TYPE 1 DIABETES MELLITUS, SELF-CARE, PAEDIATRIC

TYPE 1 DIABETES MELLITUS, SELF-CARE, PAEDIATRIC

Caring for your child who has type 1 diabetes (type 1 diabetes mellitus) means keeping your child’s blood sugar (glucose) under control with a balance of:

  • Insulin.
  • Nutrition.
  • Exercise.
  • Other medicines, if necessary.
  • Support from your child’s team of health care providers and others.

It is important for you to be an active part of your child’s diabetes care. The following information explains what you need to know to manage your child’s diabetes at home.

  • Check your child’s blood glucose every day, as often as told by your child’s health care provider.
  • Contact your child’s health care provider if your child’s blood glucose is above his or her target for 2 tests in a row.
  • Have your child’s A1c (haemoglobin A1c) level checked at least two times a year, or as often as told by your child’s health care provider.

Your child’s health care provider will set individualized blood glucose and A1c treatment goals for your child.

What is hyperglycaemia?

Hyperglycaemia, also called high blood glucose, occurs when blood glucose is too high. Make sure you know the early signs of hyperglycaemia, such as:

  • Increased thirst.
  • Hunger.
  • Feeling very tired.
  • Needing to urinate more often than usual.
  • Blurry vision.

What is hypoglycaemia?

Hypoglycaemia, also called low blood glucose, occurs with a blood glucose level at or below 70 mg/dL (3.9 mmol/L). The risk for hypoglycaemia increases during or after exercise, during sleep, during illness, and when skipping meals or not eating for a long time (fasting).

It is important to know the symptoms of hypoglycaemia and treat it right away. Your child should always have a 15-gram rapid-acting carbohydrate snack available to treat low blood glucose. Family members and caregivers should also know the symptoms and should understand how to treat hypoglycaemia.

What are the symptoms of hypoglycaemia?

Hypoglycaemia symptoms can include:

  • Hunger.
  • Anxiety.
  • Sweating and feeling clammy.
  • Confusion.
  • Dizziness or feeling light-headed.
  • Sleepiness.
  • Nausea.
  • Increased heart rate.
  • Headache.
  • Blurry vision.
  • Seizure.
  • Nightmares.
  • Tingling or numbness around the mouth, lips, or tongue.
  • A change in speech.
  • Decreased ability to concentrate.
  • A change in coordination.
  • Restless sleep.
  • Tremors or shakes.
  • Fainting.
  • Irritability.
  • Crying more often than usual.
  • A dramatic change in behaviour.

How do I treat hypoglycaemia?

If your child is alert and able to swallow safely, have your child follow the 15:15 rule:

  • Have your child take 15 grams of a rapid-acting carbohydrate. Rapid-acting options include:
    • 1 tube of glucose gel.
    • 3 glucose pills.
    • 6–8 pieces of hard candy.
    • 4 oz (120 mL) of fruit juice or regular (not diet) soda.
    • 4 oz (120 mL) of regular (not diet) soda.
  • Check your child’s blood glucose 15 minutes after he or she takes the carbohydrate.
  • If the repeat blood glucose level is still at or below 70 mg/dL (3.9 mmol/L), have your child take 15 grams of a carbohydrate again.
  • If your child’s blood glucose level does not increase above 70 mg/dL (3.9 mmol/L) after 3 tries, seek emergency medical care.
  • After your child’s blood glucose returns to normal, have your child eat a meal or a snack within 1 hour.

How do I treat severe hypoglycaemia?

Severe hypoglycaemia is when your child’s blood glucose level is at or below 54 mg/dL (3 mmol/L). Severe hypoglycaemia is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.).

If your child has severe hypoglycaemia and cannot eat or drink, your child may need an injection of glucagon. You will be taught how to check your child’s blood glucose and how to give your child an injection of glucagon. Ask your child’s health care provider if your child needs to have an emergency glucagon injection kit available.

Severe hypoglycaemia may need to be treated in a hospital. The treatment may include getting glucose through an IV tube. Your child may also need treatment for the cause of hypoglycaemia.

