Diabetes requires adjustments for all members of the family

When a child is diagnosed with diabetes it undoubtedly will affect the entire family. Much attention is usually given to the child with type 1 to ensure proper diabetes management. But less attention is often given to the siblings of the diagnosed child. It is not uncommon for there to be feelings of neglect, anger and favoritism that arise in siblings.



Siblings can adjust to diabetes in their home if parents create a supportive environment that addresses the needs of all the children, not just the one with diabetes.

 

Here are some tips for parents on how to manage the responses of siblings to the changing family dynamic of living with diabetes.

Explain diabetes in terms they can understand

It is important that you clearly explain what diabetes is and how it works to each of the children in age-appropriate language. This will help calm fears and enable them to normalize the diabetes management process much faster.

 

For example, one of the big misconceptions that siblings often have after a brother or sister is diagnosed with diabetes is that they will “catch it.” They need to clearly understand that diabetes is not contagious and that close contact with their sibling is not dangerous. In fact, you can even emphasize that when the diabetes tasks are completed, it might be easy to forget that their sibling even has diabetes.

Look for opportunities to probe the feelings of your children

Initially, siblings adjust to diabetes with some intrigue, wanting to understand what it is about. But within a few weeks most siblings would like life to go back to “normal” before the diabetes came to live in the home. This causes a wide range of feelings in kids. The goal is to listen for these emotions and coax them out when appropriate.

 

For example, suppose your non-diabetic child says he also wants to have diabetes so he can spend more time with Mom and Dad. This type of comment is full of emotion. Rather than correcting your child and instructing them about the difficulties of having diabetes, focus in on helping them talk about their feelings. You might say, “Does it seem that your brother gets more attention from Mom and Dad because of his diabetes?” An inquisitive response that attends to the emotion your child is feeling sends the message that you want them to tell you more; you want them to express their feelings and you are willing to listen.

Make a point to talk about a wide variety of topics with children

Immediately after the diagnosis it is easy for diabetes-related conversation to dominate the household interaction. While this is understandable, make an effort to broaden out the topics to include areas of interest that pertain to all members of the family. This will not only help siblings to feel their lives are important but will also help the child with diabetes to see that there is more to life than diabetes.

Limit the amount of responsibility you give regarding diabetes tasks

While it is fine to ask for sibling help now and then with diabetes-related tasks, limit the responsibilities. For example, it is okay to ask an older sibling to periodically check the younger sibling’s blood sugar, but be cautious about making this type of responsibility a routine task. Diabetes is a difficult condition to manage and can be stressful, even for teens.

Be deliberate about nurturing each child’s needs

In reality, you may end up spending more time and energy addressing the needs of your child with diabetes than the others. But this doesn’t mean you can’t make adequate time for the other children as well. Show interest in their activities and challenges. Affirm their skills, abilities and efforts. Each child will have their own unique relationship with you. Nurture it by giving them one-on-one time where there is lots of conversation and fun. This is one sure way to avoid the problem of favoritism for the child with diabetes.

 

_{Source: American Diabetes Association. "Diabetes Affects Siblings Too.”}

Pregnancy and Type 1 Diabetes

It’s very important that pregnancy in females with type 1 diabetes is planned and closely monitored from preconception until delivery by a diabetes team (endocrinologist, diabetes educator and dietitian) and an experienced obstetrician. Contraception should be used by females with diabetes unless there is active planning for a pregnancy. In the case of planning a pregnancy it’s important to have very good diabetes control, as well as any diabetes complications being stable, and folate supplementation having been commenced.

 

To ensure the best pregnancy outcomes it’s important that blood glucose levels (BGLs) are well managed both before and during pregnancy. Pregnancy should not be planned until HbA1c (3 monthly average of BGLs) is within or close to the range for people without diabetes. It’s important to aim for tight blood glucose control throughout the pregnancy while still avoiding hypos.

 

The risks of unplanned pregnancy or poorly managed diabetes during pregnancy include the risk of miscarriage, having a baby that is too large or too small and the baby having congenital malformations (especially heart or kidney problems).

Pregnancy may also increase the risk of progression of diabetes complications, especially eye damage. There is also a higher risk of developing raised blood pressure during pregnancy and problems related to it. Studies have shown that a well-managed pregnancy with good blood glucose control and regular monitoring can reduce these risks significantly.

 

During labour the medical team will monitor both mother and baby carefully. Insulin is usually required during labour and may be given by regular injections, pump or via a drip (intravenous infusion). It is possible to have a natural birth, however sometimes a caesarean section will be required to deliver the baby. Both mother and baby will be closely monitored after the birth. After the baby has been born, the mother will experience a significant fall in insulin requirements especially in the first few weeks – and this may be more marked with breastfeeding. The insulin doses will be lower than before the pregnancy.

 

More information on diabetes and pregnancy can be obtained from the Australasian Diabetes in Pregnancy Society –www.adips.org

 

To hear more about women’s experiences and medical guidelines, refer to “Diabetes and Pregnancy” by Alison Nankervis & Josephine Costa, Miranova Publishers 2001. ISBN 0 9587142 31. Available for purchase from Diabetes Australia-NSW.

 

Expert advice from Dr Glynis Ross, Endocrinologist at The Royal Prince Alfred Hospital is gratefully acknowledged.

 

Source: http://www.diabeteskidsandteens.com.au/living_with_diabetes_15.html

What Should I Eat?

Healthy eating is important for all kids, including kids with diabetes. Your body needs the right balance of healthy foods to grow and develop, and to help you look after your diabetes. Understanding all about the food you eat can help you to make healthy choices.

