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QUESTIONS ANSWERS for Parents DIABETES IN CHILDREN Louis Geoffroy Monique Gonthier Mother and Child University Hospital Center

Louis Geoffroy QUESTIONS Monique Gonthier ANSWERS …...recently diagnosed with diabetes. They will need to take ... in diabetes education, but we hope this book will reply to some

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Page 1: Louis Geoffroy QUESTIONS Monique Gonthier ANSWERS …...recently diagnosed with diabetes. They will need to take ... in diabetes education, but we hope this book will reply to some

>> What is diabetes?

>> Do we know what causes diabetes?

>> Can diabetes be prevented?

>> How do we treat diabetes in children?

>> How does a person give themselves insulin?

>> Why do children have to take insulin several times a day?

>> Do diabetic children have to follow a strict diet?

>> Can diabetic children eat sweet foods?

>> How can we tell if the child is well?

>> What is hyperglycemia?

>> What can we do when blood glucose levels are high?

>> What is hypoglycemia?

>> What are the symptoms of hypoglycemia?

>> Can diabetic children do sports?

>> Can diabetic children takemedicine besides insulin?

>> Can they sleep over at a friend’s house?

>> Does stress affect diabetes?

… and many other questions!

Louis

Ge

off

roy •

Mo

niq

ue

Go

nth

ier

Louis Geoffroy and Monique Gonthier, pediatricians at CHU Sainte-Justine, answer your questions about diabetes…

QUESTIONSANSWERSfor Parents

QUESTIONSANSWERSfor Parents diabetes

in children

dia

be

tes

in c

hil

dr

en

Éd

itio

ns

du

CH

U S

ain

te-J

ust

ine

Louis GeoffroyMonique Gonthier

ISBN 978-2-89619-197-0Mother and ChildUniversity Hospital Center

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Page 2: Louis Geoffroy QUESTIONS Monique Gonthier ANSWERS …...recently diagnosed with diabetes. They will need to take ... in diabetes education, but we hope this book will reply to some

Fil des jours 1/8/02 4:00 AM Page 96

Page 3: Louis Geoffroy QUESTIONS Monique Gonthier ANSWERS …...recently diagnosed with diabetes. They will need to take ... in diabetes education, but we hope this book will reply to some

diabetes in children

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Page 5: Louis Geoffroy QUESTIONS Monique Gonthier ANSWERS …...recently diagnosed with diabetes. They will need to take ... in diabetes education, but we hope this book will reply to some

diabetes in children

Louis GeoffroyMonique Gonthier

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Page 6: Louis Geoffroy QUESTIONS Monique Gonthier ANSWERS …...recently diagnosed with diabetes. They will need to take ... in diabetes education, but we hope this book will reply to some

Bibliothèque et Archives nationales du Québec and Library and Archives Canada cataloguing in publication

Geoffroy, LouisDiabetes in children(Questions answers for parents)Translation of: Le diabète chez l’enfant.ISBN 978-2-89619-197-0

1. Diabetes in children - Miscellanea. 2. Diabetes - Treatment - Miscellanea. 3. Diabetes in children - Diet therapy - Miscellanea. I. Gonthier, Monique. II. Title. III. Series: Questions answers for parents.

RJ420.D5G4613 2010 618.92’462 C2010-940308-8

Graphic design: Nicole TétreaultCover photo: Nancy LessardInterior photos: Claude Dolbec, Louis Geoffroy, Nancy Lessard

Diffusion-Distribution : in Quebec – Prologue inc.

Éditions du CHU Sainte-Justine 3175, chemin de la Côte-Sainte-Catherine Montreal (Quebec) H3T 1C5 Telephone: (514) 345-4671 • Fax: (514) 345-4631 www.editions-chu-sainte-justine.org

© Éditions du CHU Sainte-Justine, 2010 All rights reserved

ISBN : 978-2-89619-197-0 (print)ISBN : 978-2-89619-205-2 (pdf)

Legal Deposit: Bibliothèque et Archives nationales du Québec, 2010 Library and Archives Canada, 2010

The Sainte-Justine Hospital Foundation wishes to thank the generous donors who contributed to UniverSanté des familles

and made it possible to create this new collection for families.Thank you for your support… for the love of children!

