Skills to Get You Home · Skills to Get You Home (562) 933-8562 millerchildrens.org/Diabetes

Skills to Get You Home

(562) 933-8562 millerchildrens.org/Diabetes

………….……………….………..…..…………………………….…….. 1-6

− Letter to Patient and Family 2

− Roadmap to Health 3

− My Daily Schedule 4-6

………............................................……………………...………………… 7-12

− What is Diabetes? 8

− Where is My Pancreas and What Does Insulin Do? 10

− The Honeymoon Period 11

− An Introduction to Diabetes Management 12

………............................................................................. 13-35

− Checking Blood Sugars 14

− Diabetes Self-Care Log 15

− Hemaglobin A1C 16

− Oral Medicines for Type 2 Diabetes 18

− Insulin Regimen 19

− Types of Insulin 20

− Use and Storage of Insulin 21

− How do I Figure out how Much Insulin my Child Needs? 22

− Insulin Plan 23

− Insulin Calculation Sheet 24

− Rounding Charts 25-27

− How to Set Up and Use an Insulin Pen 30-31

− How to Fill a Syringe 32-33

− Remember to Rotate Injection Sites 34

− Sharps Disposal 35

....................................... 36-48

− Low Blood Sugar (Hypoglycemia) 37

− New Hypoglycemia Medicines 39

− High Blood Sugar (Hyperglycemia) 40

− Ketone Testing 41

− What is Diabetic Ketoacidosis (DKA)? 42-43

− Sick Day Management 44

− What Can Happen If You Don’t Manage Your Child’s Diabetes 46

− Diabetes Quiz 47-48

................................................................................. 49-72

− Carb Counting for Kids and Teens 50

− Carb Food Lists 51-55

− How to Read a Nutrition Label 56

− Meat and Meat Substitutes 57

− Healthy Fats 58-59

− “Free” Food List 60

− Smart Snacks 61

− Tips for Parties and Holidays 62

− Healthy Eating for Preschoolers 63-64

− MyPlate 65-66

− Common Foods List 67

− Meal Planning Worksheet Instructions 68

− How Much Do You Know About Carbohydrate Counting 71-72

.................................................................................... 73-77

− Physical Activity Guidelines 74

− Physical Activity and Snacks 75

− How to Use the Guidelines Chart 76

− Guidelines for Increasing Carbohydrates Before Exercising 77

................................................. 78-86

− Physcosocial Support for Families 79-84

− Alcohol and Diabetes 86

...................................... 87-92

................................ ........................ 93-104

− Discharge Letter 94

− Technological Advances 95

− Parent Tips for Infants with Diabetes 96

− How to Keep Your Child Out of the Emergency Department 97

− Monitoring Diabetes and Health 98

− Things to Remember 99

− Safety and Travel 100

− Safety and Driving 101

− Dental & Foot Health 103

................................................................................................. 105-124

− Diabetes at School 106

− Tips for Teachers of Students with Diabetes 108

− Supplies at School 109

− Sample Individualized School Healthcare Plan 110-112

− Family Resource Center Referral Form 113

− To the Caretaker 114

− Bag of Hope 115

− Famous People with Diabetes 116-117

− Diabetes Resources 119

− Helpful Mobile Apps 120

− Questions for Your Child’s Care Team 121

− Notes 122-124

1

Date: ___________________

Dear Patient and Family, Your child’s health care is important to us. As your care team, we are here to support you through the introduction to diabetes. We will help you through the initial diagnosis, teach you the basic self management skills needed to take care of your child and take control of your child’s diabetes. We encourage you to ask questions and partner with us as we share this experience with you. The following information will provide you with the basics of diabetes self management skills. You will become familiar with different diabetes tools, medications, exercises and meal planning while you are at MemorialCare Miller Children’s & Women’s Hospital Long Beach. Your child’s diabetes journey will continue as you settle into and make adjustments to your lifestyle. Please continue to seek support through educational resources and the community. There are several support systems available to you in the hospital. We encourage you to visit the Family Resource Center at Miller Children’s & Women’s. The Family Resource Center can be reached at (562) 933-8048.

Sincerely, Your diabetes care team MemorialCare Miller Children’s & Women’s Hospital Long Beach

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8:30 a.m. Doctor (M.D.) and

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9 a.m. Certified Diabetes

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10 a.m. Dietitian (R.D.)

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7

Children need energy to grow, play sports, do homework and be happy and healthy. This energy comes from the food you eat. Inside the body, food is changed into glucose (sugar) that is carried throughout the entire body. Insulin is a hormone that helps the body use glucose for energy. Insulin is made in the pancreas and helps the glucose move from the blood into the body’s cells. There are two main types of diabetes. When the body stops producing insulin, this is called type 1 diabetes. When the body does not produce enough insulin or cells fail to use the insulin, this is called type 2 diabetes. When there is no insulin or the body is not using the insulin correctly, the body’s cells do not have glucose energy despite the large amounts of glucose in the blood stream. Therefore, the body does not have enough energy to keep you active and strong.

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Diabetes Mellitus

Image courtesy of Shutterstock

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Type 1 Diabetes

• Also known as “juvenile diabetes,” however, people are being diagnosed with Type 1 into their 80’s.

• Auto-immune

• The immune system gets confused and attacks and kills off the cells that produce insulin.

• The pancreas cannot make enough insulin and eventually stops making it altogether.

• People with Type 1 diabetes must take insulin for the rest of their lives.

• Only 5% of those living with diabetes have Type 1, but it is the most common cause of diabetes in kids/adolescents.

• Environmental

• Genetics (tends to run in the family)

• Auto-immunity

• If you have a relative with diabetes

• If there is autoimmune conditions in your family (thyroid problems, celiac disease, lupus, etc.)

Type 2 Diabetes

• Also known as “adult-onset diabetes,” however, more and more children and adolescents are being diagnosed with this.

• The body does not make enough insulin compared to what the person needs and/or the body ignores insulin being produced.

• People with Type 2 may or may not take insulin.

• They may only need to take a pill to restore the body’s sensitivity to insulin.

• Type 2 is the most common form of diabetes (95%) overall (adults and children/adolescents combined).

• Genetics (tends to run in the family)

• Environmental factors

• Overweight/obesity

• Sedentary lifestyle

• Unhealthy food choices

• If other people in your family have it, you are at risk.

• You are at higher risk if you are an African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian or Pacific Islander.

• If you are physically inactive

• If you are overweight

The pancreas lies behind your stomach. Insulin is made in the pancreas. Insulin allows the sugar to pass into our cells to be used for energy. It also turns off the body’s ability to make sugar. When there is not enough insulin, sugar cannot pass from the blood into the cells. Instead, the sugar goes through the kidneys and passes out of the body in urine.

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Pancreas

Stomach

Large intestine

Gallbladder

Liver

Some people with Type 1 diabetes may experience a time where they need very little to no insulin. This is known as the honeymoon period. During this time, the pancreas may still make some insulin. Your diabetes has not gone away, it has just taken a break that may last from weeks to years. Over time, the insulin production stops and as this happens you will require more insulin. It is important to continue to check blood sugars four times a day and communicate with your diabetes doctor.

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For now, diabetes cannot be cured, but it can be managed. Learning how to manage diabetes can help your child grow up healthy. It can also help him or her develop good habits for the future. Managing diabetes means balancing:

• The amount and type of foods eaten

• Exercise and activity levels

• Insulin and/or oral medicines

• Blood glucose levels

• Stress levels

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Checking the level of sugar in your blood and keeping track of the numbers is an important part of taking care of your diabetes. The information helps you and your health care providers know how to balance food, activity and insulin dosing.

To Check Your Child’s Blood Glucose Level:

1. Wash hands with soap and water then dry completely.

2. Insert the test strip into the meter.

3. Poke finger with the lancet to get a drop of blood (it may hurt less if you poke the side of the finger).

4. Put the drop of blood onto the testing strip.

5. After a few seconds, the meter shows the blood glucose level.

6. Record the blood glucose level in your log book.

The poke may scare a young child. Be honest. Say that the poke may hurt. But also explain that the poke will keep him or her healthy. This may ease your child’s fears. As your child gets older, he or she may decide to test their own blood glucose levels with appropriate supervision.

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15

Nam

e:

Ph

on

e #:

KEY

B

Blo

od

Sugar

C

Carb

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ydrate

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I In

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Date

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day

Tuesd

ay

Wed

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Thu

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Friday

Saturd

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Sun

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Hemoglobin (Hgb) is a protein in our red blood cells. Sugar attaches to the hemoglobin and forms Hgb A1C. This blood test helps you and your provider to see how well you are managing your blood sugars. Below you will see the average blood glucose for each level.

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12

11

10

9

8

7.5

7

6

212 mg/dL

183 mg/dL

298 mg/dL

269 mg/dL

240 mg/dL

169 mg/dL

154 mg/dL

125 mg/dL

MY Hgb A1C goal is _______________________

My blood sugar goal before a meal is ________

My blood sugar goal at bedtime is ___________

The consequence of over-treating a low is a high blood sugar, which requires a correction dose of insulin. Too much insulin in our desire to get our blood sugar back down leads to another low and thus, more food. The bigger picture is weight-gain, exhaustion and mood swings. By learning how to manage hypoglycemia and hyperglycemia appropriately you can limit the amount of ups and downs that will occur.

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Time

There are many different pills and injections that are used to treat Type 2 diabetes mellitus. Most of these pills and injections are for adults and not generally used in children. The main medicine that we use is Glucophage®, also known as metformin. The job of Glucophage is to decrease the amount of glucose the liver produces and increase insulin sensitivity. This drug is usually started at 500mg and the dose is increased each week until the appropriate amount of medication is given to reach the desired effect. The maximum dose is 2,000 mg per day. The reason the dosage is gradually increased is to avoid side effects such as diarrhea, nausea, vomiting, bloating, gas and loss of appetite. If you experience symptoms that do not go away, you should contact your diabetes doctor. To decrease the risk of the side affects of this drug, take it with food. Metformin rarely causes low blood sugar or weight gain, and can help improve your triglycerides and cholesterol. Glucophage also comes in a liquid form called Riomet®. This medicine should not be taken when having any test done that requires you to have IV contrast. If you are going to have a test with IV contrast, call your diabetes doctor. Also, this medicine should not be taken if you have kidney or liver disease, recent surgery, a serious infection, dehydration or heavy alcohol use.

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Your child’s insulin regimen will be prescribed by your endocrinologist. Typically, they will prescribe mealtime rapid acting insulin and bedtime long acting insulin. This is to mimic what a non-diabetic body would produce. Because your child’s body is not producing insulin or not using insulin appropriately, you will need to “think like a pancreas.” Remember, when you eat, your pancreas is supposed to secrete insulin. That insulin should be used to unlock muscle and fat cells so they can use the food you eat for energy. Because your child’s pancreas is not working appropriately, you will need to count the carbohydrates your child will eat and calculate how much insulin he or she will need so their body can use those carbohydrates for energy.

• Rapid acting insulins take 10 - 15 minutes to start working, therefore they work best when given before meals.

• Rapid acting insulins peak (works hardest) about 1 1/2 hours after injection, and are mostly done working between two to four hours.

• It is important to only inject rapid acting insulin no more than every three hours when correcting high blood sugar.

• If given more often than every three hours for high blood sugar correction, rapid acting insulin will stack and increase the risk of hypoglycemia.

• Long acting insulins should be given at the same time everyday.

• If using rapid acting and long acting vials, do not mix in same syringe.

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What type of insulin your child ends up using will depend on what the physician decides will work best for your child, as well as what your insurance will cover. Most people with diabetes will need to use a rapid acting insulin before meals and a long acting insulin at either bedtime or first thing in the morning. Below is a list of the most widely used insulins.

describes the amount of time it will take the insulin to start working.

describes when the insulin will be working the hardest.

describes how long the insulin will stay in your body. This can vary person to person.

Information derived from a combination of manufacturer’s prescribing information, online professional literature sources and clinical studies. Individual response to insulin preparations may vary. **Peak and length of action may depend on size of dose and length of time since initiation of therapy. ***Afrezza is FDA approved for patients 18 years and older.

Rapid Acting insulins

Lispro (HumaLOG, Admelog) ~ 15 minutes 1-2 hours 3-6 hours

Aspart (NovoLOG) ~ 15 minutes 1-2 hours 3-6 hours

Aspart (Fiasp) Less than 4 minutes 1 hour ~ 4 hours

Glulisine (Apridra) ~ 20 minutes 1-2 hours 3-6 hours

Insulin (oral inhalation)

Afrezza ***

Less than 15 minutes

~ 50 minutes 2-3 hours

Short Acting insulins

Regular (HumuLIN R, NovoLIN

R)

30-60 minutes 2-4 hours 6-10 hours

Intermediate insulins

NPH (HumuLIN N, NovoLIN N,

ReliOn)

2-4 hours 4-8 hours 10-18 hours

Long Acting insulins

Glargine (Lantus, Basaglar) 3-6 hours Minimal Up to 24 hours

Glargine (Toujeo) 6 hours No Significant Peak 24-36 hours

Detemir (Levemir) 3-4 hours Minimal** Up to 24 hours**

Degludec (Tresiba) 1-4 hours No Significant Peak About 42 hours

Mixed insulins

NPH/Regular (NovoLIN 70/30,

HumuLIN 70/30)

30 minutes 2-12 hours 18-24 hours

Lispro protamine and lispro

(HumaLOG 75/25)

10-15 minutes 0.8-4.8 hours 12-24 hours

Aspart protamine susp and

aspart (NovoLOG 70/30)

10-15 minutes 1- 4 hours 18-24 hours

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• Your child’s doctor will decide when, how frequent and how much insulin he or she will take.

