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Diabetes in Pediatrics

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Diabetes in Pediatrics Understanding Type I and Type II Diabetes in Children and Adolescents By: Erica Glover Type 1 vs. Type 2 DM-1 Insulin dependent No connection ... – PowerPoint PPT presentation

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Title: Diabetes in Pediatrics


1
Diabetes in Pediatrics
  • Understanding Type I and Type II Diabetes in
    Children and Adolescents
  • By Erica Glover

2
Type 1 vs. Type 2
  • DM-1
  • Insulin dependent
  • No connection to family history
  • Auto-immune disease
  • DM-2
  • Not insulin dependent (hopefully)
  • Family history
  • Strong relation to obesity and IGT
  • Insulin resistance
  • Hyperinsulinemia

3
Goals of Medical Nutrition Therapy
  • Maintenance of near-normal blood glucose (BG)
    levels by balancing food intake with insulin and
    activity levels
  • Hypoglycemia multiple events can cause impaired
    brain development in young children
  • Intensive BG management NOT recommended under
    ages of 13 years old

4
Goals of Medical Nutrition Therapy
  • Achievement of optimal lipid levels
  • Begins with maintaining normal glucose levels
  • Children at high risk lipid abnormalities should
    be screened and monitored
  • Provision of adequate calories for normal growth
    and development
  • Height and weight every 3-6 months
  • Plot growth on NCHS growth chart

5
Goals of Medical Nutrition Therapy
  • Prevention, delay, or treatment of
    nutrition-related risk factors and complications.
  • The rule of 15
  • Improvement of overall health through optimal
    nutrition.

6
Meal Planning Approaches
  • Carbohydrate Counting
  • Specific calorie levels not generally
    recommended
  • Usually based on the amount of CHO normally
    consumed
  • Exchange List for Meal Planning
  • Helpful in formulating meal plan for specific
    nutrition needs
  • Simply not practical

7
Physical Activity
  • Generally reduces insulin requirements
  • Better to consume 15g CHO per hour of activity
    than to adjust insulin
  • Decreases insulin resistance in type 2
  • Check BG levels!!
  • May have lipid-lowering effect

8
Insulin Regimens
  • Conventional
  • Multiple daily injections
  • Insulin pump
  • The child/adolescent must take more
    responsibility for additional BG testing and CHO
    counting

9
Initial Nutrition Education
  • Food components that influence BG levels
  • Meal timing and consistent CHO intake
  • Meal plan
  • Prevention treatment of hypoglycemia
  • BG control in illness

10
Secondary Nutrition Education
  • Monitoring discussion of growth
  • Review modify meal plan
  • Use of BG monitoring to develop CHO to insulin
    ratios
  • Problem-solving/troubleshooting

11
Age-specific Toddlers
  • Daily variation in meal patterns
  • Typically graze with small, frequent meals
  • Food jags, selective eating
  • Sporadic activity

12
Age-specific Toddlers
  • Schedule adequate regular meals and snacks
    containing carbohydrate
  • Suggest to parents alternate sources of CHO if
    food refusal occurs
  • Avoid withholding food in hyperglycemia

13
Age-specific Preschool and School-aged Children
  • More consistent predictable appetites
  • Generally eat same amounts of CHO at same time
    each day
  • More meals snacks away from home
  • Birthday parties
  • Overnight parties

14
Age-specific Preschool and School-aged Children
  • Involve more in food preparation and meal
    planning
  • Morning and afternoon snack encouraged
  • Instruct parents on management during special
    occasions
  • Review meal plan often to ensure meals and snacks
    correspond to changes in activity.

15
Age-specific Adolescents
  • Variable meal schedules
  • Work
  • School activities
  • Social activity
  • More responsibility for food choices
  • Inconsistent meal timing, frequency, and amounts
    of CHO

16
Age-specific Adolescents
  • Peer influence in food choices and timing
  • Mismanagement of meal plan common
  • Growth spurts and variation of appetite
  • Sports become central in the lives of some
    adolescents.

17
Age-specific Adolescents
  • Assess involvement of activity on a regular basis
  • Make suggestions for appropriate snacks
    supplements
  • Screen for insulin omission eating disorders
  • Instruct on the potential hypoglycemic effects of
    alcohol

18
Age-specific Adolescents
  • Instruct adolescents who drive on the importance
    of BG monitoring carrying a source of CHO with
    them at all times.
  • Provide practical knowledge as needed on
    alternative eating patterns (i.e. vegetarianism)

19
Eating Disorders in Adolescents with DM-1
  • Pubertal changes in body shape may cause
    development of unhealthy eating attitudes.
  • Dx of DM-1 heightens awareness of dietary
    restraints, weight gain, and food preoccupation.
  • Insulin misuse to lose weight

20
Eating Disorders in Adolescents with DM-1
  • Pay attention to those who express body
    dissatisfaction
  • Lead them toward healthy weight control practices
  • Screen regarding weight
  • How concerned are you about your weight?
  • Do you ever skip meals to lose or maintain weight?

21
Eating Disorders in Adolescents with DM-1
  • In the past year have you ever tried to lose
    weight by vomiting, taking pills, using
    laxatives, skipping insulin, or modifying your
    insulin dose?
  • Include Behavioral Health Counselor and Family

22
Practical Advice to Parents
  • Parents can have trouble dealing with their
    childs new diagnosis. Here are points to help
  • 1. Dont Isolate Yourself
  • Find support, lean on others
  • Support groups, family, friends, place of worship

23
Practical Advice to Parents
  • 2. Ask for Help
  • Bring a friend or relative to help you take notes
    when you talk to medical providers.
  • 3. Dont Blame yourself
  • Remind yourself that BG monitoring and insulin
    shots are now a fact of life
  • You didnt give your child diabetes

24
Practical Advice to Parents
  • 4. Mind your Marriage
  • Make time for your spouse everyday, putting aside
    your childs diabetes
  • 5. Work with Your Ex
  • Put aside negative feelings to work together for
    the sake of your child
  • Seek counseling if needed.
  • Dont play good parent, bad parent to drive a
    wedge between child and other parent

25
Practical Advice to Parents
  • 5. Be Consistent
  • Routines make children feel secure
  • 6. Educate Yourself
  • Knowledge may help reduce anxiety
  • 7. Consider counseling
  • Sometimes you just need a little help
  • 8. Take a break from diabetes
  • Take care of Yourself!

26
Do you have questions for me?
  • Clarifications?
  • Cultural/Native American Differences?
  • More Information?
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