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Table of Contents

Preface..................................................................... 10

What is diabetes?

}What is diabetes ? .................................................. 11}What happens when you have

type 1 diabetes? ..................................................... 11}What happens when you have

type 2 diabetes? ..................................................... 13}Is diabetes common? ............................................. 13}Do we know what causes diabetes? ....................... 13}Can diabetes be prevented? .................................. 14}Are some forms of diabetes more severe

than others? .......................................................... 14}How is diabetes diagnosed? .................................. 15}What are the short-term effects of diabetes? ....... 15}What are the long-term effects of diabetes? ........ 16

Core principles for treating type 1 diabetes

}Can diabetes be cured in children and teens ? ... 18}How do we treat diabetes in children? ................ 18

Insulin

}What is insulin? ..................................................... 21}Can insulin be given in pill form? ....................... 21}How does a person give themselves insulin? ....... 21

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6 Questions/Answers for Parents

}Are the injections painful? ................................... 22}How do the kinds of insulin vary? ...................... 22}Why do children have to take insulin

several times a day? ............................................... 24}What is an insulin pump? ..................................... 27}Why do doses of insulin vary? ............................. 28}Can alternative medicine replace

insulin treatment? ................................................. 29}Are there other products that can help

treat diabetes? ....................................................... 29

Diet

}Do diabetic children have to follow a strict diet? ........................................................... 31

}What is the “diet” of diabetic children? .............. 31}Is it difficult to calculate carbohydrate

content in the diet of diabetic children? ........... 34}Can diabetic children eat sweet foods? ................ 36}What if children get hungry? ............................... 37}What if children are not hungry enough

to eat all the portions recommended in their meal plan? ................................................ 39

}Can they eat at unscheduled times? .................... 39}Can young diabetics eat the same foods

as their friends at parties?.....................................40

Monitoring diabetes

}Why do we have to test blood glucose? ............... 41}What should the results of these tests be? ........... 41

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Diabetes in Children 7

}What is the purpose of the urine test?.................44}What is glycated hemoglobin (HbA1c)? ..............44}How can we tell if the child is well? .....................46

Hyperglycemia

}What is hyperglycemia? ......................................... 47}When does hyperglycemia become worrying? .... 47}What factors can lead to hyperglycemia? ........... 50}What can we do when blood sugar

levels are high? ...................................................... 51

Hypoglycemia

}What is hypoglycemia? .......................................... 53}What causes hypoglycemia ? ................................. 53}What are the symptoms of hypoglycemia ? .......... 53}Is hypoglycemia dangerous? ................................. 55}How do we treat hypoglycemia ? .......................... 57

Exercise

}Can diabetic children do sports? ........................ 59}Should young diabetics exercise? ......................... 59}How does exercise affect diabetes? ...................... 61}Can diabetic children exercise if their

blood sugar is too low or too high? ..................... 62}What precautions must be taken

when exercising? ................................................... 62}What general advice should be followed,

before, during, and after exercise? ...................... 63}Are there other precautions that should

be observed? .......................................................... 65

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8 Questions/Answers for Parents

Diabetes and childhood illnesses

}Do diabetic children get sick more often than others? .......................................................... 67

}Do illnesses affect diabetes ? ................................ 67}Can diabetic children take medicine

besides insulin? ...................................................... 67}What do we do when diabetic children

fall ill? .....................................................................68

Supervision and independence

}At what age can young diabetics take care of their diabetes? ........................................... 71

}What level of supervision or independence can we expect? ....................................................... 71

}Can they sleep over at a friend’s house? .............. 75}Can they go to camp, or on field trips…? ............ 75

