Having Kids with Type 1 Diabetes

Both my son's have Type 1 Diabetes and it seems more and more kids lately are developing this mystery disease. But what Is Type 1 Diabetes? According to the Junior Diabetes Research Foundation, they simply explain it this way:

 

"Type 1 diabetes (juvenile diabetes) can occur at any age, but most commonly is diagnosed from infancy to the late 30s. In this type of diabetes, a person's pancreas produces little or no insulin. Although the causes are not entirely known, scientists believe the body's own defense system (the immune system) attacks and destroys the insulin-producing cells in the pancreas. People with type 1 diabetes must inject insulin several times every day."

 

When our oldest, Russell, got sick, we had no idea what the symptoms where. Honestly, we thought he was going through a growth spurt. But is just wasn't right. He was thirsty all the time, soaked his bed every night, lethargic and eating more then normal but losing weight. I took him to the doctor and they did a simple urine test and checked his blood. At the time his brother was only 4 months old and sleeping in my arms. As soon as the tests came back, the Dr. told me I need to get him to the ER right away! I called my husband and we raced to Children's Hospital. He spent 1 night in the ICU as his blood sugar numbers where so high and out of control.

 

We felt guilty waiting so long to take him in, but honestly had no idea what was going on in his body. He spent 4 days total at the hospital (they did move him to a reg. room after the first day) so my husband and I could be educated on how to take care of him at home.

 

A few short years later, his little brother Brian was also diagnosed weeks before his 3rd birthday. He was showing the same symptoms for about a week or so and so we used his big brothers meter to check his blood sugar. Finally, while on Russell's 7th birthday, we decided to take Brian to Children's Hospital as the blood sugar meter kept saying "hi" (meaning his numbers where over 600). He spent 5 days at Children's Hospital because he also developed a viral infection.

So now we have two kids with Diabetes, two kits, two sets of insulin, meters, syringes, test strips, etc. All the tools of the trade to manage this mystery disease from home. But we do manage it. The kids have taken it on as normal as brushing their teeth.

 

Both my kids are on Lantus (long acting insulin) and Humalog (short acting). Every morning they each get a shot of Lantus, units are different for each child due to age and weight. The Humalog is given every time they eat food with carbohydrates that fall within a ratio of their target blood sugar. For example, at lunch, my youngest may eat food that ads up to 25 grams of carbs, so if his blood sugar is within its normal range before he eats, his shot will be 1 unit of Humalog. Same applies with his big brother, just a different dosage ratio.

How do we figure out their dosages for Lantus and Humalog? Every three months since the date of their diagnosis, we visit the Endocrine Clinic at Children's Hospital here in Seattle. Their Dr. takes a blood sample, much like their finger pokes and that will tell her their A1C levels (A1C is a test that measures a patient's blood glucose level over the previous three months that might also help predict serious health complications like heart attack and stroke).

 

They also download their blood glucose meters to get a readout of their average blood sugars over the last few months. With this information, she can decide where the peaks and lows are, and where the Lantus and Humalog may need adjusting. Their Dr also has a computer program on the hospital database that helps with the calculations as well as "cheat sheets" we use for each child. You see. They many times have different dosages for the Humalog for EACH meal during the day, for EACH child. A chart for Breakfast, Lunch and Dinner (if they eat a snack, for example, mid morning, I use the dosage for breakfast to treat it if necessary).

 

We've been very lucky with Children's Hospital, they've got the best Endocrine team there and have helped us weather many storms through both boys dealing with illness or simply not able to get their numbers under control.

This leads me to another thing we have to watch out for, ketones. Or as we like to tell our kids, we need to fight the "ketone monsters".

 

What are Ketones?

Ketones are due to not enough insulin being available to meet the body's needs. The 2 main causes are illness/infections (the body needs extra energy to fight off a virus or bad cold) or forgetting to take an insulin shot. There are other causes, but the primary ones we've had to deal with are the two mentioned. Another bugger, which is worse, is acidosis.

 

Now acidosis is the result of letting ketones get out of hand. Perhaps insulin isn't available due to an emergency situation, or the person is simply not taking care of their diabetic needs properly. See, it is not high blood sugar that causes ketones or acidosis; eating sugar does not cause acidosis. Ketones come from the breakdown of body fat. The role of insulin is to shut off fat breakdown. Now if the stress hormones are high or there simply isn't enough insulin, fat will begin to break down. And the side product of fat breakdown is ketones production. In the early stages, it can be tested with urine. But if left undetected, ketones can also build up in the blood and eventually in the body tissues. When it gets this far, it will result in acidosis (DKA).

