3 year old with type 1 diabetes?

Question

He's my godson...I'm looking for tips to give to his mom to make his injections a little bit less stressful for him (and her).

He was diagnosed 1 week ago.

Thanks!

Answer 1

Diabetes Overview

Diabetes is a set of related diseases in which the body cannot regulate the amount of sugar (glucose) in the blood.

Glucose in the blood gives you energy—the kind you need when you walk briskly, run for a bus, ride your bike, take an aerobics class, and perform your day-to-day chores.

* Glucose in the blood is produced by the liver from the foods you eat.

* In a healthy person, the blood glucose level is regulated by several hormones, one of which is insulin. Insulin is produced by the pancreas, a small organ near the stomach that also secretes important enzymes that help in the digestion of food.

* Insulin allows glucose to move from the blood into liver, muscle, and fat cells, where it is used for fuel.

* People with diabetes either do not produce enough insulin (type 1 diabetes) or cannot use insulin properly (type 2 diabetes), or both.

* In diabetes, glucose in the blood cannot move into cells, and it stays in the blood. This not only harms the cells that need the glucose for fuel, but also harms certain organs and tissues exposed to the high glucose levels.

Type 1 diabetes: The body stops producing insulin or produces too little insulin to regulate blood glucose level.

* Type 1 diabetes comprises about 10% of total cases of diabetes in the United States.

* Type 1 diabetes is typically recognized in childhood or adolescence. It used to be known as juvenile-onset diabetes or insulin-dependent diabetes mellitus.

* Type 1 diabetes can occur in an older individual due to destruction of pancreas by alcohol, disease, or removal by surgery or progressive failure of pancreatic beta cells, which produce insulin.

* People with type 1 diabetes generally require daily insulin treatment to sustain life.

Type 2 diabetes: The pancreas secretes insulin, but the body is partially or completely unable to use the insulin. This is sometimes referred to as insulin resistance. The body tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they do not continue to secrete enough insulin to cope with the higher demands.

* At least 90% of patients with diabetes have type 2 diabetes.

* Type 2 diabetes is typically recognized in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non–insulin-dependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes need to use insulin.

* Type 2 diabetes is usually controlled with diet, weight loss, exercise, and oral medications. More than half of all people with type 2 diabetes require insulin to control their blood sugar levels at some point in the course of their illness.

Gestational diabetes is a form of diabetes that occurs during the second half of pregnancy.

* Although gestational diabetes typically goes away after delivery, women who have gestational diabetes are more likely than other women to develop type 2 diabetes later in life.

* Women with gestational diabetes are more likely to have large babies.

Metabolic syndrome (syndrome X) is a set of abnormalities in which insulin-resistant diabetes (type 2) is almost always present and includes hypertension, hyperlipidemia (increased serum lipids, predominant elevation of LDL, decrease in HDL, and elevated triglycerides), central obesity, and abnormalities in blood clotting and inflammatory responses. A high rate of cardiovascular disease is associated with the metabolic syndrome.

Prediabetes is a common condition related to diabetes. In people with prediabetes, the blood sugar level is higher than normal but not high enough to be considered diabetes.

* Prediabetes increases your risk of getting type 2 diabetes and of having heart disease or a stroke.

* Prediabetes can be reversed without insulin or medication by losing a modest amount of weight and increasing your physical activity. This can prevent, or at least delay, onset of type 2 diabetes.

* An international expert committee of the American Diabetes Association recently redefined the criteria for prediabetes, lowering the blood sugar level cut-off point for prediabetes. Approximately 20% more adults are now believed to have this condition and may develop diabetes within 10 years if they do not exercise or maintain a healthy weight.

About 17 million Americans (6.2%) are believed to have diabetes. About one third of those do not know they have it.

* About 1 million new cases occur each year, and diabetes is the direct or indirect cause of at least 200,000 deaths each year.

* The incidence of diabetes is increasing rapidly. This increase is due to many factors, but the most significant are the increasing incidence of obesity and the prevalence of sedentary lifestyles.

Complications of diabetes

Both forms of diabetes ultimately lead to high blood sugar levels, a condition called hyperglycemia. Over a long period of time, hyperglycemia damages the retina of the eye, the kidneys, the nerves, and the blood vessels.

* Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness.

* Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of kidney failure.

* Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot wounds and ulcers, which frequently lead to foot and leg amputations.

* Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis), chronic diarrhea, and an inability to control heart rate and blood pressure with posture changes.

