Coping with Diabetes

Coping with Diabetes

Programme What to tell the family 1 School issues 7 2 Dispelling myths and false beliefs 8 Exercise 3 Acute illness 9 Smoking, alcohol and drugs 4 Nutritional advice 10 Pregnancy 5 Storing insulin 11 Fasting 6 Effects of growth on diabetes

What to tell the family

At diagnosis • First contact is crucial • Can achieve the following: • Explain diabetes symptoms • Enroll the family into care of the child • Specifically invite the father and mother • Initial diabetes education • Dispel myths and false beliefs • Family bewildered and shocked • Be supportive, empathic and caring • Answer comprehensively and respectfully

Symptoms • Explain symptoms and signs • Diagrams useful • Demonstrate glucose values and urine dipsticks • Explain mechanism • Insulin deficiency • Unknown cause • Raise questions for future discussion

Dispelling myths and false beliefs

Myths and false beliefs • Cause of diabetes/ genetics/ environment • Cure for diabetes • Use of alternative medications • Toxicity of insulin • Use of pills for treatment • Infectiousness of diabetes

Acute illness

Acute illness • Acute illness may cause: • High glucose (hyperglycaemia) • Low glucose (hypoglycaemia) • Ketones • Ketones may occur during, before or after the illness • Children with diabetes do not have more frequent illness • Know how to advise families on management of acute illness

Management (1) • Do not stop insulin delivery • May increase or decrease dose • Need frequent monitoring • Glucose 3-4 hourly • Ketones 1-2 times per day • Admit if: • no home monitoring • it is not getting better despite doing all you can at home • Treat illness • Sugar-free medication • No steroids

Management (2) • Supportive care • Easily digested food • Adequate fluid intake • Antipyretics (paracetamol) • Consider admission • Adjust insulin doses – never stop insulin • Educate family on management of illness • Provide written guidelines for family

Nutritional advice

Nutritional advice (1) • Food provides energy for growth and day-to-day functioning • Food intake influenced by • Family functioning • Psychological and emotional factors • Societal factors • Socio-economic factors

Food (carbohydrate)intake to be balanced against insulin Food intake to be balanced against activity Glucose monitoring used to balance food intake, activity and/or insulin dose Nutritional advice (2)

General dietary guidelines • Use meal plans rather than a diet • Try not to have do’s and don’ts • Keep plans simple and practical

Meal plans Depend on local factors Calorie restriction for obese patients Allow for individual choice Allow flexibility and variety in food selection Balance financial needs and availability of foods and snacks Depends on what is available locally

Food and insulin • Balance food and insulin • Adapt insulin to suit meal • Different regimens allow change in • Meal plans • Meal frequency Insulin Food

Food and insulin • Twice daily regimen • Regular snacks and meals • Risk of hypos is missed meals/snacks • Emphasise regularity and portion sizes at meals • Multiple daily injections • More flexibility • Less short-acting insulin for smaller meals • Need to understand effects of food and insulin on glucose

Teaching about food • Plan for balanced meals • Aim for: • 50-60% carbohydrates • 15-20% protein • <30% fats • Teach food groups and reading food labels • Teach entire family – especially the father and grandparents • Energy requirements change with growth

Storing insulin

Storing insulin • Insulin is a ‘fragile’ protein medication • Denatured if frozen or in excessive heat • Stored at 2-8°C • Use before expiry date • Once opened, may last • 1 month if not refrigerated • 3 months if refrigerated • Storage of insulin is important

Storage of insulin • Clinic and home • Power refrigeration • Not freezer • Back-up generator • Passive/water refrigeration • Underground • Clay pots • Rotate stock by expiry date

Questions

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Coping with Diabetes