 

For example, my youngest spent a week at Children's Hospital when he got the stomach flu last February. He was so sick; we couldn't get him to keep any food or liquid down. Because he wasn't eating, his blood sugar dropped low, and we couldn't give him insulin to deal with the heavy ketones because he wasn't eating. So in turn, he was on an IV drip to help rehydrate his little system as well as supply glucose for his body to work with. Even the smallest amount of long acting insulin dropped him low to the point the Glucagon wouldn't work (that is an emergency glucose administered through as a shot to help the body draw stores of sugar from the liver). But because we where able to get him in and on an IV drip, he never got as far as DKA.

 

Our oldest son has also developed ketones because of the flu and or a head cold. His body will have really high blood sugars (only a couple of times has he had heavy ketones and low blood sugars, luckily never needing to be admitted, but did have an ER visit). So we follow a sick day management regimen and different calculations according to how heavy his ketones are so we know how much extra insulin he needs to get his blood sugar under control. As with any illness, lots of fluids, especially water are a necessity but even more so with diabetics.

 

So anytime my kids come down with even just a sniffel, we're on them to check for ketones and watching their blood sugars closely. We have test strips that can be dipped in urine that show a color code to how light or heavy their ketones are. Staying on top of their sick day management has prevented many trips to the ER.

 

What can my kids eat?

Anything! What is so nice about the insulin they're on; they're not restricted to how much food or type of food they can eat. We do, however watch how much fat (limited "fast food" and "junk food") and salt intake because it raises blood pressure as well as threatens the circulatory system. The reason fat restriction is very important because high cholesterol and diabetes are two of the four risk factors for developing heart disease. (The other two for developing heart disease is smoking and family history).

 

So I make a lot of my own foods for home. I've posted many of our favorite recipes at The Poor Chef website. I also input the nutrition information on a program I use at home that gives me the carb amount on home recipes per serving (FitDay.com). Another great resource for food items, especially if you're eating out (most restaurants now supply nutrition info) is a pocket book from Calorie King. I keep a copy in the car just in case, trust me, having extra resources to go to in a snap is so handy.

 

What about school?

Again, we are very lucky to have a great school district who supplies a full time nurse. Nurse Alice is the best. We have a system down for my oldest son Russell. I make his lunch and provide all the carb info for what is packed. She just has to add up what he's eaten and is able to use the "cheat sheets" I've provided so she knows how much insulin to give him at lunch time. We talk almost every day about his numbers so I have a complete log for when it's time to go to the doctor. It's a team effort and I can use all the help I can get. Brian isn't quite ready for school yet, but I know he'll be well taken care of when it's time.

 

I can't say it's been an easy road and wouldn't wish it on anyone. But if you're reading this and have a loved one with Type 1 Diabetes, I hope the information has been of some help. It's an ongoing education and we're so grateful to live in a time where medical breakthroughs are happening all the time. Who knows, maybe by the time my kids are in high school, there may be a cure for Diabetes. Until then, we'll keep managing their care, not let it get us down or hold us back from living a happy and normal life.

 

For more information regarding Type 1 Diabetes, please visit:

http://www.jdrf.org

 

"Understanding Diabetes, A Handbook for People Who Are Living with Diabetes", by H. Peter Chase, MD (aka: The Pink Panther Book)

 

This Article is Written by Kathleen Schmidt (c) 2009

Kathleen Schmidt:

Domestic Goddess and Work At Home Mom

877-762-1450

[http://www.zyourdream.com]

[http://twitter.com/IndigoBlue68]

Article Source: http://EzineArticles.com/?expert=Kathleen_Schmidt

Article Source: http://EzineArticles.com/2737142

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

Physical Activity and the Benefits of Being Active

Physical activity is important for all children, including children with type 1 diabetes. There is no reason for a child with diabetes to be excluded from or not participate in sport or any form of physical activity.

Benefits of being active

There are many benefits to physical activity, active children are more likely to:
• Be a healthy weight
• Be happy, relaxed and sleep better
• Maintain healthy growth and development
• Feel good, inside and out
• Have good coordination and be flexible
• Develop good social skills

Physical activity and diabetes

Physical activity may assist with managing blood glucose levels (BGLs) in children with diabetes. Physical activity usually lowers BGLs by making the body more sensitive to insulin. Sometimes BGLs may be higher prior to and following physical activity because of other hormones released during the activity. Rises in BGLs during activity are usually temporary and may be followed by lower BGLs and the risk of delayed hypoglycaemia, 12-16 hours following the activity.