• It is important to use different areas including thighs, arms, hips, buttocks and stomach. Do not use an area if red, bruised, hard or swollen. Stay at least two inches away from the belly button (navel). NEVER give the shot in the belly button.

• If the insulin looks discolored, lumpy, sticks to the sides of the vial/cartridge or the glass is cracked, DO NOT USE IT!

• It is important to plan ahead and have a back up supply. You should have one vial or cartridge that is unopened in your refrigerator for emergency use.

• All insulin vials/cartridges have an expiration date. Whether or not a vial/cartridge has been opened, do not use it after the expiration date. Although each insulin has its own expiration date, discard the insulin 30 days after opening it.

• Storage:

− Insulin in use may be stored at room temperature (less than 86°F) for 30 days after opening it.

− Refrigerate unopened insulin.

− Avoid direct sunlight and/or freezing temperature.

− If you keep the insulin in the refrigerator, let insulin warm to room temperature (15 minutes) before you use it.

− When choosing a new insulin vial/cartridge, compare all expired dates on unopened vials/cartridges and use the one that expires first.

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This depends on your child’s blood sugar and how many carbohydrates your child will be eating. Using the following calculations will allow your child and your family to have some flexibility with the amount of food to be eaten. You will be meeting with a dietitian who will help you learn how to count carbohydrates. This is a very important step in your diabetes education. If you are finding the math to be challenging, please let your nurse know. There are other options for insulin dosing, however these do not allow as much flexibility.

At every meal you will check your child’s blood sugar. Only if your child’s blood sugar is greater than their target blood sugar of ______mg/dl, will you need to give insulin to correct it. Use the following calculation to do this:

Blood Sugar—Target BG = Amount to Correct ÷ Correction Factor = Correction Insulin

(One Unit for Every _____ mg/dl BG)

- = ÷ =

(This calculation will also be used at bedtime if blood sugar is above the target blood sugar). At every meal you will figure out how many carbohydrates your child will eat. (For toddlers and picky eaters, you will count carbohydrates eaten and then calculate the dose). Use the following calculation to do this:

Carbohydrates ÷ Insulin to Carb Ratio = Carb Insulin

(One Unit Will Cover _____ GM of Carb)

÷ =

Add the two calculations together and round to either that half or whole unit.

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Name: _____________________________ Date: _____________________

Before Breakfast Lunch, and Dinner – Test Blood Sugar

Food

• 1 unit Humalog®/NovoLog® per _______ (carb ratio) grams of carbohydrate to be eaten

• Total carbohydrates divided by _______ (carb ratio) = number of units for food

Note: If blood sugar is ____ or below you are done; if ____ or above go to Step 2

High Sugar

• 1 unit Humalog®/NovoLog® per _______ (insulin sensitivity factor) over ____ mg/dl of blood sugar

• Blood sugar minus ____ divided by _______ (insulin sensitivity factor) = number of units for elevated blood sugar

Add Step 1 AND Step 2 together for total Humalog®/NovoLog® dose.

At _____: Give _____ units of Levemir®/Lantus®

Correctional may not be given more than every 3 hours.

Before Bedtime and 2 a.m. – Test Blood Sugar

Food

• 1 unit Humalog®/NovoLog® per _______ (carb ratio) grams of carbohydrate to be eaten

• Total carbohydrates divided by _______ (carb ratio) = number of units for food

Note: If blood sugar is ____ or below you are done; if ____ or above go to Step 2

High Sugar

• 1 unit Humalog®/NovoLog® per _______ (insulin sensitivity factor) over ____mg/dl of blood sugar

• Blood sugar minus ____ divided by _______ (insulin sensitivity factor) = number of units for elevated blood sugar

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25

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8

0 - 0.49 = No insulin

1.01 - 1.49 = 1 unit

2.01 - 2. 49 = 2 units

3.01 - 3. 49 = 3 units

4.01 - 4. 49 = 4 units

5.01 - 5. 49 = 5 units

6.01 - 6. 49 = 6 units

7.01 - 7. 49 = 7 units

8.01 - 8. 49 = 8 units

9.01 - 9. 49 = 9 units

10.01 - 10. 49 = 10 units

11.01 - 11. 49 = 11 units

12.01 - 12. 49 = 12 units

13.01 - 13. 49 = 13 units

14.01 - 14. 49 = 14 units

15.01 - 15. 49 = 15 units

16.01 - 16.49 = 16 units

17.01 - 17.49 = 17 units

18.01 - 18.49 = 18 units

19.01 - 19.49 = 19 units

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If dose is 0.01-0.49 round down If dose is 0.50-0.99 round up

0.50 - 1.00 1 unit

1.50 - 1.99 = 2 units

2.50 - 2.99 = 3 units

3.50 - 3.99 = 4 units

4.50 - 4.99 = 5 units

5.50 - 5.99 = 6 units

6.50 - 6.99 = 7 units

7.50 - 7.99 = 8 units

8.50 - 8.99 = 9 units

9.50 - 9.99 = 10 units

10.50 - 10.99 = 11 units

11.50 - 11.99 = 12 units

12.50 - 12.99 = 13 units

13.50 - 13.99 = 14 units

14.50 - 14.99 = 15 units

15.50 - 15.99 = 16 units

16.50 - 16.99 = 17 units

17.50 - 17.99 = 18 units

18.50 - 18.99 = 19 units

19.50 - 19.99 = 20 units

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1. 3.44 _______ / _______

2. 4.79 _______ / _______

3. 8.99 _______ / _______

4. 2.23 _______ / _______

5. 6.50 _______ / _______

6. 9.63 _______ / _______

7. 3.13 _______ / _______

8. 5.51 _______ / _______

9. 7.77 _______ / _______

10. 2.12 _______ / _______

11. 2.39 _______ / _______

12. 7.89 _______ / _______

13. 9.03 _______ / _______

14. 8.62 _______ / _______

15. 9.97 _______ / _______

16. 4.29 _______ / _______

17. 8.75 _______ / _______

18. 3.33 _______ / _______

19. 5.39 _______ / _______

20. 3.64 _______ / _______

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1. 3.5 3.0

2. 5 5

3. 9 9

4. 2 2

5. 6.5 7

6. 9.5 10

7. 3 3

8. 5.5 6

9. 8 8

10. 2 2

11. 2.5 2

12. 8 8

13. 9 9

14. 8.5 9

15. 10 10

16. 4.5 4

17. 9 9

18. 3.5 3

19. 5.5 5

20. 3.5 4

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1. Remove cap from pen

2. Wipe top of pen with alcohol swab

3. Remove the protective pull tab from the needle, and screw it onto the pen until snug (but not too tight).

4. Remove the plastic outer cap and inner needle cap.

5. Look at the dose window, and turn the dosage knob to ‘2’ units.

6. Holding the pen with the needle pointing upwards, press the button until at least a drop of insulin appears. This is the ‘air shot’ or safety shot. Repeat this step if needed until a drop appears

7. Dial the units of insulin you need to take.

8. To hold the pen, wrap your fingers around the pen with your thumb free to reach the dosing knob.

9. Gently pinch up the skin (if needed) around where you will give the shot and hold firmly.

10. Insert needle under skin at either a 45 or 90 degree angle as directed, and inject the insulin.

11. Count to 10 (or slowly to 5) before removing needle from skin

12. Carefully place outer needle cap over needle. Press down and rotate needle off.

13. Place needle in a sharps container.

14. Place pen cap on pen.

15. Store at room temperature

16. Discard pen after ___ days.

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The artist, Fiona Galaretta, was diagnosed with Type 1 diabetes when she was three years old.

Insulin

_____

32

Insert needle at a

90 degree angle

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Here are a couple of tips:

• Avoid the NO ZONE, that is the belly button and two inches around it. (see the red circled area below.

• Rotate every injection. This is important. If you don’t, your child will end up with scar tissue and your child’s insulin won’t work as well.

Illustration by Isaiah Hicks.

It is illegal to put any syringes, lancets or pen needles in the trash can. Some public restrooms have receptacles, but most do not. Most cities now have hazardous event days where you can bring your syringes, lancets and pen needles to dispose of them. Contact your city waste disposal center to find out how they want you to dispose of your syringes, lancets and pen needles.

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My target range for meals is ____—____mg/dL

My target range for bedtime is ____—____mg/dL

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The goal of your child’s diabetes treatment is to keep his/her blood sugar level within the target range. A blood sugar below the target range is referred to as hypoglycemia. Causes of hypoglycemia include:

• Too much insulin for amount of carbs eaten

• Insulin given and meal missed

• Increased insulin sensitivity

• Unplanned exercise

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1. Check Blood sugar.

2. When blood sugar is less than ____mg/dL (or if no meter available and child is having symptoms) treat with 15 grams of fast acting carbs (1/2 cup juice or four glucose tabs).

3. Recheck blood sugar in 15 minutes.

4. If blood sugar is less than___mg/dL, retreat with fast acting carb. Continue to check blood sugar and treat every 15 minutes until greater than____mg/dL.

5. If greater than ___mg/dl, give 15 gram snack with protein or give meal.

6. Give insulin after meal.

7. Call your diabetes doctor if your child’s sugar is not returning to normal range within 60 minutes.

8. Call your diabetes doctor or nurse if you have three or more low blood sugars in one week.

© 2009 Novo Nordisk Inc.

Store your unused glucagon kit at room temperature. Monitor expiration date. Severe hypoglycemia occurs when there is too much insulin in the body with no glucose to move into cells.

• Inability to eat or drink anything safely

• Unconsciousness

• Unresponsiveness

• Seizures

Glucagon/GlucaGen® is a life-saving injectable hormone that will stimulate the liver to release stored glucose causing the blood sugar to go up. If your child is experiencing any of the above signs, prepare and give Glucagon. The emergency kits contains a vial with 1mg of dried Glucagon and 1ml of liquid in a syringe for mixing with the powder. The kit may be red or orange in color.

1. Remove vial and syringe from kit.

2. Flip cap off vial.

3. Remove cap from syringe.

4. Put needle into vial and inject all the fluid.

5. Without taking the needle out of the vial, gently shake the vial in your hand until the powder has completely mixed with the fluid. The solution should be clear and colorless.

6. Draw up the prescribed amount back into the syringe: 0.5mL for children less than 44 lbs., 1.0mL for children equal to or greater than 44 lbs.

7. Clean site for injection, but do not delay giving medication.

8. Give injection at 90 degree angle into skin of the thigh, arm or buttocks with skin pulled tight.

9. Although it is preferable to remove the clothing from the site, it is OK to give the injection through the clothing.

10. Call 911.

Place child is on his/her side for comfort and safety. Nausea and vomiting may occur. It may take 10 to 20 minutes before the child begins to wake up. Check blood sugar. Give sips of carbohydrate fluids once child is awake and able to drink. Give solid food when child is able to eat. Watch child carefully because another low blood sugar may occur. Call your doctor after giving injection.

38

In 2019, The FDA approved two new treatments for severe hypoglycemia: • BAQSIMI — a nasally administered Glucagon, for the treatment of severe hypoglycemia in people

with diabetes four years and older. • GVOKE — a pre-mixed Glucagon pen, which can be used for severe hypoglycemia in people with diabetes

who are at least two years of age. GVOKE is a room-temperature, liquid, stable Glucagon that is ready-to-use in an emergency.

Please check your insurance to see if these are covered

39

The goal of your child’s diabetes treatment is to keep his/her blood sugar level within the target range. An elevated blood sugar above the target range is referred to as hyperglycemia.

• Missed insulin dose for meal, or long acting dose

• Not enough insulin (either long acting or rapid acting)

• Ilness

1. Test blood sugar often (every two to three hours ) and ketones (every three to four hours) if the blood sugar is above _________.

2. If no ketones, give correction.

3. If trace or small ketones, give correction and give water to drink.

4. NO EXERCISE IF KETONES ARE POSITIVE

5. If moderate or large ketones, give correction, give water to drink, and call your diabetes doctor/endocrinologists.

6. Remember to continue to check ketones every three to four hours until they are gone.

7. Call your diabetes doctor or nurse if the sugar remains high for three consecutive tests or if your child has moderate to large ketones in the urine.

40

A ketone test checks for ketones in your urine or blood. Ketones are acids that accumulate in the blood and appear in the urine when your body does not have enough insulin. Ketones in the urine may mean that your diabetes is out of control or that you are getting sick.

• Testing your urine for ketones should be done whenever your blood sugar is greater than 250 mg/dL or when you don’t feel well.

• Urine ketones are measured with strips. Follow package instructions carefully. Dip the strip in a container (paper cup) of your urine or urinate on the strip. Wait the specified amount of time as seen on the bottle and compare the color change to the chart on the container.

• Be sure to store all strips in the original container with the lid on it in a cool dry place. Do not use the strips after the expiration date.

• If you have a moderate to large amount of ketones, call your diabetes doctor/endocrinologist.

• Insulin may need to be adjusted based on blood sugar and ketone level.

• Check ketones every 3 - 4 hours until negative.

41

Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. When your child’s blood sugar is high, usually greater than 250mg/dL, or they are ill, your child’s body is looking for energy. Since it can’t get to the sugar in the blood, it will start breaking down fat for energy. This LEADS TO KETONES IN THE BLOOD. When there are a lot of ketones in the blood, they turn the blood acidic. This is a dangerous situation and must be corrected quickly.