Healthy Eating is easy! 
Healthy eating is as easy as choosing foods from the “eat most” section of the healthy food pyramid everyday, with smaller amounts of “eat moderately” foods each day. The “eat only a little” foods should only be included in small amounts or enjoyed for treats.

 
To be healthy you need to eat a variety of food every day
This food pyramid is a good guide to making good choices

Kids with diabetes don’t need special foods, so your friends, brothers and sisters should all be eating the same healthy foods as you, everyday!

All About…Carbohydrates, Proteins & Fats 
Carbohydrates, proteins and fats are found in the food you eat. They give your body energy and help you to grow. Everyone needs the right amounts of carbohydrates, proteins and fats each day for good health.

Carbohydrates 
Carbohydrate foods give your body the energy to do all the things you like doing. When you eat carbohydrate foods, they break down into sugar or glucose in your body. With the help of insulin, your body uses this glucose for energy.

Carbohydrate foods are things like:
• Bread and bread rolls
• Breakfast cereals
• Dairy and soy milk, yoghurt, ice cream and custard 
• Fruit and fruit juice
• Starchy vegetables like potato, sweet potato and corn
• Rice, pasta and noodles
• Baked beans and lentils
• Snack foods like biscuits, chips, muesli bars
• Sugars and sugary foods 
• Takeaway foods like pizza, chips and burgers

• To look after blood glucose levels (BGLs) it’s important to eat carbohydrate foods at each meal and snack and try to balance these from day to day.
• Carbohydrate exchanges can help – exchanges (or serves) tell you how much carbohydrate is in different foods. Counting carbohydrate exchanges can help you balance the carbohydrate foods that you eat with your activity level and insulin dose. 
• The type of carbohydrate foods that you eat is also important. The best carbohydrates to choose every day are things like fruit, bread, cereals, low fat milk & yoghurt, starchy vegetables, rice and pasta. 
• Sugars and sugary foods are not the best carbohydrates to choose because they put a lot of glucose in to the blood stream and may cause high BGLs. 
• Some carbohydrate foods give you longer lasting energy. These foods are things like grainy breads, raisin bread, fruit, baked beans, pasta, noodles, yoghurt and milk. These carbohydrates are good when you need longer lasting energy, like before sport. They are also a great choice before bed.

Proteins
Protein foods are important to help you grow and develop. Protein foods are things like:
• Meat
• Fish
• Chicken 
• Eggs
• Cheese

Kids need about 1-2 serves of protein foods each day for good health. One serve is how much fits into the palm of your hand. Most protein foods don’t breakdown into glucose in your body, so they don’t raise BGLs. Unlike carbohydrate foods, you don’t need to count protein foods or eat these at each meal and snack. The best protein foods to choose are the ones that are the lowest in fat – like fish, lean meat, chicken without skin, eggs and low fat cheese.

Fats
Fats are important for good health, but you only need a small amount everyday. Fats are found in lots of different foods, especially:
• Butter
• Margarine 
• Oil
• Cream

Some fats are better for you than others. The best types to choose are the vegetable fats like margarine and vegetable oils. Fats don’t raise BGLs, but too much fat can lead to health problems like being overweight or having high cholesterol (a type of fat in the blood). Remember that fat can also be added to foods, especially things like snack foods and takeaways. Try not to eat too much fat or foods high in fat.

Food & Diabetes 
It is important for everyone to make healthy food choices. When you have diabetes there are some extra things that you also need to think about to help look after diabetes and keep you healthy. It is important to:

Eat your meals and snacks at the right time 
Depending on the insulin you are on, you might need to eat every 3 hours or so. If you forget to eat, skip meals or leave it too long until you eat, you might have a hypo (low BGL).

Eat carbohydrate foods at each meal and snack
You need to make sure that you eat some carbohydrate foods at breakfast, lunch and dinner and at snacks like recess, afternoon tea and supper. If you have been told to follow carbohydrate exchanges, try and eat around the same number of exchanges at meals and snacks each day.

Choose foods low in fat
Too much fat can be bad for your health. Try to choose low fat milk, yoghurt, and cheese. Watch out for foods that are high in added fats, like snack foods - crisps, biscuits, chocolates, cakes, donuts, as well as takeaways, fatty meats and fried foods.

Watch out for foods that are high in sugar
Foods high in sugar like regular soft drinks, cordials and lollies can cause BGLs to go too high. Make sure that you use diet / low joule soft drinks and cordials and try to save lollies for special occasions. Foods high in sugar can be used to treat a hypo.

Always carry hypo foods
Sometimes BGLs can drop too low and you can have a hypo. To treat a hypo, you need to quickly eat or drink something sweet and then eat something else straight away to stop the hypo from coming back. Make sure that you always have hypo foods like juice or jellybeans with you, plus follow up carbohydrate foods like plain biscuits or a muesli bar to stop you from dropping low again.

Healthy Eating Day 2 Day
To be healthy, it’s important to make healthy food choices from day to day. This means having a healthy lunchbox, having healthy snacks and being a detective in the supermarket and looking for healthy food choices.

Food at School

A healthy lunchbox…
It is important that you eat the right amounts of food at recess and lunch to help keep your BGLs mostly within the normal range. If you are not sure, mum, dad or someone at home can help by writing you a list for your lunchbox and labelling what to eat when. Stickers are a fun way to label your food! It is important not to skip recess or lunch or you might have a hypo.

