This survival guide has been compiled by Prof David Segal and Beverley Davey.
Dear Parent’s and child
Your child has been newly diagnosed with type 1 diabetes and we are aware that you may be feeling emotional, confused and shocked about the diagnosis and may have many questions about what is happening and where to go from here.
Everything that you will need to know about diabetes and managing it will come in time but for now we will be teaching you the basics to manage your child’s diabetes in the next few days.
The only important things that you will need to know how to do in the next few days is:
The rest of the information regarding the diagnosis will be done in follow up appointments in the next few days and weeks and you will be in daily telephonic contact with the doctor or your educator.
There is a lot to learn about managing your child’s diabetes in the beginning and you cannot possibly learn it all in one day. Your child is unique and you will learn in time how diet, exercise and different life situations affect your child’s blood sugar levels.
YOUR CHILD IS FIRST AND FOREMOST STILL A CHILD BEFORE THEY HAVE DIABETES AND DIABETES NEEDS TO FIT INTO THEIR LIFESTYLE NOT THE OTHER WAY ROUND.
Diabetes is your new partner in life, even if it’s an unwelcome one. It is okay to feel angry, sad, resistant and even guilty. These are normal emotions and will ease with time. Most importantly one needs to live with diabetes and not fight it. A positive outlook and active management bring’s about good long term results. Every year we are closer to a cure and the tools and knowledge we have to manage diabetes improve.
You and your child are not alone in managing this condition, of course you have to do all the daily working in managing good blood glucose control, but our diabetes team will help you every step of the way. Regular contact with the team is essential.
This manual is designed to help you with all the basic survival tools to look after your child, but each day will be a learning experience.
Simply defined it is lack of insulin secreted from the pancreas, resulting in high levels of sugar (glucose) in the blood.
There are 2 main types of diabetes
|TYPE 1||TYPE 2|
Lifestyle or oral medication initially but later may need insulin
|Usually in childhood and early adulthood||Adulthood and occasionally in children|
|Pancreas has stopped producing insulin||Pancreas produces too little insulin and the body does not use the insulin effectively|
|Thin body type||Large body type|
Sudden onset of symptoms
|Condition may be present for many years without being aware or without any symptoms.|
Diabetes develops gradually, the beta-cell failure occurs over many months or years. There is a “genetic predisposition” (inherited factor) that needs to be present for the process to start and a viral infection can be the external trigger required to start the immune attack.
When your child has diabetes it means that they have too much glucose (sugar) in their blood. The food your child eats’, especially carbohydrates are broken down into glucose and stored in their cells for energy now or later so that your child can perform their daily activities like, learning, running, swimming and playing and more importantly having fun. Your child will still be able to perform all these activities as they did before.
You or your child did not do anything to cause diabetes. It is not caused by eating or drinking too much sugar. Sometimes a viral infection can trigger diabetes in some children, but you could not have stopped diabetes from happening.
Diabetes is not currently curable; however with proper management such as insulin injections and blood glucose testing, proper meal plans and regular exercise your child can have a normal long happy life, both physically and emotionally.
Your child should be eating meals that are balanced with carbohydrates (sugars and starches), fats and protein (mostly meat). Your body normally processes the food and in particular the carbohydrate you eat in the following sequence:
Carbohydrates are broken down in your child’s stomach, converted to glucose and absorbed into the blood stream as one of the major sources of energy for the body.
The pancreas senses the rise in blood glucose levels and secretes the right amount of insulin to move the glucose out of the blood stream into their cells. Insulin’s function in the body is to direct the storage and use of glucose. Insulin directs the uptake of glucose into the cells either to meet immediate energy needs or to store it for later use. This insulin is released in bursts at meal and snack times. In between meals and during fasting low levels of insulin regulate the amount of glucose produced from the liver (your body’s main glucose store).
Quite simply insulin is secreted every time we eat and a slow release in the background between meals.
As your child does not produce insulin anymore they rely on their insulin injections to provide meal time coverage and the background insulin needs. This is usually achieved by using 2 or 3 kinds of insulin, usually a long acting (background insulin) and a rapid acting insulin (meal time insulin).
This is a snap shot of your body during the night when your liver is releasing stored glucose back into your blood stream to supply a constant amount of glucose to the brain while you sleep.
When food enters your stomach, the carbohydrates get broken down into glucose and the glucose gets absorbed into your blood stream and your blood glucose level starts rising.
If your pancreas is working, it samples the amount of glucose in the blood stream and produces the right amount of insulin and releases the insulin into the blood stream The insulin opens the cells and allows the sugar in and blood sugar will come down. This process is repeated every time you eat carbohydrates.