• Missed insulin dose

• Illness

• Dehydration

• Abdominal pain

• Nausea and/or vomiting

• Heavy/noisy breathing, fruity smelling breath

• Weakness or fatigue

• Confusion

If your child is experiencing any of the above symptoms, go to the emergency room right away! If not addressed quickly, DKA can be fatal.

42

43

• Give long acting insulin (ex. Lantus/Basaglar®) as usual.

• Check blood sugars every three hours

• Check ketones every three hours even if blood sugar is normal. Illness can cause the body to break down fat stores even when blood sugar is normal. If ketones are positive, please refer to ketone management (next page).

• If blood sugar is elevated, give correction dose of insulin every three hours. If your child is not vomiting, also give insulin for carbs that your child eats/drinks (check blood sugar prior, but give insulin after your child eats/drinks if appetite is poor).

• If blood sugar is greater than 300 mg/dl two times in a row, or if your child is having low blood sugars, call your diabetes team or doctor

• Give long acting insulin (ex. Lantus®/Basaglar®) as usual. Check with the clinic if you think the dose needs adjustment

• Check blood sugar and ketones every three hours even if blood sugar is normal. If ketones are positive, follow ketone management (on next page).

• Give insulin correction dose for high blood sugar every three hours as needed (or every two hours for moderate/large ketones).

• Give fluids with carbohydrates (i.e., regular 7-Up, popsicles). Do not give insulin for these carbohydrates.

• Give insulin correction dose every three hours (or every two hours for moderate/large ketones).

• Once vomiting has stopped, try giving your child bland foods such as saltine crackers, rice, apple sauce or toast. If no more vomiting occurs, start giving insulin injections before meals (if your child ir older than 5 years old and usually receives insulin before meals).

If vomiting is severe, with or without ketones, and your child is unable to keep fluids down, bring your child to the emergency room (or call 911) for IV fluid replacement and further evaluation.

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Give long acting insulin (ex. Lantus/Basaglar®) as usual whether ketones are present or not. Check with the clinic if you think the dose needs adjustment (i.e., frequent high or low blood sugars).

Check urine for ketones:

• if your blood sugar > 250 mg/dL

• if you are ill (no matter what the blood sugar is)

If urine ketones are moderate/large positive and do not improve by four hours; OR if your child is vomiting

and unable to tolerate fluids by mouth, lethargic, has severe abdominal pain, or is having difficulty breathing,

take him/her to the emergency room or call 911.

• Give high blood sugar correction

with insulin every three hours as

needed (as well as insulin for carbs,

if not vomiting).

• Give carbohydrate-free and caffeine-

free fluids (i.e., water, Crystal Light®,

diet 7-up®).

• Give high blood sugar correction dose

every 3 hours as needed.

• Get rest.

• Check blood sugar every 2 hours

and give high blood sugar

correction dose as needed.

• Push carb free fluids and get rest.

• 8 am – 5 pm: call Miller Children’s

& Women’s Endocrine Center

(562) 933-8562 and ask for

diabetes nurse.

• After hours: call hospital

operator: (562)933-2000. Ask the

operator to page the Pediatric

Endocrinologist on call via

PerfectServe.

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For now, diabetes cannot be cured, but it can be managed. However, diabetes can get out of control especially if:

• Diabetes medicines are not taken as directed.

• The meal plan is not followed (like eating too much or not enough food without adjusting diabetes medicines).

• Regular exercise is not made a priority or medication is not adjusted appropriately prior to more or less exercise.

• Illness or too much stress is not managed appropriately.

• Blood sugar checks and correctional dosing are not done as directed.

If diabetes is not managed it can lead to diabetic ketoacidosis. Over time the following complications can occur:

• Eye problems (Retinopathy)

• Kidney problems (Nephropathy)

• Nerve problems (Neuropathy)

• Poor circulation (especially of the feet)

• Slower healing

• Slow stomach emptying (gastroparesis)

These problems don’t usually show in kids or teens who have had diabetes for only a few years, but complications can start to appear as they get older. The good news is that keeping blood sugar levels under control can help keep them healthy and prevent health problems from happening later.

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1. Diabetes is:

a. Disease where the body either does not make insulin, does not make enough insulin or the cells can’t use the insulin the way they should

b. Thyroid disease

c. Type of infection

2. What effect does insulin have on the blood sugar?

a. It increases the blood sugar

b. It decreases the blood sugar

c. It does not have any effect

3. List three common symptoms of a high blood sugar.

________________________________________________________

________________________________________________________

________________________________________________________

4. List three common symptoms of a low blood sugar.

________________________________________________________

________________________________________________________

________________________________________________________

5. When should insulin be thrown away?

a. When it looks discolored

b. For most insulins, when it has been open for 30 days or greater. EXCEPTION: Levemir discard after 42 days and, Tresiba and Toujeo discard after 56 days.

c. Discard after the expiration date, even if the vial has never been opened

d. All of the above

6. When do you need to test the urine for ketones?

a. Once per day

b. When the blood sugar is below 70

c. Whenever the blood sugar is over 250 and when sick.

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7. How often can a correctional dose of rapid acting insulin be given? Every _____ hours.

8. The blood sugar level usually____ in times of stress.

a. Decreases

b. Increases

c. It does not have any effect

9. What should you do if your child has stomach pain/nausea/vomiting?

_____________________________________________________________________

10. What should you give your child if they have a blood sugar of 62?

a. 1/2 cup of juice

b. 1 cup of water

c. 1 glucose tablet

11. When do you need to inject glucagon?

______________________________________________________________________

12. A person with diabetes should NOT exercise if they have?

a. Blood sugar of 200

b. Positive ketones in their urine

c. Negative ketone in their urine

13. Which of the following is important when you exercise?

a. Carry a source of sugar (glucose tablets)

b. Dress warmly

c. Eat a full meal

14. Humolog/Novolog is:

a. Type of long lasting insulin given once per day

b. Type of rapid acting insulin given with meals or to correct high blood sugar

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49

Carbohydrate counting helps keep your blood sugar closer to target levels. Foods with carbohydrates (carbs) turn into glucose in the blood. Glucose is fuel for your brain and body so that you can think, learn and be active. You need to balance the right amount of food with insulin to allow your body to keep your blood sugar on target.

• Eat meals and snacks at regular times.

• Try not to skip meals or snacks, even if your blood sugar is high.

• Stop eating carbohydrates at least two hours before you plan to check your blood sugar.

Good nutrition along with controlled blood sugar helps you feel better, grow well and stay healthy and strong. Eat a variety of foods from each food group.

Include one fruit, grain and dairy at each meal.

Fruits: 2-3 servings daily

Eat whole fruits.

Grains (cereal, rice, pasta), beans, starchy vegetables: 5-9 servings daily

Eat whole grains more often.

Milk and yogurt: 3-4 servings daily

Drink low-fat milk.

Sweets: count your carbs

Spend your carbs wisely. These offer little nutrients.

You need very little insulin when you eat these foods.

Nonstarchy vegetables: 2-3 servings daily

Choose colorful vegetables.

Meat, poultry, fish, eggs, nuts and cheese: 5-6 ounces daily

Go lean with the protein.

Fats: 4-6 servings daily

Choose heart-healthy fats.

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Apple 1 small (4 oz.) 15 1

Apple sauce, unsweetened 1/2 cup 15 1

Banana 1 medium (8 oz.) 30 2

Blackberries, blueberries 3/4 cup 15 1

Cantaloupe 1 cup cubed (11 oz.) 15 1

Cherries, fresh 12 (3 oz.) 15 1

Dates 3 15 1

Dried fruits 2 Tbsp 15 1

Figs, dried 1 1/2 15 1

Figs, fresh 1 1/2 large or 2 med. (3 1/2 oz.)

15 1

Fruit cocktail 1/2 cup 15 1

Grapes 12-15 (3 oz.) 15 1

Guava, 1½ fruit, medium About 5 oz. 15 1

Kiwi 1 (3 1/2 oz.) 15 1

Mandarin oranges, canned 3/4 cup 15 1

Mango, small 1/2 fruit or ½ cup (5 1/2 oz.) 15 1

Nectarine, small 1 (5 oz.) 15 1

Orange, small 1 (6 1/2 oz.) 15 1

Papaya 1/2 fruit cubed (8 oz.) 15 1

Peaches, canned 1/2 cup 15 1

Peaches, fresh, medium 6 oz. 15 1

Pears, canned 1/2 cup 15 1

Pear, large 1/2 (4 oz.) 15 1

Pineapple, canned 1/2 cup 15 1

Pineapple, fresh 3/4 cup 15 1

Plums, dried (prunes) 3 15 1

Plums, fresh, small 2 (5 oz.) 15 1

Strawberries, whole 1 1/4 cups 15 1

Tangerines, small 2 (8 oz.) 15 1

Watermelon 1 1/4 cup cubed (13 1/2 oz.) 15 1

Baked beans 1/3 cup 15 1

Beans, lentils, red, black, pinto 1/2 cup 15 1

Edamame, boiled, drained 1 cup (6 oz.) 15 1

Garbanzo beans, cooked 1/2 cup 15 1

Hummus 1/3 cup 15 1

Peas, cooked (black-eyed, split) 1/2 cup 15 1

Refried beans, canned 1/2 cup 15 1

Bagel 1/2 (2 oz.) 30 2

Bagel 1 (4 oz.) 60 4

Barley, cooked 1/3 cup 15 1

Barley, cooked 1 cup 45 3

Biscuit 2 1/2inches 15 1

Bread (white, whole-grain, rye) 1 slice (1 oz.) 15 1

Bread, reduced calorie 2 slices (1 1/2 oz.) 15 1

Chapatti, small 6 inches across 15 1

Cornbread 1 3/4 inch cube (1 1/2 oz)

15 1

Cold cereal, unsweetened 3/4 cup 15 1

Cold cereal, sugar frosted 1/2 cup 15 1

English muffin 1 whole 30 2

Grits, cooked 1/2 cup 15 1

Hot cereal, oatmeal 1/2 cup 15 1

Hot dog or hamburger bun 2 oz 30 2

Naan 8 x 2 inches 60 4

Pancake 4 inches across, 1/4 inch thick

15 1

Pasta, cooked 1/3 cup 15 1

Pasta, cooked 1 cup 45 3

Pita 6 inches across 30 2

Polenta, cooked 1/3 cup 15 1

Quinoa, cooked 1/3 cup 15 1

Rice, cooked 1/3 cup 15 1

Rice, cooked 1 cup 45 3

Roll, plain, small 1 oz. 15 1

Tabbouleh, Tabouli, prepared 1/2 cup 15 1

Taco shell 5 inches across x2 15 1

Tortilla, corn or flour 6 inches across 15 1

Tortilla, flour 10 inches across 45 3

Waffle 4 inches square or 4 inches across

15 1

Wild rice, cooked 1/2 cup 15 1

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A carbohydrate (carb) choice has about 15 grams of carbohydrate. It is important to read food labels for the exact carb amount in a food item.

Chocolate milk 1 cup 30 2

Fat free or reduced-fat milk 1 cup 15 1

Fat-free plain yogurt ∕₃ cup (6 oz.) 15 1

Fat-free, artificially sweetened flavored yogurt ∕₃ cup (6 oz.) 15 1

Soy or rice milk 1 cup 5-15 0-1

Cassava 1/3 cup 15 1

Corn 1/2 cup or 1/2 cob (5 oz.)

15 1

French fries, baked 10-15 fries (2 oz.) 15 1

Hominy, canned 3/4 cup 15 1

Mix vegetables with corn, peas, or pasta) 1 cup 15 1

Peas, green 1/2 cup 15 1

Plantain, ripe 1/3 cup 15 1

Potato, baked small, 3 oz. 15 1

Potato, mashed with milk & fat 1/2 cup 15 1

Pumpkin, canned, no sugar added 1 cup 15 1

Spaghetti/pasta sauce 1/2 cup 15 1

Squash, acorn, butternut 1 cup 15 1

Succotash 1/2 cup 15 1

Sweet potatoes, yam, plain 1/2 cup 15 1

Taro, cooked 1/3 cup 15 1

1 serving =

1/2 cup cooked or 1 cup raw

5 or fewer

0

Artichoke, asparagus, baby corn, bamboo shoots

Green beans, bean sprouts, beets, bitter melon

Broccoli, brussel sprouts, cabbage

Carrots, cauliflower, celery, coleslaw

Cucumber, chayote, eggplant, greens

Heart of palm, jicama, kohlrabi, leeks

Mixed vegetables

Mushrooms, okra, onion, radish or daikon

Pea pods, peppers, radishes, spinach, tomatoes

Turnips, water chestnuts or zucchini

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Animal crackers 7 15 1

Cake, unfrosted 2 in. square (1 oz.) 15 1

Chocolate chip cookies 2 cookies (2 1/4 inches) 15 1

Cookie (sandwich type) 2 small 15 1

Cupcake, frosted 1 small (about 1 3/4 oz.) 30 2

Crackers: cheese or peanut butter filling 3 15 1

Graham crackers 3 squares 15 1

Gingersnaps 3 cookies 15 1

Snack chips, potatoes or tortilla 15-20 (3/4 oz.) 15 1

Jam/jelly/syrup/table sugar 1 Tablespoon 15 1

Ice cream 1/2 cup 15 1

Fruit juice bars 1 bar (3 oz.) 15 1

Frozen yogurt, fat free 1/3 cup 15 1

Matzoh 3/4 oz. 15 1

Oyster crackers 20 15 1

Popcorn 3 cups 15 1

Pretzels 3/4 oz. 15 1

Pudding, made with reduce fat milk 1/2 cup 30 2

Pudding, sugar free (made with fat free milk) 1/2 cup 15 1

Saltine type or round butter type crackers 6 15 1

Snack chips (fat-free or baked) 15-20 (3/4 oz.) 15 1

Snack chips (regular tortilla, potato) 9-13 (3/4 oz.) 15 1

Vanilla wafers 5 cookies 15 1

Fruit juice blends, 100% 1/3 cup 15 1

Juice (apple, orange, grapefruit) 1/2 cup 15 1

Juice (cranberry, grape, prune) 1/3 cup 15 1

Pineapple juice 1/2 cup 15 1

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Pizza, cheese/vegetarian, thin crust 1/4 of 12 inches

(4 1/2 - 5 oz.)

