Diabetes in Children

Diabetes in Children

Diabetes in Children

Are you a child or young person, teenager who has got Diabetes?

We are here to help you. We hope that you will find this brochure friendly, welcoming, fun and exciting but most of all informative. So what do we have in the way of managing diabetes for children and young adults?

It is important for you to find out more about diabetes to help you understand it and help explain to your friends and family, who will always be there if you need them.

Our diabetes team provides specialized care and support to children and their families in a friendly, relaxed and informative environment, where they can feel confident and secure. The team will enable each diabetic to achieve the best possible control of their diabetes.

What is Diabetes?

Diabetes in Children

Diabetes Mellitus is a metabolic disorder characterised by hyperglycaemia (high blood sugar) resulting from de-fects in insulin secretion, insulin action, or both

Insulin is a hormone produced in the pancreas that is nec-essary for the body to convert carbohydrates into energy.In people with diabetes, either the pancreas doesn’t make insulin, the body cannot use the insulin properly, or both.

Without insulin, glucose (sugar)- the body’s main energy source- builds up in the blood.

There are two major types of diabetes. Children with diabetes usually have type 1 (insulin dependent diabetes).

Type 2 diabetes (Adult onset diabetes) is usually found in adults; however, children can also have type 2 diabetes, which is now on the rise in children and adolescents due to obesity & sedentary lifestyle.

Type 1 Diabetes

If you have type 1 diabetes, you are unable to make insulin. The pancreas produces little or no insulin. This develops when most or all of your insulin producing cells are destroyed.

Type 1 diabetes most commonly appears in childhood from the age of one onwards but it can appear in adults.The diabetes often develops quickly, over a few weeks, with marked weight loss and the person would become very ill without treatment.

Diabetes in Children

You may be born with a chance of developing diabetes, or it may have been triggered by an illness.

The goal of insulin delivery in diabetes is to regulate glucose levels to achieve normoglycemia.

Type 2 Diabetes

If you have type 2 diabetes, the pancreas is still making insulin but there is not enough for the body’s needs or the insulin it produces is not used properly or there is a fault in the way the body responds to insulin, which is known as insulin resistance.

Glucose cannot be transported in to the muscles to provide energy. Therefore, the levels of sugar (glucose) in the blood get higher (hyperglycemia).Type 2 Diabetes is treated with a diet and lifestyle changes as well as medication.

Genetic Defect

Rarely diabetes is caused by genetic defect e.g. Maturity Onset Diabetes of the Young (MODY).

MODY is caused by genetic defects in β-cell function. It is characterized by the onset of mild hyperglycemia at a young age, with impaired insulin secretion and little to no insulin resistance

Symptoms of Diabetes

  • Unusual or excessive thirst
  • Weight loss
  • Tiredness
  • Frequent urination

Symptoms that are more typical for children include:

  • Tummy pains
  • Headaches
  • Behavioral problems

Sometimes diabetes ketoacidosis occurs before diabetes is diagnosed.

Treatment

Insulin is the only treatment for type 1 diabetes.With type 1 diabetes, no insulin is produced. It has to be injected into the body.

Why insulin and why injections?

Insulin is very important, as you need it to help move sugar from the blood stream into parts of the body which need it to make energy. Insulin controls the level of sugar in your blood. Insulin cannot be taken orally as it will not work.

It is also important to monitor your blood glucose levels because the dose you require at each injection may vary depending on the food you are eating, your personal lifestyle, activities and wellbeing or illness.

Your diabetes team will help you self-manage your insulin therapy and diabetes.

How is diabetes treated in children?

The specialized nature of managing childhood diabetes means that most children are cared for by the hospital rather than by their GP (General Practitioner).

  • Most children with diabetes need insulin treatment. If this is the case, your child will need an individual insulin routine, which will be planned with the diabetes team.
  • Most now use frequent daily dosage regimes of fast-acting insulin during the day and slow acting insulin at night.
  • Very small children may not need an injection at night, but will need one as they grow older.
  • Increasing numbers of (older) children use continuous insulin pumps.

Often in the first year after diagnosis, your child may need only a small dose of insulin. This is referred to as “the honeymoon period”.

Diet and exercise

Dietary Guideline for Type 1 Diabetes

Nutritional Needs:

Diabetes in Children

Dietary control is an integral part of management for Type 1 diabetes. The diet should always provide the essentials for good nutrition, and adjustments should be made from time to time for changing metabolic needs.

It is also essential in type 1 diabetes to understand about balancing the intake of food with insulin dosage

Energy: Enough calories should be provided to increase the weight and thereafter to maintain the ideal weight. (Type 1 Diabetics are mostly underweight individuals)

Energy: Enough calories should be provided to increase the weight and thereafter to maintain the ideal weight. (Type 1 Diabetics are mostly underweight individuals)

Protein: A diet high in protein is good for the type 1 diabetes because:

  • t supplies the essential amino acids needed for tissue repair
  • Protein does not raise the blood sugar during absorption as do carbohydrates
  • It does not supply as many calories as fats.
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The ADA recommends that 12 to 20% percent of calories should be derived from protein.

Diabetes in Children

Carbohydrates: For most diabetics, about 50% of calories as carbohydrates mainly of the complex type, is recommended.

Fat: The fat allowance is 30 to 35% of the calories. Foods high in saturated fat and cholesterol should be limited.

Fiber: Short-term studies with high fiber diets have been associated with reductions in postprandial blood glucose.

