Coping with Diabetes

1
Coping with Diabetes
2
Programme
1
What to tell the family
School issues
7
2
Dispelling myths and false beliefs
8
Exercise
3
Acute illness
9
Smoking, alcohol and drugs
4
Nutritional advice
10
Pregnancy
5
Storing insulin
11
Fasting
6
Effects of growth on diabetes
3

• What to tell the family

4
At diagnosis

• First contact is crucial
• Can achieve the following
• Explain diabetes symptoms
• Enroll the family into care of the child
• Specifically invite the father and mother
• Initial diabetes education
• Dispel myths and false beliefs
• Family bewildered and shocked
• Be supportive, empathic and caring
• Answer comprehensively and respectfully

5
Symptoms

• Explain symptoms and signs
• Diagrams useful
• Demonstrate glucose values and urine dipsticks
• Explain mechanism
• Insulin deficiency
• Unknown cause
• Raise questions for future discussion

6

• Dispelling myths and false beliefs

7
Myths and false beliefs

• Cause of diabetes/ genetics/ environment
• Cure for diabetes
• Use of alternative medications
• Toxicity of insulin
• Use of pills for treatment
• Infectiousness of diabetes

8

• Acute illness

9
Acute illness

• Acute illness may cause
• High glucose (hyperglycaemia)
• Low glucose (hypoglycaemia)
• Ketones
• Ketones may occur during, before or after the
  illness
• Children with diabetes do not have more frequent
  illness
• Know how to advise families on management of
  acute illness

10
Management (1)

• Do not stop insulin delivery
• May increase or decrease dose
• Need frequent monitoring
• Glucose 3-4 hourly
• Ketones 1-2 times per day
• Admit if
• no home monitoring
• it is not getting better despite doing all you
  can at home
• Treat illness
• Sugar-free medication
• No steroids

11
Management (2)

• Supportive care
• Easily digested food
• Adequate fluid intake
• Antipyretics (paracetamol)
• Consider admission
• Adjust insulin doses never stop insulin
• Educate family on management of illness
• Provide written guidelines for family

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• Nutritional advice

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Nutritional advice (1)

• Food provides energy for growth and day-to-day
  functioning
• Food intake influenced by
• Family functioning
• Psychological and emotional factors
• Societal factors
• Socio-economic factors

14
Nutritional advice (2)

• Food (carbohydrate) intake to be balanced against
  insulin
• Food intake to be balanced against activity
• Glucose monitoring used to balance food intake,
  activity and/or insulin dose

15
General dietary guidelines

• Use meal plans rather than a diet
• Try not to have dos and donts
• Keep plans simple and practical

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Meal plans

• Depend on local factors
• Calorie restriction for obese patients
• Allow for individual choice
• Allow flexibility and variety in food selection
• Balance financial needs and availability of foods
  and snacks
• Depends on what is available locally

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Food and insulin

• Balance food and insulin
• Adapt insulin to suit meal
• Different regimens allow change in
• Meal plans
• Meal frequency

Insulin
Food
18
Food and insulin

• Twice daily regimen
• Regular snacks and meals
• Risk of hypos is missed meals/snacks
• Emphasise regularity and portion sizes at meals

• Multiple daily injections
• More flexibility
• Less short-acting insulin for smaller meals
• Need to understand effects of food and insulin on
  glucose

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Teaching about food

• Plan for balanced meals
• Aim for
• 50-60 carbohydrates
• 15-20 protein
• lt30 fats
• Teach food groups and reading food labels
• Teach entire family especially the father and
  grandparents
• Energy requirements change with growth

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• Storing insulin

21
Storing insulin

• Insulin is a fragile protein medication
• Denatured if frozen or in excessive heat
• Stored at 2-8C
• Use before expiry date
• Once opened, may last
• 1 month if not refrigerated
• 3 months if refrigerated
• Storage of insulin is important

22
Storage of insulin

• Clinic and home
• Power refrigeration
• Not freezer
• Back-up generator
• Passive/water refrigeration
• Underground
• Clay pots
• Rotate stock by expiry date

23
Questions
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