Children and Diabetes

Type 1 diabetes is the most common form of diabetes among children. With the parallel rise in childhood obesity, more and more children are at risk for or diagnosed with type 2 diabetes. Dealing with diabetes during the childhood and teenage years adds to the challenges of growing up. Most kids don't want to be different.

The first guideline-help your child maintain or grow into a healthy weight to reduce the chance of type 2 diabetes. If your child is overweight, ask your doctor about testing for diabetes at about age ten or at puberty if your child has other risk factors.

If your child is diagnosed with diabetes, accept and manage it together in a calm, careful, and positive way.

  • Work closely with your child's healthcare team to manage diabetes and help your child grow nor-mally—physically, mentally, and emotionally.
  • Gradually involve your child in taking responsibility for his or her diabetes. Encourage rather than nag, even when things aren't perfect. Help your child learn when, how, and where to get help. Learning lifelong skills for diabetes management— and making them a habit—is part of growing up. Diabetes won't go away.
  • Get advice from your healthcare team about handling special eating events such as birthday parties, sleepovers, field trips, and active play or sports.
  • Be matter-of-fact, sensitive, and supportive as you help your child or teen learn about diabetes. A support group or diabetes camp for kids can help. Find a reliable Web site for kids about diabetes.
  • Help teachers, baby-sitters, coaches, school food service staff, the school nurse, and others who supervise your child understand your child's diabetes and how they can support the diabetes care plan. Meet with them. Write instructions, list symptoms, and provide phone numbers for your doctor and other responsible adults. Provide appropriate snacks. Teach a sitter how to do blood sugar checks and give diabetes medication, if needed. Ensure that your child has the time and privacy for diabetes care without discrimination.
  • Help your child or teen feel comfortable about asking to leave class or play to monitor blood sugar and take insulin.
  • Make diabetes management part of your parenting responsibility, but not the sole focus. Keep the joys of growing up and a healthy family life.

For more parenting tips, see chapter 16, "Food to

Grow On."

to overeating later and to an eating pattern that won't match your plan for managing diabetes.

• Advice: Stick to a regular meal and snack schedule. Carry an emergency snack in case you must change your regular eating routine. Consider several small meals, often better for blood sugar control than three big meals. A registered dietitian can help you pick the best food choices for snacking. If you need insulin or other diabetes medicine, take it on schedule, too.

Go Easy: Alcoholic Drinks. Can you enjoy alcoholic drinks now and then? That's a question to discuss with your doctor before you drink alcoholic beverages. Some people with diabetes are wise not to drink at all.

What are some risks? Drinking can worsen some diabetes-related health problems such as high blood pressure, nerve damage from diabetes, and high triglyceride levels. Heavy drinking causes liver damage, which makes diabetes control harder. And alcoholic drinks contribute calories when you're trying to keep your weight under control. Alcoholic beverages also interfere with some diabetes medications.

If your blood glucose levels are under control and if your doctor indicates that alcoholic beverages in moderation are okay, a registered dietitian or a certified diabetes educator can help you work them into your meal plan. Keep these guidelines in mind:

  • As always, limit alcoholic drinks: no more than one serving a day for women, and two for men—the same limits as for people without diabetes. A serving of alcohol is 5 ounces of wine, 12 ounces of beer, or 1 !/2 ounces of distilled spirits. Discuss your individual limits with your doctor and registered dietitian.
  • Always eat when you have an alcoholic drink to reduce the chance for hypoglycemia, or low blood sugar. When your liver is detoxifying alcohol, it doesn't produce as much glucose. Blood glucose that drops too low from drinking can be dangerous.
  • As an alternative, choose low-alcohol wine, beer, or distilled spirits. They have fewer calories and less alcohol and carbohydrates than regular beer or sweet wine. Ask how they fit into your plan.
  • Recognize that some wine coolers and mixed drinks (made with regular soda and juice) contain sugars. Count them as part of your eating plan (as fat and carbohydrate servings/exchanges) for diabetes management. Mix drinks or spritzers with sugar-free mixers such as club soda, diet soft drinks, diet tonic, seltzer, or water. Or try "virgin" drinks without alcoholic mixers.

See "Taking Control: Drinking Responsibly!" in chapter 8.

Get Moving

Get moving! Active living is important in managing diabetes for several reasons. For one, regular physical activity increases insulin sensitivity, moving glucose out of blood more effectively. Second, being active can lower blood sugar as your muscles use glucose for energy. Third, physical activity burns energy, making weight management easier; your body controls your blood sugar level better at a lower body weight. And fourth, regular physical activity helps reduce your risk for heart disease and high blood pressure, both linked to diabetes.