Try some of these healthy lunchbox ideas:
• Sandwiches 
– try different types of breads like rolls, grain bread, Turkish bread, bagels, lavash or pita bread
– fill with your fave fillings like salad, low fat cheese, vegemite, ham, chicken, tuna, salmon, egg, baked beans, spaghetti or banana
• Pasta, potato or rice salad
• Fresh pieces of fruit eg. apples, pears, mandarins, oranges
• Chopped fruit eg. rockmelon, pineapple
• Fruit in zip lock bags eg. grapes, cherries
• Fruit snack packs (plus a spoon)
• Crispbreads, rice cakes or corn thins
• Pikelets, scones or low fat muffins
• Low fat yoghurt or dairy desserts
• Dried fruit boxes eg. sultanas, apricots
• Small tins of baked beans or spaghetti
• Low fat milk tetra pack
• Rice crackers or rice crisps

To keep lunch cool, add a frozen water bottle to your lunchbox or use a cool pack!

Lunchbox swaps…
If you want to do a lunchbox swap, make sure you are swapping something the same, like a sandwich for a sandwich. Otherwise you might not get enough carbohydrate and might have a hypo later. Try not to swap your lunch too often.

At the canteen…
Canteen foods are OK, but not a good choice everyday – once a week is plenty. Talk to mum, dad or someone at home about the best types of foods to choose from the canteen.

Special events at school…
Parties, birthdays and special events at school can be lots of fun. You can join in the fun like all of your friends and enjoy some special treat foods. Remember to tell mum, dad or someone at home when there's a party at school, this can help them work out if they need to make any changes to your insulin. They can also help you decide how to swap some party foods for your usual recess or lunch.

Snack Attack 
Snacks like recess, afternoon tea and supper are important to help keep BGLs mostly in the normal range. Kids love snacks and there are heaps of healthy snacks that you can try, like:

• Piece of fresh fruit e.g. apple, pear, banana, orange
• Chopped fruit – rockmelon, pineapple, honeydew
• Fresh fruit salad
• Frozen pieces of fruit
• Grapes or cherries
• Canned fruit snack pack e.g. two fruits, peaches, pears, fruit salad
• Dried fruit boxes e.g. sultanas, fruit salad, sultanas and apricots
• Low fat yoghurt
• Low fat dairy desserts
• Low fat custard
• Corn cob
• Pikelets with fruit jam
• Fruit loaf or fruit bun 
• Plain or fruit scones
• Crispbread or rice cakes with low fat toppings e.g. tomato, low fat cheese
• Popcorn
• Crumpets or English muffins
• Rice crackers with low fat dip
• Rice crisps
• Low fat fruit bars

Being a Supermarket Detective
Looking at food labels when you are in the supermarket can help you find the best everyday food choices. To work out the best choices, look at the nutrition panel on the food label. This tells you things like how much carbohydrate and fat is in different products. A nutrition panel looks like this:

Servings per pack: 1 Serve Size 200 g
	Per 200g serve	Per 100g
Energy Protein Fat Saturated fat Carbohydrate -total -sugar Sodium	864kJ 8.2g 5.0g 2.0g 31.8g 27.8g 298mg	432kJ 4.1g 2.5g 1.0g 15.9g 13.9g 149mg
Ingredients: Full cream milk, concentrated skim milk, skim milk, sugar, thickener, vegetable gums, mineral salts, flavour

To make healthy food choices, compare different products and look for foods that are lowest in fat, especially saturated fat. To work out carbohydrate exchanges, look at how much total carbohydrate is in the food in the amount that you are going to eat.

One exchange is the amount of food that contains 15 grams of total carbohydrate. Look at the amount of total carbohydrate in the per serve column, then divide by 15. For example, the food shown above is equal to about two exchanges because it has around 30 grams of total carbohydrate divided by 15 = 2 exchanges.

You can also look at the ingredient list to work out whether or not the food is a healthy choice. If fat (e.g. butter, cream, oil) or sugar (e.g. sugar, sucrose, glucose) are listed first or second then the product may not be a good everyday choice.

It’s party time!
Everyone loves parties, and kids with diabetes can join in and have as much fun as everyone else and enjoy some special treat foods. Mum, dad or someone at home will help you work out how to balance your food, activity and insulin dose when you go to a party.

Kids with diabetes can enjoy party fun as much as everyone else, but don’t forget to:
• Eat regular carbohydrate foods while you’re at the party 
• Take some hypo foods with you and make sure that an adult at the party knows what to do if you have a hypo
• Take some diet soft drink with you or maybe everyone at the party can have diet soft drink?
• Have a good supper that night – you might need extra carbohydrates at supper, especially if you have been running around a lot
• Have fun!!

Try some of these tasty party treats:
• Mini pizzas – with chicken, ham or vegies on top
• Pikelets – plain, banana or sultana
• Chunky chips or potato wedges
• Crumbed chicken strips
• Fish fingers 
• Chicken skewers
• Muffins – try berry, banana or choc chip
• Frozen fruit blocks
• Yummy yoghurt cups
• Fruit kebabs
• Ice cream in a cone
• A Paddlepop or Billabong
• Popcorn 
• Party pretzels
• Crackers and dip
• Chocolate mousse cups 
• Diet jelly cups
• Sushi

Food 4 Sport
When you are active you need extra carbohydrate foods for energy and to stop your BGL from dropping too low. You might need extra carbohydrate foods before the activity, then every 30-40 minutes, especially if you are really active. Sometimes you might also need extra carbohydrates at dinner or before bed, to stop you from having a hypo later on.