* Diabetes accelerates atherosclerosis, or the formation of fatty plaques inside the arteries, which can lead to blockages or a clot (thrombus), which can then lead to heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease).

* Diabetes predisposes people to high blood pressure and high cholesterol and triglyceride levels. These independently and together with hyperglycemia increase the risk of heart disease, kidney disease, and other blood vessel complications.

In the short run, diabetes can contribute to a number of acute (short-lived) medical problems.

* Many infections are associated with diabetes, and infections are frequently more dangerous in someone with diabetes because the body's normal ability to fight infections is impaired. To compound the problem, infections may worsen glucose control, which further delays recovery from infection.

* Hypoglycemia, or low blood sugar, occurs from time to time in most people with diabetes. It results from taking too much diabetes medication or insulin (sometimes called insulin reaction), missing a meal, doing more exercise than usual, drinking too much alcohol, or taking certain medications for other conditions. It is very important to recognize hypoglycemia and be prepared to treat it at all times. Headache, feeling dizzy, poor concentration, tremors of hands, and sweating are common symptoms of hypoglycemia. You can faint or have a seizure if blood sugar level gets too low.

* Diabetic ketoacidosis is a serious condition in which uncontrolled hyperglycemia (usually due to complete lack of insulin or a relative deficiency of insulin) over time creates a buildup in the blood of acidic waste products called ketones. High levels of ketones can be very harmful. This typically happens to people with type 1 diabetes who do not have good blood glucose control. Diabetic ketoacidosis can be precipitated by infection, stress, trauma, missing medications like insulin, or medical emergencies like stroke and heart attack.

* Hyperosmolar hyperglycemic nonketotic syndrome is a serious condition in which the blood sugar level gets very high. The body tries to get rid of the excess blood sugar by eliminating it in the urine. This increases the amount of urine significantly and often leads to dehydration so severe that it can cause seizures, coma, even death. This syndrome typically occurs in people with type 2 diabetes who are not controlling their blood sugar levels or have become dehydrated or have stress, injury, stroke, or medications like steroids.

Diabetes Causes

Type 1 diabetes is believed to be an autoimmune disease. The body's immune system attacks the cells in the pancreas that produce insulin.

* A predisposition to develop type 1 diabetes may run in families but much less so than for type 2.

* Environmental factors, such as certain types of viral infections, may also contribute.

* Type 1 diabetes is most common in people of non-Hispanic white persons of Northern European descent, followed by African Americans and Hispanic Americans. It is relatively rare in those of Asian descent.

* Type 1 diabetes is slightly more common in men than in women.

Type 2 diabetes: Type 2 diabetes is believed to have a strong genetic link, meaning that it tends to run in families. Several genes are being studied that may be related to the cause of type 2 diabetes. Risk factors for developing type 2 diabetes include the following:

* High blood pressure

* High blood triglyceride (fat) levels

* Gestational diabetes or giving birth to a baby weighing more than 9 pounds

* High-fat diet

* High alcohol intake

* Sedentary lifestyle

* Obesity or being overweight

* Ethnicity: Certain groups, such as African Americans, Native Americans, Hispanic Americans, and Japanese Americans, have a greater risk of developing type 2 diabetes than non-Hispanic whites.

* Aging: Increasing age is a significant risk factor for type 2 diabetes. Risk begins to rise significantly at about age 45 years, and rises considerably after age 65 years.

Diabetes Symptoms

Symptoms of type 1 diabetes are often dramatic and come on very suddenly.

* Type 1 diabetes is usually recognized in childhood or early adolescence, often in association with an illness (such as a virus) or injury.

* The extra stress can cause diabetic ketoacidosis.

* Symptoms of ketoacidosis include nausea and vomiting. Dehydration and often-serious disturbances in blood levels of potassium follow.

* Without treatment, ketoacidosis can lead to coma and death.

Symptoms of type 2 diabetes are often subtle and may be attributed to aging or obesity.

* A person may have type 2 diabetes for many years without knowing it.

* People with type 2 diabetes can develop hyperglycemic hyperosmolar nonketotic syndrome.

* Type 2 diabetes can be precipitated by steroids and stress.

* If not properly treated, type 2 diabetes can lead to complications like blindness, kidney failure, heart disease, and nerve damage.

