Diabetes Help Tauranga Youth

                               Children & Young People with Diabetes


Children and Young People Living with Diabetes

Caring for a child or young person with diabetes can have its challenges and often means learning new ways of dealing doing things very quickly!. The good news is however that most children and young people with diabetes live healthy, happy lives!  Keeping blood glucose levels in a healthy, safe range, avoiding hypoglycaemia (low blood sugar) and hyperglycaemia (high blood sugar) is the aim. Diabetes Help Tauranga Youth is able to put you in touch with local families in the Western Bay of Plenty who can journey with you and provide valuable practical help and advice. 

Click here for more information about type one in children/teens
Click here for more information about type two diabetes in children/teens
Click here for more information about cystic fibrosis related diabetes   

Coping with a Diagnosis - Parents and carers 

A diagnosis of diabetes is usually unexpected and can be very stressful for the whole family. Feelings of shock, sadness, anger and guilt are all normal and each member of your family may react differently. There are a number of people to include the hospital diabetes team able to support you, your child and whanau through this difficult time and help you get back to home life and day-to-day routines. You can find more information on Kidshealth.org.nz on emotional and mental wellbeing concerns around a diagnosis of diabetes

Click here to watch a video with tips on how to manage - Starship Hospital

Blood Glucose Monitoring 

Blood glucose measurements are IMPORTANT for children and young people with diabetes to:

  • monitor blood glucose control to make sure that the amount of insulin you are getting is just right for you!
  • look for high or low glucose levels so that they can be treated if needed
  • monitor and treat diabetes during exercise and illness
Click here for more information on glucose monitoring

Injecting Insulin

Insulin is needed to

  • Replace the insulin that the Islet or Beta cells in the pancreas are not making
  • Balance with carbohydrate food that is being eaten
  • Bring blood glucose levels down when levels are high, or if you are not exercising or are unwell

 Hypoglycaemia (Hypo's)

Hypo's occur when the blood sugar level drops too low. A 'hypo' or low blood sugar is one that is below 4mmol/l.

The causes of a hypo are:

  • Not eating enough carbohydrate 
  • Delayed or missed meals
  • Too much insulin
  • More exercise or activity than usual
  • Alcohol 

Signs and symptoms of a hypo can include: pale, headache, shaky, sweaty, dizzy, drowsy, changes in behaviour, hunger, decreased concentration, crying, irritability, agitation, quietness or tantrums (in the younger child), confusion, blurred vision, slurred speech.

If you notice any of these symptoms in your child, or if you are concerned about your child's behaviour for any reason it is important to check their blood sugar levels. Check out the Starship website for details of treating hypos. 

Treatment

Foods for the treatment of hypoglycaemia must always be carried by the family or child with diabetes so they are readily available in the case of a hypo. Children who are having a hypo must be supervised until completely recovered and must never be left alone.

Step One

If the blood sugar drops below 4mmol/l, 10-15gm of a fast acting carbohydrate should be given.

There are many options for fast acting carbohydrate that are suitable to treat a hypo:125ml pre packed juice drinks,  4-5 'dextro' glucose tablets, 3-5 mentos, 2-3 teaspoons honey, 00-150mls soft drink

Note: chocolate should not be used to treat hypoglycaemia as this contains too much fat which slows the absorption of the sugar into the blood stream.

 Step Two

  • After treating with fast acting carbohydrate your child should sit quietly for 10-15 minutes. Hands should then be re-washed and blood sugar checked again.
  • If the blood sugar is still below 4mmol/l repeat treatment with fast acting carbohydrate and sit quietly for 10-15 minutes before re-checking blood sugar level  
  • If after two treatments of fast acting carbohydrate your child's levels remain below 4mmol/L please ring the diabetes doctor for advice

 Step Three

Once the blood sugar is above 4mmol/l a longer acting carbohydrate snack (equivalent to 15grams carbohydrate) must be eaten. There are many options for longer acting carbohydrates. Some of these are listed below:
A piece of fruit, 
1-2 large crackers or 6 smaller crackers or Fruit bar or plain muesli bar

 Please note that if it is a meal time the meal is used as the longer acting carbohydrate part of the treatment.

 Preventing Night Hypoglycaemia

 This can occur on days when you child has been more active or done more exercise than usual, if they have not eaten as much food as they normally would throughout the day or if your child is unwell.   Prevention of night time hypoglycaemia is important as if left untreated this could lead to a severe hypo.   