Try these great carbohydrates before sport:
• A piece of fruit
• A small flavoured milk 
• A muesli bar
• A fruit snack pack
• A crumpet or slice of raisin toast
• A ‘fun size’ chocolate bar

To top up during sport, try:
• A 100% fruit juice popper 
• A cup of sports drink
• A piece of fruit eg. banana, orange

Don’t forget to pack a hypo kit with hypo foods for sport.

Takeaways
Lots of takeaway foods can be high in fat and sugar. To be healthy, it is a good idea not to eat takeaways any more than once a week. When you choose takeaways, it is important to try and make the healthiest choices, look for lower fat takeaways like:
• Lean meat or chicken salad roll / wrap
• Doner kebab with lots of salad
• Plain hamburger with lots of salad
• A grilled chicken burger with lots of salad
• Baked potato (skip the butter)
• Toasted sandwich
• Corn cob 
• Sushi roll
• Vegie pizza or gourmet pizza 
• Toasted sandwich or focaccia
• Small bowl of pasta with tomato based sauce 
• Stir fried vegetables & noodles or plain rice

Take care with choosing drinks - avoid regular soft drinks as these are very high in sugar, choose diet or low joule drinks instead. If you are having juice, look for 100% fruit juice and choose a popper or small bottle.

Lots of takeaways are also very high in carbohydrate (eg. pizza, fries, smoothies). If you can, check out to see if the takeaway outlet has any nutrition information available. Many of the popular fast food chains eg. McDonalds, Subway, Krispy Kreme have nutrition information brochures that tell you the amount of fat and carbohydrate in their different products. Look for foods that are lower in fat and have about the same amount of carbohydrate to what you would normally eat at your meals. If you and your family adjust your insulin depending on what you eat, use this information to make sure that you take the right amount of insulin when you eat takeaways.

Healthy eating on an Insulin Pump…
Insulin pumps can be a great way to help manage your diabetes. If you decide to start on a pump you might notice that a few things about food are a little bit different…like closer counting of your carbohydrate exchanges / amounts, and more flexible meal times and amounts of food.

Why do you need to count carbohydrates?
We know that carbohydrate foods put glucose (sugar) into your blood stream for energy. The insulin you inject needs to match your carbohydrate foods (and activity) to keep BGLs mostly in the normal range. This is important whether you are on a pump or not.

When you are on a pump you can match your food and insulin more closely because every time you eat, you program the pump to give you quick acting insulin. Your diabetes team will tell you how much insulin you need to give for every carbohydrate exchange you eat. Some pumps even let you program in how many grams of carbohydrate you have eaten and it then works out how much insulin to give.

How do you work out how much carbohydrate is in different foods?
Your dietitian can help you work out how much carbohydrate is in different foods. You might need to weigh or measure some foods to help you count carbohydrates. You and your parents also need to be able read food labels to work out how much carbohydrate is in different foods.

Do you need to follow set carbohydrate exchanges?
When you are on an insulin pump you don’t need to eat the same number of exchanges at your meals each day. If you are not very hungry you can eat less and if you are really hungry, you can eat more. You can then give your insulin depending on how much carbohydrate you have eaten.

Do you need to eat snacks between meals?
On an insulin pump you don’t need to have snacks if you don’t want to, but it is important to eat three main meals a day to be healthy. Some kids still might need to have snacks to get the energy they need for all fun things they like to do.

Does being on a pump mean you eat anything you want?
When you are on a pump, you still need to make healthy food choices. Lollies, soft drinks, crisps and chocolates are not an everyday food for anyone. On a pump, you should still use diet or low joule soft drinks and keep snack foods as special occasion treats.

What do you do at school when you are on a pump?
At school, you need to remember to give your insulin bolus when you eat. To do this, you need to know how much carbohydrate is in the foods that you have at recess and lunch – asking mum, dad or someone at home to label the food in your lunchbox can help. Knowing the amount of carbohydrate in different canteen choices is also important.

What about food for sport when you are on a pump?
When you are on an insulin pump you can still play sport. You might find that you still need some extra carbohydrate foods for energy. On a pump you can reduce your insulin before and after sport and you might not need to eat as much extra food to prevent hypos. When you start on a pump your Dietitian can give you some extra healthy eating info.

Source: http://www.diabeteskidsandteens.com.au/foodnews.html

 

Information for parents of teens aged 13 - 17 years

A teenager aged 13-17 years with or without diabetes

 

Teenage years are a time of feeling different, making changes, testing limits, experimenting with decision making, making mistakes, challenging adult rules, feeling that nothing can go wrong, risk taking, enjoying life, looking forward to new challenges.

The teenager:
• May feel caught between their inner drives, peer group pressure and family expectations
• Is very self-conscious about physical development, physical health, sexuality
• Values possessions, popularity and status
• Develops "crushes" on peers
• Becomes angry with what they see as interference of parents in their life.
• May be moody and irritable
• Begins to reason and see things from different points of view
• Begins to handle a wider range of problems
• Seeks and develops a close circle of friends for social support and generally becomes more social

When a 13-17 year old is diagnosed with diabetes

•They may feel more and more angry having to consider their diabetes before they can do things that their friends take for granted, staying out late, applying for a driving licence
• They may find that eating, drinking, trying things out and general socialising with friends puts pressure on them as they try to be one of the gang and manage their diabetes
• There may be problems with willingness to carry out their diabetes management. It may become just too limiting, stopping them doing more interesting things
• The need to be accepted and being seen as attractive are of great importance. diabetes is seen as a hindrance to friendship and relationships
• They may find that the career path they want to pursue is one of the very few that excludes people with diabetes
OR
• They may sail through adolescence, managing everything beautifully including their diabetes!!