Managing physical activity

There are some important things you need to consider when a child with type 1 diabetes participates in physical activity. These include:

Blood Glucose Testing
Blood glucose testing provides you with useful information about your child's response to exercise and will help you to determine how to manage your child's diabetes during physical activity. It's important to test before, during and after the activity.

Insulin 
Adjustments may be required to your child's insulin dose prior to and following exercise. This adjustment will depend on factors such as type of activity, duration and your child's individual response to the activity. Discuss insulin adjustments for physical activity with your diabetes team.

It's advisable not to give insulin into an exercising muscle as it is absorbed more quickly and may increase the risk of hypos. The tummy is the best place to give your child's insulin.

Carbohydrate Foods
Extra carbohydrate foods may be required before, during and after physical activity. This is very individual and depends on factors such as type of activity, duration, your child's individual response to the activity and BGL. As a guide, one additional serve or exchange of carbohydrate may be required for every 30-40minutes of exercise. Lower GI foods such as fruit, yoghurt, milk or raisin toast prior to exercise may assist in maintaining BGLs during physical activity.(GI)

Hypos
Hypoglycaemia (hypo) or low BGLs may occur as a result of physical activity. It’s important to make sure that your child has a hypo kit readily available when they are exercising (hypos). Teachers and sports coaches need to be aware of the risks of hypos during and following sport and allow your child to treat the hypo immediately and re-treat if necessary. Click here to view The Schools Pack.

Exercise may also cause delayed hypoglycaemia for 12-16 hours afterwards. To prevent delayed hypos, it's important to ensure that your child eats additional carbohydrate following the activity and that bedtime BGLs are above 7mmol/L. Testing your child's BGLs overnight is also advised after strenuous physical activity.

Lowering the insulin dose, giving extra carbohydrate foods and carrying out regular blood glucose testing can reduce the risk of hypos.

Physical Activity & High BGLs
Physical activity should be avoided when your child is unwell or their BGL is over 15mmol/L with the presence of ketones. Exercise at this time may increase your child's BGL even further causing them to feel more unwell.

High risk activities

There are some activities that need a cautious approach when undertaken by children and teenagers with type 1 diabetes. These include: 
• Sports which are solo in nature
• Activities which take place in a potentially dangerous environment such as mid air or in water
• Those which limit the ability to recognise and self treat hypos

High risk activities include rock climbing, flying, abseiling, car and motorbike racing, skiing, swimming, surfing and snorkeling. The older child or teenager with type 1 diabetes may be able to participate in these activities with careful planning.

Sports that should not be undertaken include scuba diving, solo hang-gliding or solo flying.

Encouraging physical activity

Help your child or teenager with type 1 diabetes to be active by:
• Being an active parent
• Turning off the TV more often
• Limiting the time your child spends on the computer and playing video games to 30 minutes each day
• Encouraging active play such as skipping, ball games, bike riding, roller blading or walking the dog
• Finding fun activities that your child enjoys
• Waking your child to and from school if possible
• Being an active family, explore new places - parks, trails, walks and sporting facilities
• Encouraging your child to try new sports and activities like dancing, netball, swimming, athletics, cricket and soccer
• Keeping them active around the house

Source: http://www.diabeteskidsandteens.com.au/living_with_diabetes_8.html

What is Diabetes? - Animated Video

Diabetes Dictionary

A

 

 

Adrenal glands
Glands located at the top of each kidney that secrete important hormones for the function of many organ systems in the body.

Adrenaline
One of the secretions of the adrenal glands. It helps the liver release glucose (sugar) and limit the release of insulin. It also makes the heart beat faster and can raise blood pressure.

Alpha Cells
Alpha cells are found in the pancreas. They produce a hormone called glucagon, which raises blood glucose levels. 

Antibodies
Proteins that the body makes to protect itself from foreign substances.

Antibody
A special kind of protein made by the immune system that is released in response to something foreign in the body eg. virus. Antibodies help fight infection.

Autoimmunity
Pertaining to development of an immune response to one's own tissue. 

B

Basal Bolus Injections
Insulin injections four times a day.

Beta Cells
Cells in the pancreas that make the hormone insulin.

Biopsy
Removal of a small amount of tissue or fluid from the body, examined under a microscope to determine whether disease is present. 

Blood Glucose Level (BGL)
The amount of glucose (sugar) in the blood stream.

Blood Glucose Meter
A device used to measure blood glucose levels.

Bovine (beef) insulin
Insulin extracted from the pancreas of cattle. Has been replaced by human insulin.