  • Before you start a physical activity plan, talk with your doctor, along with a registered dietitian or a certified diabetes educator. Balance exercise with eating to keep your blood sugar level within a target range. If you take insulin, planning for physical activity is trickier.
  • Before you start your physical activity, check your blood glucose level. If it's low (below 70 mg/dL or less), eat a snack with about 15 carbohydrate grams right away (a medium apple or bread slice); wait about 15 minutes, then check again. If it's 70 to 100 mg/dL, enjoy the same snack if your next meal is at least an hour away, then get moving. If your blood sugar is 100

to 150, it's okay to start, but eat a light snack if you plan to be active for thirty minutes or more. If your blood sugar is 240 mg/dL or more, wait, and get your blood sugar level down first.

  • Take a carbohydrate-rich snack along when you're physically active—just in case you start feeling lightheaded. If that happens, stop moving and eat it. Too much exercise and not enough food can lead to hypo-glycemia, or low blood sugar.
  • Get a partner. Besides being more fun, it's safer. Let your partner know about your diabetes, and what to do if you need help.
  • Wear a tag, a necklace, or a bracelet with diabetes identification. And wear proper footwear.
  • Keep well hydrated when you're active. Water is a fine choice. Check with your doctor or a registered dietitian about beverage choices if you need a fast-acting carbohydrate source; fruit juice, regular soda, or a sports drink may be advised.

Control Your Weight

Whether you're overweight or not, manage your body weight as part of your personal approach for diabetes management. If you're overweight, losing 10 to 20 pounds may make blood sugar easier to control if you have type 2 diabetes. Why? A lower weight helps lower insulin resistance, so you may no longer need diabetes medication. Other potential benefits of weight loss: lower blood lipid levels and lower blood pressure. Remember, with diabetes your risks for heart disease are higher! (Check with your doctor to see if weight loss is right for you.)

Consult a registered dietitian about losing or maintaining weight: how much you need to lose, over what time frame, and how to eat for weight loss and diabetes management. Limit weight loss to 1 pound weekly. A few good tips for starters: Choose mostly lean and low-fat foods. Rather than skip meals, eat smaller portions to consume fewer calories. And move more to use up calories! See chapter 2, "YourHealthy Weight."

Team Up for Health!

To manage diabetes properly, seek advice from your healthcare team, whose specialties help you deal with the complexities of diabetes: your physician, a regis tered dietitian, a certified diabetes educator, a nurse, an eye doctor, a podiatrist, and a pharmacist, among others. Follow through on your care plan.

Remember: You're the most important team member! For the team to work well:

  • Set your target blood glucose levels with your doctor. For people with diabetes, near normal is generally 70 to 150 mg/dL. Be realistic; you can't avoid some "ups and downs." Numbers that are mostly within a safe range reduce your risks for complications.
  • Keep all appointments for checkups, counseling, and laboratory tests. If your blood glucose levels are under control, see your doctor two to four times a year; if not under control, go in more often. Can't make it? Change your appointment—don't skip it!
  • Take diabetes medications as directed, even if you're sick. Tell your doctor or pharmacist about all other medicine and supplements (including herbal products) you take, both prescriptions and over-the-counter medications. Also tell your team about any side effects or problems you have with any medicine or supplement. Plan ahead; call for prescription refills well before you run out. If you take insulin, ask about an insulin pump, which gives a constant, small dose, or other newer devices. Caution: Diabetes medicines can't substitute for healthful eating and physical activity.
  • Learn to check your own blood glucose level. Self-monitoring, perhaps several times daily, is wise with diabetes, especially if you're taking diabetes medication, if you're pregnant, or if your blood glucose levels are low or out of control. For adults, ask about a noninvasive blood glucose monitoring device. It can check your blood glucose level every 20 minutes without puncturing your skin for a blood sample. Use it with conventional blood glucose monitoring.
  • Learn how to detect and safely treat an insulin reaction, hypoglycemia, and hyperglycemia—before you get into severe danger. Immediate, appropriate treatment, perhaps medical assistance, is essential! Wear a medical alert tag or carry a card to let others know what to do in case you pass out.
  • Consult a registered dietitian to create a healthful eating plan (food guide for diabetes, exchange lists, or carbohydrate counting) specific to you, including an approach to managing weight. The dietitian also can offer specific advice on shopping, label reading, eating out, and using alcoholic beverages.
  • Get help with stress control if needed. Under stress, it's harder to be diligent about diabetes care: staying active, eating smart, checking your blood sugar level, and perhaps controlling alcoholic beverages. Besides that, stress may affect your blood glucose level.
  • Know that you don't need to struggle with diabetes alone. If your medications, eating plan, or physical activity program cause problems or concerns, make an appointment to explore new strategies with your health team members. Managing diabetes can be complex—but your health now and later depends on it!
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