Living with diabetes

As your teenager progresses through the teenage years
• This age group gradually takes over all of their diabetes care, although it is important for them to have your support, encouragement and sometimes, advice. Continuing education sessions with the diabetes team will also help
• You and your teenager may become frustrated and irritated on occasions when there is lack of consistency of blood glucose results despite the effort put into insulin adjustments, exercise and diet. Blood glucose levels (BGLs) may be erratic due to varied activity and food intake, stress, varied rates of growth and development, hormonal changes, behavioural problems or difficulty adhering to diabetes routines
• Willingness to carry out diabetes management is sometimes a problem as the need for a routine interferes with a carefree existence. Doing things on the spur of the moment may be difficult and the need for adult supervision is still there, despite wanting to do their own thing
• The fear and embarrassment of hypos occurring in public may cause your teenager to 'run' their BGLs high
• Activity is often varied at this age and blood glucose levels may follow suit!
• 13-17 year olds may be more willing to have multiple injections once they realise it may give them more flexibility in their everyday life. This is not the best option for all teenagers, it may encourage them to skip their insulin injections. They may also start to use devices such as insulin pens or pumps which may make life easier
• Trying things out is a part of this age group's everyday life - it is important that your teenager understands the implications of drugs and alcohol and their possible influence on the management of their diabetes
• It’s important that you 'keep the door open' for when your teenager wants advice

Coping from Day to Day
The difficult thing for any parent is letting go. When your child has diabetes it can be even more difficult. It's not easy to let go and encourage independence. Your understandable concern may be perceived as lack of trust.

Changes in their diabetes management plan should be talked over with your teenager. This is a scary time for them. They want independence yet don't want to feel alone or ignored. Finding that happy medium between enough supervision and letting go is a real challenge for any parent!! Here are a few tips:

Negotiate
This is a great way for your teenager to learn to deal with others. Your concern may be seen as nagging, causing anger and resentment. However, your teenager may need to be reminded that your questions arise from concern and that it's part of your responsibility as a parent. You may even need to negotiate your negotiations such as "What can we do so that you don't feel I'm nagging and I know you're OK?"

Be consistent
Some rules are flexible but injections cannot be forgotten! Identification should be worn! Hypo food should be on hand! It is important to set clear limits. Teenagers need consistent rules to feel safe, but also need parents who can look at each situation on its own merit and decide when rules can be relaxed!!

Keep communicating
It may be strained at times but maintain the lines of communication. Your teenager needs to learn how to problem solve and subsequently make decisions. Their way of doing things may not be yours and there may be much discussion!

Ask how you can help
They may ask you to draw up their insulin once in a while or do some blood glucose recordings for them. Once they see that you are helping and not just interfering they are more likely to respond.

Give praise
When things are going well, praise your teenager on their management and sense of responsibility. Sometimes things don't go well despite everyone's efforts, and acknowledgement of this is important. Remind them that the payoff for being granted more freedom is for them to gradually take on more responsibility.

Be understanding
Recognise the frustrations for your teenager when things are not going so well.

Be patient
This is a difficult time for all of you. Remember that things will get better.

To care for your teenager you must care for yourself
diabetes takes a lot of time and energy so it's normal to feel frustrated and tired from the constant daily demands of management. Your emotions may change and recur (perhaps often) - guilt, frustration, helplessness, sadness, anger... and elation when all goes according to plan! Here are some tips on how to cope:

• Talk to someone who may understand, such as other parents of a teenager in the same situation
• Share your feelings with your partner, a friend or relative, support groups, your doctor, other health professionals such as a social worker or psychologist
• Share diabetes-related tasks with your partner
• Keep in touch with your educator as ongoing education can help you and your teen at different stages
• Don't be afraid to ask your health professional team for support and guidance.
• Encourage relatives or friends to attend education sessions and/or support groups to learn more about diabetes so that they may in turn give you support
• Camps are a good way to introduce your teenager to others going through the same things. These camps are only for teenagers with Type 1 diabetes and are divided into age-appropriate groups - 13-14 years and 15-17 years
• Find some time for yourself. It's worthwhile for the daily demands of parenting

Siblings
• Brothers and sisters may not like the sudden focus on the child with diabetes - Why all the fuss? Why do we have to rush home for injections? Why do we have to worry about food all the time? Your child with diabetes may well take advantage of this
• Brothers and sisters who previously had no axe to grind may suddenly find one. If they thought their brother or sister were the favourite prior to having diabetes, this may add to the problem 
• Brothers and sisters may fear that they will be loved less and pushed to one side in favour of the child with diabetes

Ideas for coping:
• Try to keep things as normal as you can (not always easy) and play down the diabetes as much as is possible. Try and spend some special time alone with your child without diabetes, doing something fun and that they really enjoy
• Be consistent in the way you discipline all your children 
• Some children worry that diabetes is catching or that their brother or sister with diabetes might die. They may think that something they have done has given their brother or sister diabetes - such as breaking a toy or not sharing. They may have nightmares, suddenly start wetting the bed or cling to you (Remember that there are health professionals to help you and your family). Your child's brothers and sisters need to know what is happening and to feel involved
• Families often find that they have become closer because of diabetes, so problems can be sorted out with patience and understanding
• Involving siblings in the initial diabetes education when appropriate may help

