Coping with Diabetes

Changing Diabetes® and the Apis bull logo are registered tradem

arks of Novo Nordisk A/S

Coping with Diabetes

Programme

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2

4

3

5

6

What to tell the family

Effects of growth on diabetes

Storing insulin

Nutritional advice

Acute illness

Dispelling myths and false beliefs

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8

10

9

11

School issues

Fasting

Pregnancy

Smoking, alcohol and drugs

Exercise

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

Food Insulin

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

Changing Diabetes® and the Apis bull logo are registered tradem

arks of Novo Nordisk A/S