
          • Test only freshly voided urine, which means: test right after you have "peed."

          • Obtain a test strip, such as "ketodiastix" from the bottle and promptly cap the bottle back.

          • Dip the test strip into the urine making sure the pad gets wet and then remove the strip.

          • Wait 30 - 45 seconds and compare the results with the color chart on the bottle.

          • Record the results in you logbook for you and your doctor.

          • Always keep the bottle of urine test strips tightly closed when not in use.

          • Call your doctor if you are spilling ketones in your urine.

          • Do not exercise is you have ketones in your urine.

            ABOUT INSULIN

            What are the different kinds of insulin?
            Regular Insulin:

            • Transparent in color (clear)
            • Begins to work within 30 minutes to 1 hour
            • Works best 2-3 hours after administration
            • Stops working in 6-8 hours

              NPH Insulin:

              • Cloudy in color
              • Works slower and lasts longer
              • Begins to work in 1-1 1/2 hours
              • Still working 5-15 hours after administration

              General Insulin Tips:
              • Take before meals
              • Rotate sites of injection. One way to do this is by injecting the left side of body one day and the right side the next day.
              • Keep your insulin vials in the refrigerator or in a cool dry place.

              How do I give myself/my child insulin?

              • Wash your hands well for at least 30 seconds with soap and water before handling your insulin.
              • Roll the vial(s) between your hands to warm and mix the insulin.

              • Wipe the top of the vials with alcohol.

              • Inject the right amount of air into the NPH insulin (cloudy) first and then the regular insulin (clear) according to how much insulin you will be giving.

              • Always withdraw regular insulin (clear) first. Remove only the required amount with the syringe. (Never change your insulin without your doctor knowing.)

              • Using the same syringe, withdraw the needed amount of NPH (cloudy) insulin.

              • Hold the syringe up to the light. If there are air bubbles, tap the side of the syringe with your fingers to get them out.

              • Use your arms or abdomen for the insulin shots in the morning and your legs or buttocks for the evening dose.

              • Throw away all needles and lancets in a heavy duty plastic container such as a jug. Keep it away from younger brothers and/or sisters. After container is 3/4 full, seal tightly with a lid and put out with your regular garbage.

              • Wash your hands again.

              FOOT CARE
              How do I care for my feet?
              People with diabetes may have poor blood flow to their feet. you need to take care of your feet daily.

              To care for your feet:

              • Keep your feet clean and always wear shoes. Never go barefoot, even if you're at the beach.

              • Cut your toe nails straight across. Be careful not to cut your skin by mistake.

              • Always keep any cuts clean and bandaged.

              • Massage and put lotion on your feet, but keep lotion from between the toes.

              • Look at your feet closely everyday. Check for any cuts, scratches, bruised, red or dark purple areas, swelling or drainage.

              • Remember to check in between your toes, too. If you do see any cuts, scratches, bruises, etc. call your doctor right away.


                • Always carry a sweet, glucose tablets, or something with sugar in your pocket or school bag in case your sugar becomes too low when you are not home.

                • Check your blood sugar every day and record it.

                • Always wash your hands before the insulin shot.

                • Keep all doctor appointments and ask questions when you do not understand something.

                  Remember...You are the most important person on your diabetes care team.

View all articles of expert Shireen Khan

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