C

Carbohydrate
A nutrient in food that provides a major source of energy. Usually found in grains, fruits, starchy vegetables and dairy foods. Is broken down to glucose in the blood stream and raises blood glucose levels.

Cannula
A small tube that is inserted into the body to assist in various methods of insulin delivery eg. pumps, insuflon.

Cholesterol
A fatty waxy substance made by the body and also found in some foods. High levels of cholesterol in the blood stream are a risk factor for heart disease.

Coeliac Disease
A condition where there is an intolerance to gluten, a protein found in foods that causes damage to the small intestine.

Complications
The long term effects of uncontrolled diabetes on the body.

Convulsion
A fit or seizure that can be a symptom of severe or untreated hypoglycaemia.

D

Dawn Phenomenon
This occurs when BGLs rise in the early hours of the morning due to the natural release of the hormones cortisol and adrenaline.

Diabetic ketoacidosis (DKA)
A sudden loss of control of type 1 diabetes with high blood glucose levels and breakdown of fat leading to a build up of acids in the blood with nausea, vomiting and dehydration. Without urgent medical attention, DKA can lead to coma and death.

Diabetes Educator
A health professional who specialises in providing education about the management of diabetes.

Diabetes Dietitian
A health professional who provides advice on the dietary management of diabetes.

Diabetes Control and Complications Trial (DCCT)
A 10-year study (1983 - 1993) in the United States to assess the effects of intensive therapy on the long–term complications of diabetes.

E

Endocrinologist
A doctor who specialises in the management of diseases of the glands, including the adrenal, thyroid, pituitary, parathyroid glands, ovaries, testicles and pancreas.

Enzymes
A special protein made in the body that assists with naturally occurring biological functions of the body.

Erectile Dysfunction (Impotence)
The loss of a man’s ability to have an erection. Some men may become impotent after having diabetes for a long time because the nerves or blood vessels have become damaged. Sometimes the problem has nothing to do with diabetes and may be treated with counselling.

F

Fats
One of the three main classes of foods and a source of energy in the body. Fats help the body use some vitamins and keep the skin healthy. They also serve as energy stores for the body. In food, there are three types of fats: saturated, polyunsaturated and monounsaturated.

Fibre
A substance found in foods that come from plants. Fibre helps in the digestive process and is thought to lower cholesterol and help control blood glucose (sugar). The two types of fibre in food are soluble and insoluble.

Fit
A convulsion or seizure that can be a symptom of severe or untreated hypoglycaemia.

G

Gastroparesis
A complication of diabetes that causes delayed digestion resulting in unpredictable swings in blood glucose levels

Glucose
The body’s main source of energy.

Glucagon
A hormone made by the pancreas that causes the liver to release glucose from body stores. Manufactured glucagon is injected to raise blood glucose levels in a person with severe hypoglycaemia.

Glycaemic Index
A ranking of carbohydrate foods according to their effect on blood glucose levels.

Glycemic Response
The effect of different foods on blood glucose (sugar) levels over a period of time.

Glycemic Load
The predicted effect of a food on blood glucose levels that takes into account glycemic index and total available carbohydrate.

Glycogen
The body’s stores of glucose in the liver and muscle which release glucose (sugar) into the blood when needed by cells. Glycogen is the chief source of stored fuel in the body.

H

HbA1c
A test to identify the average blood glucose level over the last 2-3 months. Also known as glycosylated haemoglobin, this test measures the amount of glucose that attaches to red blood cells which depends on how much glucose is in the bloodstream. If BGLs have been high over the 2-3 month period, more glucose will attach to the red blood cells and HbA1c will be high. If BGLs are mostly within the recommended range, then HbA1c will be closer to the desired level.

Honeymoon Period
A remission phase after the diagnosis of type 1 diabetes when there is partial, temporary recovery of insulin production by the pancreas. The amount of injected insulin required to manage diabetes is significantly reduced. The honeymoon period may last a few months to a year.

Hormone
Hormones are chemicals released by special cells that tell other cells what to do. For instance, insulin is a hormone made by the beta cells in the pancreas. When released, insulin tells other cells to use glucose (sugar) for energy.

Human Insulin
Insulin that has been manufactured to be identical to that produced naturally in the human pancreas.

Hyperglycaemia
Blood glucose levels higher than the desirable range.

Hypoglycaemia
Blood glucose levels lower than the desirable range.

Hyperlipidemia
Too high a level of fats (lipids) in the blood.

I

IDDM 
Insulin dependant diabetes mellitus, now known as type 1 diabetes.

Immune system
A system of the body that provides protection from infection.

