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Managing Diabetes Magazine - diabetes

Your Child with Diabetes
What to expect after the diagnosis

I looked down onto the small child lying in the hospital emergency bed, my heart went out to her parents sitting shocked and disbelieving at her side. Samantha was only two years old and had just been diagnosed with type 1 diabetes. Samantha's mother said she had known there was something wrong. Her usually active and healthy little girl was suddenly thirsty all the time, and wetting her diapers constantly. She ate well but lost weight, and was so tired. She cried more than usual, and had become irritable. Still, Samantha’s father couldn't believe it when the doctor said it was diabetes. He thought only older people got diabetes, not two-year-olds! Samantha is their first child. It was hard enough in the beginning to learn how to be good parents. Now they must learn how to care for a toddler with diabetes. Samantha’s parents have been told that she will need insulin injections every day. Her blood glucose levels must be checked using a blood glucose monitor. They will need to watch her constantly in case her blood glucose levels go too high or too low. It all sounds so frightening and complicated. Of course, they will do everything they can to keep their little girl healthy – but it won't be easy. Trying to get a two-year-old to eat the right kinds of food at the right time to keep her blood glucose levels stable will be difficult. They wonder if they can cope.

The shock of the diagnosis

Like Samantha's mother and father, most parents react with shock, disbelief and sadness when a child is first diagnosed with diabetes. Many thought that diabetes only affects older people. It is hard to accept the diagnosis.

Once the first shock is over, parents are faced with managing a complicated daily routine to keep their child healthy. Creating an environment in which their child can thrive and grow seems difficult. Many parents do not feel equipped to cope with the needs of their child. They may become stressed and exhausted. Parents, as well as children, need care, support and education to get through this difficult transition.

Understanding diabetes and how to manage it is essential. Children who are supported adjust well when they are diagnosed, and are more likely to maintain good control over diabetes throughout life.

Sadly, Samantha and her concerned parents are not unusual. More and more children, of all ages and from every background, are being diagnosed with diabetes. In Canada, one in every 500 children under the age of 17 will develop this condition. The largest increase over the past ten years has been in preschool-aged children.

Type 1 diabetes

Type 1, or insulin-dependent diabetes, is the most common in children. In this case, beta cells in the pancreas stop making the hormone insulin. Insulin allows glucose (sugar) from food to pass from the blood stream into all the body tissues, where it is used for energy and growth.

We cannot live without insulin. Those diagnosed with type 1 diabetes must take insulin several times a day to remain healthy and to grow. It cannot be swallowed as a pill or liquid since digestive juices in the stomach destroy it. To work properly, insulin must be injected.

To know how insulin is working, blood glucose levels must be checked several times a day. A finger or another site on the skin is pricked to obtain a tiny drop of blood. The blood is then tested on a blood glucose monitor.

Overcoming the fear of needles is one of the hardest tasks children and their families have to face. Balancing the food eaten with the child's activity level and the amount of insulin taken is also challenging for families learning how to cope with diabetes.

Receiving education from a caring, supportive and informed diabetes educator is important. This is one of the first steps towards accepting, understanding, and managing a complicated condition.

The exact cause of diabetes is still not fully known. In this chronic auto immune disease, the body's own immune (defence) system affects or destroys the pancreas cells that make insulin. Hereditary factors and trig gers in the environment contribute to the start of diabetes. Research to prevent and cure diabetes is ongoing.

Type 2 diabetes

In type 2 diabetes, either the beta cells of the pancreas do not make enough or the tissues of the body resist the action of insulin. Although children with type 2 diabetes do make insulin, it is not able to work properly. We once knew type 2 diabetes as adult onset diabetes. However, in the past ten years the number of children developing this condition has increased dramatically.

Children and adults with type 2 diabetes may be able to take medications to help their own insulin work better. They may also need to inject insulin. All children with diabetes must check their blood glucose levels several times each day. Many who develop type 2 diabetes are overweight. Studies show that the rise in childhood type 2 diabetes is happening at the same time that the number of overweight kids is increasing. Once a child develops diabetes, his or her life is immediately changed, as is the lifestyle of the parents and the entire family. Still, there are ways to make the most difficult tasks of managing diabetes a little easier.

Managing injections and blood glucose checks

Adapting to life with diabetes is difficult for even the most easygoing child. Suddenly the body becomes a pin cushion for insulin injections. Fingers are pricked for blood glucose checks. Injecting or pricking a struggling toddler or protesting eight-year-old is challenging for even the most calm and logical parents. Even older children and adolescents who are learning to do these procedures themselves may find it ‘gross’ and frightening in the beginning.

