Diabetes in Pediatrics

Understanding Type I and Type II Diabetes in Children and Adolescents

By: Erica Glover

Type 1 vs. Type 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

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

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

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.

Meal Planning Approaches

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

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

Insulin Regimens

Conventional Multiple daily injections Insulin pump

– The child/adolescent must take more responsibility for additional BG testing and CHO counting

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

Secondary Nutrition Education

Monitoring & discussion of growth Review & modify meal plan Use of BG monitoring to develop

CHO to insulin ratios Problem-solving/troubleshooting

Age-specific: Toddlers

Daily variation in meal patterns Typically graze with small, frequent

meals Food jags, selective eating Sporadic activity

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

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

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.

Age-specific: Adolescents

Variable meal schedules– Work– School activities – Social activity

More responsibility for food choices Inconsistent meal timing,

frequency, and amounts of CHO

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.

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

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)

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

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?

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

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

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

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

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!

Do you have questions for me?

Clarifications? Cultural/Native American

Differences? More Information?