Infusion Set
Consists of a length of thin plastic tubing with a lock connector at one end, attached to a very small cannula placed under the skin. It is connected to the insulin pump and used to deliver insulin to the body.

Infusion Site
The place on the body where the infusion set needle is inserted under the skin.

Injection
The introduction of medication into the body with a delivery device eg. needle and syringe, pen, pump. A person with diabetes injects insulin by putting the needle into the tissue under the skin (called subcutaneous). Other ways of giving medicine or nourishment by injection are putting the needle into a vein (intravenous/IV) or putting the needle into a muscle (intramuscular/IM).

Injection Site
The place on the body where the insulin is injected.

Insulin
A hormone made by the pancreas that is responsible for controlling blood glucose levels.

Insulin Resistance
The inability of the body to recognise and use insulin as it should.

Intramuscular
Into the muscle.

J

Juvenile Onset Diabetes
Another name for type 1 diabetes.

K

Ketones
Acids in the blood formed when body fat is used instead of glucose to provide energy.

L

Lancets
A sharp needle like device used to prick the skin to test the blood glucose level.

Lipohypertrophy
Fatty lumps that form when insulin is constantly injected into the same area.

Long acting insulin
Insulin that is absorbed slowly into the body after injection. Commonly used in conjunction with short acting insulin in the management of type 1 diabetes in children.

M

Macrovascular 
Referring to the large blood vessels of the body.

Metformin
A tablet that lowers blood glucose levels by blocking the release of glucose from the liver. Usually used in the treatment of type 2 diabetes, sometimes used for weight management in children with type 1 diabetes in conjunction with insulin.

Microvascular 
Referring to the small blood vessels of the body.

Millimole (mmol)
A unit for measuring the concentration of glucose and other substances in the blood.

Microalbuminuria
Leakage of small amounts of protein into the urine.

Monounsaturated fat
A healthy fat that may help reduce the risk of heart disease. Found in olive and canola oil, nuts and avocadoes.

N

NDSS
The National Diabetes Services Scheme (NDSS) is a Federal Government funded initiative, administered on behalf of the Government by Diabetes Australia. For further information see Advocacy and Support.

Nephropathy
Damage to the kidneys.

Neuropathy
Damage to parts of the nervous system.

NIDDM
Non Insulin Dependant Diabetes Mellitus, now known as type 2 diabetes.

P

Paediatric
About children.

Paediatric Endocrinologist 
A doctor who specialises in the management of diseases of the glands, including the adrenal, thyroid, pituitary, parathyroid glands, ovaries, testicles and pancreas in children.

Pancreas
A gland or organ behind the stomach that produces hormones such as insulin.

Polydipsia
Excessive thirst and drinking large amounts of water.

Polyunsaturated fat
A healthy fat that may help reduce the risk of heart disease. Found in fish, vegetable oils such as sunflower oil, nuts and seeds.

Polyuria
Passing large amounts of urine due to excess glucose in the blood stream.

Porcine (pork) insulin
Insulin extracted from the pancreas of pigs. Has been replaced by human insulin.

Post-prandial
After a meal.

Protein
A nutrient in food that is important for growth, development and repair of tissues. Food high in protein include meat, poultry, fish, eggs, legumes and dairy foods.

R

Retinopathy
Damage to the small blood vessels at the back of the eye.

S

Saturated fat
A type of fat that has been shown to increase the risk of heart disease. Found in animal foods such as butter, full fat dairy foods, and fatty meats, as well as many processed and takeaway foods.

Sharps
A word commonly used to describe syringes, pen needles and lancets used by people with diabetes which require safe disposal after use.

Short acting insulin
Insulin that is absorbed quickly into the body after injection. Commonly used in conjunction with long acting insulin in the management of type 1 diabetes in children.

Sliding Scale
A method of insulin adjustment based on blood glucose levels.

Social Worker
A health professional who helps families cope with the diagnosis of diabetes and the impact on family life.

Subcutaneous
Underneath the skin.

T

Thyroid
A large gland located at the base of the neck that releases an important hormone for the control of normal growth and development in children, and maintenance of normal metabolism in adults.

Type 1 diabetes 
Also known as insulin dependent diabetes, occurs when the pancreas stops making insulin. Requires daily insulin injections for survival.

Type 2 diabetes 
Also known as non- insulin dependent diabetes, occurs when there is either insufficient insulin or the insulin produced does not work effectively.

U

Ultra short acting insulin 
These insulins are absorbed after injection and have a shorter duration than short acting insulins eg. Humalog and Novorapid.

Unit
A method of measurement eg. insulin dose.

 

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

Australian Diabetes Council