Your Child Has Diabetes
You have recently learned that your child has
insulin-dependent diabetes (also known as Type I or juvenile
diabetes). After the initial shock, you may feel tremendous
anxiety about two questions:
- Will I be able to do what is necessary to protect my
child's life and health?
- Will my child be able to live a full and normal life?
As parents and members of Juvenile Diabetes Foundation
International, we have had the same experience and faced the same
concerns. We want to assure you that the answer to each of these
questions is a resounding "Yes!" What now seems like a
lot of confusing instructions and techniques will soon become
second nature to you, and before too long (depending on age of
onset), your child will learn to take over much of his or her own
care. For right now, bear in mind that--
- You must believe that diabetes will not prevent you or
your child from living a full and active life.
- You are not alone--there are lots of ways your local JDF
Chapter can help you, from counseling to common sense and
support. Use your JDF International neighbors!
To help out, we've compiled some information and advice you
may find useful. This is not a comprehensive brochure. There's
much to be learned about diabetes, and you will certainly want to
educate yourself thoroughly. After all, the more you understand
what diabetes is and how it works, the better able you will be to
live with it, and help your child live with it. However, we hope
this booklet will provide you with a quick introduction and handy
reference source for basic questions.
Some Basic Definitions
What is insulin-dependent diabetes?
In this type of diabetes, also known as Type I or juvenile
diabetes, the pancreas does not produce insulin needed by the
body. Insulin is a hormone that allows the body to burn glucose
(a form of sugar produced when starches and sugars are digested)
for energy. Without insulin, unused glucose builds up in the
blood, and overflows into the urine.
Insulin injections allow your child's body to use glucose for
energy. Insulin is essential in keeping blood sugar levels
The rule of thumb is: food makes the glucose level
rise; exercise and insulin make the glucose level fall.
Hypoglycemia/Low Blood Sugar (Insulin Reaction)
Sometimes called insulin shock, this is when the blood sugar
level drops rapidly. It happens suddenly if a child using insulin
eats too little food, doesn't eat soon enough, or exercises too
much. This condition must be treated quickly because hypoglycemia
can lead to unconsciousness.
- Symptoms include crankiness, sweating, rapid
pulse, cold skin, trembling hands and feet.
- Treatment priority is to get sugary food into the
child fast. Fruit juice, candy, non-diet soda are
suggested. If necessary, liquid sugar, jam or honey can
be rubbed on the inside of the child's cheek with a
finger. Once the reaction subsides, the child should be
given a more non-sugar food to prevent a recurrence.
Milk, bread, crackers are advised.
Diabetic Coma (Ketoacidosis)
This is a diabetic emergency that develops gradually if a
diabetic gets into a state of "hyperglycemia"--too much
sugar and not enough insulin to use it--and the condition isn't
treated. Since the body can't use the sugar for energy, it
"steals" energy from the fats stored in the body. When
fats are broken down, "ketones" are released: too many
ketones become poisonous, and without proper treatment, the
diabetic may fall into a coma requiring hospitalization.
- Symptoms include dry, hot skin, excessive
urination, excessive thirst, drowsiness/lethargy, deep
and/or labored breathing, fruity-smelling breath,
elevated sugar and ketones in blood.
The Goals of Diabetes Control
"Control" means keeping the level of sugar in the
blood as close to normal as possible. The goal of control are:
- To achieve the right balance between insulin levels, food
intake and exercise.
- To avoid the problems (hyper- or hypoglycemia) that
result from too high or too low blood sugar levels.
- To maintain normal growth and development for your child.
Because children with diabetes have special needs, we
recommend a "team approach" to your child's medical
care. The team should include a physician or pediatrician who has
experience treating children with diabetes, a nurse-educator, a
dietitian who can help with your child's special dietary
considerations, and perhaps a social worker. For recommendations,
and for listings of diabetes specialists and diabetes treatment
centers, contact your local JDF chapter.
