Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S
Coping with
Diabetes
Programme
1
What to tell the family
7
School issues
2
Dispelling myths and false beliefs
8
Exercise
3
Acute illness
9
Smoking, alcohol and drugs
4
Nutritional advice
10
Pregnancy
5
Storing insulin
11
Fasting
6
Effects of growth on diabetes
What to tell the family
At diagnosis
• First contact is crucial
• Can achieve the following:
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Explain diabetes symptoms
Enroll the family into care of the child
Specifically invite the father and mother
Initial diabetes education
Dispel myths and false beliefs
• Family bewildered and shocked
• Be supportive, empathic and caring
• Answer comprehensively and respectfully
Symptoms
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Explain symptoms and signs
Diagrams useful
Demonstrate glucose values and urine dipsticks
Explain mechanism
• Insulin deficiency
• Unknown cause
• Raise questions for future discussion
Dispelling myths and false beliefs
Myths and false beliefs
• Cause of diabetes/ genetics/
environment
• Cure for diabetes
• Use of alternative medications
• Toxicity of insulin
• Use of pills for treatment
• Infectiousness of diabetes
Acute illness
Acute illness
• Acute illness may cause:
• High glucose (hyperglycaemia)
• Low glucose (hypoglycaemia)
• Ketones
• Ketones may occur during, before or after the illness
• Children with diabetes do not have more frequent
illness
• Know how to advise families on management of acute
illness
Management (1)
• Do not stop insulin delivery
• May increase or decrease dose
• Need frequent monitoring
• Glucose 3-4 hourly
• Ketones 1-2 times per day
• Admit if:
• no home monitoring
• it is not getting better despite
doing all you can at home
• Treat illness
• Sugar-free medication
• No steroids
Management (2)
• Supportive care
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Easily digested food
Adequate fluid intake
Antipyretics (paracetamol)
Consider admission
• Adjust insulin doses – never stop insulin
• Educate family on management of illness
• Provide written guidelines for family
Nutritional advice
Nutritional advice (1)
• Food provides energy for growth and day-to-day
functioning
• Food intake influenced by
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Family functioning
Psychological and emotional factors
Societal factors
Socio-economic factors
Nutritional advice (2)
• Food (carbohydrate) intake to be balanced against
insulin
• Food intake to be balanced against activity
• Glucose monitoring used to balance food intake, activity
and/or insulin dose
General dietary guidelines
• Use meal plans rather than a diet
• Try not to have do’s and don’ts
• Keep plans simple and practical
Meal plans
• Depend on local factors
• Calorie restriction for obese patients
• Allow for individual choice
• Allow flexibility and variety in food selection
• Balance financial needs and availability of foods and
snacks
• Depends on what is available locally
Food and insulin
• Balance food and insulin
• Adapt insulin to suit meal
• Different regimens allow
change in
• Meal plans
• Meal frequency
Food
Insulin
Food and insulin
Twice daily regimen
Multiple daily injections
• Regular snacks and meals
• Risk of hypos is missed
meals/snacks
• Emphasise regularity and
portion sizes at meals
• More flexibility
• Less short-acting insulin for
smaller meals
• Need to understand effects of
food and insulin on glucose
Teaching about food
• Plan for balanced meals
• Aim for:
• 50-60% carbohydrates
• 15-20% protein
• <30% fats
• Teach food groups and reading food labels
• Teach entire family – especially the father and
grandparents
• Energy requirements change with growth
Storing insulin
Storing insulin
• Insulin is a ‘fragile’ protein medication
• Denatured if frozen or in excessive heat
• Stored at 2-8°C
• Use before expiry date
• Once opened, may last
• 1 month if not refrigerated
• 3 months if refrigerated
• Storage of insulin is important
Storage of insulin
• Clinic and home
• Power refrigeration
• Not freezer
• Back-up generator
• Passive/water refrigeration
• Underground
• Clay pots
• Rotate stock by expiry date
Questions
Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S