If you do not have insulin you have no problem getting the carbohydrate into the blood stream but have no way of opening up the cells to let the sugar in and your blood sugar levels stay high.
When the sugar remains in your blood stream and cannot move into your cells because of a lack of insulin the following happens:
There are 5 main food groups that make up a balanced healthy diet in order for your child’s body to get all the vitamins, minerals and nutrients they require to function at its optimum.
The main groups are as follows:
The main food groups can be divided into 3 nutrient groups which have individual effects on the body.
There are different types of fats:
Unsaturated fats – Mainly from plants/vegetables and fish oils – positive health benefits.
Saturated fats – Mainly animal sources - more negative effects on health.
All carbohydrates are broken down to glucose as their final form of energy for the body. The rate of absorption of glucose in and out of the blood stream is called the glycaemia index (GI).
These foods are good to have before exercise and as bedtime snacks.
There are different ways to measure carbohydrates and relate them to the effect they will have on your blood glucose level, this concept is called carbohydrate counting and is a very useful tool to use. The following pictures are a few examples of the main carbohydrates consumed and they are all measured in 1 carbohydrate value.
Carbohydrates are divided in two main groups and the sugar group is further divided in 3 groups.
Most foods have nutritional information on the packaging, so these are easy to read and determine. Below are a few typical foods that have been measured in 1 carbohydrate value they may not necessarily have nutritional information on them and they may need to be learned with time.
Diabetic products are not usually encouraged as they are poorly marketed, costly and they only remove sucrose form the product but still have other glucose products in them, therefore they are not completely free ( Unless the total carbs on the nutritional label says 0 grams) and will still raise the blood glucose levels.
|DAIRY||Approximate weight||Handy measure|
|Milk (skimmed, low fat or full cream)||250 ml||1 cup|
|Fat free yoghurt (plain or artificially sweetened flavoured yoghurt)||250 ml||1 cup|
|Buttermilk||250 ml||1 cup|
|Inkomazi (maas), Mageu||250 ml||1 cup|
|Ice cream, full fat||½ cup|
|CEREALS||Approximate weight||Handy measure|
|Bran cereals (High fibre / All bran)||25g||½ cup|
|Other cereals (Cornflakes, Strawberry pops, Choco’s, Frosties etc.)||20g||½ cup|
|Soft mieliemeal porridge||100g||½ cup|
|Stiff mieliemeal porridge||60g||⅓ cup|
|Crumbly mieliemeal porridge||45g||¼ cup|
|Maltabella porridge||100g||½ cup|
|STARCHES||Approximate weight||Handy measure|
|Pasta (cooked)||100g||½ cup|
|Rice (Basmati, white, brown, cooked)||50g||½ cup|
|Sweet potato||100g||½ cup|
|Baby potatoes (baked or boiled)||100g||3 small potatoes|
|Potatoes (mashed, boiled, jacket)||100g||½ cup|
|Legumes (baked beans, uncooked lentils, bean salad)||100g||1 cup|
|BREAD/FLOUR||Approximate weight||Handy measure|
|Bread (white, brown, whole-wheat, rye)||15g||1 slice|
|Bread rolls||30g||Each half|
|Provita, Cream crackers||20g||3 biscuits|
|Ryvita, Rice cakes||20g||2 biscuits|
|FRUIT||Approximate weight||Handy measure|
|Apple, banana, orange||1 small|
|Sweet melon||½ cup (cubes)|
|Strawberries||1 large strawberry is 1g|
|FRUIT JUICE||Approximate weight||Handy measure|
|All Ceres, Liquifruit or fresh fruit juices – ONLY FOR HYPOS||125ml only||½ cup only|
|VEGETABLES||Approximate weight||Handy measure|
|Butternut, squash, pumpkin, peas, carrots and corn||150g||1 – 1 ½ cup|
|SNACKS||Approximate weight||Handy measure|
|Biscuits eg. Marie, Tennis, Boudoir||3|
|Biscuits with filling||2|
|Crackers (savoury, salty)||24g||3 - 4|
|Jelly tots||40g||1 small packet|
|Hard boiled sweets eg. Sparkles||5|
|Chocolate, plain||3 - 4 blocks|
|Custard, using custard powder (with sweetener and low fat milk)||½ cup|
|Jelly, regular with water||½ cup|
|Ice – cream||3 scoops|
|Potato crisps||15 - 30g||1 small packet|
|Popcorn||250 ml||1 cup|
Your child’s Diet needs to be individualised and you should see a dietician who understands children with diabetes to structure something for your child individually.