Common symptoms of both major types of diabetes

* Fatigue: In diabetes, the body is inefficient and sometimes unable to use glucose for fuel. The body switches over to metabolizing fat, partially or completely, as a fuel source. This process requires the body to use more energy. The end result is feeling fatigued or constantly tired.

* Unexplained weight loss: People with diabetes are unable to process many of the calories in the foods they eat. Thus, they may lose weight even though they eat an apparently appropriate or even excessive amount of food. Losing sugar and water in the urine and the accompanying dehydration also contributes to weight loss.

* Excessive thirst (polydipsia): A person with diabetes develops high blood sugar levels. The body tries to counteract this by sending a signal to the brain to dilute the blood, which translates into thirst. The body encourages more water consumption to dilute the high blood sugar back to normal levels and to compensate for the water lost by excessive urination.

* Excessive urination (polyuria): Another way the body tries to get rid of the extra sugar in the blood is to excrete it in the urine. This can also lead to dehydration because excreting the sugar carries a large amount of water out of the body along with it.

* Excessive eating (polyphagia): If the body is able, it will secrete more insulin in order to try to deal with the excessive blood sugar levels. Also the body is resistant to the action of insulin in type 2 diabetes. One of the functions of insulin is to stimulate hunger. Therefore, higher insulin levels lead to increased hunger and eating. Despite increased caloric intake, the person may gain very little weight and may even lose weight.

* Poor wound healing: High blood sugar levels prevent white blood cells, which are important in defending the body against bacteria and also in cleaning up dead tissue and cells, from functioning normally. When these cells do not function properly, wounds take much longer to heal and become infected more frequently. Also, long-standing diabetes is associated with thickening of blood vessels, which prevents good circulation and our body tissues from getting enough oxygen and other nutrients.

* Infections: Certain infection syndromes, such as frequent yeast infections of the genitals, skin infections, and frequent urinary tract infections, may result from suppression of the immune system by diabetes and by the presence of glucose in the tissues, which allows bacteria to grow well. They can also be an indicator of poor blood sugar control in a person known to have diabetes.

* Altered mental status: Agitation, unexplained irritability, inattention, extreme lethargy, or confusion can all be signs of very high blood sugar, ketoacidosis, or hyperosmolar hyperglycemia nonketotic syndrome or hypoglycemia (low sugar). Thus, any of these merit the immediate attention of a medical professional. Call your health care provider or 911.

* Blurry vision: Blurry vision is not specific for diabetes but is frequently present with high blood sugar levels.

When to Seek Medical Care

If you are not known to have diabetes but are having any symptoms that suggest diabetes or concern you in any way, make an appointment to see your health care provider as soon as possible. When you make the appointment, tell the operator that you are concerned about diabetes. He or she may make arrangements for blood sugar testing before your appointment.

If you are known to have diabetes, call your health care provider right away if any of the following apply:

* You are experiencing diabetes symptoms. This may mean that your blood sugar level is not being controlled despite treatment.

* Your blood sugar levels, when you test them, are consistently high (more than 200 mg/dL). Persistently high blood sugar levels are the root cause of all of the complications of diabetes.

* Your blood sugar level is often low (less than 60 mg/dL). This may mean that your management strategy is too aggressive. It also may be a sign of infection or other stress on your system such as kidney failure, liver failure, adrenal gland failure, or the concomitant use of certain medications.

* You have an injury to your foot or leg, no matter how minor. Even the tiniest cut or blister can become very serious in a person with diabetes. Early diagnosis and treatment of problems with the feet and lower extremities, along with regular diabetic foot care, are critical in preserving the function of your legs and preventing amputation.

* You have a low-grade fever (less than 101.5°F). Fever is a sign of infection. If you have diabetes, many common infections can potentially be more dangerous for you than for other people. Note any symptoms, such as painful urination, redness or swelling of the skin, abdominal pain, chest pain, or cough, that may indicate where your infection is located.

* You are nauseated or vomiting but can keep liquids down. Your health care provider may adjust your medications while you are sick and will probably recommend an urgent office visit or a visit to the emergency department. Persistent nausea and vomiting can be a sign of diabetic ketoacidosis, a potentially life-threatening condition, as well as several other serious illnesses.

* You have a small sore (ulcer) on your foot or leg. Any nonhealing sore or ulcer on the feet or legs of someone with diabetes needs to be seen by a medical professional right away. A sore less than 1 inch across, not draining pus, and not exposing deep tissue or bone can safely be evaluated in your health care provider's office as long as you do not have fever and your blood sugar levels are in control.