The psychosocial dimension

}Can diabetic children lead normal lives? ........... 77}How does diabetes affect family life? .................. 77}Why do children and their parents need

to take courses in diabetes education ? ............... 78}Who should be in charge of the diabetes ? ......... 78}How may we help diabetic children

at the psychological level? ..................................... 79}How may we help brothers and sisters? ................ 80}How may we take care of diabetic children

with psychosocial problems? ................................ 81

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Diabetes in Children 9

}How may we take care of diabetic children at school? ............................................................... 81

}Does stress affect diabetes ? .................................. 82}How do drugs, alcohol and tobacco

affect diabetes ? ..................................................... 83

For more information and how to find help .........84

Comparison of units of measure for blood glucose ....................................................85

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10 Questions/Answers for Parents

Preface

All of us know at least one person who is diabetic -- our grandmother, a neighbour, an old uncle. But we are more surprised to learn of diabetes in a child of ten, five or even two years old.

What is this disease that affects young people, and why does its treatment seem so complicated? What basic know-ledge do we need to possess before we can care for a diabetic child in total safety? These are some of the ques-tions frequently asked by people who have a diabetic child in their lives.

First, this book is dedicated to the families of children recently diagnosed with diabetes. They will need to take a course in diabetes education, but we hope this book will reply to some of their initial concerns.

The book is also intended for anyone wanting to under-stand and help the families of diabetic children. Care providers who work with diabetic children and their fam-ilies, grandparents, friends, youth workers, babysitters, sports coaches – everyone will find simple explanations of the treatment, and tools for helping diabetic children and their families.

The authors wish to thank Ann Gilad, nutritionist, and Lucie Desjardins, social worker, for their invaluable advice. We also thank the diabetic children and their parents who have inspired us with their courage and determination.

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Diabetes in Children 11

What is diabetes?

}What is diabetes?Diabetes is a chronic disease typified by high levels of

glycemia (blood glucose or blood sugar). Essentially, there are two types of diabetes, type 1 and type 2. Other types include gestational diabetes (diabetes in pregnancy) and forms related to other illnesses, such as cystic fibrosis, or certain medications. They all have the same result: an increase in blood glucose.

}What happens when you have type 1 diabetes?With type 1 diabetes, high blood glucose is related to

pancreas functioning. Among its other functions, this organ secretes a hormone called insulin, which in this case is deficient.

Normally glucose, an essential source of nourishment for our organism, is absorbed during digestion, trans-ported by the blood vessels and incorporated into the cells, which then use it for fuel. In a sense, insulin acts as a key to doorways into your cells, allowing energy in the form of glucose to enter. In the case of a person with type 1 diabetes, due to lack of insulin, glucose cannot be absorbed by the cells and remains “imprisoned” in the blood vessels. That is why blood glucose levels are high.

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12 Questions/Answers for Parents

When blood glucose is very high the kidneys cannot retain it all and the urine becomes overloaded with sugar The result of this is that diabetic children urinate a great deal. As the organism loses a great deal of fluid, it tries to compensate for the loss of water by increasing the thirst reflex. Finally, as the cells are incapable of absorbing sugar, an essential source of nourishment for the body’s metabolism, weight loss is observed. The three classic symptoms observed at the time of diagnosis are that chil-dren urinate a great deal, drink a lot, and lose weight, though their appetite is unchanged and some times even increases. The great majority of diabetic children have type 1 diabetes.

insulin

reserve

blood vessel cell

How insulin functions: Insulin may be considered the key that allows glucose to penetrate cells.

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Diabetes in Children 13

}What happens when you have type 2 diabetes?With type 2 diabetes, insulin is produced but problems

occur at the cellular level. Cells have developed a resist-ance to the message transmitted by the insulin. The result is the same: cells cannot absorb sugar properly, so it builds up in the bloodstream. The cells of the pancreas continue to secrete insulin, but in insufficient quantity. Generally, type 2 diabetics are obese adults. However, type 2 diabetes is increasingly common among young people, due to overweight and sedentary lifestyle.