Proteins get broken down into glucose very slowly in the blood stream and only 50-60% of protein gets converted to Glucose, making it an ideal food for your child to eat as a snack or as the main portion of a meal.
Testing your child’s blood glucose levels regularly, will help you to achieve daily blood glucose targets and it is your only tool to help you administer the correct dose of insulin or see what changes need to made to food or exercise etc.
|Insulin||Starts Working||Main Effect||All gone|
|10-15 min||1-2 Hours||4-6 Hours|
Humlin –R, Biosulin R
|30-60min||3-4 Hours||6-8 Hours|
Humlin N, Protophane, Biosulin N
|1-2 Hours||4-6 hours||8-12 Hours|
|1-2 Hours||Relatively peak less||20 - 24 Hours|
|Biosulin L||1-4 Hours||6-8 Hours||20-22 Hours|
The risk of long term diabetes complications is related to overall blood glucose control that is above ranges for many years. Complications are obviously one of your concerns as a parent, but if you and your child work hard at getting the blood glucose values as close to target as often as possible so complications can be prevented. The HbA1c is a way to measure this; it looks at the amount of glucose attached to your red blood cells. This is measured every 3 months. Children, especially very young children have different targets to adults as they don’t always detect there low blood glucose values and very low HbA1c‘s are not suitable for them and they are individualized to the child.
GET NEW INSULIN WHEN:
- Your cloudy insulin is clumped and doesn’t mix well
- If you accidentally inject clear insulin into cloudy insulin or visa versa
- If the insulin freezes or gets too hot
Any blood glucose value below 3.5 mmol/l is considered a low blood glucose value. For children below 6 years less than 4mmol/l is a low blood glucose value as they tend to not recognise their symptoms or they cannot tell you. Low blood glucose values can occur at any time, but it is most likely
Causes of low Blood glucose values
o Delaying or missing meals or snacks
o Not eating enough carbohydrates at a meal time
o If you have exercised or done a lot of activity
o If you took more insulin than your body needs
Most often when you have a low blood glucose value your body will give you warning signs – here are some symptoms, it’s also best that you recognise your individual symptoms and treat a low blood glucose values as soon as possible.
0.3g grams of glucose/Kg will increase BG value by approximately 2 mmol/l
Use any of the following glucose rich foods.
Please remember fixing a low blood sugar needs time not more food.
Your child will be very hungry when low and will tend to want to eat till feeling better.
The faster you fix a low with quick acting glucose the better your child will feel.
Don’t get into the habit of over treating low blood sugars and getting a high blood sugar thereafter by feeding them too much.
Give the above treatment and recheck blood glucose values again after 15-20 min if they still complain of feeling low.
If still low repeat above foods again and then recheck in further 20 min.
NB Insulin must be given before a meal if your child was low, you will fix the low blood glucose and then give the normal dose of insulin before that meal, you will need insulin to store that food eaten in the cells of the body otherwise the next blood sugar will be high – they will not go low again!
|STEP 1||STEP 2||STEP 3||STEP 4||STEP 5|
||Open the kitRemove the cap||
Use glucagon if unconscious, having a seizure or cannot co-operate with oral glucose
Blood sugar levels should be expected to rise in 5-15 minutes
Some nausea and even vomiting and headache may follow the injection
Give sips of sugar containing fluids as tolerated, advance to a snack once awakeDose
weight < 30kg = ½ syringe
weight > 30kg = full syringe
As long as the blood glucose value remains above 5mmol/l your child can sleep.
Blood glucose values need to be checked every 3 hour for next 6 hours after a severe episode.
ALWAYS INFORM YOUR DR OF A SEVERE HYPO.
High blood glucose values above target along with high HbA1c’s over many years can lead to complications associated with diabetes. Areas that can be damaged from high blood glucose levels are the: eyes, kidneys, heart and feet. The high blood glucose levels damage all the small nerves and arteries to the organs mentioned above, however if you and your child manage your diabetes effectively you will not develop diabetes complications. Brief episodes of high blood sugars are not dangerous but need to be managed.
When a diabetic child is ill, it is a very unstable time as blood glucose values may fluctuate erratically. They may also spill KETONES into their urine, even if blood glucose values are normal.
Diabetic children need there insulin when they are sick, sometimes even larger doses, even if they do not want to eat, insulin must NEVER be skipped and the types of foods or liquids may need to be adjusted along with the amount of insulin.
