Type 1 diabetes is a chronic and autoimmune disease characterized by the insufficient production of insulin, a hormone that is essential in transforming blood sugar (or glucose) into energy, through the pancreas. This lack in insulin secretion leads to an accumulation of blood sugar, also known as hyperglycemia. Thus the body and its organs no longer receive the fuel needed for proper functioning, since the sugar is trapped in the blood. The symptoms of Type 1 Diabetes (T1D) must always be taken seriously: untreated hyperglycemia can be deadly in the space of a few days.
Most T1D cases develop during childhood, the teen years or in early adult life. Rare cases are diagnosed in later years. So far, Type 1 Diabetes is neither preventable nor curable. T1D is presumably linked to the autoimmune destruction of insulin producing cells in the pancreas, however the exact cause is unknown.
So far, Type 1 Diabetes is neither preventable nor curable.
Pediatricians Dr. Louis Geoffroy and Dr. Monique Gonthier co-authored a book entitled Diabetes in Children (2009), published by CHU Sainte-Justine, replete with useful information for parents and written in a Q & A format.
Do you or does your child have Type 2 Diabetes, gestational diabetes or other pancreas and glucose metabolic disorders? We advise you to contact these organizations:
- Canadian Diabetes Association
- Health Canada
- Public health Agency of Canada
- Canadian Pediatric Society
SIGNS AND SYMPTOMS
As sugar saturates the blood, the kidneys work faster and cannot filter everything, which leads to frequent urination. To compensate this significant liquid drainage, the child will develop intensive thirst. As the body stops receiving the energy it needs, the child will start losing weight despite a normal diet.
Here are the symptoms that are related to diabetes (if your child is experiencing the following signs, if he or she is weak or unconscious, go immediately to the nearest hospital emergency):
- Intense or increased thirst;
- Energy loss, drowsiness;
- More frequent urination than usual;
- Yellowish urine with a smell of sugar;
- Weight loss or difficulty to gain weight;
Once T1D has been diagnosed, insulin doses are injected in the body. A blood glucose reader is used to measure glucose levels and the quantity and type of insulin are adjusted accordingly. Other factors need to be considered when administering insulin such as the time of day, physical activity, stress and fatigue levels and food intake.
Several types of insulin and insulin administration exist. Pens, needles and pumps can be used for injections. Physicians will help you choose the most appropriate treatment, by taking into account the number of injections required, the dose and the time of day of injection. Insulin prescriptions by physicians vary from child to child depending on age, weight, life style, specific needs and objectives.
Diabetics can expect a healthy and balanced life and a decent life expenctancy by taking adequate care of their diabetes.
INSULIN AND ITS ACTION
There are different types of insulin that are combined and administered according to each child’s personal treatment. The names of insulin types may vary from one pharmaceutical company to another, but their action times remain similar.
- Ultra-fast insulin: starts acting a few minutes after administration and has an action time of 2-3 hours.
- Rapid insulin: starts acting 15-30 minutes after administration and has an action time of 4-6 hours.
- Regular insulin: starts acting 30-45 minutes after administration and has an action time of 10 -16 hours.
- Long-acting insulin: starts acting 1-2 hours after administration and has an action time of 20-24 hours.
Insulin treatments vary significantly, but regular insulin may often be combined with rapid insulin, while long-acting insulin is often combined with ultra-fast insulin. If a child uses an insulin pump, only ultra-fast acting insulin will be administered in small yet ongoing doses.
PENS AND NEEDLES
Once a child is diagnosed with Type 1 Diabetes, one possible treatment is insulin administration by injection, using a needle or an insulin pen.
Insulin doses must be evaluated for each injection (twice a day minimum) depending on carbohydrate intake, blood glucose, and physical activity before or after administration, mood and any other variables that may influence sugar levels in the blood.
Some children take predetermined insulin doses and eat fixed quantities of carbohydrates during meals and eat snacks at fixed hours.
Other people follow treatments that allow them to change food quantities according to their appetite, but must take insulin injections every time they eat. In this case, insulin is calculated based on ratios.
In both cases, diabetics must test their blood glucose (blood test) at least five times a day – to make sure their treatment is working or to make adjustments when needed.
Before treatment with an insulin pump is initiated, a child or an adult diagnosed with Type 1 Diabetes will first receive insulin injections. Once the treating physician determines that the parents (and/or child, depending on age) have sufficiently understood the disease and are ready to transfer to the pump, the physician will help them learn more about the different models available. After they have assessed the pros and the cons of each model, they are ready to make an informed decision.
Insulin pumps require a catheter to be installed under the child’s skin to provide continuous sub-cutaneous insulin administration.
Some models have tubing that connects the catheter to the pump. Equivalent in size to a numeric pager, the pump can be worn on the child’s belt and is equipped with an insulin reservoir as well as programming buttons.
On other models, the catheter and insulin reservoir (the size of the pinkie finger) are placed directly on the child’s skin, with independent remote programming that can be located a few meters from the child.
All models are based on the same principle: the pump is programmed for the child and sends a basic quantity of insulin (basal), which represents a few units of insulin per hour on an ongoing basis. When the child eats, he or she must indicate to the pump the quantity of carbohydrates that he or she has eaten as well as the blood glucose. The pump will then calculate the additional dose above the “basal” and inject what is referred to as “bolus”. Different programs can be adjusted in case of intense physical activity or if the child is sick. To determine the appropriate algorithms and ratios for each child, it is crucial to test blood glucose several times per day (and night), especially at the beginning of treatment or in case of lifestyle changes (first days at school, adolescence, new job, etc.).