Regularity of Meals: Day- to Day consistency in amount and distribution of carbohydrate, protein and fat is needed especially for type 1 diabetes. Meals should coincide with the availability of insulin. A delay in meal timings may produce hypoglycemia.

Physical activity: Physical activity is important for children with diabetes, who should try to exercise every day.

Physical activity lowers the blood sugar level, so if your child takes insulin, he/ she may need to reduce the dose.

Physical activity also affects how much your child can eat. Before your child exercises or plays sport, give extra bread, juice or other carbohydrates.

Low glucose (Hypoglycemia

Hypoglycemia is the name given to those times when the blood sugar falls below normal (usually below 3.8 mmol/L or 70 mg/dl). HYPO is short for hypoglycemia, which means low blood sugar.

Hypos can occur at any time and are most often caused by one or more of the following:

Too much insulin

  • Missing a meal or not eating enough
  • Unexpected exercise (hypo may occur several hours after activity)
  • Illness, especially vomiting and diarrhea
  • Changes in weather

Hypoglycemia symptoms

Diabetes in Children

This hypo can usually be corrected by taking some glucose by mouth as soon as the signs are noticed.

Suitable treatment includes:

  • 3 glucose tablets
  • 1 small cup (100 ml) of normal sugared lemonade or orange juice
  • 1 medium cup (200 ml) of diluted normal sugared squash/li>

If symptoms do not improve in 10-15 minutes, then the same amount of glucose should be taken again.

The next meal or snack or an additional snack (e.g. a biscuit, a piece of toast, a small sandwich or cereal) should be taken within a few minutes of symptoms to prevent the hypo from happening again.

Important advice for parents and teachers

A severe hypo can make a child unconscious. The child cannot remember this hypo and cannot cooperate during the hypo. Severe hypo is characterized by loss of consciousness or seizures.

Treatment

In this situation, do not attempt to give anything by mouth. The best and easiest treatment is by injection of Glucagon.

Dosage according to age and advice from the diabetes team:

  • Age 0-12 years = 0.5 ml (½ ampule)
  • Age 12 and over = 1ml (1 ampule)

Glucagon occurs naturally in our bodies. It has the opposite effect to insulin and so can raise blood sugars for a short time. The dose is not absolutely critical and parents should not worry about giving too much – it is very safe.

When the child is conscious (approx. 5-15 minutes following the Glucagon) they must have some glucose and then a good snack (as for moderate hypo treatment) or meal to prevent the hypo happening again. It is possible the child may feel a little nauseous after a bad hypo and treatment, so you may need to be patient and have to encourage the child to eat or drink.

High glucose

Hyperglycemia

Hyperglycemia or high levels of sugar in the blood above 200 mg/dL (or 11mmol/L) are usually associated with the following symptoms:

  • Thirst
  • Excessive Urination
  • Fatigue

In case of high level of sugar in the blood, drink a lot of sugar -free liquids (water, tea, mint). In case the level is more than 240 mg/dL, don’t do any physical activity.

Untreated, hyperglycemia may develop into diabetic ketoacidosis (DKA), a very serious condition.

Diabetic Ketoacidosis (DKA)

DKA is characterized by a high blood glucose (usually above 15 mmol/l equivalent to 270 mg/dl), ketosis and acidosis. It is initiated by relative or absolute insulin deficiency.

Causes

  • Infection
  • Management errors or insulin omissions.

Signs and Symptoms

  • Polyuria
  • Polydipsia
  • Rapid weight loss
  • Muscular weakness
  • Pear drop breath (lungs excreting acetone is a late and serious sign)
  • Drowsiness and confusion
  • Abdominal pain
  • Vomiting
  • Tachycardia
  • Dehydration

Sick day

Sick day guide

  • Never stop the insulin
  • Test blood glucose more frequently
  • Decide whether more or less insulin is needed
  • Test urine/ blood for ketones
  • If appetite is not normal eat light foods like; soup or plain yogurt
  • Drink more water + sugar free drinks to stop dehydration
  • If needed, it’s OK to have paracetamol

Parents’ information - Emergency supplies for school teachers

Emergency snack supplies for school staff

It is possible for hypoglycemia to occur at school. To allow the teachers to treat the hypoglycemia effectively it is important to give the school teachers a box of emergency supplies.

Examples of snack and drinks, which could be left at school

Diabetes in Children

  • Sugary drinks: cola, orange juice
  • Glucose tablets
  • 1 packets of plain biscuits or crisps

Note:Illnesses with diarrhea and vomiting (gastroenteritis)often causes glucose/ sugar to go lower (towards a ‘hypo’) because less food is digested and absorbed from the stomach.

General advice for outdoor camps

  • Always keep an eye on your blood sugar levels
  • Carry extra glucose and wear your medical I.D. tag
  • Remember to have snack before going to bed
  • Let a friend you trust know about hypos and what to do
  • Look after yourself, be smart and stay safe

Diabetes Management at NMC Royal Hospital Sharjah

We follow a structured plan, which is evidence based and personalized to suit our individual patient’s needs

Our qualified team of Paediatric Endocrinologists, Diabetic Educators & Clinical Dieticians can help you with:

  • Prescribing medications that is best suited for each patient
  • Providing Detailed explanations of the side effects and contraindications of the medicine
  • Counselling with regards to lifestyle modifications, Diabetes monitoring & diet.