Transcript Coping with Diabetes - International Diabetes Federation

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Diabetes and
the Growing
Child
Programme
Effects of growth on diabetes
2
School issues
3
Exercise
4
Smoking, alcohol and drugs
5
Pregnancy
6
Fasting
Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S
1
Effects of growth on diabetes
Growth and diabetes
• During childhood and adolescence
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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
Effects of changes
Change
Effect
Consequence
Growth
Increasing weight
Increasing doses
Puberty
Decreasing insulin sensitivity Increased doses
Psycho-social stresses
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
School issues
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
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
Exercise
Diabetes and exercise
• Common part of children and adolescents lives
• Encouraged in diabetes
• Benefits of exercise include
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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
Effect of exercise
• Hypoglycaemia
• Hyperglycaemia
• Ketones
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
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
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
Smoking, alcohol and drugs
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
Alcohol drinks
• Use and abuse not uncommon
• May cause rapid rise in glucose, i.e. always eat
before going to bed
• Effects on liver
impaired
correction of hypoglycaemia is
• Frequent use causes weight gain
• Empowerment to deal with peer pressure
Smoking
• Similar prevalence of smoking with or without diabetes
• General risks
• Cardiac disease
• Emphysema
• Cancers
• In people with diabetes, worse
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Cardiovascular disease
Micro- and macrovascular complications
Hypertension
Hyperlipidaemia
Marijuana
• Excessive or frequent use associated with:
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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
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
Pregnancy
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
Risks for mother
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Hypertension in pregnancy
Urinary tract infections
Later risk for type 2 diabetes
Preterm labour
Polyhydramnios
Macrosomia
DKA
Progression of microvascular
complications
Risks for baby (1)
• Congenital abnormalities
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Spinal
Heart
Gastro-intestinal
Limb abnormalities
Heart abnormalities
Poor control around
conception
Poor control late in pregnancy
• Macrosomia (big baby syndrome)
• Obstructed labour
• Intra-uterine death
Risks for baby (2)
• Asphyxia
• Birth trauma at delivery
• Hypoglycaemia
• Hypocalcaemia
• Neonatal jaundice
• Respiratory distress
• Polycythaemia
• Increased later risk of type 2 diabetes
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 mother’s complications
• Genetic implications of diabetes
Fasting
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
Questions
Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S