30 2

Pizza, meat topping, thin crust 1/4 of 12 inch (5 oz.) 30 2

Pocket sandwich 4 1/2 oz 45 3

Pot pie 1 small (7 oz.) 36-40 2½

Potato salad 1/2 cup 30 2

School lunch + plain milk Varies 45-60 3-4

Spaghetti with meatballs 1 cup 30 2

Stew (meat + vegetables) 1 cup 15 1

Submarine sandwich 1 sub, 6 inches 45 3

Taco, hard or soft shell 1 small,meat/cheese 15 1

Tomato soup (made with water) 1 cup (8 oz.) 15 1

Vegetable beef, chicken, or other broth soup 1 cup (8 oz.) 15 1

Burrito, beef + beans 5 oz. 45 3

Casseroles (tuna noodle, lasagna) 1 cup 30 2

Chicken nuggets 6 (3 1/2 oz.) 15 1

Chicken breast, breaded & fried 5 oz. 15 1

Chili (beef and beans) 1cup 30 2

Coleslaw 1/2 cup 15 1

Egg, cheese, meat, english muffin 1 sandwich 30 2

Hamburger 2 oz. buns 30 2

Macaroni and cheese 1 cup 30 2

Macaroni/pasta salad 1/2 cup 30 2

Noodles + vegetables (chow mein) 1 cup 30 2

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1. Look at serving size, all values are based on one serving.

2. Total carbohydrate - Use this number to count carb grams. For carb choices, use the guide below.

3. Acknowledge the sugar content - it is already included in the total carbohydrates.

0 - 5 0

6 - 10 1/2

11 - 20 1

21 - 25 1 1/2

26 - 35 2

36 - 40 2 1/2

41 - 50 3

51 - 55 3 1/2

56 - 65 4

66 - 70 4½

71 - 80 5

81 - 85 5 1/2

86 - 95 6

96 - 100 6 1/2

101 - 110 7

111 - 115 7 1/2

116 - 125 8

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Protein helps to build and maintain strong muscles, bones and body tissues. Protein does not raise your BG level like carbs do. Some meat and meat substitutes are high in fat and calories. It’s wise to go lean with the protein. Eat about 2-3 oz. of lean meat/meat substitutes at each meal or about 5-6 oz. per day. Make sure you choose to bake, broil, roast or grill meats to avoid extra fat.

Meat and Meat Substitutes Serving Size

Beef: Select or choice grades trimmed of fat: Ground round, roast (chuck, rib, rump), round, sirloin, steak (cubed, flank, porterhouse, t-bone), tenderloin

3 oz.

Beef jerky 1/2 oz.

Cheeses with three grams of fat or less per oz. 1 oz.

Cottage cheese 1/4 cup

Chicken or turkey without skin 3 oz.

Egg 1

Fish, fresh or frozen, plain: Catfish, cod, flounder, haddock, halibut, salmon, tilapia, trout, tuna

3 oz.

Hot dog with 3 grams of fat or less per oz (8 dogs per 14 oz. package)

Note: May be high in carbohydrate

1

Meatless burger, soy-based (read labels for carbs) 3 oz.

Meatless burger, vegetable-and starch-based (read labels for carbs)

1 patty, about 2 1/2 oz.

Nut spreads: Almond butter, cashew butter, peanut butter, soy nut butter

1 Tbsp.

Pork: Cutlet, shoulder roast

3 oz.

Processed sandwich meats with three grams of fat or less per oz: chipped beef, deli thin-sliced meats, turkey ham,

1 oz. (1-2 slices)

Tofu 4 oz. (1/2 cup)

Tuna or salmon, canned in water, drained 2 oz. (about 1/2 cup)

Good sources of protein include: beef, pork, lamb, chicken, turkey, fish, seafood, eggs, nuts, tofu and cheese.

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Fats help you grow and are important for normal brain development. This fuel can be stored for a long time in your body. Fat does not make your blood sugar level go up. Eating too much fat can make you gain weight. Choose fats that keep your heart healthy. Eat less of the fats that are not healthy for your heart.

Avocado, medium 2 tablespoon (1 oz.)

Nut butters (trans fat-free): almond butter, cashew butter, peanut butter

1 1/2 teaspoon

Nuts: Almonds

Brazil

Cashews

Filberts (hazelnuts)

Macadamia

Mixed (50% peanuts)

Peanuts

Pecans

Pistachios

6 nuts

2 nuts

6 nuts

5 nuts

3 nuts

6 nuts

10 nuts

4 halves

16 nuts

Oil: canola, olive, peanut 1 teaspoon

Olives:

Black (ripe)

Green, stuffed

8 large

10 large

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Margarine: Lower-fat spread (30-50% vegetable oil, trans fat free)

1 tablespoon

Margarine: Stick, tub (trans fat free),

1 teaspoon

Mayonnaise: Reduced fat Regular

1 tablespoon

1 teaspoon

Nuts: Pignolia (pine nuts) Walnuts, English

1 tablespoon 4 halves

Oil: Corn, flaxseed, grape seed, safflower,

1 teaspoon

Oil made from soybean & canola - Enova® 1 teaspoon

Plant stanol esters: Light Regular

1 tablespoon 2 teaspoon

Salad dressing: Reduced fat (may be higher in carb) Regular

2 tablespoon 1 tablespoon

Seeds: Flaxseed, pumpkin, sunflower sesame seeds

1 tablespoon

Tahini or sesame paste 2 teaspoon

Bacon, cooked, regular or turkey 1 slice

Butter-stick 1 teaspoon

Coconut, sweetened, shredded 2 tablespoon

Coconut, milk 1 1/2 tablespoon

Cream cheese - reduced fat 1 1/2 tablespoon (3/4 oz)

Cream cheese - regular 1 tablespoon (1/2 oz)

Lard 1 teaspoon

Shortening 1 teaspoon

Sour cream - regular 2 tablespoon

Sour cream - reduce fat or light 3 tablespoon

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You may eat up to three of these foods a day, if an amount is listed. Try not to eat them all at one time. If no amount is given, you may choose freely. Free foods have 20 calories or fewer and five grams of carbohydrates or fewer per serving.

Animal crackers 2 crackers

Bouillon, broth, consommé -

Bacon bits 1 teaspoon

Candy, hard, sugar-free 1 piece

Catsup 1 tablespoon

Cheese crackers, reduced-fat 5 crackers

Cocoa powder, sugar-free 1 tablespoon

Drink mixes, sugar-free -

Gelatin, sugar-free -

Gum, sugar-free -

Ice cream cone, cake variety 1 cone

Jam or jelly, light or low-sugar 2 teaspoon

Puffed cereal, dry 1/2 cup

Light juice drinks 1/2 cup

Margarine spread, reduced-fat 1 teaspoon

Mayonnaise, fat-free 1 tablespoon

Mini rice snacks 2 cakes

Oyster crackers, small 8 crackers

Pickles, dill 1 1/2 medium

Pickles, sweet 2 slices

Popcorn, popped without added fat 1 cup

Popsicle, sugar-free 1 pop

Pretzels 1/4 ounce

Salsa 1/4 cup

Sparkling water, sugar-free -

Sugar substitutes -

Syrup, sugar-free 2 tablespoons

Mini bear-shaped cookies (cinnamon or honey-flavored)

4 cookies

Vegetables, raw, non-starchy, such as cucumbers, peppers, salad greens

1 cup

Whipped topping, light or fat-free 2 tablespoons

60

Animal crackers 2 crackers 4 crackers 6 crackers

Apple 1/4 small 1/2 small 1 small

Applesauce 1/4 cup 1/3 cup 1/2 cup

Baked potato chips 1/4 oz. or 5 chips 1/2 oz. or 6-10 chips 3/4 oz. or 10-15 chips

Banana 1/4 medium or 1/3 extra small (1 oz.)

1/3 medium or 1/2 extra small (2.5 oz)

1/2 medium or 1 extra small (4 oz.)

Berries 1/3 cup 1/2 cup (1/2 cup strawberries = 6g carb)

1 cup

Cereal unsweetened (dry) 1/4 cup 1/2 cup 3/4 cup

Cheddar crackers 10 crackers 20 crackers 30 crackers

Cherries 4-5 cherries 8-10 cherries 12-15 cherries

Corn tortilla chips (baked) with salsa

5 corn chips, 1/4 cup salsa

7-10 corn chips, 1/4 cup salsa

10-15 corn chips, 1/4 cup salsa

Graham crackers 1 square 2 squares 3 squares

Milk (nonfat or 1%) 1/4 cup or 2 oz. 1/2 cup or 4 oz. 1 cup or 8 oz. (half pint, 236mL)

Melon 1/3 cup 1/2 cup 1 cup

Peach 1/4 medium 1/2 medium 1 medium (size of a tennis ball)

Pear 1/4 small 1/2 small 1 small or 1/2 large

Popcorn 1 cup 2 cups 3 cups

Pretzel twists, mini 5 pretzels or 1/4 oz. 10 pretzels or 1/2 oz. 15 pretzels or 3/4 oz.

Raw vegetables with dip 1 cup vegetables, 1 teaspoon peanut butter or ranch dip

1 cup vegetables, 1 tablespoon peanut butter or ranch dip

2 cup vegetables, 2 tablespoon peanut butter or ranch dip

String cheese stick with saltine crackers or whole wheat crackers

1 low fat string cheese, 4 saltine crackers or 2 whole wheat crackers (Ak-mak)



Turkey and cheese (½) sandwich with mustard, lettuce or spinach and tomatoes

Lettuce to wrap contents, 1-oz. turkey or 1-oz. slice cheese, 1 slice tomato

1 slice whole-wheat bread without crust, 1 oz. turkey or 1-oz. slice cheese, lettuce or spinach, 1 slice tomato

1 slice whole-wheat bread, 1-oz. turkey or 1-oz. slice cheese, lettuce or spinach, 1 slice tomato

61

Holidays, birthdays and other special occasions are part of life. Children with diabetes can and should actively participate in these special occasions. Planning ahead is the key to these occasions without compromising diabetes control.

• Inform the host.

• Eat sweets in moderation (this includes children without diabetes).

• Offer to buy/prepare healthful drinks/snacks for everyone at parties.

• Include physical activities/games.

• Alternative snacks — ants on a log (celery with peanut butter and a few raisins), carrot sticks, vegetables and dip, cheese and crackers or fruit.

• If cake is served at party — count the carbs, have parents discuss with medical team in advance.

• Consider non-food treats and offer to bring party favors, toys, school supplies or temporary tattoos.

• Focus on spending time with loved ones or celebrating traditions during holidays.

• Limit large holiday dinners and treats to one day. Plan to cover meals with extra insulin (talk with your doctor).

• Try new recipes for holiday favorites available in cookbooks — sugar-free, reduced fat or reduced carbs.

• Trade in some of your child’s candy for money or toys (i.e., a quarter for each candy) or donate some of your child’s candy to charity.

• Plan a house party instead of “trick-or-treating” door to door.

• Read the book Trick-or-Treat for Diabetes by Kim Gosselin.

• Visit a haunted house or rent a scary movie.

• Allow one piece of candy with a meal as part of your child’s meal plan allowance.

• Make the Halloween costume extra special.

• Call your local chapters of the American Diabetes Association or Juvenile Diabetes Research Foundation.

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63

64

65

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Using the table provided, write a list of foods frequently eaten at home, along with your usual serving size and the grams of carbohydrate in that specific amount.

67

Example: Rice 1/3 cup 15 g.

Please complete the “Meal Planning Worksheet” and “How Much do you Know about Carbohydrate Counting?” before your next appointment with the dietitian (RD) or diet technician (DTR).

• Record all food and beverages your child plans to eat and drink in a sample day.

• Write down the food, the amount and how many grams of carbohydrates.

• Be specific as possible. See an example below.

100% whole wheat bread 1 slice 15 grams

Banana 1/2 medium 15 grams

2% milk 1 cup 15 grams

Egg 1 0 grams

Butter 1 teaspoon 0 grams

7:30 am (example)

Total: 45 grams of carbs

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Total:

Total:

Total:

_______

_________ carbohydrate choices or __________ grams carbohydrate

_______


_______


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Total:

Total:

Total:

: _______


_______


_______


Total daily carb choices or grams of carb:

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1. Why should you count carbohydrates (carbs)?

A. Carb counting helps you plan meals to manage your blood glucose (blood sugar) levels

B. Carb counting helps you figure out how much insulin you need to cover for meals

C. Both a and b are correct

2. Which food would have about 15 grams of carbs?

A. Peanuts (1 oz.)

B. Banana (1/2 medium)

C. Cheese (1 oz.)

3. Which three food groups have carbs that affect your blood glucose?

A. Meat/meat substitute group, fruit group, vegetable group

B. Milk/yogurt group, meat/meat substitute group, grains/beans/starchy vegetables group

C. Milk/yogurt group, fruit group, grains/beans/starchy vegetables group

4. Which four starchy vegetables are counted as carbs?

A. Peas, corn, potatoes, yams/sweet potatoes

B. Broccoli, cucumbers, tomato, carrots

C. Lettuce, corn, green beans, tomato

5. Which of the following foods have little or no carbs?

A. Pizza, cookies, rice

B. Cheese, zucchini, eggs

C. Yogurt, banana, cereal

6. What are the two main parts of the food label that you need to read?

A. Serving size and total carbohydrates

B. Sugars and fats

C. Total carbohydrate and sugars

7. If a food is labeled “sugar-free,” does this mean the food is always “carbohydrate-free”?

A. Yes

B. No

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8. Below is the dinner Chris ate last night. Mark all of the foods that have carbohydrates.