Physical Activity
Teenagers with diabetes should be encouraged to exercise regularly, the same as their peers. When doing any physical activity your teenager may have to adjust their diabetes routine.
• Experience and frequent blood glucose monitoring help determine the most appropriate way to deal with this – everyone responds differently
• Exercise increases the body's sensitivity to insulin (increasing the risk of hypos) and this effect may continue for 12 to 16 hours following the activity
• Blood glucose levels need to be measured before, during and after exercise
• Extra carbohydrate foods are often required before, during and after exercise, depending on BGLs and type of activity. For moderate and intense activities a general rule is one extra carbohydrate exchange / serve for every 30-40 minutes of exercise
• It’s important that your teenager packs a hypo kit to take with them to sport
• Exercise should be avoided if the BGL is above 15mmol/L particularly if ketones are present

Activities to be approached with caution 
• Activities that are solos in nature, take place in water or mid-air, or limit the individual’s ability to recognise and self-treat hypoglycaemia
• The Australian diabetes Society recommends that Type 1 diabetes is an absolute contraindication to Entry Level (qualified to plan and execute dives to 18 meter SCUBA diving)

Driving
When your teenager first mentions learning to drive, don't panic!! Any parent is anxious when their teenager wants to learn to drive. However, with a responsible attitude, driving is generally safe and research shows that people with diabetes do not have a greater frequency of motor accidents than anyone else. The major added risk for the teenager with diabetes is hypoglycaemia.

• It is very important that they have a good knowledge about hypoglycaemia, its treatment and prevention
• Driving and alcohol is not a good mix at any time and in a teenager with diabetes, it may cause delayed hypos
• It is wise for your teenager to check their blood glucose prior to driving a car and to have hypo treatment readily at hand
• Each State and Territory has its own regulations regarding the allocation of licences to people with diabetes
• For further information on driving and Type 1 diabetes visit: www.austroads.com.au

School

Your teenager may find that hiding their diabetes takes less energy than explaining and confronting it. Usually a few close friends are OK to tell, but they may not be keen to tell their teachers. This may cause problems if they have a hypo in class - if they eat something in class it will draw more attention to them. It is therefore important to encourage them to tell their main teachers, especially those who supervise sport. Telling them can prevent misunderstandings, for instance, when they have to suddenly leave the game to get an orange juice.

Three good reasons for your teenager to let the teachers know that they have diabetes:

1. Safety - So that the staff are aware that a student has diabetes. 
2. Convenience - They may have to eat a snack in class or on the sports field or leave the room for an injection. A hypo may make them lose concentration and appear inattentive. An understanding teacher may make life a lot easier.
3. Because they want to - One teacher may be someone they particularly relate to and talking about their diabetes is part of talking about themselves.

If your teenager doesn't want diabetes mentioned they have a right to privacy. However, their school should have official notice with a letter in their school medical records. If they don't want their diabetes mentioned during class, they should let their teachers and friends know that this is their wish.

Despite your teenager being reluctant for you to speak to their teachers, it is important to stress to them that authorities should be notified of their diabetes from a safety/legal point of view. Your diabetes educator or an educator from diabetes Australia may be able to help. Alternatively one of your teenager's friends may persuade them.

Your teenager may have to be the teacher regarding diabetes. Teachers and friends cannot be expected to understand problems relating to diabetes until they know more about it.

For more information about managing diabetes at school click here.

Examinations
In New South Wales there are four programs which deal with illness / misadventure and exam conditions for students with any difficulty.
1. School assessment policies. Determined and ruled by individual schools/colleges. They include arrangements in case of illness (hypo during an examination).
2. Special examination provisions. Run by the Board of Studies for the School Certificate Reference tests and HSC examinations.
3. Illness/misadventure program. Run by the Board of Studies for the HSC. It involves illness or misadventure immediately prior to, or during, the examinations.
4. Special access to universities. Run entirely by universities. Students who have experienced difficulties during Year 12, contact each university to whom they wish to apply, and ask for information on their special access program.

HSC/State Examination
In some States the school is required to send an "Application for Candidates with Disabilities" form together with a medical certificate, to the "Special Provisions for Students with Disabilities" Program at the Board of Studies. This is to be done six to twelve months prior to the examination. 
During examinations the student is usually allowed to: 
• Take bite-sized carbohydrate food such as dried fruit (but no noisy wrappers) to 'top-up' blood glucose levels throughout a lengthy exam
• Be seated near an exit so others are not disturbed if the student has to leave the room
• Take a blood glucose meter and test strips into the exam room
• Have a maximum of 5 minutes extra time per half hour of exam time for toilet breaks
• Have a maximum of 20 minutes extra time per exam to take remedial action if required
• Be seated in a separate room with a supervisor
• Take their insulin pump into the examination room and operate it according to medically prescribed guidelines

Special provisions are made on an individual basis with recommendations from your doctor. The student who experiences a hypo during the HSC (or equivalent) should apply to be treated as an “illness or misadventure case”. Students treated in this way can usually receive a mark based on a school assessment instead of their examination mark.

You can obtain further information from your teenager's school, diabetes Australia in your State or Territory or The Department of Education. These are listed below for your convenience.