HEREFORE, WHEN YOUR CHILD IS SICK ALWAYS:
CHECK KETONES AND BLOOD GLUCOSE LEVELS FREQUENTLY
Your child should avoid exercise when blood glucose levels are high (>15mmol/l) and when they have Ketones- exercise will make the situation worse.
“WHEN YOU ARE SICK PEE ON A STICK”
Encourage your child to eat their usual meal or something from the list below if there stomach is upset or they are having difficulty eating.
|Fruit juice (unsweetened) 125 ml (1/2 cup)||Jelly and Custard|
|Milk 250ml ( 1 cup)||Yoghurt|
|Coke or lemonade 200ml||Biscuits or cereal|
If your child is vomiting and there are no Ketones they need to have small sips of fluid every 15 minutes to avoid dehydration. Anti-nausea suppositories can be given every 6 hours, if your child needs a second suppository call your Dr.
We may even use small doses of glucagon every hour to manage the low sugars
Over the counter medicines are okay to take for management of illness including antibiotics
Medicines for fever, pain, decongestants, runny tummy or nausea, coughs and colds may contain small amounts of sugar. This amount of sugar is too small to significantly affect blood sugars. Cortisone and or steroid containing medications cannot be taken, they increase Blood glucose levels aggressively the list is below. Please consult your diabetes doctor if steroid containing medicines have been prescribed
In the absence of insulin your body cannot use your glucose for energy provided by the food you eat. Instead fat is broken down for energy and converted to Ketones. Ketones are an acid and there build up makes the blood ph level acidic. If undetected or untreated your child could develop DIABETIC KETOACIDOSIS (DKA), this is a medical emergency and they will need to be hospitalised.
Ketones are checked in the urine or blood
They should be checked whenever your child is:
1. Sick, even if blood glucose levels are normal
2. Nausea and abdominal pain
3. Successive blood glucose readings are higher than 15mmol/l.
Early detection and treatment may prevent a hospital admission.
When Ketones are detected you should contact your Dr, Educator or the 24 hour emergency hot line, so they can advise you on clearing the Ketones.
Diabetes camps are one of the best experiences that a child with diabetes can have and it is advisable that you allow your child to be involved in this experience, especially when they are newly diagnosed.
We host 4-5 diabetic camps through the year for a weekend.
Camp is a place for your child to learn self-confidence, independence from mom and dad, to be with other kids with diabetes, and simply to have a great time as well as have the opportunity to make lifelong friends.
It's also an excellent opportunity for mom and dad to take a break from diabetes.
The Facilities and facilitators
The camp is just outside of Hekpoort (45 min from JoBurg) at CAMP NELU.
We always use the facilitators of CAMP NELU, Pieter and his team who are excellent with the kids and Our qualified diabetes team Dr Dave, Bev and Hester and our Diabetes Youth Leaders (DYL)
What do we do at Camp?
We interact with each other, learn teamwork, make friends, survival skills and time to play, be creative and do some rhythm workshop and have lots of FUN, FUN, FUN!!
You can go to the following web address if you would like to attend a camp or find out more information www.youthwithdiabetes.com
I have type 1 diabetes. I know this may make you feel scared or worried to have me in your class as there are a lot of misconceptions about my condition.
The purpose of this note is to let you know the implications of diabetes and how it may affect me at school. I would like to explain my diabetes and I am sure you will see that I can lead a normal life jut like any other child in your class.
If there are any questions please write them down and I will get my parents or my doctor to answer them for you.
The main dangers that arise from diabetes at school are low blood glucose values or hypoglycemia.
The things that are most likely to cause my blood glucose values to drop are:
The symptoms I may experience in increasing order of severity:
If I experience a low blood glucose value during class I will need to test my blood glucose values and I will need to eat foods that have glucose in them to raise my blood glucose values again.
The following is an example of the pack I will have at school at all times.
The following can be used
1 x FIZZER
OR GLUCOGEL OR 2-3 GLUCOSE TABLETS
OR ½ GLASS NORMAL COKE OR FRUIT JUICE
OR 2-3 X SUPER C’S
OR 6 JELLY BABIES
If I am unconscious or have a seizure from a low blood glucose value I will need to be injected with the following injection called glucagon that will increase my blood glucose values.
When I wake up please give me sips of juice or coke and check my blood glucose every 5-10min. If I can tolerate fluids give me ½ a slice of bread or 2 provitas.
Glucagon needs 15-20 minutes to have its full effect in raising the blood glucose values.
There may be some side effects 30 min after the injection such as: Nausea,vomiting, bloating and headache.
ALWAYS INFORM MY PARENTS AND OR DR OF A SEVERE HYPO.