❑ 2 pieces of baked chicken (no skin or breading)

❑ 1 cup of rice

❑ 1/2 cup of pinto beans

❑ 1/2 cup of corn

❑ 1 cup of salad (lettuce and shredded carrots) with 1 tablespoon of ranch dressing

❑ 1 cup (8 ounces) of reduced-fat (2%) milk

9. How many grams of carbohydrates did Chris eat for dinner last night? ______

(Remember this hint: it’s not just what you eat, but it’s also how much!)

10. Read the Nutrition Facts below. How many grams of carbohydrates are in one tortilla? ______

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Exercise at least one hour per day. This can be broken up into sessions of a minimum of 20 minutes at a time (i.e., three 20-minute sessions, two 30-minutes sessions, etc).

Tips to stay active:

• Use the stairs instead of elevators or escalators.

• Walk instead of driving to nearby stores, schools and parks.

• Look into classes through your local parks & recreation department.

• Sign up for a sports team/class, join a dance or martial arts class, join a gym.

• Add PE as an elective (middle school, high school and college).

• Exercise on the weekends and after school before screen time.

• Regular exercise helps lower the blood sugar by helping insulin work better.

• Exercise helps with weight loss, decreases stress, improves blood flow, lowers cholesterol and triglycerides and helps you feel better.

• Knowing how you may feel when blood sugar is low is VERY important as exercise may lower your blood sugar.

• Start slowly and set a pace that is right for you. Gradually increase the time and how hard you work. Remember to warm up before exercise and cool down afterwards.

− Good examples of regular exercise include: speed walking, jogging, swimming, biking, dancing, and skating. Play at the park or playground. Join a sports team. Do something you enjoy!

• Test your blood sugar before and after exercise and every 30 minutes for prolonged exercise or as needed for symptoms. Don’t forget that exercise can affect your blood sugar for up to 24 hours.

• Always carry a sugar source with you such as honey, juice, glucose tablets, or glucose gel in case your blood sugar decreases.

− If you often have low blood sugar reactions with exercise, tell your doctor, diabetes nurse, or physical therapist.

− It is always wise to exercise with a friend or parent.

• Always wear supportive shoes.

• Precautions:

• Do not exercise if you have blood sugar greater than 300 mg/dL or if ketones are present in the urine.

− Exercise should be avoided until the blood sugar comes down and ketones are negative or trace.

• Avoid exercise if your blood sugar is under 90 mg/dL.

− Correct blood sugar by eating 15 grams of fast acting carbohydrates.

− Recheck blood sugar in 15 minutes.

− Refer to the Carbohydrate Replacement Chart to determine amount of carbohydrates to eat to avoid low blood sugar with exercise. 74

Physical activity may increase the amount of carbohydrates (carbs) you need to eat in order to have a blood sugar within target range. The amount of carbs you will need will depend on:

• How long you exercise.

• How hard you exercise.

• Your blood sugar level before you exercise.

The chart on the following pages is a guideline that will help you get started. It may not be the best plan for you. You may need a different snack plan or you may need to change the amount of insulin you take.

Remember: Keep a record of your blood sugar when you’re active to exercise safely.

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Remember: Monitor your blood sugar 15 to 20 minutes before you begin to exercise.

Answer the following questions:

• What is your blood sugar level?

• Is it less than 90 mg/dL?

• 90 to 150 mg/dL? 150 to 300 mg/dL?

• Or greater than 300 mg/dL?

• How long do you plan to exercise?

• How difficult (how much effort) do you think the exercise will be?

Note: Mild exercise feels “light” or easy to do, moderate activity takes more effort and feels a little bit hard to do and hard activity is vigorous and requires a lot of effort. Locate your exercise effort on the chart.

1. Using your answers to these questions, look at the chart to figure out about how many extra carbohydrates you need to eat BEFORE your activity.

2. Choose a snack that provides the right amount of carbohydrates. See the chart for a list of snack suggestions.

3. Check your blood sugar every 30 minutes during any activity that lasts longer than 45 to 60 minutes.

4. Check your blood sugar after exercise and again one to two hours later. If you have done much more activity than usual, it also is a good idea to set your alarm clock and check your blood sugar again at 2 a.m. Blood sugar levels can continue to go down for many hours after you have exercised, especially if you have done large amounts.

5. Figure out whether you need to eat extra carbohydrate foods at your next meal or snack to keep your blood sugar level healthy.

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Mild

Eat 15 grams of fast acting

carbs. Recheck in 15 minutes.

If above 90 mg/dL, follow the

appropriate column.

0-15 0 For 15 grams of

carbohydrates, choose one fruit or one starch

(six saltine crackers, three graham crackers, a small - check the label for exact

carbohydrates).

For 30 grams of

carbohydrates, choose two.

For 45 grams of

carbohydrates, choose three.

15-30 Minutes Moderate 15 0-15

Hard 15 0-15

Mild 15-30 0-15

30-60 Minutes Moderate 15-30 15

Hard 15-30 15-30

Mild 15-45 15-30

60-90 Minutes Moderate 30-45 30-45

Hard 30-45 30-45

Mild Follow guidelines for 60-90 minutes of activity. Check blood glucose and consume about

15 grams of carbohydrates for every 30 minutes of exercise.

More than Moderate

Hard

Note: If your blood glucose level is between 250 and 300 mg/dL, check your urine or blood for ketones. If your ketone test is positive, do not exercise until you have asked your health care provider for advice. If your blood glucose is higher than 300 mg/dL, do not exercise until you have asked your health care provider for advice.

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Having a child diagnosed with diabetes is a major event. Although your life will never be the same, it's important to keep things in perspective. Managed properly, diabetes should not prevent your child from doing any activities other kids do.

The role of the social worker is to help you and your child adjust to having diabetes by providing emotional support, evaluation and community resources. The social worker collaborates with other members of the care team (such as doctors, nurses, dietitians and physical therapists) to ensure that the psychological and social needs of patients and their families are addressed.

The social worker also can help patients and their families to maintain a level of control over their treatment. This task may become particularly challenging as the child transitions into adolescence. The social worker can help parents understand their child’s development as it relates to their diabetes and help them maintain a level of responsibility, even as their child strives for increased independence.

The social worker informs parents of ways they can assist their child with managing diabetes; including helping them with their everyday care, attending scheduled medical appointments, and communicating any questions or concerns with their child’s diabetes care team between visits. They can also help families identify strengths and barriers that may be preventing them from reaching their treatment goals. Resources such as counseling services, support groups, and information on how to access government benefits are often provided to help overcome common barriers to healthy diabetes management.

It is important for parents to understand that your child may take a step or two back in their development in response to any crisis, including being diagnosed with diabetes. Adopting behaviors of a younger person can be comforting to your child during the adjustment, but is temporary. Eventually, your child will get back on the developmental schedule that they were on before diabetes became a part of their life. Here is some basic information you can expect based on your child’s stage of development.

This is a time of rapid change and development and your child is starting to learn about their world. Children at this age are not able to care for themselves or their diabetes. Children under the age of three will usually cry due to their injections or blood sugar checks. Normally their crying is not due to any pain caused by the injection, but because it’s interrupting their activity. Children at this age need to be cuddled and loved; this is especially needed after an injection or blood sugar check to support your child’s development of trust.

During the child’s teething period, parents may need to increase blood glucose testing until they can tell the difference between fussiness from teething vs. low blood sugars. The adult can let the child choose where they want to get their injections and which finger is going to be used to do their blood sugar as long as sites get rotated. Children at this age may be inconsistent with eating and mayeed

need to get their injection after they eat. As with any stage of development, diabetes care must be accepted as a part of normal life.

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Children at this age have concrete thinking; everything is black or white, right or wrong, good or bad. They may think of their injections as punishment. It is important for the parent to reassure the child that they did nothing wrong and that the shots are to help them from getting sick. During this stage, children become more cooperative with injections and checking their blood sugars. They start to learn how they feel when they are having a low blood sugar, but may not be able to treat the low blood sugar on their own. They may still be inconsistent with their eating and need to have their injection after they eat. As soon as their eating is consistent, it is better to give the injection before they eat.

During this stage of development, children require their parents to do most of their diabetes task. If they do some of the tasks by themselves, then they need direct adult supervision. They should not be drawing up insulin by themselves because their fine motor coordination is not completely developed. The adult can let the child choose where they want to get their injections and which finger is going to be used to check their blood sugar as long as sites get rotated. Some children between the ages of three to seven may have a basic understanding of what they can and cannot eat, but may still choose the wrong food. They will usually wear a medic alert tag starting at this young age, which is important so that when they are older, it is already a habit. Most importantly, it is important to keep a positive attitude with a child of this age.

Investigators have reported that as children develop from the school-age years to early adolescence, they assume greater responsibility for managing their diabetes. While giving your child more responsibility during the school-aged years is considered a normal part of development, investigators have also found that children who have more responsibility for their diabetes make more mistakes in their daily care, and are in poorer metabolic control. Research suggests that well-intentioned efforts to encourage independence may inadvertently encourage some children to do “too much too soon” with managing their diabetes. Even as children age and gradually learn to self-manage their diabetes, parents must remain involved by supervising their child when testing their blood sugar levels, helping them calculate the correct insulin dose, and supervising them when taking their insulin.

At this age, children are still concrete thinkers, so consistency is very important. They have increased socialization with peers, so peers can be used as part of their support system. Team sports start to become important to the child, which may lead to the need for increased blood glucose monitoring. Although they start to understand the difference between safe and dangerous, they may not understand the complications of diabetes and importance of good blood glucose control. They will start to test their own blood sugars and give their own insulin injections, but still require adult supervision for their entire diabetes task. Drawing up insulin is usually not accurate until the age of 10 or 11. They can start to count carbohydrates at this age. They also can learn to tell when their blood sugars are low and how to treat their low blood sugars, but need to be watched. They become more aware of time and better about eating meals and snacks on time. It is important to be supportive and not to nag at the child.

When a child cannot do the task, it may be necessary for the parent to take over and perform the diabetes task completely until the child is able. At this age, they are not likely to ask their parents for help, so a parent should monitor to see if the child needs help. Kids at this age may also feel like “life is not fair,” especially when it comes to diabetes. Parents can support their child by validating their feelings and obtaining counseling services for their child should their emotions consistently interfere with good diabetes control.

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Teens start to develop independence and their own identity. Body image becomes a major concern at this age. They spend more time with their friends and start to be away from home more. Teens will take over most of their diabetes care and should be encouraged to do so, but adult supervision is still needed. Independent research has shown that teens who are expected to be independent in their own diabetes care (meaning little adult supervision or support) tend not to follow their diabetes treatment plan and have worse metabolic control. The data suggests that parents need to do more than merely remind their teen to complete their diabetes tasks. Parents must still be responsible for at least some aspects of the daily regimen, which may mean doing tasks during the time of day when the teen is most likely to forget. This evidence is consistent with literature on brain development, which shows that the last parts of the brain to develop are the areas that manage sense of risk, impulse control, ability to plan and organize, and ability to think about the future. This research actually shows that these areas do not finish developing until our mid-20s!

At this stage, transitioning the child to take care of their diabetes should start to occur since they will be leaving your care and will eventually need to know how to manage their diabetes on their own. This includes learning how to order supplies, when to call the doctor and how to take care of emergencies. Experimentation with drugs and alcohol may occur, causing loss of blood sugar control. The teen needs to understand how drugs and alcohol may affect their blood sugars.

Ultimately, good parent and peer support becomes important to manage their diabetes. These are only guidelines. Your child may develop sooner or maybe a little slower to be able to manage their diabetes tasks.

• Lack of support needed to grieve the loss of the patient’s former state of health and guilt associated with the child’s new diagnosis can unintentionally create emotional barriers.

• Diabetes “burnout.”

• Mental health disorders, such as clinical depression and anxiety.

• Lack of family involvement and/or unhealthy family dynamics.

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It is normal for you and your child to grieve the loss of your child’s former state of health. Because this loss is not physically visible, it can be easy to overlook. We encourage your child to work through grief by talking about it, and by acknowledging and accepting feelings such as guilt, denial, anger and sadness. As time goes on, these feelings can take their toll on you and your child and it will be important to take time to acknowledge your emotions. Accepting that the actual target of these feelings is the fact that your family has diabetes and that you cannot send it back is key. If acceptance does not occur, these feelings can lead to depression or anxiety.

Although diabetes will eventually become a regular part of your life, it is not unusual for the grief process to start up again later in life. Just when you think you’ve fully accepted your child’s diabetes, the grief process can happen again as your child grows older and diabetes takes on a new meaning. It is normal to feel frustration or anger after a diagnosis. Many parents experience the following feelings:

• Guilt — Feeling guilty after you child is diagnosed with diabetes is common, but please don't blame yourself for your child's diabetes - it is not your fault. While there is research into preventing diabetes, at this time, there is nothing you could have done to prevent it.

• Denial — Hoping that your child’s diagnosis is wrong , or insisting everything is “fine” are examples of denial.

