Five Basics of Diabetes Management for Kids with Type 1

When your child has been diagnosed with type 1 diabetes, it can be overwhelming and frightening. Suddenly it seems like there is so much to learn, and so much to keep track of, that life will never be normal again.

Life might never go back to the way it was, but it will go forward and with support and teaching, it will become manageable. There are five major areas that parents need to focus on when their child is diagnosed with type 1 diabetes.

1. Understand Insulin Dosing

Because your child's body can no longer make insulin, it must be replaced throughout the day, usually by injecting it. There are several methods of insulin dosing:

• Fixed doses of intermediate and rapid-acting insulins. With fixed doses of insulin your child must have meals at the time of insulin peak action. Meals should be as close as possible to the same time every day with the same proportions of carbs, fats and proteins.

• Kids who take long acting insulins such as Lantus still need to take rapid acting insulin doses at meals. The amount of rapid acting insulin is calculated depending on the carbohydrate content of the meal.

• Kids who use insulin pumps also need an additional rapid-acting insulin dose before meals based on the carbohydrate content of the meal

• Insulin Action Reference Chart
• How To Give An Insulin Injection

2. Blood Glucose Testing Is Vital

Your child's blood glucose should be tested before meals and at bedtime. The National Diabetes Education Program recommends blood glucose levels for children. They vary by age group and may be adjusted depending on your child's individual experiences with hypoglycemia. The recommended levels may seem high compared to levels for adults with diabetes. The reason behind the higher numbers is because children, especially young children, are at an increased risk for hypoglycemia. Please see the chart at the end of this article outlining the blood glucose levels.

Keep a journal of meals and blood glucose numbers, times and physical activities to get the big picture of how to manage your child's diabetes. That way, you'll get a feel for the fluctuations in your child's blood glucose and be able to keep it at a more even keel.

• Download the ADA Diabetes Record Keeping Guide
• How to use a Glucometer

3. Learn to Manage Low Blood Sugar

Also known as hypoglycemia, low blood sugar is a common problem for kids with type 1 diabetes. Symptoms include:

• Irritability
• Shakiness, trembling or weakness
• Lack of coordination
• Drowsiness or confusion
• Headache
• Dizziness
• Double vision
• Convulsions or unconsciousness
• Blood glucose level below 70

Sometimes kids, especially younger kids, can't tell that they're becoming hypoglycemic or can't express what is wrong.

If your child's blood sugar is too low, have your child drink or eat a concentrated amount of sugar (approx. 10 to 15 grams) to raise the blood glucose value to greater than 80 mg/dl. Some examples of this would be:

• Two glucose tablets or 2 doses of glucose gel
• One small tube of cake decorator's gel
• Two to four pieces of candy
• Half a can of regular soda
• One-half cup of orange juice or other sweet juice such as grape. Juice boxes come in handy for this
• Seven to 10 jelly beans
• One to two tablespoons of honey

It's a good idea to keep a small bag in the glove compartment of your car packed with 15-gram portions of quick sugar sources such as the above.

If your child is unable to eat or drink, use a glucagon kit. Glucagon is a hormone that helps the liver release sugar into the blood. It comes in a kit and it is an injectable medication. It usually raises blood glucose within a half hour. Glucagon requires a prescription from your doctor.

Keep one or two kits ready and waiting before a hypoglycemic emergency happens. Practice using the kit. Your doctor, diabetes educator or the pharmacist might be able to provide you with a practice kit, so that you are comfortable using it before you need to.

If your child loses consciousness and you don't have glucagon, your child will need to go to the hospital immediately. It's a medical emergency.

4. Nutrition: Eating Right Is Key

A registered dietitian, nutritionist, diabetes educator or other healthcare professional should help you develop a plan of eating that is balanced so that blood glucose levels don't fluctuate too much, and also meets the needs of your growing child.

There are also good resources on the internet to help you gather information about nutrition and supplement your child's eating plan. The internet should not be your only source of information, however. You still need the support of healthcare providers who will get to know your child and his or her particular nutritional needs.

• Meal Plans for Diabetes Management
• Healthy Habits for Healthy Kids
• Recipes from KidsHealth.org
• Healthy Eating from the American Diabetes Association

5. Exercise Affects Blood Sugar, Too

Physical activity lowers blood glucose levels. Kids with diabetes should get regular daily exercise. Parents need to be aware that hypoglycemia can occur during exercise so kids should check their blood glucose levels before they start to exercise. If their blood glucose is low, they should have a carbohydrate snack and sit out until their blood glucose returns to a normal level (over 80 mg/dl).

Parents should make gym teachers, coaches and team managers aware of their child's diabetes and about the possibility of hypoglycemic reactions.

• The Safe Exercise Check List

_Sources:

"Overview of Diabetes in Children and Adolescents." National Diabetes Education Program. Aug. 2006. National Institutes of Health. 26 Mar 2007.

"For Parents and Kids." The American Diabetes Association. ADA. 26 Mar 2007.[/link]