New South Wales
Board of Studies NSW
117 Clarence Street, Sydney NSW 2000 
GPO Box 5300, Sydney NSW 2001
Ph: 02 9367 8111

Victoria
Victorian Curriculum to Assessment Authority
41 St Andrew’s Place East Melbourne Victoria 3002
Ph: 03 9651 4300

Tasmania
Tasmania Qualifications Authority
PO Box 147, Sandy Bay TAS 7006
Ph: 03 6233 6364

South Australia
Senior Secondary Assessment Board of South Australia
60 Greenhill Rd, Wayville SA 5034
Ph: 08 8372 7400

Western Australia
Curriculum Council
27 Walters Drive, Osborne Park WA 6017
Ph: 08 9273 6300

Queensland
Queensland Studies Authority
Level 7, 295 Ann Street, Brisbane
PO Box 307, Spring Hill QLD 4004
Ph: 07 3864 0299

Australian Capital Territory
ACT Board of Secondary Studies
186 Reed St Tuggeranong ACT 2900
PO Box 2901 , Tuggeranong ACT 2901
Ph: 02 6205 7162

Northern Territory
Northern Territory Board of Studies
14th Floor, Mitchell Centre, Mitchell St NT 0800
GPO Box 4821, Darwin NT 0801
PH: 08 8999 5767

Career options
In recent years a number of workplace discrimination cases against people with diabetes have been successfully challenged in the courts. With improved understanding and management of diabetes there are now few occupations from which people with diabetes are excluded.

Should your teenager need further information regarding career options, please call diabetes Australia in your State or Territory.

Risky Business

• Your teenager with diabetes is just like other teenagers, and is just as likely to take risks with their health. This occurs particularly in early teenage years when it is more important to be like their friends and to fit in socially, than it is to display healthy behaviour!
• Your teenager sees themselves as unstoppable and doesn't believe they could become addicted to something harmful, or that anything could go terribly wrong in their lives
• It's natural for you to worry that your teenager might make wrong choices. Mistakes will happen and usually lessons will be learned! This is a normal part of growing up
• Puberty in both boys and girls is a time when the need for insulin increases. Your teenager's blood glucose control will vary with growth and hormonal changes

Smoking
Smoking is harmful to the health of everyone no matter what their age and smoking should be discouraged in people with diabetes. Nicotine damages blood vessels. Smoking is also associated with high blood pressure, poor diabetes control and has additional risks in pregnancy.

Alcohol
Teenagers with diabetes need to be aware of the additional risks of drinking alcohol. Alcohol blocks the body's natural method of correcting hypos, and may lead to them being undetected. The combination of alcohol-induced confusion and a low BGL is dangerous. Reaction times during a hypo have been shown to be reduced. Hypos can also occur many hours after drinking alcohol.

 

Whether or not you allow your teenager to drink, they may experiment with alcohol anyway. Your teenager is advised to:
• Drink in moderation and avoid binge drinking
• Not exceed the recommended safe intakes – 2 standard drinks for adult males, 1 standard drink for females
• Avoid consuming alcohol on an empty stomach
• Test BGL regularly during and after consuming alcohol
• Eat carbohydrate foods while consuming alcohol – regular soft drinks or juice are suitable if there is no food available
• Eat snacks and meals on time
• Test BGL before going to bed, eat a bedtime snack and make sure their BGL is above 8mmol/L.
• Don't count alcohol as part of carbohydrate exchanges.
• Always carry some medical identification, so that if an emergency situation arises, appropriate action may be taken
• Have a friend that knows about diabetes and can recognise the signs of a hypo and knows how to treat it
• When combining alcohol with being physically active such as dancing at parties, try to check BGLs. This may not be possible in every situation. Alternatively, check BGLs before going out and then again before bed, to prevent an overnight hypo. Ensure BGL is above 8mmol/L before bed. Asking a parent or family member to do a 3am BGL is another way of preventing an overnight hypo

There are ways of stretching drinks so that it's still possible to be part of the crowd without feeling pressured to keep up! 
• Alternate alcoholic drinks with non-alcoholic drinks such as Diet Coke or lemon, lime and bitters
• Halve the serve of alcohol per drink. Two drinks can become four by ordering wine spritzers (half wine and half soda), half nips of spirits with soda/diet mixers in a tall glass, or shandy (half beer and half lemonade)
• Choose low alcohol beers

Your teenager may feel more comfortable talking to their doctor, dietitian or diabetes educator by themselves to discuss practical aspects of living with diabetes (eg. parties, alcohol). This can help your teenager in managing their diabetes and taking more responsibility for their wellbeing.

Drugs
Drug use, which usually occurs with other risk-taking behaviour, is likely to be experimental or recreational and its effect on diabetes management may be minimal to severe. Tobacco and alcohol are the most common substances which have the potential to lead to abuse. Regular drug use affects diabetes control and this may be denied by the teenager.

Recreational drugs may:
• Alter awareness and understanding
• Alter consciousness and sensation
• Alter understanding and the ability to make judgements
• Reduce capacity and interest in achieving good blood glucose control
• Reduce interest in routines, injections and meal times
• Reduce appetite and interest in food, increasing the risk of hypos
• Increase the risk of hypos going undetected
• Stimulate appetite (marijuana) leading to high BGLs

Contraception 
As teenagers may not actively seek contraceptive advice, discussion about sexual activity and the need for safe contraception should be a routine part of management for all adolescents. Unplanned pregnancies for adolescents with diabetes can have a harmful effect on the mother and baby if diabetes care is neglected. However, with good diabetes control prior to conception and through to delivery, a healthy mother and baby should result.

Impotence
Fear of impotence is very real in this age group. This is unusual in the adolescent age group and may be minimised /prevented by good management of BGLs. Risk factors include increasing age, duration of diabetes and poor diabetes control.