• Anger — It is natural to feel angry when something in our life feels unfair. You have every right to feel angry that your child has diabetes and can bet that your child is angry too. When you are trying to focus on learning, practically overnight, how to care for your child who was just critically ill, you may try to hide your anger so you can focus on coping with diabetes. Your anger may “leak out” as a little irritation that gets directed at one another, unintentionally causing tension to rise at home.

• Sadness — Sadness can accompany diabetes, just as it does with other kinds of loss. Because you are so busy coping and adjusting to your child’s new diagnosis, feelings of sadness may not show until everyone is settled into the new routine. At this point, you may be surprised to feel sad, since things may feel like they are getting back to “normal.”

Children with diabetes often suffer from “diabetes burnout,” which can lead to depression. Several studies suggest that diabetes doubles the risk of depression compared to those without the disorder and the chances of becoming depressed increases as diabetes complications worsen. Kids with diabetes may spend a lot of time worrying about their diabetes, feel “different” from their peers, or just become frustrated with how much work they have to put into caring for their health. And if this “burnout” turns into clinical depression or anxiety, one may not have the energy or motivation to take care of their diabetes. Unfortunately, individuals who are depressed or anxious may not realize that they need help, because they may think their symptoms are due to diabetes.

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Epidemiologic studies show that the risk of psychological disorder is increased in children who have a chronic illness. The first year of illness was the highest risk period for developing depression in a 10-year prospective longitudinal study of juvenile diabetes. Just like diabetes can be treated and controlled with medical treatment, mental health disorders such as anxiety and depression are treatable disorders of the brain. However, if left untreated, they can harm a person’s emotional and physical health as well as those who help care for them. The social worker provides families with basic mental health information. This includes reviewing different treatment options, such as medication and psychotherapy, to help improve a patient’s ability to manage their diabetes. It is important to remember that mental health treatment should always be obtained under the treatment of a trained mental health professional.

Epidemiologic studies show that the risk of psychological disorder is increased in children who have a chronic illness. The first year of illness was the highest risk period for developing depression in a 10-year prospective longitudinal study of juvenile diabetes. Just like diabetes can be treated and controlled with medical treatment, mental health disorders such as anxiety and depression are treatable disorders of the brain. However, if left untreated, they can harm a person’s emotional and physical health as well as those who help care for them. The social worker provides families with basic mental health information. This includes reviewing different treatment options, such as medication and psychotherapy, to help improve a patient’s ability to manage their diabetes. It is important to remember that mental health treatment should always be obtained under the treatment of a trained mental health professional.

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As previously mentioned, family dynamics have been shown to have an impact on diabetes management in children and adolescents. Diabetes is a family disease. When a child is diagnosed with diabetes, inevitably other family members are affected by it as well. In that respect, diabetes is no different from any other chronic illness. However, diabetes is unique in the sense that so much of the daily disease management rests with patients and their families.

Although physicians, nurses, mental health professionals and other team members are important sources of information and support, at the end of the day, parents have the greatest impact on how their child manages their diabetes.

The Family Approach to Diabetes Management (FADM) is a novel model that stresses the importance of looking for family communication that prevents or supports good diabetes management. In this approach, the emphasis is on changing behaviors related to diabetes management. The main objective is to help families figure out how to support responsible and age-appropriate behavior in their child or adolescent. Parents may tend to "back off" and give their child more room and responsibility, but this program focuses on engaging parents to provide their children with a sense of structure and boundaries that are clear and consistent. The following are clinical assumptions of the FADM Model:

• Individual family members’ behaviors are influenced by family communication, needs, rules and expectations.

• The "patient" is defined as the entire family. The family is the focus of treatment.

• Responsible self-care in an age-appropriate manner is a non-negotiable issue, as is going to school and doing homework.

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• More thinking ahead — Parents often find that it is helpful to form a consistent schedule, and that they will need to start carrying around diabetes supplies such as snack foods and treatment for low blood glucose.

• More active role in health care — Hopefully, you will get into the habit of arranging for routine follow-up visits, call your doctor if you have questions between visits and become an advocate for your child’s health.

• More detail, keeping organized — Perhaps you will put your diabetes routine on the refrigerator until you do not need to refer to it anymore. We suggest that parents carry around an organized kit or small cooler, labeling the items inside and keeping spares on hand.

• More communication — We encourage that you and your family develop a system to help you and your child remember when and who gave the insulin and ways of keeping in contact with your child, school and other caregivers (e.g. texting, e-mail, phone calls). Posting emergency numbers in an obvious location also can be helpful to others caring for your child while you're away.

• Take care of yourself — Parents, when possible, should share the load and try to do things together (e.g. draw insulin, review data, discuss solutions). Parents also need to have time to themselves. Parents should educate and prepare other caregivers, such as babysitters, grandparents and older siblings so that they do not have to be with their child at all times.

Living with diabetes can be scary, especially at first as your family gets used to their new routine. Diabetes has been added, but nothing about your wonderful child has been taken away. Sometimes diabetes changes things for the good. For example, the entire family may adopt a healthier lifestyle. If all family members eat food from the diabetes plan, obtain exercise and follow a routine, this can be healthy for everyone involved. In addition, diabetes can provide an opportunity to become more of an expert in using problem-solving skills (if you think about it, managing blood glucose involves the use of problem-solving skills). Furthermore, caregivers may find that helping their child care for their diabetes can become an opportunity to improve their parenting skills and increase their involvement in their child’s life. Finally, having met and accepted what most people would call adversity, diabetes may make you and your child stronger and help you get through other challenges in life!

Diabetes Spectrum, Volume 10 Number 4, 1997, Behavioral and Psychosocial Research With School-Aged Children With Type 1 Diabetes, Barbara J. Anderson, PhD, and Lori M.B. Laffel, M.D., M.P.H.

childrenwithdiabetes.org DTQ-20100921002210, Original posting 27 Sep 2010, Posted to A1c, Glycohemoglobin, HgbA1c and Hyperglycemia and DKA.

Diabetes Spectrum 17:31-36, 2004, © American Diabetes Association®, Inc.,2004 The Family Approach to Diabetes Management: Theory Into Practice Toward the Development of a New Paradigm. Joe Solowiejczyk, RN, MSW.

Advice for Newly Diagnosed Parents and Kids. ChildrenWithDiabetes.org.

Diabetes, Depression and Stress, Carol E. Watkins, MD.

“Depression in Pediatric Chronic Illness” PsychiatryOnline.org/cgi/content/full/40/1/5. Patrick Burke, M.A. & Melanie Elliot, B.A.

American Psychiatric Association (2017). Diagnostic and Statistical Manual of Mental Disorders (5th Ed.). Washington DC: American Psychiatric Association.

Diabetes Spectrum 17:31-36, 2004, © American Diabetes Association®, Inc., 2004 The Family Approach to Diabetes Management: Theory Into Practice Toward the Development of a New Paradigm. Joe Solowiejczyk, RN, MSW. 85

Individuals with diabetes need to be cautious when considering drinking alcohol. Alcohol is made by fermenting yeast, sugars and starches. When an individual drinks, the liver metabolizes the alcohol and clears it out of the body. When a diabetic has low blood sugar the liver will usually begin to make glucose from stored carbohydrates to help increase the blood sugar.

Especially as your child get’s older (ages 13-18), it’s important to explain to them the risks of drinking alcohol. Make sure they know the following information and understand the risks of drinking with diabetes.

When you are drinking, the liver is busy trying to get rid of the alcohol and is not able to produce sugar. When you are drinking your glucagen/glucagon will not work. If you become unresponsive, 911 must be called. If your blood sugars are not controlled you should not drink. You must make sure you are wearing your medic alert tag and carry a quick acting glucose source in case of low blood sugar.

• It is recommended that you limit your drinking to no more than two drinks per day. Drink slowly and avoid mixed drinks with fruit juices or regular sodas.

• It also is recommended that you do not drink alcohol and exercise.

• It is important to eat small meals or snacks when you are drinking.

• Make sure you test your blood sugar while you are drinking and before you go to bed to make sure your blood sugar is between 100 and 140.

• Before you go to bed for the night, you also should set your alarm and check your blood sugar two to three hours after you go to bed.

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Celiac disease is an autoimmune disorder that's more likely to occur in people with Type 1 diabetes, affecting about 1 in 20 people. It interferes with the intestine's ability to tolerate the protein gluten, which is found in grains like wheat, oats, rye and barley. When children with celiac disease eat foods containing gluten, their immune systems react to it, causing gastrointestinal symptoms. Over time, exposure to gluten damages the small intestine and prevents it from properly absorbing nutrients from food.

Some children have no symptoms, but others may have frequent diarrhea, stomach pain, gas, bloating, weight or appetite loss or fatigue. Some children with celiac disease have growth problems because they aren't getting enough nutrients. If not treated, celiac disease can lead to hypoglycemia, osteoporosis (a disease that causes brittle, fragile bones) and certain types of cancer.

If your child has Type 1 diabetes, your doctor may do a blood test to check for celiac disease, even if there are no symptoms. If the doctor suspects celiac disease, your child might undergo a small-bowel biopsy (the removal of a piece of tissue from the small intestine for examination) to confirm the diagnosis.

People who have celiac disease must follow a gluten-free diet (no wheat, rye, oats and barley products). They will still need to eat a balanced diet to stay healthy and maintain good control of blood sugar levels. Your diabetes doctor may recommend that you meet with a registered dietitian to learn about choosing and preparing gluten-free foods.

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Children with Type 1 diabetes are more likely to get disorders affecting the thyroid, a gland located behind the skin and muscles at the front of the neck, just at the spot where a bow tie would rest. The thyroid, which is part of the endocrine system, makes hormones that help control metabolism and growth. These hormones play a role in bone development, puberty and many other body functions. Thyroid disorders are fairly common in people with Type 1 diabetes, affecting 15 - 20 percent of them.

Thyroid disorders can cause the thyroid gland to make too much thyroid hormone (hyperthyroidism) or too little hormone (hypothyroidism). Both hyperthyroidism and hypothyroidism can have an enlarged thyroid gland, also called a goiter, present.

Hyperthyroidism can cause nervousness, irritability, increased perspiration, intolerance to heat, fatigue, difficulty sleeping, a fast heartbeat, irregular menstrual periods in girls and muscle weakness. People with this problem might lose weight even though they're eating more than usual. The eyes may feel irritated or look like they're staring. Sometimes the tissues around the eyes become inflamed and swollen, and the eyes appear to bulge out.

Someone with mild hypothyroidism may feel just fine, and in fact, might have no symptoms at all. However, symptoms can become more obvious if the condition worsens. People with underactive thyroids might feel depressed and sluggish, may gain weight even though they're not eating more or getting less exercise than usual. Kids with hypothyroidism also might have slow growth in height, slow sexual development, irregular menstrual periods in girls, muscle weakness, dry skin, hair loss, poor memory and difficulty concentrating.

To check for thyroid disorders, the doctor may ask about symptoms and feel your child's neck for an enlargement of the thyroid gland or order blood tests on a yearly basis. Children with thyroid problems might be prescribed medication to bring their thyroid hormone levels back to normal.

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Cystic fibrosis related diabetes is unique, but shares features of Type 1 and Type 2 diabetes. Twenty percent of the adolescents and 40 - 50 percent of adults with Cystic Fibrosis (CF) develop CFRD. Cystic fibrosis related diabetes is primarily caused by insulin deficiency. Damage to the pancreas causes scarring (fibrosis), which destroys about half of the insulin-secreting cells leading to insulin deficiency.

Insulin resistance also plays a role in CFRD. Acute lung infections, steroid use or chronic underlying infections can cause insulin resistance. Diabetes is not caused by something you did or ate, there is nothing you can do to cause CFRD.

Insulin is the treatment of choice for CFRD. Pills to treat diabetes do not work in CFRD and are not recommended. Persons with CFRD need to continue eating a balanced, high-calorie, high-salt, high-protein and high-fat diet. Decline in lung function and nutritional status is associated with undiagnosed or untreated CFRD.

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Steroid induced hyperglycemia refers to prolonged high blood sugars due to medications used to treat other medical conditions such as asthma, organ transplantation, cystic fibrosis, inflammatory bowel disease or chemotherapy induction for leukemia or other cancers.

The most common medications responsible for steroid induced hyperglycemia are prednisolone, prednisone and dexamethasone. These medications interfere with the way insulin works causing insulin resistance and the liver to increase blood sugar levels. Most people can make enough extra insulin to have normal blood sugar levels, but those who cannot develop hyperglycemia.

Insulin is used for treatment of high blood sugars. Treatment with insulin in some cases may be temporary and stopped once steroids are discontinued. Other children may need to remain on insulin to keep their blood sugars in control. Children with diabetes may need to take higher doses of insulin while on steroids.

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Puberty can cause insulin resistance (insulin does not work as well) and psychosocial challenges that can make glycemic control hard to obtain. Insulin dosages usually increase during puberty. Females’ blood sugars can increase before and during their menstruation. It will be important to watch for elevated blood sugars during menstruation and talk with your child’s diabetes team so that your child’s insulin can be adjusted during menstruation.

The insulin resistance is caused by hormonal changes. Teenagers can also be rebellious and practice high-risk behaviors such as drinking or drugs. For teenagers, non-adherence to their diabetes management plan can be seen as personal freedom. Diabetes is often not a priority with teenagers. Teenagers are struggling with their identity, peer relationships, emotional changes and changes in their body image. Parents need to develop a partnership with their child and open communication so they can help their child with managing their diabetes with less resistance.