When you call your health care provider, tell the operator that you have diabetes and are concerned.

* You will probably be referred to a nurse who will ask questions and make a recommendation about what to do.

* Be prepared for this conversation. Have a list of your medications, medical problems, allergies to medicines, and your blood sugar diary handy by the phone.

* The nurse may need any or all of this information to decide both the urgency of your condition and how best to recommend treatment for your problem.

Diabetic emergencies

The following situations can become 911 medical emergencies and warrant an immediate visit to a hospital emergency department.

* The person with a severe diabetic complication may travel to the emergency department by car or ambulance.

* A companion should go along to speak for the person if the person is not able to speak for himself or herself with the emergency care provider.

* Bring a list of medical problems, medications, allergies to medications, and the blood sugar diary to the emergency department. This information will help the emergency care provider diagnose the problem and treat it appropriately.

The following are signs and symptoms of diabetic complications that warrant emergency care.

* Altered mental status: Lethargy, agitation, forgetfulness, or just strange behavior can be a sign of very low or very high blood sugar levels.

o If the person is a known diabetic, try giving him or her some fruit juice (about 6 ounces) if the person is awake enough to swallow normally without choking. Avoid giving things such as hard candy that can lodge in the throat. Your health care provider can prescribe glucose wafers that melt under the tongue.

o If the person does not wake up and behave normally within about 15 minutes, call 911.

o If the person is not a known diabetic, these symptoms can be signs of stroke, drug intoxication, alcohol intoxication, oxygen starvation, and other serious medical conditions. Call 911 immediately.

* Nausea or vomiting: If you are known to have diabetes and cannot keep food, medications, or fluids down at all, you may have diabetic ketoacidosis, hyperosmolar hyperglycemic nonketotic syndrome, or another complication of diabetes.

o If you have not already taken the latest insulin dose or oral diabetes medicine, do not take it without talking to a medical professional.

o If you already have low blood sugar levels, taking additional insulin or medication will drive your blood sugar level down even further, possibly to dangerous levels.

* Fever of more than 101.5°F: If your primary health care provider cannot see you right away, you should seek emergency care for a high fever if you are diabetic. Note any other symptoms such as cough, painful urination, and abdominal pain or chest pain.

* High blood sugar level: Your blood sugar level is more than 400 mg/dL, and your primary care provider cannot see you right away. Very high blood sugar levels can be a sign of diabetic ketoacidosis or hyperosmolar hyperglycemic nonketotic syndrome, depending on the type of diabetes you have. Both of these conditions can be fatal if not treated promptly.

* Large sores or ulcers on the feet or legs: If you have diabetes, a nonhealing sore larger than 1 inch in diameter can be a sign of a potentially limb-threatening infection.

o Other signs and symptoms that merit immediate care are exposed bone or deep tissue in the wound, large areas of surrounding redness and warmth, swelling, and severe pain in the foot or leg.

o If left untreated, such a sore may ultimately require amputation of the limb.

* Cuts or lacerations: Any cut penetrating all the layers of skin, especially on the legs, is a potential danger to a person with diabetes. Proper wound care, although important to anyone’s recovery, is especially important in diabetes to assure good wound healing.

* Chest pain: If you are diabetic, take very seriously any pain in your chest, particularly in the middle or on the left side, and seek medical attention immediately.

o People with diabetes are more likely than nondiabetic people to have a heart attack, with or without experiencing chest pain.

o Irregular heartbeats and unexplained shortness of breath may also be signs of heart attack.

* Severe abdominal pain: Depending on the location, this can be a sign of heart attack, abdominal aortic aneurysm (widening of the large artery in the abdomen), diabetic ketoacidosis, or interrupted blood flow to the bowels.

o All of these are more common in people with diabetes than in the general population and are potentially life threatening.

o Diabetics also get other common causes of severe abdominal pain such as appendicitis, perforated ulcer, inflammation and infection of the gallbladder, kidney stones, and bowel obstruction.

o Severe pain anywhere in the body is a signal for timely medical attention.

Exams and Tests

Doctors use special tests in diagnosing diabetes and also in monitoring blood sugar level control in known diabetics.

If you are having symptoms but are not known to have diabetes, your evaluation should always begin with a thorough medical interview and physical examination. Your health care provider asks you about your symptoms, risk factors for diabetes, past medical problems, medications you are taking, allergies to medications, family history of diabetes or other medical problems such as high cholesterol or heart disease, and habits and lifestyle.

