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What Should A Child Or Teen With Diabetes Do Every Day?
The National Institutes Of Health's "National Diabetes Education Program"
To control diabetes and prevent complications, blood glucose levels must be as close to a "normal" range as safely possible. Families should work with a health care professional to help set a child's or teen's targets for blood glucose levels and help develop a personal diabetes plan for the child. They should also discuss ways to manage hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose).
A Personal Diabetes Plan
A personal diabetes plan ensures that a daily schedule is in place to keep diabetes under control. The plan shows the child how to follow a healthy meal plan, get regular physical activity, check blood glucose levels, take insulin or oral medication as prescribed, and manage hyperglycemia (high blood glucose) and hypoglycemia (low blood glucose).
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Follow a healthy meal plan. Young people with diabetes need to follow a meal plan developed by a registered dietitian, diabetes educator, or physician. For children with type 1 diabetes, the meal plan must ensure proper nutrition for growth. For children with type 2, the meal plan should outline appropriate changes in eating habits that lead to better energy balance and reduce or prevent obesity. A meal plan also helps keep blood glucose levels in the target range.
Children or adolescents and their families can learn how different types of food — especially carbohydrates such as breads, pasta, and rice — can affect blood glucose levels. Portion sizes, the right amount of calories for the child's age, and ideas for healthy food choices at meal and snack time also should be discussed including reduction in soda and juice consumption. Family support for following the meal plan and setting up regular meal times is a key to success, especially if the child or teen is taking insulin.
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Get regular physical activity. Children with diabetes need regular physical activity, ideally a total of 60 minutes each day. Physical activity helps to lower blood glucose levels, especially in children and adolescents with type 2 diabetes. Physical activity is also a good way to help children control their weight. In children with type 1 diabetes, the most common problem encountered during physical activity is hypoglycemia. If possible, a child or a teen should check blood glucose levels before beginning a game or a sport. If blood glucose levels are too low, the child should not by physically active until the low blood glucose level has been treated.
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Check blood glucose levels regularly. Young people with diabetes should know the acceptable range for their blood glucose. Children, particularly those using insulin should check blood glucose values regularly with a blood glucose meter, preferably one with a built-in memory. A health care team member can teach a child how to use a blood glucose meter properly and how often to use it. Children should keep a journal or other records of blood glucose results to discuss with their health care team. This information helps providers make any needed changes to the child's or teen's personal diabetes plan.
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Take all diabetes medication as prescribed. Parents, caregivers, school nurses, and others can help a child or teen learn how to take medications as prescribed. For type 1 diabetes, a child or teen takes insulin at prescribed times each day via multiple injections or an insulin pump. Some young people with type 2 diabetes need oral medication or insulin or both. In any case, it is important to stress that all medication should be balanced with food and activity every day.
Hypoglycemia And Hyperglycemia
Diabetes treatment can sometimes cause blood glucose levels to drop too low, with resultant hypoglycemia. Taking too much insulin, missing a meal or snack, or exercising too much may cause hypoglycemia. A child can become irritable, shaky, and confused. When blood glucose levels fall very low, loss of consciousness or seizures may develop.
When hypoglycemia is recognized, the child should drink or eat a concentrated sugar to raise the blood glucose value to greater than 80 mg/dl. Once the blood glucose is over 80, the child can eat food containing protein to maintain blood glucose levels in the normal range. The concentrated sugar will increase blood glucose levels and cause resolution of symptoms quickly, avoiding over-treatment of "lows." If the child is unable to eat or drink, a glucose gel may be administered to the buccal mucosa of the cheek or glucagon may be injected.
Glycemic goals may need to be modified to take into account the fact that most children younger than 6 or 7 years of age have a form of "hypoglycemic unawareness." They lack the cognitive capacity to recognize and respond to hypoglycemic symptoms and may be at greater risk for hypoglycemia.
Causes of hyperglycemia include forgetting to take medications on time, eating too much, and getting too little exercise. Being ill also can raise blood glucose levels. Over time, hyperglycemia can cause damage to the eyes, kidneys, nerves, blood vessels, gums, and teeth.
Intercurrent illnesses are more frequent in young children. Sick-day management rules, including assessment for ketosis with every illness, must be established for children with type 1 diabetes. Families need to be taught what to do for vomiting and for ketosis to prevent severe hyperglycemia and ketoacidosis.
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