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Date: ___________________

Dear Patient and Family, Now that you have been discharged, you need to be scheduled to see your diabetes doctor (Endocrinologist). If you will be followed at the Miller Children’s & Women’s Endocrine & Diabetes Center, you will be scheduled to see a diabetes nurse educator within 1-2 weeks and your diabetes doctor within 3-4 weeks following discharge. Plan to call your diabetes doctor or team in 2-3 days to review blood sugars or sooner if your child is experiencing any hypo or hyperglycemia. When you call, please have your blood sugar records, insulin doses and any notes you have related to the blood sugars. If you are to follow up at the Miller Children’s & Women’s Endocrine & Diabetes Center, you may call (562) 933-8562, Monday through Friday from 8 a.m. to 5 p.m. with your questions or concerns. Until your care is established with your endocrinologist, if you have questions or concerns about your child’s blood sugars after 5 p.m. during the week, on Saturdays, Sundays and holidays, please call (562) 933-2000 and ask for the Pediatric Endocrinologist on call. In the event of an emergency (for example, your child has a seizure or becomes unconscious), CALL 911. Please remember to bring your child’s glucometer with you to all visits. We look forward to seeing you soon. Sincerely, Your Diabetes Team

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Diabetes management is rapidly changing. Technological advances are providing alternatives to insulin injections and blood glucose monitoring via fingerstick.

Insulin pumps allow for continuous insulin delivery that works like your long acting insulin. You wear the pump and there is a small cannula that delivers insulin under the skin. At mealtimes, you enter your blood sugar and carbohydrates into the pump and it will calculate and deliver your mealtime insulin.

Insulin pumps allow for more precise dosing delivering insulin in 0.025, 0.05, or 0.1 unit increments and allow for more flexibility with mealtimes.

Continuous Glucose Monitoring systems (CGMS) provide blood glucose information in 5-10 minute increments. It can tell you if your blood sugar is changing and how rapidly. This allows for you to make decisions to help prevent hypoglycemia and hyperglycemia. These systems can be used as “stand alone” or in conjunction with insulin pumps. The blood sugar readings from the CGMS can be used to calculate insulin doses.

Technology is advancing and there are new systems in which an individual wears a CGMS that can communicate with an insulin pump that is worn in a separate area of the body. Some pumps can temporarily shut off insulin delivery if the blood sugar is dropping low, and there are also closed loop hybrid systems that allow the pump to make some adjustments in insulin delivery based on CGMS readings. The current systems still require programming, blood sugar checks with a meter and/or entering blood sugars into the pump, as well as entering carbohydrate information.

In the next few years, we hope to see these technologies further evolve to lessen the burden of diabetes care.

In the meantime, follow your diabetes plan created by your endocrinologist. The better control you are in now (including checking your blood sugar frequently, at least four times daily), the easier it will be to transition to one of these technologies.

If you are interested in learning more about current technology available, discuss with your endocrinologist and certified diabetes educator nurse. For more information regarding Type 1 Diabetes research, check out JDRF.org. We are living in an exciting time and hope to see many changes in the next few years!

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• Use heels rather than sensitive fingers to reduce the discomfort of blood glucose checks.

• Give insulin immediately after eating might be recommended due to the irregularity in food behaviors at this age.

• Never sneak up on little ones hoping not to distress them with blood glucose or insulin injections, as the child may become anxious then when the parent comes closer anticipating a possible shot or blood glucose stick – instead perform the blood glucose check calmly and give your child a hug at the end.

• Set up a diabetes station for checks – not at the child’s bed – leave this as their comfort area.

• Check your child’s blood glucose level if he/she is acting out of sorts. Behavior change may be the first sign of blood glucose changes, typically low glucose levels. Other signs might include sweating, trembling or a particular cry.

• Identify the required amount and type of foods/fluids to treat lows – maybe as little as 5-10 grams of carbs in infants. An oral syringe on hand is a good idea for administering syrup type fluids if low. Never give anything by mouth if unconscious – instead turn the child on their side and call 911 immediately.

• Identify hyperglycemia if here is an increase in frequency of diaper changes, infections, sleepiness or fussiness.

• Check blood glucose more frequently when infants/toddlers get sick. There is an increased risk for BG elevation. Remember to encourage lots of fluids. Check for signs of dehydration — a decrease in wet diapers will be a sure sign as will a dry looking and sounding mouth.

• Make diabetes a family condition. It is always best when all family members are involved in the care so that the responsibility does not fall on any one person.

• Don’t neglect the emotional aspects of diabetes! It can be frightening to have an infant with diabetes because they cannot tell you how he/she is feeling. Share these thoughts and feelings with other family members or friends, diabetes support groups or with your diabetes care team.

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• Always have a bottle, insulin pen or cartridge of each type of insulin for emergency in your refrigerator.

• If your child’s blood sugar is above 250 or they do not feel well check for ketones. If ketones are present check for ketones every four hours until they are negative.

• Always have ketostix at your home that have not expired.

• Call your diabetes doctor if blood sugars are not decreasing after giving two correctional dosages.

• Call your diabetes doctor/endocrinologist if there are large ketones present.

• If your child is ill do not skip insulin dosages. If unsure of how much insulin to give, call your diabetes doctor/endocrinologist.

• If you are away from home and forgot your insulin or other diabetes supplies find the phone number of a pharmacy close to you and then call the diabetes doctor/endocrinologist. They will call a prescription into the pharmacy for you. Your insurance may not cover your diabetes supplies.

• Check blood sugars at least four times per day. If your child’s blood sugars are high or your child is ill check blood sugars every three hours until blood sugars are back in normal range.

• Always have a glucagon/glucagen emergency kit that has not expired at your home.

• If you have had to use a glucagon/glucagen emergency kit call the diabetes doctor.

• Do not store your opened vials, insulin pens or cartridges of insulin in temperatures above 86 degrees or below 36 degrees. Do not store insulin in your car. Unopened bottles of insulin should be stored in the refrigerator between 36-46 degrees. If insulin freezes you can not use this insulin and it needs to be thrown away.

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Hemoglobin A1C

(Measures average blood sugar for past 3 months) Every diabetes doctor visit

Blood pressure, height and weight Every diabetes doctor visit

Foot inspection by doctor or nurse Every diabetes doctor visit

(begins at puberty or at doctor’s discretion)

Dilated eye exam

For Type 1, first time at 10-years-old, if patients has had diabetes for 3-5 years or at doctors

discretion

For Type 2, shortly after diagnosis and every year/doctor’s discretion

Lipid profile (preferred fasting) (cholesterol; HDL: LDL: triglycerides)

Every year

Kidney function (blood creatinine: urine microalbumin)

Every year

Dental exams Every six months

Flu shot-vaccine Every year before flu season

for children above six months old

Pneumococcal vaccine Every five years

Your health care goals Every visit

Stopping smoking Every visit

Alcohol, drug or complimentary medicine use Every visit

Being sexually active/pre-pregnancy-family planning counseling

As needed

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• Always have a bottle, insulin pen or cartridge of each type of insulin for emergency in your refrigerator.

• If you are going to be away from home, always have your diabetes emergency supplies with you that includes food, glucose tablets, glucose meter, medication and Glucagon/GlucaGen® kit.

• In order to stay healthy, keep your appointments with your diabetes doctor. If you miss your appointment, reschedule as soon as possible. Also, call your diabetes doctor with your child’s blood sugar so that their insulin dosage can be adjusted if needed.

• Have an emergency back up supply in your home (insulin, syringe and food) and rotate supplies (for earthquake, etc.).

• Take your insulin and eat your meals and snacks routinely.

• Change your meter batteries as needed and yearly with daylight savings time.

• Make sure the code on strips match the code on your meter.

• It is important to tell all of your child’s doctors or specialists that your child has diabetes.

• Routine procedures and visits to the dentist can usually be handled without changes to your diabetes plan. We recommend that you request a morning appointment. If a procedure requires medication that will make your child sleepy, your child may be told not to eat or drink anything for four to eight hours before the procedure. Continue the usual dose of long acting insulin (Lantus® or Levimir®) or the set basal rate, if on an insulin pump. If not eating breakfast, hold the Humalog® or Novolog® dose unless your child’s blood sugar is above 200, in which case you will need to give a correctional dose of insulin.

• Plan to take your glucose meter, insulin and supplies with you to any procedure or appointment. Test your child’s blood sugar before the start of the procedure. If your child’s blood glucose is low, treat with 15 grams of rapid acting carbohydrates and wait 15 minutes to retest their blood sugar. The procedure may need to be rescheduled.

• Typically your child will not require antibiotics and medication by mouth with routine dental procedures unless an infection is present.

• If your child is having surgery, follow the above guidelines. Medication by mouth may be required on the day of surgery. Having your child’s diabetes in control when surgery is planned allows for the best outcome.

• People with diabetes should brush their teeth at least twice a day and floss at least one time per day. It is recommended that you/your child visit the dentist every six months. At your first visit with the dentist/dental hygienist make sure that you speak with both of them about your diabetes and the medications you are taking.

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• Getting ready to go on a trip can be exciting. But when you have diabetes, you need to plan ahead to prevent surprises from happening while you are on your trip. Make a checklist of what you need to take with you. While you are on vacation, your insulin may need to be adjusted. Active days require less insulin, while less active may cause you to need an increase in insulin dosage.

• If traveling by airplane, it is necessary to have the pharmacy label on your insulin, syringes and Glucagon/GlucoGen® emergency kits.

− It is recommended to get a travel letter from your diabetes doctor to take on your trip with you.

− Take batteries for your blood glucose meter and extra supplies.

− When going on the plane, make sure you carry your supplies with you.

− Bring sources of quick acting carbohydrates along with snacks because meals may be delayed and leave you at risk for low blood sugar.

• If traveling by car you can pull over occasionally and allow time for play to help keep the blood sugar in range.

− It also is important when traveling in a car to make sure your insulin does not get too hot or too cold.

• Make sure to take your doctor’s phone number with you so if you have an emergency you can contact him/her.

− If your supplies or medication become damaged, you can contact your doctor to call a new prescription in to the pharmacy close to where you are staying.

− Before you call your diabetes doctor, make sure you have the phone number of the pharmacy including the area code and a list of items you need the doctor to call in for you.

• Be aware that your insurance company may not pay for these supplies and you may have to pay for them.

• Remember, planning decreases the risk of problems occurring. Have a great trip!

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It is an exciting time when your child gets his or her driver’s license. If your child has diabetes, it is important to make sure that his or her blood sugar is in range before he or she drives.

If blood sugar is below 90, he or she will need to eat a small snack before driving. This becomes especially important if your child has been exercising, playing sports or are more active than normal. You should make sure your child has quick acting glucose sources along with snacks in his or her car at all times.

When driving long distances, make sure your child takes the time to pull over and check blood sugar every two to three hours. If your child feels like his or her blood sugar is going low, he or she should pull over, treat the low blood sugar, and sit there until blood sugar is back to normal range. Your child should not resume driving until blood sugar and cognition have returned to normal (it may take 30 - 45 minutes).

Driving with low blood sugar has been shown to leave the driver more impaired than a drunk driver so caution should be taken before your child drives.

Remember Your diabetes doctor needs to provide written permission for your child to be able to obtain a driver’s license. For more information, you can contact your local Department of Motor Vehicles.

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Growing up is about becoming more independent and more responsible, that includes taking care of health needs as well. Teens with and without health care needs may have difficulty transitioning from pediatric to adult health care. MemorialCare Miller Children’s & Women’s Hospital Long Beach’s outpatient clinics serve children with California Children’s Services (CCS) insurance until they are 21-years-old. After that, our patients must find a new primary doctor, a new specialist and a new insurance plan. Patients also will be managing their own appointments, medications and other health-related responsibilities (e.g., diet paying medical bills, etc.).

It is understandable if talking about transition makes your child feel anxious. It is not only difficult for teens to make these and other changes, it is difficult for parents too. Some parents have a hard time allowing teens to be more independent. However, this is an exiting time of growth and your child’s care team would like to help your child learn to work towards managing his or her diabetes more independently.

The good news is that your child is growing up, exploring new opportunities, such as college or finding a job, and Miller Children’s & Women’s is going to be there to provide you with the tools you and your child need for a successful transition.

Start early — our transition planning begins at age 14. Encourage your child to:

• Ask questions during doctors appointments and be prepared to answer the questions he or she knows will be asked at every visit.

• Build independence — when leaving the office, schedule the next appointment. Be there to help your child with any information that’s needed.

• In the future, your child’s team will provide more education on diabetes and the health care system so you your child will be prepared to eventually find a new doctor.

• Talk with his or her pediatrician about transition — it also can be challenging for pediatricians and clinic teams to see their patients grow up.

Transition for teens and young adults encompasses every aspect of their lives. In school, teens begin to prepare for college, work or vocational school. They may get their first job, which starts the transition to financial independence. Transitioning to adult centered care and being responsible for ones own health is another major milestone on the journey of growing up.

If you need more information on your child’s specific needs and situation, please contact your child’s clinic, nurse or social worker for help.

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• Gently wash your child’s feet everyday with warm water and mild soap, and dry completely including between the toes.

• Put lotion on your child’s feet every night before going to bed. DO NOT put lotion or cream between the toes unless prescribed by your child’s doctor.

• Provide your child with comfortable shoes, not shoes that are tight or worn out and clean socks everyday.

• DO NOT LET YOUR CHIILD GO BAREFOOT. Not even in the house.

• DO NOT use sharp tools on your child’s feet. Supervise your child’s nail trimming. Don’t treat foot problems by yourself. If there is redness, swelling, drainage or pain, call your child’s primary care doctor.