DAILY CARE OF DIABETIC CHILDREN
Parents play a crucial role in the treatment and delivery of care to their diabetic child. While at first, the routine of caregiving may seem burdensome and complicated, over time and with good advice from the medical team, daily diabetic care will become automatic and you will gain confidence in your skills. It is important to be comfortable with your child’s treatment so that he or she will also feel comfortable with the treatment and eventually take charge.
Naturally, there will be harder and more stressful moments for children and parents, at various stages in life such as beginning school or traveling. It is completely normal. For this reason, it is important to know that The Diabetic Children’s Foundation provides resources that can be found in the Toolbox section. These resources may help you overcome challenges with optimism and in good health.
Parents are expected to perform or to guide their child with the following actions:
- Encourage a regular schedule for meals and snacks;
- Ensure a healthy diet and lifestyle;
- Test blood glucose levels 5 to 8 times a day on average;
- Administer insulin doses according to the plan prescribed;
- Recognize signs of hypoglycemia and hyperglycemia;
- Set clear plans in the event of hypoglycemia or hypeglycemia;
- Plan a continuum of care with family caregivers and school personnel;
- Establish a contact list in case of emergencies.
Depending on your child’s age and level of understanding, it is important to discuss diabetes and to include him or her in the decision-making process. The more your child is informed and feels involved, the faster he or she will learn autonomy.
There are several ways to foster your child’s responsibility with regards to his or her condition:
- Create a flow chart that is easy to understand and to fill out;
- Use play strategies when providing care;
- Include siblings;
- Maintain an open dialogue with other family members, friends, school personnel, etc.
The best tips are those that suit your daily routine and values. Stay optimistic and avoid being over dramatic.
BLOOD GLUCOSE MONITORING
Blood glucose meters measure the quantity of glucose in the blood. Levels between 4 and 8 mmol/L are considered normal, depending on age, weight, diet, physical activity as well as other factors including stress, emotions, etc. Generally, for a type 1 diabetic child, levels under 4 indicate low blood glucose (hypoglycemia), whereas levels above 10 indicate high blood glucose (hyperglycemia).
LOW BLOOD GLUCOSE
Low blood glucose, or hypoglycaemia, occurs when the level of sugar in the blood is insufficient for normal body functioning. For type 1 diabetics, this situation can be triggered by different factors, such as when a child is more active than usual – the body will use all the sugar available to meet the needs related to exercise. Furthermore, if the quantity of carbohydrates in a meal is miscalculated, there may be a risk of administering too much insulin that will lead to a lack of sugar to transform, thus leading to low blood glucose.
Symptoms of low blood glucose are very different from one child to another. Generally speaking, it is a condition in which the brain no longer has enough sugar to function properly: the body becomes weak, confusion sets in and children feel exhausted or powerless.
Imagine running for 4 days non-stop and then reaching the foot of a mountain that you must climb immediately, as fast as you can. That is how diabetics feel when they have low blood glucose and are asked to sit up straight.
To rectify blood glucose levels, “fast sugar” (that is quickly assimilated in the body) must be administered such as juice, candy or tablets called Dex4 designed especially for this purpose. Blood glucose must be tested 15 minutes later to check the level sugar. Depending on the time of day, it might be necessary for children to eat a high protein snack to maintain a normal blood glucose level.
HIGH BLOOD GLUCOSE
High blood glucose is excess sugar in the blood. Due to lack of insulin, sugar cannot reach cells and remains trapped in the blood. This situation occurs when children do not have enough insulin, either because it was difficult to calculate the right dose, or because of excessive carbohydrate intake. Consequently, sugar may accumulate in the urine and create ketones in the urine, and in some cases it might lead to ketoacidosis.
Symptoms of high blood glucose are fairly consistent: insatiable thirst, frequent need to urinate, fatigue, and drowsiness. If left untreated, a person who experiences sustained episodes of high blood glucose over a short period of time will tend to lose a lot of weight.
To decrease blood glucose levels, insulin must be administered. This can be done with an insulin injection, or with a “bolus” administered by an insulin pump. Exercise can also help lower blood glucose, but a child may not feel capable of doing so. Drinking water can help a child feel better, even though it has no effect on lowering sugar levels in the blood.
It is possible to determine a child’s glycated hemoglobin with blood tests. This test is conducted several times a year during pediatric follow-up visits that allow the attending physician to evaluate blood glucose levels over the past months.
In fact, glycated hemoglobin indicates the average blood glucose levels over the past three months. That is why it is one of the tools used to evaluate the diabetes treatment and make adjustments as needed. It allows the treating physician to have an overall view of blood glucose levels. However, it should not be the only indicator used in follow-up, since an individual may experience numerous low blood or high blood glucose episodes, and after three months show a “good” average. High glycated hemoglobin may indicate that the treatment needs to be adjusted, but it may also be the result of a long period of stress or intense emotion for the child, when it is harder to control blood glucose levels.
Ketoacidosis is an accumulation of ketone bodies in the blood. It is a critical condition that requires emergency treatment. It occurs when a diabetic has neither received nor produced insulin for an excessive period of time. Before being diagnosed with Type 1 Diabetes, a child might be rushed to the hospital because of ketoacidosis. Symptoms might also appear before the child’s condition reaches this point.
When the body lacks insulin, sugar (carbohydrates) in the body cannot be transformed and accumulates in the blood. In this case, the body will try to eliminate excess sugar through the urine – therefore traces of sugar will be found in the urine. At this point, the child’s condition is referred to as “having ketones”. If the blood sugar level is not restored within a few days and there is still no presence of insulin, the child develops ketoacidosis, which in some cases can be deadly.
Sources:Canadian Diabetes Association
GEOFFROY, Louis Geoffroy and Monique Gonthier, Diabetes in Children, CHU Sainte-Justine, Montreal, 2009
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