A number of lab tests are available to confirm the diagnosis of diabetes.

Fingerstick blood glucose: This is a rapid screening test that may be performed at a medical office or at a hospital emergency department.

* A fingerstick blood glucose test is not as accurate as testing your blood in the laboratory but is easy to perform, and the result is available right away.

* The test involves sticking your finger for a blood sample, which is then placed on a strip. The strip goes into a machine that reads the blood sugar level. These machines are only accurate to within about 10% of actual laboratory values.

* Fingerstick blood glucose values may be inaccurate at very high or very low levels, so this test is only a preliminary screening study. This is the way most diabetics monitor their blood sugar levels at home.

Fasting plasma glucose: You will be asked to eat or drink nothing for 8 hours before having your blood drawn (usually first thing in the morning). If the blood glucose level is greater than or equal to 126 mg/dL without eating anything, you probably have diabetes.

* If the result is abnormal, the fasting plasma glucose test may be repeated on a different day to confirm the result, or you may undergo an oral glucose tolerance test or a glycosylated hemoglobin test (often nicknamed "hemoglobin A1c") as a confirmatory test.

* If your fasting plasma glucose level is greater than 100 but less than 126 mg/dL, then you have what is called impaired fasting glucose or IFG. This is a prediabetes condition. You do not have diabetes, but you are at high risk of developing diabetes in the near future.

Oral glucose tolerance test: This test involves drawing blood for a fasting plasma glucose test and then drawing blood for a second test 2 hours after you drink a very sweet drink containing 75 grams of sugar.

* If the blood sugar level after the sugar drink is greater than or equal to 200 mg/dL, you are probably diabetic.

* If the blood glucose level is between 140 and 199, then you probably have impaired glucose tolerance, which is also a prediabetic condition.

Glycosylated hemoglobin or hemoglobin A1c: This test is a measurement of how high your blood sugar level has been over about the last 120 days—the lifespan of a red blood cell.

* Excess blood glucose hooks on to the hemoglobin in red blood cells and stays there for the life of the red blood cell, which is approximately 90 days.

* The percentage of hemoglobin that has had excess blood sugar attached to it can be measured in the blood. The test involves having a small amount of blood drawn.

* A hemoglobin A1c test is the best measurement of blood sugar control in people known to have diabetes. A hemoglobin A1c result of 7% or less is considered to indicate good glucose control. A result of 8% or greater is considered to indicate that your blood sugar level is too high too much of the time.

* The hemoglobin A1c test is also beginning to be used as a diagnostic test for diabetes. A hemoglobin A1c result greater than 6.1% is highly suggestive of diabetes. Generally, a confirmatory test would be needed before diagnosing diabetes.

* The hemoglobin A1c test is generally measured about every 3-6 months for people with known diabetes, although it may be done more frequently for people who are having difficulty achieving and maintaining good blood sugar control.

* This test is not used for people who do not have diabetes or are not at increased risk of diabetes.

* Normal values may vary from lab to lab, although an effort is under way to standardize how measurements are performed.

Diagnosing complications of diabetes

If you have diabetes, you should be checked regularly for early signs of diabetes complications. Your health care provider can do some of these checks; for others, you should be referred to a specialist.

* You should have your eyes checked at least once a year by an eye specialist (ophthalmologist) to screen for diabetic retinopathy, a leading cause of blindness.

* Your urine should be checked for protein (microalbumin) on a regular basis, at least 1-2 times per year. Protein in the urine is an early sign of diabetic nephropathy, a leading cause of kidney failure.

* Sensation in your legs should be checked regularly using a tuning fork or a monofilament device. Diabetic neuropathy is a leading cause in diabetic lower extremity ulcers, which frequently lead to amputation of the feet or legs.

* Your health care provider should check your feet and lower legs at every visit for cuts, scrapes, blisters, or other lesions that could become infected.

* You should be screened regularly for conditions that may contribute to heart disease, such as high blood pressure and high cholesterol.

Diabetes Treatment

Self-Care at Home

If you have diabetes, you would be wise to make healthful lifestyle choices in diet, exercise, and other health habits. These will help to improve glycemic (blood sugar) control and prevent or minimize complications of diabetes.

Diet: A healthy diet is key to controlling blood sugar levels and preventing diabetes complications.