• DO NOT LET YOUR CHILD SMOKE. Smoking damages the blood supply to feet.

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People who have diabetes have an increased risk of gum disease, gingivitis, periodontitis, bacterial infections, thrush and dry mouth. These infections in the mouth can cause an increase in blood sugars.

People with diabetes should brush their teeth at least twice a day and floss at least one time per day. It is recommended that you/your child visit the dentist every six months. At your first visit with the dentist/ dental hygienist make sure that you speak with both of them about your diabetes and the medications you are taking.

It is important to tell all of your child’s doctors or specialists that your child has diabetes.

Routine procedures and visits to the dentist can usually be handled without changes to your diabetes plan. We recommend that you request a morning appointment. If a procedure requires medication that will make your child sleepy, your child may be told not to eat or drink anything for four to eight hours before the procedure. Continue the usual dose of long acting insulin (Lantus® or Levimir®) or the set basal rate, if on an insulin pump. If not eating breakfast, hold the Humalog® or Novolog® dose unless your child’s blood sugar is above 200, in which case you will need to give a correctional dose of insulin.

Plan to take your glucose meter, insulin and supplies with you to any procedure or appointment. Test your child’s blood sugar before the start of the procedure. If your child’s blood glucose is low, treat with 15 grams of rapid acting carbohydrates and wait 15 minutes to retest their blood sugar. The procedure may need to be rescheduled.

Typically your child will not require antibiotics and medication by mouth with routine dental procedures unless an infection is present.

If your child is having surgery, follow the above guidelines. Medication by mouth may be required on the day of surgery. Having your child’s diabetes in control when surgery is planned allows for the best outcome.

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When your child has diabetes, going to school can be overwhelming in the beginning. But with some extra planning and a care plan in place, you will become more comfortable with your child at school. Here are a few things to think about to help you begin or continue your school year with ease.

• Partner with the staff at your child’s school. Request a meeting before school starts with the school nurse, principal and your child’s teacher to discuss the care of your child while at school. At this meeting, your school nurse will request a set of orders from your child’s diabetes doctor. Contact the doctor as soon as possible since it can take up to three days to complete these orders.

• Educate the staff and teacher about the signs of hyper/hypoglycemia (high and low blood sugar) and what actions to take.

• Put a plan in place that is agreed upon by you and the teacher if your child should need to take several trips to the bathroom, eat a snack to correct a low blood sugar or drink extra water.

• Encourage your child to participate in all sports, extracurricular activities and field trips. Talk with the school staff about any concerns that they might have about exercise with diabetes.

• You will need to provide a diabetes supply kit that will last a minimum of five days in the event of an emergency. This will include treatment for hypoglycemia, extra insulin, test strips, ketone strips, syringes or pen needles, if necessary. Ask the school office where this kit should be kept.

• Purchase a medical alert tag for your child to wear.

• There are many resources available to support you and your child in the transition to school. Become familiar with the American Diabetes Association and the 504 laws that protect against discrimination. For more information, visit diabetes.org.

• Develop an open, supportive relationship with your child’s teacher and school staff. This will be a very important partnership. Talk with them frequently about the concerns or issues that may come up.

• Be patient. This school routine may take a month or so for everyone involved including your child to get used to.

• Prepare for bumps in the road. Remember that this routine is new to you, your child and the school.

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The following items should be brought to school no later than the first day of school. Make sure your child’s supplies are labeled with his/her name.

• Fast acting carbohydrate drinks or other fast-acting carbohydrate source

• Glucose tablets and/or glucose gel

• Prepackaged snacks

• Water bottle

• Ketone strips

• Blood glucose monitor, testing strips and control solution

• Extra lancets

• Extra battery for your glucose meter

• Glucagon/GlucoGen® kit

• A vial/cartridge of each type of insulin your child is using

• Up-to-date phone numbers to contact you or other emergency providers

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SAMPLE

SAMPLE

SAMPLE

Date:_____________

Child’s name:_______________________ DOB:____________ Gender:___________

Child’s diagnosis (if known):______________________________________________

Parent/Guardian:______________________________________________________

Address:___________________________ City:_______________ Zip Code:_______

Phone:________________ Cell Phone:______________ E-mail:_________________

Best time to reach parent/caretaker:_______________________________________

Best way to contact:____________________________________________________

Referred by:___________________ Dept.:____________ Phone:________________

Add to Family Resource Center mailing list _____ yes _____ no

❑ Parent support

❑ Hospital room visit (#___________)

❑ Organizational notebook

❑ Literature/research assistance:

❑ Community referral

❑ March of Dimes NICU Family Support Program

❑ Parent education/workshop

For more information call (562) 933-8048 or fax (562) 933-8430.

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Paren

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____

The Bag of Hope

Until research is successful in finding a cure for Type 1 Diabetes (T1D), JDRF is committed to providing support and

resources for those living with T1D. It is for this reason that JDRF, the leading global organization funding T1D research,

created the Bag of Hope, a resource containing educational and inspirational materials as well as Rufus, the Bear with

Diabetes. The Bag of Hope is offered free to newly diagnosed youth and their families by JDRF and our program

sponsor, Roche Diagnostics.

Required information – please complete the following:

In accepting this Bag of Hope, I agree to release the information provided above to JDRF. If I have noted my interest for support below, JDRF staff or

volunteers may contact me. I also understand that in providing this information to JDRF they will periodically send information regarding local activities

and T1D research progress.

Signature of Parent / Guardian: ___________________________________ Date: _______________________

❑ YES, I would like to be contacted by a local JDRF Mentor family who is living with T1D and who can share their personal experiences, answer

nonmedical questions, and provide valuable support when we need it most.

❑ At this point in time I am not ready for personal contact. I will reach out to the JDRF Chapter Office when I am ready to talk with a JDRF Mentor family.

Please scan and email or fax completed form to: [email protected] or (213)622-6276

Direct Phone Line (213) 233-9901

Internal Use

Only

Child’s Name: Gender: M F

Child’s Date of Birth: Date of Diagnosis:

Endocrinologist:

Parent Name(s):

Address:

City, State, Zip:

Telephone: Email:

(If needed) Secondary Parental Address:

City, State, Zip:

Telephone: Email:

Additional Information (often helpful in determining appropriate Mentor family: )

School:

Grade:

Child’s Hobbies:

Sibling’s Names/Ages:

Other:

Form Received by: ____________________________ Sent for Data Entry 1

Bag of Hope: Mailed 1 Hand Delivered 1 Date Mailed/Delivered: ___________

Delivered at: Hosp/Clinic 1 Dr/PCP Office 1 Patient’s Home 1 Other: ________________

Mentor Assigned: Yes 1 No 1 Mentor Name: ______________________ Date Assigned: ______________

At times your child may feel like he or she is the only one with diabetes. As your child begins his or her journey with diabetes, your child will realize that there are many people living with diabetes, just like your child. In fact, some of these people are celebrities, inventors, leaders and athletes. Sometimes knowing that there are famous people living with diabetes can be inspiring.

Here are a few:

• Jay Cutler – Former NFL Quarterback; diagnosed in 2008 at 25 years old

• Nick Jonas – Singer; diagnosed at 13 years old

• Anne Rice – Author; diagnosed in 1998

• Elliott Yamin – Singer (3rd place on the 5th season of American Idol); diagnosed at 21 years old

• Sonia Sotomayor – Justice on the U.S. Supreme Court; diagnosed at eight years old

• Gary Hall Jr. – Olympic Swimmer (10 Olympic medals), diagnosed a year before the 2000 Olympics

• Halle Berry – Actress

• Crystal Bowersox – Singer (runner up on American Idol); diagnosed at six years old

• Dorian Gregory – Actor; Diagnosed at 9 years old

• Damon Dash – Former CEO and co-founder of Roc-A-Fella Records; prominent in music, fashion, and movies; diagnosed at 15 years old

• Jordan Morris – MLS player

• Jennifer Stone – Actress; diagnosed at 20 years old

• Sam Talbot – Co-founder of Beyond Type 1; Contestant on season two of Top Chef

• Derek Theler – Actor; diagnosed at three years old

• Kendall Simmons – Retired NFL Player

• Brandon Green – Retired NFL Player

• Katelyn Prominski – Professional Ballet Dancer; diagnosed at 16 years old

• Will Cross – Professional climber who summitted Everest and the Seven Summits (the highest peak on each continent); diagnosed at nine years old

• Roddy Riddle – Ultra marathon runner; diagnosed at 40 years old

• Tommy Neal – Marathon runner; diagnosed at 28 years old

• Bobby Clark – Hall of Fame NHL Hockey player; diagnosed at 13 years old

• Brandon Marrow – MLB player; diagnosed at 17 years old

• Adam Duvall – MLB player; diagnosed at 23 years old

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• Dustin McGowan – MLB player

• Bret Michaels – Singer for the band Poison; diagnosed at six years old

• Chris Dudley – Former NBA Player; Founded the Chris Dudley Foundation in 1994

• Adam Morrison – Former NBA Player; College Basketball Coach

• Bill Carlson – Ironman Athlete; diagnosed at 16 years old; has competed in over 300 triathlons, marathons, ultramarathons and bike road races since diagnosis

• James “Buster” Douglas – Former Professional Boxer

• Zippora Karz – professional Ballerina; diagnosed at 21 years old

• Kelli Kuehne – Professional Golfer; diagnosed at 10 years old

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• American Diabetes Association diabetes.org

• Children with Diabetes childrenwithdiabetes.com

• DLife.com

• Juvenile Diabetes Association jdrf.org

• Journey for Control journeyforcontrol.com

• National Diabetes Education Program ndep.nih.gov

• Think Like a Pancreas (good site for teenagers) thinklikeapancreas.com

• calorieking.com

• KidsEatRight.org (The USDA National Nutrient Database)

• kidshealth.org**

• mealsmatter.org**

• caloriecount.about.com

• nutritiondata.com

• Tracker.Diabetes.org

• carbcards.com

• diabetesdesigns.com

• type1tools.com

• type2tools.com

• Diabetic Youth Services, Inc. Camp Conrad-Chinnock dys4kids.org

• Diabetic youth camps diabetescamps.org

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http://www.diabetes.org/

http://www.childrenwithdiabetes.com/

http://www.jdrf.org/

http://www.journeyforcontrol.com/journey_for_control/journeyforcontrol/index.jsp

http://www.ndep.nih.gov/

http://www.thinklikeapancrease.com/

http://www.calorieking.com/

KidsEatRight.org

http://www.caloriecount.about.com/

http://www.nutritiondata.com/

Tracker.Diabetes.org

http://www.carbcards.com/

http://www.diabetesdesigns.com/

http://www.type1tools.com/

http://www.type2tools.com/

http://www.dys.org/

• American Medical ID IdentifyYourself.com

• Medic Alert 1-888-ALERT90 medicalert.org

• Sticky Jewelry stickyJ.com

• Sugar Stats sugarstats.com

• Diabetes Exercise and Sports Association diabetes-exercise.org

• Blood Sugar Tracker

• The Snack App (Everyday Health)

• Vree for Diabetes

• Calorie King

• Eating Out G-Free

• Gluten Free Daily

• Calorie Counter & Diet Tracker by MyFitness Pal

• Calorie Tracker by Livestrong.com

• Sparkpeople Food and Fitness Tracker

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Allows users to easily log blood sugar levels, set target blood glucose ranges and view history and simple graphs to quickly identify numbers that are out of range.

Helpful tips of the day for general nutrition health; lists snacks by 50, 100 or 200. Lists nutrition facts including carbs.

Includes blood glucose tracking, nutrition tracking, activity tracking, medication tracking, progress charts and blood pressure tracking.

Resources for calories, fat and carbs for foods, restaurants and fast food. Also helpful for weight management.

Offers tips on how to find a gluten-free menu, create a gluten-free shopping list, lists of foods to avoid and how to stay gluten-free while dining away from the home. Supplements The G-Free Diet, by Elisabeth Hasselbeck.

An online guide built to provide education and resources about following a gluten-free diet.

Tracks food, exercise, weight and all nutrients listed on a nutrition facts label. Includes daily inspirational articles, healthy recipes and an easy-to-understand help section.

Tracks a combination of fitness goals and nutrition analysis features to help you lose weight.

Features a classic food diary that tracks calories, water, fitness and the time each food item is consumed and an option to create your own diet and physical activity plan and an Integrated Body Tracker.

Food and fitness diary designed to help you achieve your diet and nutrition goals, whether you want to lose, maintain or gain weight.

Created by the Dietitians of Canada, eaTipster delivers daily healthy eating tips to your mobile devices.

Fitness and food tracker for people looking to lose a half-pound to 2 pounds per week or to maintain weight.

* Available on Android

@ Available on iPhone

# Three Academy of Nutrition and Dietetics spokespeople have reviewed top-rated, free iPhone apps. For more reviews, visit http://www.eatright.org/Media/content.aspx?id=6442467022

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http://www.eatright.org/Media/content.aspx?id=6442467022

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Griselda Alvarez, M.D.

Roja Fallah, M.D.

Rebecca Hicks, M.D.

Karen Kennedy, R.N., C.D.E.

Valerie Macy-Hurley, L.C.S.W.

Aimee Miguel, P.T.

Erin Okawa, M.D.

Kathleen Sopp, L.C.S.W.

Casie Tappon, P.T.

Brandy Welch, R.N.

Tamal Williams, R.D., C.D.E.

Amy Wolk, RN, C.D.E.

Documents

Skills to Get You Home · Skills to Get You Home (562) 933-8562 millerchildrens.org/Diabetes