Complications

Your teenager needs to know about the possible health effects of diabetes, and this should be relayed in a positive but sensitive way. Frightening stories of complications and long-term health problems will not motivate them but rather make them dwell on bad things that could happen. It may cause them to give up their diabetes care altogether because 'it won't matter anyway'. Make sure they are up to date with diabetes education, and that they are well informed about how to minimise their risk of developing complications.

Screening for complications is usually carried out yearly, but depends on the advice of your teenager's diabetes specialist. With a detailed screening program early signs of complications can be detected before they affect health. The following checks should be performed:

Eyes
Yearly testing of the back of the eye (retina) by an opthalmologist or trained optometrist is advised.

Kidneys 
Yearly testing of kidney function by your diabetes specialist is advised.

Feet
A yearly visit to a podiatrist is necessary to check for pain, numbness, sensation, ankle reflexes and response to pinprick.

Blood tests
A yearly blood test to check cholesterol, triglycerides and other associated problems is advised.

Early detection is positive because:
• Prompt treatment in many cases results in improvement.
• It warns people to take extra care of their diabetes.
Some doctors perform these tests in their hospital clinics or private rooms. For further information contact your local diabetes centre or specialist paediatric unit.

It will help your teenager to receive some re-education, perhaps with a friend, and to be given some information regarding drugs, alcohol, contraception and complications.

What does any teenager do with food at this age?

Being a teenager is a time of growing up and becoming an adult, testing out independence and trying new and different things. This means that teenagers often hate strict regulations and being told what to do. This includes being told what to eat!

You may notice that your teenagers eating patterns change, often this means:
• Missing meals, particularly breakfast
• Eating snacks, especially in the afternoon after school and grazing right up until dinner
• Eating takeaway food after school
• Wanting unconventional meals at different times eg pizza for breakfast!
• Experimenting with alcohol
• Drinking excessive amounts of soft drink
• Having distinct food likes and dislikes
• Eating more than adults - especially teenage boys
• Trying out fad diets

 

Riding the food merry-go-round... of diabetes

Some of the typical teenage eating behaviours may pose particular problems for teenagers with diabetes.

Missing Meals
For a teenager without diabetes the result of missing meals and eating at unconventional times is most likely hunger pains, mood changes and snacking on junk food. However, for a teenager with diabetes there is the potential for more serious risks such as varying BGLs.

Teenagers usually don’t want to appear to be different from their friends. Those with diabetes may feel resentful that their diabetes management plan interferes with their social life. It’s common for teenagers to experiment with missing injections or varying injection times or food. This may be the age when multiple injections and/or insulin pens are worth considering. For some teenagers it provides a more flexible way of managing their diabetes for others it may not be the best option. Any changes should be discussed with their doctor, dietitian and diabetes educator.

Skipping breakfast
Mornings are not everyone's best times and this applies equally to teenagers. Breakfast is important for good nutrition, concentration at school and managing BGLs. If your teenager doesn't feel like eating, try some of these ideas for breakfast in a flash:
• Cereal and low fat milk
• Fruit and low fat yoghurt
• Toast, such as raisin 
• Warm muffin
• Toasted sandwich
• Milo with low fat milk
• Crumpet or toast with banana, peanut butter or honey
• Fresh or canned fruit
• Low fat flavoured milk

Takeaway Foods
Takeaway foods often feature heavily in teenage eating patterns. Many of these foods are high in saturated fat and not suitable every day choices. Try to encourage variety in your teenagers eating habits and the better takeaway choices where possible.

Better takeaway choices include:
• BBQ chicken on a roll
• Plain hamburger with salad 
• Doner kebab and salad 
• Toasted sandwiches or focaccia 
• Grilled fish and chips
• Asian stir-fry or noodle dishes
• Vegetable based or gourmet pizzas
• Fruit smoothies or low fat milkshakes
• Low fat flavoured milk drinks
• Reduced fat ice cream / frozen yoghurt
• Diet or low joule soft drinks

Filling them up!
Teenagers, particularly teenage boys, seem to eat extremely large amounts of food. These changes in appetite are normal during growth spurts and need to be discussed with the diabetes team so that insulin dose is matched with food intake. To ensure that your teenager is growing up but not out, it’s also important to encourage healthy ‘filling’ food choices based on wholegrain breads, cereals, fruit, vegetables and low fat dairy foods.

Disordered Eating
At puberty, teenagers experience a growth spurt, weight gain and significant changes in body shape. This can cause some teenagers to become very concerned about their appearance. Appetites will increase during growth spurts and insulin requirements will vary in response to hormonal changes. BGLs can be difficult to control and it’s important to seek regular and appropriate advice regarding changes to diet and insulin regimens.

Preoccupation with weight most often occurs in girls but may be present in boys. Dieting behaviours are common and in some cases eating Disorders can be the result. Fad diets can be harmful due to their variable carbohydrate and poor nutrient content. Diet pills are sometimes seen as a quick solution but have side effects and are not recommended. Encouraging teenage girls in particular to remain active in high school can help improve body image and assist with maintaining a healthy weight. Advice from a dietitian can also assist to identify and manage weight problems.

Warning signs of an eating disorder include: 
• Preoccupation with food
• Converting to vegetarianism
• Skipping insulin injections
• Extreme weight loss
• Wearing multiple layers of clothing (to cover what is perceived as fat)
• Trips to the bathroom after meals or snacks
• Food restriction followed by binge eating

If you are concerned your teenager is at risk of an eating disorder, seek the advice of your diabetes team

Source: http://www.diabeteskidsandteens.com.au/parents_and_carers_5.html