Having diabetes can put your child at risk for other long-term (chronic) conditions, such as thyroid disease, celiac disease, high cholesterol, heart disease, and kidney disease. Your child’s health care provider may prescribe medicines to help prevent complications from diabetes.

Have your child use insulin as told

  • Have your child take insulin every day.
  • Do notelet your child run out of insulin. Plan ahead so your child always has insulin available.
  • Adjust your child’s insulin dosage based on how physically active your child is and what foods your child eats. Your child’s health care provider will tell you how to do this.

Encourage healthy food choices

The things that your child eats and drinks affect his or her blood glucose and insulin dosage. Helping your child make good choices helps to control your child’s diabetes and prevent other health problems. A healthy meal plan includes eating lean proteins, complex carbohydrates, fresh fruits and vegetables, low-fat dairy products, and healthy fats.

Make an appointment to see a diet and nutrition specialist (registered dietitian) to help you create an eating plan that is right for your child. Make sure that your child:

  • Follows instructions from his or her health care provider about eating or drinking restrictions.
  • Drinks enough fluid to keep his or her urine clear or pale yellow.
  • Eats healthy snacks between nutritious meals.
  • Tracks the carbohydrates that he or she eats. You and your child can do this by reading food labels and learning the standard serving sizes of foods.
  • Follows his or her sick day plan whenever he or she cannot eat or drink as usual. Make this plan in advance with your child and his or her health care provider.

Encourage activity

  • Have your child exercise regularly, as told by your child’s health care provider. This may include:
    • Stretching and doing strength exercises, such as yoga or weightlifting, at least 2 times a week.
    • Doing 60 minutes of moderate-intensity exercise each day. Moderate-intensity exercise includes brisk walking, running, and certain sports.
  • Your child may need more carbohydrates before, during, and after physical activity. It is important for your child to have a rapid-acting carbohydrate snack available before, during, and after exercise. This helps to prevent or treat hypoglycaemia.
    • If your child’s blood glucose level is below normal, your child should have a 5–15 gram carbohydrate snack before physical activity. Your child should have another 5–15 gram carbohydrate snack for every 30 minutes of continued activity.
  • If your child plays a sport, tell the coach that your child has diabetes.
  • Talk with your child’s health care provider before your child starts a new exercise or activity. Work with his or her health care provider to adjust insulin, medicines, or food intake as needed.

Care for your child’s body

  • Keep your child’s immunizations up to date.
  • Schedule an eye exam for your child when he or she is age 10 or older and has had diabetes for 3–5 years.
    • After the first exam, your child should have an eye exam every year.
  • Check your child’s skin and feet every day for cuts, bruises, redness, blisters, or sores.
  • After your child begins puberty, he or she should have a complete foot exam done by a health care provider.
    • After the first exam, your child should have a foot exam every year.
  • Have your child:
    • Brush his or her teeth and gums two times a day.
    • Floss at least one time a day.
    • Visit the dentist at least once every 6 months.
  • Have your child’s blood tested by a health care provider every year.
    • If your child has not had a blood test in over 1 year, ask your child’s health care provider if blood tests are needed.
  • Keep in mind that growth spurts and puberty can affect blood glucose levels and the amount of insulin that your child needs.

General instructions

  • Give over-the-counter and prescription medicines only as told by your child’s health care provider.
  • Share your child’s diabetes management plan with your child’s caregivers, including people in your child’s school and household.
  • Check your child’s urine for ketones:
    • When your child is ill.
    • As told by your child’s health care provider.
    • When your child’s blood glucose is above 240 mg/dL (13.3 mmol/L) for 2 tests in a row. If this happens and your child has moderate or large ketone levels in his or her urine, contact your child’s health care provider.
  • Have your child carry a medical alert card or wear medical alert jewellery.
  • Teach your child to avoid alcohol and tobacco.
  • Ask your child’s health care provider:
    • Do my child and I need to meet with a diabetes educator?
    • Where can I find a support group for children with diabetes?
  • Keep all follow-up visits as told by your child’s health care provider. This is important.

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