Particularly with young children, both parents need to be involved in sharing responsibility for diabetes management. Giving injections and finger pricks, as well as cuddles and comfort afterwards, should be done by both parents. If only one parent is available, the support of a grand- parent or good friend can be essential especially when the child is first diagnosed. For older children and teens, an understanding peer or best friend can provide much needed support.

Needle time should be kept as short and tranquil as possible. A nervous parent can create fear and resistance in the child. Although keeping still is necessary, a crying child should not be shamed. Kids should know that it is all right to cry. Needles and finger pricks hurt, and others understand. Praise for bravery and keeping still, even if the child cries, is important. Emphasize that the child is loved.

Singing a special song, telling a funny story, blowing bubbles or breathing deeply can distract and eventually take the place of crying. Using a “magic” ice cube to numb the skin before an injection can also help.

For infants and very young children, a soother or bottle at injection time can comfort and lessen the impact and stress caused by the pain of the needle. With toddlers and older children, a cookie in the hand can give comfort and pleasure as insulin is injected. To allow a young child to feel more involved, provide a syringe with out a needle. This can be used to inject a favourite toy or to a relative, so the child is not the only one being poked.

A child cannot live or grow without insulin. Kids diagnosed with type 1 diabetes should be taught that taking insulin regularly keeps them healthy and allows them to eat the food they like. New, improved insulin can now be taken before or after a meal, and the dose can be adjusted according to how much food the child eats. The child has greater flexibility in the amount and type of food eaten. Stress and anxiety around meal times is also reduced.

Blood glucose checks are usually done before each meal and at bedtime. Some children who have type 2 diabetes take medication to help their own insulin work better. These children also check their blood glucose level two hours after each main meal. Both parents and children need to understand why this is done so often.

Checking blood glucose is like looking through a small window into the body to see what is going on inside. Once you know what the blood glucose level is, you know how much insulin to give and how much food must be eaten. This explanation often satisfies young children as well as adolescents and parents. Kids may be more willing to test because they are curious to see what number comes up on the mon itor screen. Although testing is invasive, it is very simple. With encouragement, even children as young as three can successfully prick their own finger to do a blood glucose check.

Dealing with some common problems and concerns

Knowing things will not always go smoothly can lessen the guilt and frustration experienced by parents of children newly diagnosed with diabetes. No matter how careful or exact parents are in managing the diabetes, blood glucose levels can still rise too high or drop too low. Rapid growth, anxiety, excitement, stress, illness, activity levels and the kind of food eaten can all affect blood glucose levels. It is essential to maintain close contact with the doctor and diabetes educator to make frequent insulin adjustments and get advice.

In hypoglycemia, blood glucose is too low. It happens if a child with diabetes gets too much insulin, eats too little or does a lot of extra activity without eating more. Low blood glucose develops rapidly and can be frightening. Symptoms include sweat ing, looking pale, feeling shaky, dizzy and weak, and having a headache. They disappear quickly when treated immediately with a quick form of sugar such as fruit juice, regular pop or glucose tablets, followed by food. If left untreated, the child may become unconscious.

Children diagnosed with diabetes should always carry an emergency supply of juice or glucose tablets and food with them wherever they go. They must also wear a medical alert bracelet or other form of identification that lets everyone know they have diabetes. Teach all family members, babysitters and other caregivers how to recognize and immediately treat low blood glucose levels. Older children should be taught how to recognize and treat their own symptoms. Very young children like Samantha, who cannot under stand, depend entirely on a respon sible adult. Every caregiver should learn how to manage emergency diabetes situations in a young child.

Before a school-aged child returns to school following the diagnosis of diabetes, visit the school principal and the child's teacher. The school will need adequate information about how to manage the diabetes and, in particular, how to treat low blood glucose. It is the parents' responsibility to provide emergency supplies for treating low blood glucose levels at school. Check often with the teacher or principal about restocking these supplies.

Trusting others and moving forward

Many parents of young children with diabetes are afraid to trust their child to another's care. Parents of school-aged children can share the same anxiety. A cellular phone or pager can be a very successful tool for these parents. Being able to be reached instantly can reduce stress and anxiety.

Parents are the most essential members of the diabetes management team. They have an awesome and challenging responsibility. Children also grow up to become essential monitors of their own management. However, it is impossible for them to manage their diabetes without strong support and caring from family and community. Providing a loving, safe environment in which the child feels secure helps assure long-term successful diabetes management and the future well-being of the entire family.

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FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
While effort is made to reflect accepted medical knowledge and practice, articles in Family Health Online should not be relied upon for the treatment or management of any specified medical problem or concern and Family Health accepts no liability for reliance on the articles. For proper diagnosis and care, you should always consult your family physican promptly. Copyright 2012, Family Health Magazine, a special publication of the Edmonton Journal, a division of Postmedia Network Inc., 10006 - 101 Street, Edmonton, AB T5J 2S6  [DI_MDa05]
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