The following recommendations will help to prevent hypoglycaemia at night:   

  • Checking the blood sugar level before bedtime aiming for a level between 6-10mmol/L. If the blood sugar level is less than 6mmol/L at this time, it is recommended that 10-15grams longer acting carbohydrate is consumed
  • Some children require a reduction to evening doses of insulin following sport or exercise to prevent overnight hypoglycaemia - this can be discussed with your diabetes nurse or doctor
  • Alcohol intake increases the risk of overnight hypoglycaemia

 Some children in their "honeymoon phase" following diagnosis of diabetes may have lower sugar levels overnight in the range of 3.5-4mmol/L which is not defined as hypoglycaemia. Please talk to your diabetes team about this.

Hypoglycaemia Unawareness

 Hypoglycaemia unawareness is where the blood sugar level is less than 4 but the person with diabetes is unaware that the level is low.  Toddlers and younger children may take some time before they develop the skills to be able to recognise and describe their hypo symptoms and detection of low levels relies on those adults caring for them. To support your child in learning how to describe their hypos, encourage your child to talk about how hypos feel soon after they have experienced a hypo.

In older children, hypoglycaemia unawareness can develop after a period where low levels are happening frequently or undetected overnight, and the body resets the level at which hypoglycaemia symptoms occur. This can be dangerous. If your child is having blood sugar levels below 4mmol/L with no symptoms please contact your diabetes team for advice.

It is important that all people with diabetes regardless of age wear an identification bracelet indicating that they have diabetes.

What to do when your child is sick

Children and young people with diabetes generally don't get sick more often than other children if their diabetes is well managed. However, illness can have a significant impact on diabetes. The stress hormones produced during illness can cause changes to blood glucose levels. Levels can go high or low depending on the type of illness. Infections that cause fever and pain often cause high blood glucose levels. Gastroenteritis (vomiting and diarrhoea) can cause low blood glucose levels. Vomiting can also be a sign of not enough insulin.

If your child is sick:

  • Always give insulin, but call the diabetes doctor for advice on changes to the usual amount
  • Take your child to your GP for assessment and treatment of the underlying illness
  • Test blood glucose levels 2 hourly
  • Check blood or urine ketones 2 hourly
  • Encourage your child to drink plenty of fluids
  • If your child is unable to eat:
  • If blood glucose levels are under 10, give fluids with sugar (such as diluted juice, jelly or ice-blocks - not sugar-free)  
  • If blood glucose levels are 10 or higher, give water or sugar-free fluids
  • If your child has been vomiting or has diarrhoea, Pedialyte™ may be recommended by the diabetes doctor or your GP (this can be purchased from the pharmacy)
  • Relieve the symptoms of pain and fever with Paracetamol or Ibuprofen
  • Even teenagers who usually manage their diabetes independently need to be looked after when they are sick
Check out advice from Starship on how to manage sick days

Exercise and Diabetes

Keeping active is an important part of a healthy lifestyle for all children, including children and young people with diabetes. After a new diagnosis of diabetes, children are able to return to usual sports and activities once blood glucose levels have stabilised and families have learnt about managing diabetes and sports and other physical activities. Check out this information from Starship about managing exercise in diabetes

I'm still me, I'm not my diabetes!

Children & young people with diabetes require 'useful' support from friends and family, not the kind that causes them to feel 'different' or 'suffocated', but the kind that allows them to live life to the full. Here are our top tips:

  • Ask how you might be helpful 
  • There may be lots of little things that a child/young person might 'want' however, what they really 'need' may be very different. Please ask first    
  • Be aware that your help might be needed at any stage, not just following diagnosis. Be ready to help at any time 
  • Be supportive of any efforts for self-care, the need to test and inject is unlikely to ever go away. The quicker the child/young person can look after their own diabetes, with supervision as needed, the better
  • Have fun with them, but be patient if they need to stop activities to test their blood glucose/inject
  • Try not to look horrified watching blood sugars testing or injection giving 
  • Encourage testing and insulin injections, let the person know that it is OK to test in front of you as you understand they need to take control of their diabetes
  • Don't presume what food is OK and what is not, ask. You may be surprised
  • Don't presume the child/young person can't do sleep overs or camps just because they have diabetes; children/young people with diabetes are a pretty resilient group of people and learn quickly how to manage lots of different situations.

