Diabetes and the Growing Child

1. Diabetes and the Growing Child

2. Effects of growth on diabetes 1 2 School issues 3 Exercise 4 Smoking, alcohol and drugs 5 Pregnancy 6 Fasting Programme

3. Effects of growth on diabetes

4. Growth and diabetes • During childhood and adolescence • Physical growth • Maturation of organ systems • Increasing intellectual maturity and understanding • Puberty • Not affected by diabetes if well controlled • Poorly controlled diabetes may cause • Poor growth • Delayed puberty

5. Effects of changes

6. School issues

7. Diabetes at school • Safe and supportive school environment • The child and adolescent with diabetes has rights • Right to be admitted to school • Right to receive appropriate care • Right to be fully integrated into a school environment • Responsibility of parents and care team • Educating carers (teachers) at school • Supporting schools and teachers • Providing supplies for care

8. Educating the people at school • Information on diabetes and management • Effect of illnesses • Hyperglycaemia and ketones • Recognition, treatment and prevention of hypoglycaemia • Practical knowledge and practice in glucose and ketone testing and insulin injections • Effects of diet and activity on diabetes • Social and psychological impact of diabetes

9. Exercise

10. Diabetes and exercise • Common part of children and adolescents lives • Encouraged in diabetes • Benefits of exercise include • Sense of well-being • Weight control • Limit rise in glucose after meals • Lowers heart rate and blood pressure • Lowers blood lipid levels • Reduces cardio-vascular risk

11. Effect of exercise Hypoglycaemia Hyperglycaemia Ketones

12. Factors affecting glucose response Duration Intensity of activity Type of activity Metabolic control Insulin regimen Absorption of insulin Timing and type of food Stress and competition involved

13. Managing exercise (1) Very variable effects in different children Monitoring glucose is the key Know glucose value before activity May need snack adjustments (preferably quick carbohydrates) Monitor glucose 30-60 minutes after the end of the activity

14. Managing exercise (2) • Treat low glucose with additional rapid sugar • Sugar cube, coke, honey, sweets • After prolonged activity: • Additional snack before sleeping • Have glucose monitored during the night • Decrease bedtime insulin dose after afternoon or evening exercise • Accurate records of activity, food intake and glucose values to learn

15. Smoking, alcohol and drugs

16. Alcohol and drugs Peer pressure to experiment Depend on availability, cost and societal attitudes Experimentation may start in very young children Children and adolescents with diabetes no different from any other Empower discussion rather than challenging behaviour

17. Alcohol drinks Use and abuse not uncommon May cause rapid rise in glucose, i.e. always eat before going to bed Effects on liver correction of hypoglycaemia is impaired Frequent use causes weight gain Empowerment to deal with peer pressure

18. Smoking • Similar prevalence of smoking with or without diabetes • General risks • Cardiac disease • Emphysema • Cancers • In people with diabetes, worse • Cardiovascular disease • Micro- and macrovascular complications • Hypertension • Hyperlipidaemia

19. Marijuana • Excessive or frequent use associated with: • School and learning difficulties • Behaviour problems • Depression • Low self-esteem • Anxiety • Family/peer interactions • Socially deviant behaviour • No major direct effects on diabetes • Unless overeating carbohydrates

20. Other drugs • May have • No direct effect on glucose (hypoglycaemia at rave parties) • Increase blood glucose levels • Dehydration (amphetamine) or water intoxication (ecstasy) • Potential for addiction • Have psychosocial effects • Interfere with diabetes self-management • Some drugs have direct effects on the heart(amphetamine?) • May need psychological intervention

21. Pregnancy

22. Diabetes and pregnancy Diabetes in pregnancy poses challenges There are increased risks for both mother and baby All pregnancies complicated by diabetes should be managed by an experienced team Diabetes may be existing type 1 diabetes or gestational diabetes

23. Risks for mother Hypertension in pregnancy Urinary tract infections Later risk for type 2 diabetes Preterm labour Polyhydramnios Macrosomia DKA Progression of microvascular complications

24. Risks for baby (1) • Congenital abnormalities • Spinal • Heart • Gastro-intestinal • Limb abnormalities • Heart abnormalities • Macrosomia (big baby syndrome) • Obstructed labour • Intra-uterine death Poor control around conception Poor control late in pregnancy

25. Risks for baby (2) Asphyxia Birth trauma at delivery Hypoglycaemia Hypocalcaemia Neonatal jaundice Respiratory distress Polycythaemia Increased later risk of type 2 diabetes

26. Pre-pregnancy planning • Unplanned pregnancies hopefully to be avoided • Counsel on • Abstinence and contraception (incl. emergency contraception) • Effects of diabetes on the pregnancy • Need for tight control of diabetes before and during pregnancy • Planned pregnancies • Risk of progression of mother’s complications • Genetic implications of diabetes

27. Fasting

28. Fasting • Fasting for Ramadan • Not compulsory for anyone with illness • Some choose to fast • Insulin required despite the fasting • Need to adjust the insulin regimen • Practical tips in manual • Special circumstances need active management

29. Questions

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