* If you are obese and have had difficulty losing weight on your own, talk to your health care provider. He or she can recommend a dietitian or a weight modification program to help you reach your goal.

* Eat a consistent, well-balanced diet that is high in fiber, low in saturated fat, and low in concentrated sweets.

* A consistent diet that includes roughly the same number of calories at about the same times of day helps your health care provider prescribe the correct dose of medication or insulin.

* It will also help to keep your blood sugar at a relatively even level and avoid excessively low or high blood sugar levels, which can be dangerous and even life threatening.

Exercise: Regular exercise, in any form, can help reduce the risk of developing diabetes. Activity can also reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure, blindness, and leg ulcers.

* As little as 20 minutes of walking 3 times a week has a proven beneficial effect. Any exercise is beneficial; no matter how light or how long, some exercise is better than no exercise.

* If you have complications of diabetes (eye, kidney, or nerve problems), you may be limited both in type of exercise and amount of exercise you can safely do without worsening your condition. Consult with your health care provider before starting any exercise program.

Alcohol use: Moderate or eliminate your consumption of alcohol. Try to have no more than 7 alcoholic drinks in a week and never more than 2-3 in an evening. One drink is considered 1.5 ounces of liquor, 6 ounces of wine, or 12 ounces of beer. Excessive alcohol use is a known risk factor for type 2 diabetes. Alcohol consumption can cause low or high blood sugar levels, nerve pain called neuritis, and increase in triglycerides, which is a type of fat in our blood.

Smoking: If you have diabetes, and you smoke cigarettes or use any other form of tobacco, you are raising your risks markedly for nearly all of the complications of diabetes. Smoking damages blood vessels and contributes to heart disease, stroke, and poor circulation in the limbs. If you need help quitting, talk to your health care provider.

Self-monitored blood glucose: Check your blood sugar levels frequently, at least before meals and at bedtime, and record the results in a logbook.

* This log should also include your insulin or oral medication doses and times, when and what you ate, when and for how long you exercised, and any significant events of the day such as high or low blood sugar levels and how you treated the problem.

* Better equipment now available makes testing your blood sugar levels less painful and less complicated than ever. Your daily blood sugar diary is invaluable to your health care provider in seeing how you are responding to medications, diet, and exercise in the treatment of your diabetes.

* Medicare now pays for diabetic testing supplies, as do many private insurers and Medicaid.

Medical Treatment

The treatment of diabetes is highly individualized, depending on the type of diabetes, whether you have other active medical problems, whether you have complications of diabetes, and your age and general health at time of diagnosis.

* Your health care provider will set goals for lifestyle changes, blood sugar control, and treatment.

* Together, you will devise a plan to help you meet those goals.

Education about diabetes and its treatment is essential in all types of diabetes.

* When you are first diagnosed with diabetes, your diabetes care team will spend a lot of time with you, teaching you about your condition, your treatment, and everything you need to know to care for yourself on a daily basis.

* Your diabetes care team includes your health care provider and his or her staff. It may include specialists in foot care, neurology, kidney diseases, and eye diseases. A professional dietitian and a diabetes educator also may be part of the team.

Your care team will see you at appropriate intervals to monitor your progress with your goals.

Type 1 diabetes

Treatment of diabetes almost always involves the daily injection of insulin, usually a combination of short-acting insulin such as regular or Lispro or Aspart insulin and a longer acting insulin such as NPH, lente, glargine, detemir, or ultralente insulins.

* Insulin must be given as an injection. If taken by mouth, insulin would be destroyed in the stomach before it could get into the blood where it is needed.

* Most people with type 1 diabetes give these injections to themselves. Even if someone else usually gives you your injections, it is important that you know how to do it in case the other person is not available.

* A trained professional will show you how to store and inject the insulin. Usually this is a nurse who works with the health care provider or a diabetes educator.

* Insulin is usually given in 2 or 3 injections per day, generally around mealtimes. Dosage is individual and is tailored by the health care provider. Longer acting insulins are typically administered 1 or 2 times per day.

* Some people have their insulin administered by continuous infusion pumps to provide adequate blood glucose control. Supplemental mealtime insulin is programed into the pump by the individual as recommended by his or her health care provider.
* It is very important to eat if you have taken insulin, as the insulin will lower your blood sugar regardless of whether you have eaten. If you take insulin without eating, you could have hypoglycemia. This is called an insulin reaction.