}Is diabetes common?Yes. Diabetes is one of the most common chronic dis-

eases. In North America, one person in twenty is diabetic. The great majority of these people are type 2 diabetics.

Though rarer than type 2, type 1 diabetes is one of the most common chronic diseases among children. Its fre-quency varies according to region. The Scandinavian countries have the highest rate of diabetes among chil-dren. In both Europe and Canada, the numbers seem to have increased over the past twenty years. The reasons for this are unknown.

Moreover, the risk of having a second diabetic child in the same family is around 4%.

}Do we know what causes diabetes?The causes of type 1 diabetes are unclear. They are far

clearer in the case of type 2 diabetes.

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14 Questions/Answers for Parents

There is no single cause for type 1 diabetes – it is related to a number of factors. Basically, children have a certain genetic baggage that predisposes them to dia-betes. Then other factors, yet to be determined (viruses, food, etc.) can trigger an abnormal immune reaction that ultimately destroys cells of the pancreas that normally produce insulin. However, heredity is only one of many factors associated with type 1 diabetes. Quite often, dia-betic children have no known diabetic relatives. It is important to note that eating a lot of sweets does not increase the risk of type 1 diabetes, nor is diabetes conta-gious. This may seem obvious to adults but not necessarily to children.

Unlike type 1, type 2 diabetes does have a strong her-editary factor. Among this population at risk, obesity and lack of exercise are major causes of type 2 diabetes.

}Can diabetes be prevented?At this time, there is no known way of preventing the

onset of type 1 diabetes.

Strategies aimed at decreasing the incidence of obesity and raising the level of physical activity are essential to the prevention of type 2 diabetes.

}Are some forms of diabetes more severe than others? By definition, all cases of type 1 diabetes are severe, for

they are typified by a near-total lack of insulin. However, it is important to know that in the months following a diagnosis of diabetes, there is often a remission phase that

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Diabetes in Children 15

lasts from a few months to two years. During this period, the pancreas is still able to secrete a certain amount of insulin and diabetes can be relatively well-controlled.

The situation is different for cases of type 2 diabetes, whose severity may vary, depending on circumstances.

}How is diabetes diagnosed?In young people with type 1 diabetes, symptoms are

usually quite clear. They drink more than usual, urinate much more often - or are even incontinent-, and lose weight, though their appetite remains the same or increases.

These symptoms develop quite rapidly, over several weeks or months.

If the young person displays possible symptoms of diabetes, the diagnosis should be confirmed as soon as possible with a laboratory test that checks the level of blood glucose (glycemia). The level is usually high. In non diabetics, fasting blood glucose is normally below 5.6 mmol/L.

}What are the short-term effects of diabetes?Before treatment has begun, the cells, which do not

have access to their main source of energy (glucose), must draw on the body’s reserves, such as fat. That is why people start losing weight, are more tired and grow increasingly ill. This decline in health can happen quite quickly in the case of type 1 diabetes. When the body must use its fat reserves, certain kinds of waste are produced in the form of acids. The accumulation of this matter in the

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16 Questions/Answers for Parents

organism can provoke an acute and serious condition called diabetic acidosis. In acidosis, blood glucose is high, the urine indicates the presence of acetone, and the blood becomes acidic (decreased pH). Children become dehydrated, vomit, and sometimes breathe more quickly. Eventually their state of consciousness may be altered. Left untreated, diabetic acidosis can lead to death in several days.

This rapid decline leading to acidosis can also occur once diabetes is being treated, that is, if the organism lacks insulin. Children who regularly forget to take their insulin will display a rapid decline in their diabetes. If an infection develops, insulin needs are greater; in this case, children who have been poorly controlling their diabetes are at much greater risk of developing acidosis. All young diabetics who once again start drinking vast quantities of liquid, frequently urinating and losing weight, must be closely supervised. If they display high blood glucose and acetone in the urine or bloodstream, a doctor should immediately be consulted to make sure that the child is not in a state of acidosis.

