Diabetes in Pediatrics

1. Diabetes in Pediatrics Understanding Type I and Type II Diabetes in Children and Adolescents By: Erica Glover

2. DM-1 Insulin dependent No connection to family history Auto-immune disease DM-2 Not insulin dependent (hopefully) Family history Strong relation to obesity and IGT Insulin resistance Hyperinsulinemia Type 1 vs. Type 2

3. Goals of Medical Nutrition Therapy • Maintenance of near-normal blood glucose (BG) levels by balancing food intake with insulin and activity levels • Hypoglycemia: multiple events can cause impaired brain development in young children • Intensive BG management NOT recommended under ages of 13 years old

4. Goals of Medical Nutrition Therapy • Achievement of optimal lipid levels • Begins with maintaining normal glucose levels • Children at high risk lipid abnormalities should be screened and monitored • Provision of adequate calories for normal growth and development • Height and weight every 3-6 months • Plot growth on NCHS growth chart

5. Goals of Medical Nutrition Therapy • Prevention, delay, or treatment of nutrition-related risk factors and complications. • The rule of 15 • Improvement of overall health through optimal nutrition.

6. Carbohydrate Counting Specific calorie levels not generally recommended Usually based on the amount of CHO normally consumed Exchange List for Meal Planning Helpful in formulating meal plan for specific nutrition needs Simply not practical Meal Planning Approaches

7. Physical Activity • Generally reduces insulin requirements • Better to consume 15g CHO per hour of activity than to adjust insulin • Decreases insulin resistance in type 2 • Check BG levels!! • May have lipid-lowering effect

8. Insulin Regimens • Conventional • Multiple daily injections • Insulin pump • The child/adolescent must take more responsibility for additional BG testing and CHO counting

9. Initial Nutrition Education • Food components that influence BG levels • Meal timing and consistent CHO intake • Meal plan • Prevention & treatment of hypoglycemia • BG control in illness

10. Secondary Nutrition Education • Monitoring & discussion of growth • Review & modify meal plan • Use of BG monitoring to develop CHO to insulin ratios • Problem-solving/troubleshooting

11. Age-specific: Toddlers • Daily variation in meal patterns • Typically graze with small, frequent meals • Food jags, selective eating • Sporadic activity

12. Age-specific: Toddlers • Schedule adequate regular meals and snacks containing carbohydrate • Suggest to parents alternate sources of CHO if food refusal occurs • Avoid withholding food in hyperglycemia

13. Age-specific: Preschool and School-aged Children • More consistent & predictable appetites • Generally eat same amounts of CHO at same time each day • More meals & snacks away from home • Birthday parties • Overnight parties

14. Age-specific: Preschool and School-aged Children • Involve more in food preparation and meal planning • Morning and afternoon snack encouraged • Instruct parents on management during special occasions • Review meal plan often to ensure meals and snacks correspond to changes in activity.

15. Age-specific: Adolescents • Variable meal schedules • Work • School activities • Social activity • More responsibility for food choices • Inconsistent meal timing, frequency, and amounts of CHO

16. Age-specific: Adolescents • Peer influence in food choices and timing • Mismanagement of meal plan common • Growth spurts and variation of appetite • Sports become central in the lives of some adolescents.

17. Age-specific: Adolescents • Assess involvement of activity on a regular basis • Make suggestions for appropriate snacks & supplements • Screen for insulin omission & eating disorders • Instruct on the potential hypoglycemic effects of alcohol

18. Age-specific: Adolescents • Instruct adolescents who drive on the importance of BG monitoring & carrying a source of CHO with them at all times. • Provide practical knowledge as needed on alternative eating patterns (i.e. vegetarianism)

19. Eating Disorders in Adolescents with DM-1 • Pubertal changes in body shape may cause development of unhealthy eating attitudes. • Dx of DM-1 heightens awareness of dietary restraints, weight gain, and food preoccupation. • Insulin misuse to lose weight

20. Eating Disorders in Adolescents with DM-1 • Pay attention to those who express body dissatisfaction • Lead them toward healthy weight control practices • Screen regarding weight • How concerned are you about your weight? • Do you ever skip meals to lose or maintain weight?

21. Eating Disorders in Adolescents with DM-1 • In the past year have you ever tried to lose weight by vomiting, taking pills, using laxatives, skipping insulin, or modifying your insulin dose? • Include Behavioral Health Counselor and Family

22. Practical Advice to Parents • Parents can have trouble dealing with their child’s new diagnosis. Here are points to help: • 1. Don’t Isolate Yourself • Find support, lean on others • Support groups, family, friends, place of worship

23. Practical Advice to Parents • 2. Ask for Help • Bring a friend or relative to help you take notes when you talk to medical providers. • 3. Don’t Blame yourself • Remind yourself that BG monitoring and insulin shots are now a fact of life • You didn’t give your child diabetes

24. Practical Advice to Parents • 4. Mind your Marriage • Make time for your spouse everyday, putting aside your child’s diabetes • 5. Work with Your Ex • Put aside negative feelings to work together for the sake of your child • Seek counseling if needed. • Don’t play good parent, bad parent to drive a wedge between child and other parent

25. Practical Advice to Parents • 5. Be Consistent • Routines make children feel secure • 6. Educate Yourself • Knowledge may help reduce anxiety • 7. Consider counseling • Sometimes you just need a little help • 8. Take a break from diabetes • Take care of Yourself!

26. Do you have questions for me? • Clarifications? • Cultural/Native American Differences? • More Information?