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Diabetes and the Growing Child

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1. 2. 4. 3. 5. 6. Effects of growth on diabetes. Fasting. Pregnancy. Smoking, alcohol and drugs. Exercise. School issues. Programme – PowerPoint PPT presentation

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Title: Diabetes and the Growing Child


1
Diabetes and the Growing Child
2
Programme
3
  • Effects of growth on diabetes

4
Growth and diabetes
  • During childhood and adolescence
  • Physical growth
  • Maturation of organ systems
  • Increasing intellectual maturity and
    understanding
  • Puberty
  • Not affected by diabetes if well controlled
  • Poorly controlled diabetes may cause
  • Poor growth
  • Delayed puberty

5
Effects of changes
Change Effect Consequence
Growth Increasing weight Increasing doses
Puberty Decreasing insulin sensitivity Psycho-social stresses Increased doses More education Alcohol and drug use Risk taking behaviour
Menses Changes in insulin sensitivity Fluctuating insulin needs with increased doses during menses
Lifestyle Increasing activity Increase food intake / decreased doses
Intellectual maturation Increased understanding Increased independence More education Increased autonomy

6
  • School issues

7
Diabetes at school
  • Safe and supportive school environment
  • The child and adolescent with diabetes has rights
  • Right to be admitted to school
  • Right to receive appropriate care
  • Right to be fully integrated into a school
    environment
  • Responsibility of parents and care team
  • Educating carers (teachers) at school
  • Supporting schools and teachers
  • Providing supplies for care

8
Educating the people at school
  • Information on diabetes and management
  • Effect of illnesses
  • Hyperglycaemia and ketones
  • Recognition, treatment and prevention of
    hypoglycaemia
  • Practical knowledge and practice in glucose and
    ketone testing and insulin injections
  • Effects of diet and activity on diabetes
  • Social and psychological impact of diabetes

9
  • Exercise

10
Diabetes and exercise
  • Common part of children and adolescents lives
  • Encouraged in diabetes
  • Benefits of exercise include
  • Sense of well-being
  • Weight control
  • Limit rise in glucose after meals
  • Lowers heart rate and blood pressure
  • Lowers blood lipid levels
  • Reduces cardio-vascular risk

11
Effect of exercise
  • Hypoglycaemia
  • Hyperglycaemia
  • Ketones

12
Factors affecting glucose response
  • Duration
  • Intensity of activity
  • Type of activity
  • Metabolic control
  • Insulin regimen
  • Absorption of insulin
  • Timing and type of food
  • Stress and competition involved

13
Managing exercise (1)
  • Very variable effects in different children
  • Monitoring glucose is the key
  • Know glucose value before activity
  • May need snack adjustments (preferably quick
    carbohydrates)
  • Monitor glucose 30-60 minutes after the end of
    the activity

14
Managing exercise (2)
  • Treat low glucose with additional rapid sugar
  • Sugar cube, coke, honey, sweets
  • After prolonged activity
  • Additional snack before sleeping
  • Have glucose monitored during the night
  • Decrease bedtime insulin dose after afternoon or
    evening exercise
  • Accurate records of activity, food intake and
    glucose values to learn

15
  • Smoking, alcohol and drugs

16
Alcohol and drugs
  • Peer pressure to experiment
  • Depend on availability, cost and societal
    attitudes
  • Experimentation may start in very young children
  • Children and adolescents with diabetes no
    different from any other
  • Empower discussion rather than challenging
    behaviour

17
Alcohol drinks
  • Use and abuse not uncommon
  • May cause rapid rise in glucose, i.e. always eat
    before going to bed
  • Effects on liver correction of hypoglycaemia
    is impaired
  • Frequent use causes weight gain
  • Empowerment to deal with peer pressure

18
Smoking
  • Similar prevalence of smoking with or without
    diabetes
  • General risks
  • Cardiac disease
  • Emphysema
  • Cancers
  • In people with diabetes, worse
  • Cardiovascular disease
  • Micro- and macrovascular complications
  • Hypertension
  • Hyperlipidaemia

19
Marijuana
  • Excessive or frequent use associated with
  • School and learning difficulties
  • Behaviour problems
  • Depression
  • Low self-esteem
  • Anxiety
  • Family/peer interactions
  • Socially deviant behaviour
  • No major direct effects on diabetes
  • Unless overeating carbohydrates

20
Other drugs
  • May have
  • No direct effect on glucose (hypoglycaemia at
    rave parties)
  • Increase blood glucose levels
  • Dehydration (amphetamine) or water intoxication
    (ecstasy)
  • Potential for addiction
  • Have psychosocial effects
  • Interfere with diabetes self-management
  • Some drugs have direct effects on the
    heart(amphetamine?)
  • May need psychological intervention

21
  • Pregnancy

22
Diabetes and pregnancy
  • Diabetes in pregnancy poses challenges
  • There are increased risks for both mother and
    baby
  • All pregnancies complicated by diabetes should be
    managed by an experienced team
  • Diabetes may be existing type 1 diabetes or
    gestational diabetes

23
Risks for mother
  • Hypertension in pregnancy
  • Urinary tract infections
  • Later risk for type 2 diabetes
  • Preterm labour
  • Polyhydramnios
  • Macrosomia
  • DKA
  • Progression of microvascular complications

24
Risks for baby (1)
  • Congenital abnormalities
  • Spinal
  • Heart
  • Gastro-intestinal
  • Limb abnormalities
  • Heart abnormalities
  • Macrosomia (big baby syndrome)
  • Obstructed labour
  • Intra-uterine death

Poor control around conception
Poor control late in pregnancy
25
Risks for baby (2)
  • Asphyxia
  • Birth trauma at delivery
  • Hypoglycaemia
  • Hypocalcaemia
  • Neonatal jaundice
  • Respiratory distress
  • Polycythaemia
  • Increased later risk of type 2 diabetes

26
Pre-pregnancy planning
  • Unplanned pregnancies hopefully to be avoided
  • Counsel on
  • Abstinence and contraception (incl. emergency
    contraception)
  • Effects of diabetes on the pregnancy
  • Need for tight control of diabetes before and
    during pregnancy
  • Planned pregnancies
  • Risk of progression of mothers complications
  • Genetic implications of diabetes

27
  • Fasting

28
Fasting
  • Fasting for Ramadan
  • Not compulsory for anyone with illness
  • Some choose to fast
  • Insulin required despite the fasting
  • Need to adjust the insulin regimen
  • Practical tips in manual
  • Special circumstances need active management

29
Questions
30
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