Vomiting can also signal acidosis. Keep this in mind, especially when vomiting is not accompanied by diarrhea. Blood glucose and acetone levels must be checked. If in doubt, contact immediately your doctor.

}What are the long-term effects of diabetes?In the long term, if glucose levels remain high in the

blood vessels, the diabetic may be faced with serious com-plications. That is the great danger of the illness. Com-plications are directly linked to metabolic control, but

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Diabetes in Children 17

there are other, lesser known factors. Because these com-plications only appear 10, 15 or 20 years down the road, it is difficult for young diabetics to remain motivated to maintain the best possible blood glucose level. A moder-ately high level of blood glucose produces almost no symptoms in the short term.

There are different kinds of complications. Small blood vessels can be damaged: in the eyes, this can lead to blindness; if kidneys are damaged, kidney failure may result. Nerves can also be damaged. Large vessels can also be involved which increases the risk of heart disease.

Foot care is especially important for adults with poor circulation and nerve damage, because foot infections are more frequent and can lead to gangrene or even amputation. However, for young diabetics with good circulation, the risk is low.

For diabetics, the risk of complications can be reduced if they maintain good control of their diabetes. The better they control the disease, the better their chances of not developing complications. However, the idea of complica-tions developing 10 or 20 years in the future is too abstract for young people to understand. It is unlikely to motivate them to take care of their diabetes.

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18 Questions/Answers for Parents

Core principles for treating type 1 diabetes

}Can diabetes be cured in children and teens?At the present time, there is no cure for diabetes. The

kind of diabetes that affects children and teens is almost always type 1, and insulin is the only treatment that can ensure their survival.

The loss of insulin-producing cells is irreparable; for the time being, no one knows any way of healing or replacing these cells. Thus, diabetes is a chronic disease, and treatment with insulin must be considered perma-nent.

}How do we treat diabetes in children? Diabetes is treated with insulin -- but it is not as simple

as that. The organism must be provided with the right amount of insulin at the right time, so that blood glucose is maintained at a level as close as possible to normal.

To keep in mind…

Insulin is the only treatment that can ensure the survival of a diabetic child.

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Page 21: Louis Geoffroy QUESTIONS Monique Gonthier ANSWERS …...recently diagnosed with diabetes. They will need to take ... in diabetes education, but we hope this book will reply to some

Fil des jours 1/8/02 4:00 AM Page 96

Page 22: Louis Geoffroy QUESTIONS Monique Gonthier ANSWERS …...recently diagnosed with diabetes. They will need to take ... in diabetes education, but we hope this book will reply to some

>> What is diabetes?

>> Do we know what causes diabetes?

>> Can diabetes be prevented?

>> How do we treat diabetes in children?

>> How does a person give themselves insulin?

>> Why do children have to take insulin several times a day?

>> Do diabetic children have to follow a strict diet?

>> Can diabetic children eat sweet foods?

>> How can we tell if the child is well?

>> What is hyperglycemia?

>> What can we do when blood glucose levels are high?

>> What is hypoglycemia?

>> What are the symptoms of hypoglycemia?

>> Can diabetic children do sports?

>> Can diabetic children takemedicine besides insulin?

>> Can they sleep over at a friend’s house?

>> Does stress affect diabetes?

… and many other questions!

Louis

Ge

off

roy •

Mo

niq

ue

Go

nth

ier

Louis Geoffroy and Monique Gonthier, pediatricians at CHU Sainte-Justine, answer your questions about diabetes…

QUESTIONSANSWERSfor Parents

QUESTIONSANSWERSfor Parents diabetes

in children

dia

be

tes

in c

hil

dr

en

Éd

itio

ns

du

CH

U S

ain

te-J

ust

ine

Louis GeoffroyMonique Gonthier

ISBN 978-2-89619-197-0Mother and ChildUniversity Hospital Center

QR_Couv_diabetis.indd 1 10-02-01 11:11