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Diabetes and the Growing

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Effects of growth on diabetes

Fasting

Pregnancy

Smoking, alcohol and drugs

Exercise

School issues

Programme

Effects of growth on diabetes

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

Change Effect Consequence

Growth Increasing weight Increasing doses

Puberty Decreasing insulin sensitivityPsycho-social stresses

Increased dosesMore educationAlcohol and drug useRisk taking behaviour

Menses Changes in insulin sensitivity Fluctuating insulin needs with increased doses during menses

Lifestyle Increasing activity Increase food intake / decreased doses

Intellectual maturation Increased understandingIncreased independence

More educationIncreased autonomy

Effects of changes

School issues

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

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

Exercise

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

Effect of exercise

• Hypoglycaemia• Hyperglycaemia• Ketones

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

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

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

Smoking, alcohol and drugs

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

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

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

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

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

Pregnancy

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

Risks for mother

• Hypertension in pregnancy• Urinary tract infections• Later risk for type 2 diabetes• Preterm labour• Polyhydramnios• Macrosomia• DKA• Progression of microvascular

complications

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

Risks for baby (2)

• Asphyxia• Birth trauma at delivery• Hypoglycaemia• Hypocalcaemia• Neonatal jaundice• Respiratory distress• Polycythaemia• Increased later risk of type 2 diabetes

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

Fasting

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

Questions

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