Your ten-year-old daughter tells you that she invited a new friend to the house for a playdate, and that her guest is new to the school and has diabetes.
According to the American Diabetes Association, 29.1 million Americans, or 9.3 percent of the population, had diabetes in 2012. These statistics show how important it is for everyone to understand the basic facts about the condition. If your child has a friend with a diagnosis of diabetes, you may have questions about her diet, any special needs you should be aware of and what you should do if a diabetic emergency occurs.
One approach is to talk with the child’s parent and ask if there is anything special that is needed during the time the girls will be together. You should ask for emergency phone numbers, what the child likes to eat and any additional questions that would make you feel comfortable caring for the child when she is in your home. You also might have playdates with the parent present until you feel more knowledgeable about the care involved.
The majority of youth with diabetes have type 1. A child with type 1 diabetes does not make insulin as cells in the pancreas are damaged — which usually leads to a total lack of insulin production. Insulin must be given through injections or an insulin pump to control blood glucose levels. Insulin taken by injection or pump does not cure diabetes. A child with type 1 diabetes will always need insulin as diabetes is a chronic illness that does not go away.
Type 2 diabetes has been shown to be on the increase in youth. The increase may be due to the rise in obesity and decrease in physical activity. A child with type 2 diabetes does make insulin but the body may not use it properly so the blood glucose level may be elevated. The child needs to adhere to a management plan that may include diet and exercise alone or may require oral medications and/or insulin injections. All children and teens with type 1 and type 2 diabetes must monitor food, medication and activity levels carefully to keep blood glucose levels as close to normal as possible.
The extent of involvement in diabetic self-care by children and teens depends on their motor development, ability to understand their individualized treatment plan and emotional maturity. The family and school should encourage and support their capabilities and willingness to participate.
School-age children gradually assume more involvement with insulin injections and blood glucose testing with adult supervision. They still need help with decision making about insulin adjustments as the amount of insulin a child receives depends upon the blood glucose level at meal time, the amount of carbohydrates that will be consumed at the meal and the expected level of physical activity. Children and teens usually test their blood sugar four times a day and either receive multiple injections per day or administer insulin as needed through their pump.
The goal for children and teens is to establish positive diabetes-related behavior patterns and maintain glucose levels as near to normal as possible. When diabetes is poorly managed and poorly controlled, it can lead to serious short- and long-term health outcomes. The short-term complications of poorly controlled diabetes are hypoglycemia or hyperglycemia.
Hypoglycemia or low blood sugar may be the result of too much insulin, delayed food, not enough food consumed at meals or missed meals, or excessive physical activity that was not planned for. Too-low blood glucose levels can result in an emergency situation.
Mild symptoms of hypoglycemia may include shakiness, dizziness or irritability. Treatment is a quick sugar source such as four ounces of juice or six ounces of regular soda. Symptoms of moderate hypoglycemia include blurred vision, slurred speech and behavior changes. Treatment is the same for mild hypoglycemia with a repeat blood test after 15 minutes and an additional sugar source if indicated. If a child has a sudden change in behavior, he should be treated for hypoglycemia. Severe hypoglycemia is an emergency situation — with an inability to swallow or a loss of consciousness — and you should notify emergency services.
The child’s family, school personnel or someone aware of the child’s health status can give a glucagon injection, but a parent not familiar with the child should call 911 immediately. Children and teens should always have their blood glucose monitoring kit with them and test their blood with any mild or moderate symptoms of hypoglycemia. If their blood glucose levels are low, they can easily drink a quick source of sugar and prevent a severe medical emergency. Children and teens have an individual target blood glucose level, and they need to know the steps to take if results are out of that range.
The other short-term complication is hyperglycemia or high blood sugar. Sometimes the blood glucose levels are elevated or above the child’s target range. This may result when the child receives too little insulin, eats more food than planned and insulin coverage is not enough, is stressed, is sick with an underlying infection and may be unaware of growth spurts. Symptoms of mild hyperglycemia may include thirst, frequent urination, fatigue or sleepiness. In addition to those symptoms, moderate hyperglycemia may include nausea and vomiting.
When a child has severe hyperglycemia, he will also have symptoms of labored breathing, confusion and loss of consciousness. Children and teens should always have their blood glucose monitoring kit with them and test their blood with any mild or moderate symptoms of hyperglycemia. With signs of hyperglycemia, the diabetes treatment plan needs to be adjusted as the child may need additional insulin, but if he has any symptoms of severe hyperglycemia, you should call 911. If children test their sugar as scheduled and comply with carbohydrate counting and insulin administration, glucose control should stay within their target range.
Complications of diabetes can be prevented by controlling and managing blood glucose levels. With poor glucose control, there is the potential for complications with kidneys, eyes, damage to the nerves of the arms and legs and elevated cholesterol and blood pressure. Regular eye exams, urine and blood tests and blood pressure screenings should be part of routine care. Children with elevated blood pressure should reduce sodium intake, have low-fat dairy products and have their weight and BMI monitored. In addition, if indicated, you should encourage weight loss and an increase in physical activity.
When children are newly diagnosed with diabetes, they are usually hospitalized. Diabetic teaching involving both the child and family begins immediately. Depending upon their age, they are taught how to test their sugar and how to administer insulin. As they mature, they learn all about calculating insulin based on their blood glucose levels and how to plan their meals and snacks.
Children are very adaptable and, with the right teaching and support, diabetic management becomes a part of their everyday routine and they can participate in all activities. There are times when children rebel and become frustrated. As parents, we have to be ready to provide whatever assistance they need and monitor their adherence to their diabetic treatment plan to prevent short- and long-term complications.
The best thing we can do for our children is to recognize their special interests, talents and strengths and provide venues to showcase how special they are.
Sheryl Zang, EdD, FNP, CNS-BC, is an Associate Professor at Downstate Medical Center, College of Nursing. A nurse for 38 years, she is presently running groups for diabetic children and teens.