Diabetes in Pediatrics

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Diabetes in Pediatrics

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

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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

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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

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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

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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.

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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

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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

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Insulin Regimens

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

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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

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Secondary Nutrition Education

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

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Age-specific Toddlers

• Daily variation in meal patterns
• Typically graze with small, frequent meals
• Food jags, selective eating
• Sporadic activity

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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

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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

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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.

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Age-specific Adolescents

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

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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.

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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

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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)

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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

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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?

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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

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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

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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

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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

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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!

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Do you have questions for me?

• Clarifications?
• Cultural/Native American Differences?
• More Information?