Caring For a Baby With Diabetes
Crying may mean nothing important--or it may mean the
beginning of a drop in your baby's blood sugar level (insulin
reaction). What should you do?
- Monitor the baby's blood sugar level yourself and
eliminate your doubts about the crying. You can use a
commercially available self blood glucose monitoring
- Give the baby some juice or a sugared snack if he keeps
crying for no apparent reason and if you are not able to
check his blood sugar level. As a general rule, it's
better to err in the direction of too much sugar
(hyperglycemia) than too little sugar (hypoglycemia).
- Best syringes for babies are the low-dose disposable
syringes that only measure up to 30 units (one unit per
line). They are intended for use with U-100 insulin only.
- Rotate site of insulin injection. It is important that
you give each injection spot a rest between injections in
order to avoid lumps of depressions under the skin. There
are charts available from your
local JDF chapter that show various places on the
body that can be used for injecting insulin.
- Keep insulin at room temperature to make the injection
- Be calm, direct, firm in giving the shot. Remember,
giving the injection is necessary for your baby's life.
Your attitude in giving the injection is very important
to the way your baby receives it. If you are fearful or
shaky, your baby will feel your anxiety and be upset by
- Both parents should give injections. The baby should not
depend on one parent exclusively.
- After a shot of insulin, the baby must eat within a
reasonable period of time. Even if the baby doesn't want
to eat, you must find a way to feed him.
- Small snacks may work better than larger, regular meals.
You will have to experiment to find out what works, but
it may be useful to have an assortment of snacks on hand:
hard-boiled eggs, sliced fruits and whatever else you and
your doctor or dietitian work out.
- Check commercial baby food labels for added sugars and
avoid those that have it. You may want to try making your
own baby food in a blender or food processor.
- If a baby is unconscious or won't take sugar by
mouth, 1/2 cc of glucagon (a safe prescription drug that
causes blood sugar levels to rise) should be injected
into the buttocks to raise blood sugar and make the baby
alert enough to take oral sugar. If there is no response
in 15 minutes, inject another 1/2 cc and call your
physician at once for further instructions. (Note:
Vomiting may result from administering glucagon.)
- Avoid risk of reaction at night or during a long nap by
giving your baby a snack before sleep.
- If a baby vomits after an insulin injection, he
must eat something which has enough carbohydrates to ward
off an insulin reaction but which won't upset his
stomach. Non-diet soda or popsicles are recommended.
Discuss the situation with your doctor before it arises.
- Loss of appetite is another problem because nourishment
must be taken to balance the insulin. Your doctor may
adjust the baby's insulin dosage during even a mild
- Blood: With blood glucose monitoring, a drop of
blood is placed on a chemically-treated strip which is
then put into a meter for a blood sugar reading. It is
believed that with more precise monitoring and better
control, the complications of diabetes can be reduced,
- Urine: Urine tests can be used to monitor ketones,
whose presence is a warning sign of ketoacidosis that can
lead to a diabetic coma. Wring out a recently wetted
diaper to obtain a baby's urine sample.
- Give the sitter a brief course in diabetes so she can
recognize the onset of an insulin reaction and know what
to do about it. (See JDF brochure A
Child With Diabetes is in Your Care.)
- Provide snack food for the baby and detailed
- Always have food and insulin in your hand luggage. Be
prepared in case of delay. Insulin does not need to be
refrigerated; any cool place where it will not overheat
or freeze is okay.
- Have letters from your doctor explaining your syringes in
case your suitcase is examined. Be sure to bring
prescriptions and information about doctors along your
- Carry spare bottles of insulin in case of breakage.
- Carry an adequate supply of insulin and syringes,
particularly if you are visiting a foreign country, so
that you won't have to buy unfamiliar products.
- Climate changes may affect the baby's insulin needs. Talk
to your doctor about this and be alert for any changes.
- Sunburn or heat from being on the beach can affect blood
- Time changes must be considered in planning the baby's
eating and injection schedule.