* There is an adjustment period while you learn how insulin affects you and how to time your mealtimes and exercise times with your insulin injections to keep your blood sugar level as even as possible.

* Keeping accurate records of your blood sugar levels and insulin dosages is crucial in helping your health care provider take care of your diabetes.

* Eating a consistent, healthy diet appropriate for your size and weight is essential in controlling your blood sugar level.

Type 2 diabetes

Depending on how elevated your blood sugar and glycosylated hemoglobin are at the time of your diagnosis, you may be given a chance to lower your blood sugar level without medication.

* The best way to do this is to lose weight if you are obese and begin an exercise program.

* This will generally be tried for 3-6 months, and then your blood sugar and glycosylated hemoglobin will be rechecked. If they remain high, you will be started on an oral medication, usually a sulfonylurea or biguanide (Metformin), to help control your blood sugar level.

* Even if you are on medication, it is still important to eat a healthy diet, lose weight if you are overweight, and engage in moderate physical activity as often as possible.

* Your health care provider will monitor your progress on medication very carefully at first. It is important to get just the right dose of the right medication to get your blood sugar level in the recommended range with the fewest side effects.

* Your doctor may decide to combine two types of medications to get your blood sugar level under control.

* Gradually, even people with type 2 diabetes may require insulin injections to control their blood sugar levels.

* It is becoming more common for people with type 2 diabetes to take a combination of oral medication and insulin injections to control blood sugar levels.

Medications

Many different types of medications are available to help lower blood sugar levels in type 2 diabetes. Each type works in a different way. It is very common to combine 2 or more types to get the best effect with fewest side effects.

* Sulfonylureas: These drugs stimulate your pancreas to make more insulin.

* Biguanides: These agents decrease the amount of glucose produced by your liver.

* Alpha-glucosidase inhibitors: These agents slow absorption of the starches you eat. This slows down glucose production.

* Thiazolidinediones: These agents increase your sensitivity to insulin.

* Meglitinides: These agents stimulated the pancreas to make more insulin.

* D-phenylalanine derivatives: These agents stimulate your pancreas to produce more insulin more quickly.

* Amylin synthetic derivatives: Amylin is a naturally occurring hormone secreted by the pancreas along with insulin. An amylin derivative, such as pramlintide (Symlin), is indicated when blood sugar control is not achieved despite optimal insulin therapy. Pramlintide is administered as a subcutaneous injection along with insulin and helps achieve lower blood sugar levels after meals, helps reduce fluctuation of blood sugar levels throughout the day, and improves hemoglobin A1C levels.

* Incretin mimetics: Incretin mimetics promote insulin secretion by the pancreas and mimic other blood sugar level lowering actions that naturally occur in the body. Exenatide (Byetta) is the first incretin mimetic agent approved in the United States. It is indicated for diabetes mellitus type 2 in addition to metformin or a sulfonylurea when these agents have not attained blood sugar level control alone.

* Insulins: Human insulin is the only type of insulin available in the United States; it is less likely to cause allergic reactions than animal-derived varieties of insulin. The type of insulin chosen to customize treatment for an individual is based on the goal of providing optimal blood sugar control. Different types of insulin are available and categorized according to their times of action onset and duration. Commercially prepared mixtures of some insulins may also be used to provide constant (basal) control and immediate control.

o Rapid-acting insulins

+ Regular insulin (Humulin R, Novolin R)

+ Insulin lispro (Humalog)

+ Insulin aspart (Novolog)

+ Insulin glulisine (Apidra)

+ Prompt insulin zinc (Semilente, slightly slower acting)

+ Inhaled insulin (Exubera)
o Intermediate-acting insulins

+ Isophane insulin, neutral protamine Hagedorn (NPH) (Humulin N, Novolin N)

+ Insulin zinc (Lente)
o Long-acting insulins

+ Extended insulin zinc insulin (Ultralente)

+ Insulin glargine (Lantus)

+ Insulin detemir (Levemir)

Next Steps

Follow-up

Treatment: Follow your health care provider's treatment recommendations. Keep daily records of your blood sugar levels, the times you checked the levels, when and how much insulin or medication you took, when and what you ate, and when and for how long you exercised. Call your health care provider if you have any problems with your treatment or symptoms that suggest poor glucose control.

Education: Attend diabetes education classes at your local hospital. The more educated you are about your disease, the better you are likely to do.

Regular visits to your primary care provider: If you are on insulin, you should see your health care provider about every 3 months or more often. For other diabetics, every 3-6 months is generally adequate, unless you are having problems.

