Diabetes and the Growing Child

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

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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

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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

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• School issues

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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

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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

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• Exercise

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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

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Effect of exercise

• Hypoglycaemia
• Hyperglycaemia
• Ketones

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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

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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

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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

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• Smoking, alcohol and drugs

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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

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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

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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

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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

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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

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• Pregnancy

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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

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Risks for mother

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

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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
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Risks for baby (2)

• Asphyxia
• Birth trauma at delivery
• Hypoglycaemia
• Hypocalcaemia
• Neonatal jaundice
• Respiratory distress
• Polycythaemia
• Increased later risk of type 2 diabetes

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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

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• Fasting

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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

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Questions
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