Caring For A Child With Diabetes
Diabetes does make a child somewhat different from classmates
and brothers and sisters who do not have diabetes. The trick is
for you to help your child accept the difference with a minimum
of fuss. You must learn to provide supervision while giving
your child responsibility to learn SELF-CARE and control. How
quickly a child takes on responsibility varies, but to encourage
independence and relieve anxiety, allow your child to participate
to the full extent of his ability.
Diet, exercise and insulin are the three building blocks of
- Diet: Other than concentrated sweets, children
with diabetes can eat the same ordinary nutritious food
the rest of the family eats. The only real difference is
that both the amount of food the child eats, and when he
eats must be as consistent as possible.
- Exercise is important because it burns sugar
without insulin and keeps blood sugar levels down. Before
strenuous activity, your child should have an extra snack
to avoid too sudden a drop in blood sugar.
- Insulin dosage and the number of daily injections
will be determined by your child's physician. Even after
your child starts to manage his or her own injections,
you should administer it occasionally so you won't forget
the technique if an emergency arises.
Be Realistic About Control
- There is no such thing as perfectly controlled blood
sugar and no matter how well-regulated the insulin dosage
may be, children are too busy and diversified in their
daily activities to lead an "ideal" predictable
What About Unexplained High Blood Sugar?
- If a child's blood or urine test shows a high sugar level
that seems to be unexplainable, keep in mind that it
doesn't always mean he or she has eaten excessively or
inappropriately. A child can be very responsible about
diet and insulin and still spill sugar occasionally.
Particularly during adolescence, hormonal changes make
diabetes especially hard to control.
- Straying from one's meal plan from time to time is not
life-threatening. One chocolate bar never hurt a child
with diabetes, and may in fact be a good source of sugar
before exercising. Remember, sugar can be a friend as
well as an enemy.
Your Child's Anxiety
- Children with diabetes worry more. And why not?
Children with diabetes are threatened both physically and
psychologically--they have important responsibilities and
know that diabetes can do unpleasant things to them. As a
parent, you must be sympathetic without becoming
- Self-care creates self-confidence. Self-care is a
lot to ask of a child. But as your child masters the
situation and understands the cues which tell him how he
is doing, he will gain a means through which maturity,
independence, self-esteem and self-control can be
Adolescence: Difficult Years
Teenagers often seem incapable of following their self-care
routine. They have mood swings, rebel against authority, are
grumpy and distant. You may wonder if bad attitude is the reason
their blood glucose levels are so difficult to control.
The fact is, hormonal changes which no one can control are
affecting your child's blood sugar levels. Even if your child is
conscientious about self-control, there may still be big swings
in glucose levels. So remember, poor control is not just "in
their head"--it's in their body too.
The Role of the Doctor
It is vital for a teenager to have a doctor he or she can
talk to freely without a parent getting involved. The doctor can
provide expert advice without making the teenager feel childish
or overly dependent.
Family Attitude Makes A Difference
The way you and your family respond to the situation will
determine the way your child accepts or denies his or her
diabetes and copes with its management. Evidence suggests the
- In an atmosphere or relaxed, knowledgeable, tolerant
though alert acceptance, a child with diabetes will
thrive physically and emotionally and take responsibility
- An overly strict or punishing attitude will often result
in an angry and rebellious child who deliberately fails
to take care of himself.
- Parental denial of the significance and dangers of
diabetes will induce the same denial in the child, also
resulting in poor control.
- An over-protective parent will produce an overly
It's a difficult balancing act for parents, but we have found
that by accepting the realities of living with diabetes--by
understanding every aspect of the disease--our children will
learn to do likewise and lead full, active lives "like every
Please call your local chapter
of JDF International if you want to talk to others who are
dealing with the same problems you and your family are facing.
Copyright © 1996 Juvenile Diabetes
Foundation International. ALL RIGHTS RESERVED.
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CURE, 1-800-JDF-CURE and 1-800-WALK-JDF are Trademarks and
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