Recognize low blood sugar levels and know how to treat them: You and your family should be taught how to recognize the signs and symptoms of low blood sugar levels. You should have a clear plan for treating low blood sugar levels and when to call 911. Mild symptoms include confusion and sweating. These symptoms progress to lethargy, agitation (sometimes with violent, jerking motions), or even seizures.

Prevention

We do not yet know of a way to prevent type 1 diabetes. Type 2 diabetes, however, can be prevented in some cases.

* Control weight to normal or near-normal levels by eating a healthy low-fat, high-fiber diet.

* Regular exercise is crucial to the prevention of type 2 diabetes.

* Keep alcohol consumption low.

* Quit smoking.

* If you have high blood fat levels (such as high cholesterol) or high blood pressure, take your medication as directed.

* Lifestyle modification and/or certain medications can be used in people with prediabetes to prevent progression to diabetes. Prediabetes can be diagnosed by checking fasting glucose and 2 hours after ingesting 75 grams of glucose.

If you already have diabetes, your focus should be on preventing the complications, which can cause serious disabilities such as blindness, kidney failure requiring dialysis, amputation, or even death.

* Tight glucose control: The single best thing you can do is to keep your blood sugar level within the suggested range every day. The only way to do this is through a combination of regular blood sugar checks, a balanced diet low in simple sugars and fat and high in complex carbohydrates and fiber, and appropriate medical treatment. Please consult a nutritionist or check with your doctor about questions that you may have regarding diet.

* Quit smoking

* Maintain a healthy weight

* Increase your physical activity. Aim for moderately vigorous physical activity for at least 30 minutes every day.

* Drink an adequate amount of water and avoid taking too much salt.

* Take care of your skin. Keep it supple and hydrated to avoid sores and cracks that can become severely infected.

* Brush and floss your teeth every day. See your dentist regularly to prevent gum disease.

* Wash and examine your feet every day, looking for small cuts, sores, or blisters that may cause problems later. You should file rather than cut your toenails to avoid damaging the surrounding skin. You may need to see a specialist in foot care (podiatrist) to help you care for your feet.

Outlook

Diabetes is a leading cause of death in all industrialized nations. Overall, the risk of premature death of people with diabetes is twice that of people who do not have diabetes. Prognosis depends on the type of diabetes, degree of blood sugar control, and development of complications.

Type 1 diabetes

About 15% of people with type 1 diabetes die before age 40 years, which is about 20 times the rate of that age group in the general population.

* The most common causes of death in type 1 diabetes are diabetic ketoacidosis, kidney failure, and heart disease.

* The good news is that prognosis can be improved with good blood sugar control. Maintaining tight blood sugar control has been proven to prevent, slow the progression of, and even improve established complications of type 1 diabetes.

Type 2 diabetes

The life expectancy of people who are diagnosed with type 2 diabetes in their 40s decreases by 5-10 years because of the disease.

* Heart disease is the leading cause of death for people with type 2 diabetes.

* Excellent glycemic control, tight blood pressure control, and keeping the bad cholesterol level at the recommended level of 100 mg/dL or lower and the good cholesterol as high as possible. Use of aspirin when indicated can prevent, slow the progression of, and improve established complications in diabetes.

Support Groups and Counseling

You may wish to join a support group with other people to share your experiences. The American Diabetes Association and the Juvenile Diabetes Research Foundation are both excellent resources. Your health care provider will have information about local groups in your area. The following groups also provide support:

American Association of Diabetes Educators
100 W Monroe, Suite 400
Chicago, IL 60603
[phone]

American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
(800) DIABETES (342-2383)
[e-mail]

American Dietetic Association
120 South Riverside Plaza, Suite 2000
Chicago, IL 60606-6995
[phone]

Juvenile Diabetes Research Foundation International
120 Wall Street
New York, NY 10005-4001
(800) 533-CURE (2873)
[e-mail]

National Diabetes Education Program
One Diabetes Way
Bethesda, MD 20814-9692
[phone]
[e-mail]

For More Information

Web Links

American Diabetes Association, Diabetes Statistics

National Diabetes Education Program, About Diabetes and Pre-diabetes

National Diabetes Information Clearinghouse, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Treatments for Diabetes

US Food and Drug Administration (FDA), Diabetes Information

Centers for Disease Control and Prevention, Diabetes: Disabling, