Juvenile Diabetes Foundation International Educational Publications

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 normal.

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.

Professional Help

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

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 system.

• 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).

Injections

• 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 more comfortable.

• 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 it.

• Both parents should give injections. The baby should not depend on one parent exclusively.

Eating

• 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.

Insulin Reaction

• 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.

Minor Illness

• 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 illness.

Testing

• 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, even reversed.

• 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.

Baby Sitters

• 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 instructions.

Travel

• 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 route.

• 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 sugar levels.

• 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.

Controlling Diabetes

Diet, exercise and insulin are the three building blocks of diabetes control.

• 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 day-to-day life.

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 over-protective.

• 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 achieved.

Adolescence: Difficult Years

Hormonal Changes

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 following:

• In an atmosphere or relaxed, knowledgeable, tolerant though alert acceptance, a child with diabetes will thrive physically and emotionally and take responsibility for self-care.

• 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 dependent child.

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 other kid."

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.

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