Please know that sometimes diabetes can be hard work, it can be a 'full-time job' that the person did not apply for, didn’t want and can’t quit.' It involves thinking about what, when, why and how much a person eats/drinks; whilst factoring in exercise levels, stress/hormone levels, blood sugar levels and so much more, each and every day. 

Trials to Study Preventing T1

TrialNet is a network of 21 clinical centres working in cooperation with screening sites throughout the United States, Canada, Finland, United Kingdom, Italy, Germany, Australia, and New Zealand. This network is dedicated to the study, prevention, and early treatment of type 1 diabetes. You can find information on a number of studies being run by visiting the TrialNet website

Contact details for the New Zealand study centres are:   Auckland 64 9 923 7897, Christchurch 64 3 3640 448 or 64 3 3640 860, Dunedin 64 3 474 7644 or 64 3 474 0999, Wellington 64 4 806 2458

Food and children/youth with Type One Diabetes

 


School and Diabetes

The NZ Child and Youth Clinical Network, a collection of Doctors, Diabetes Nurse Specialists and others have put together some information to help you and your family work out the best way to manage your diabetes at school and kindergarten.  Information is also available to assist when planning for camps and looking for work. 

The Independent Diabetes Trust (IDDT), UK, an organisation for people living with diabetes run by people living with diabetes. has recently published "Diabetes - What schools need to know" and "Parents Passport for Schools. ' These documents give parents ideas of the kind of information that is needed to ensure school staff are able to meet the needs of child/youth with type one diabetes.  To ensure a New Zealand context however,  these document should read alongside those from the NZ National Child and Youth Clinical Diabetes Network, who, in consultation and collaboration with consumer representatives, have undertaken significant work looking at available school diabetes health resources across New Zealand, identifying educational gaps and determining specific resources required to support the safe care of children and youth with diabetes in schools.


Diabetes action and management plans - provide a formal guide for the consistent care and management of children and young people with diabetes in schools and early childcare organisations.

Diabetes action and management plans for kindergarten or early childhood settings:
 1. 2017 New Zealand Diabetes Management Plan (Twice daily injections)
2. 2017 New Zealand Diabetes Action Plan (Twice daily injections)

3. 2017 New Zealand Diabetes Management Plan (Multiple daily injections)
4. 2017 New Zealand Diabetes Action Plan (Multiple daily injections)
5. 2017 New Zealand Diabetes Management Plan (Insulin pump)
6
. 2017 New Zealand Diabetes Action Plan (Insulin pump)

Diabetes action and management plans for primary and secondary schools:
1. 2017 New Zealand Diabetes Management Plan (Twice daily injections)
2. 2017 New Zealand Diabetes Action Plan (Twice daily injections)3. 2017 New Zealand Diabetes Management Plan (Multiple daily injections)4. 2017 New Zealand Diabetes Action Plan (Multiple daily injections) 

5.  2017 New Zealand Diabetes Management Plan (Insulin pump)6. 2017 New Zealand Diabetes Action Plan (Insulin pump)

The Management Plans are a collaboration between Diabetes Victoria, The Royal Children's Hospital and Monash Children's Hospital, Melbourne, Australia. They have been adapted in consultation with the Paediatric Society of New Zealand and the National Clinical Diabetes Network for use in New Zealand. They are based on current best practice evidence for diabetes care for young people with type 1 diabetes (ISPAD 2014, APEG 2011).Questions or comments about the plans are welcome and should be directed to Rosalie Hornung, nursing workstream leader, at rosalieh@adhb.govt.nz 

Exams and Diabetes

Click here for 'special assessment condition' applications for students with diabetes which allow children and youth with both type one and type two diabetes to be fairly assessed 
and have access to assessment for National Qualifications.  Find out how to prepare for exams.

For parent and caregiver guidelines visit:  http://www.nzqa.govt.nz/providers-partners/assessment-and-moderation/managing-national-assessment-in-schools/special-assessment-conditions/  For guidelines on Exams and diabetes click here

Parent Education Program 2017

The Starship Diabetes Nurse Specialist team is delighted to announce the electronic release of a complete online education programme designed to cover all essential aspects of paediatric diabetes care via the Starship website.

Carbohydrate Counting in type one diabetes 

Check out the Starship Resource here to help you with carb counting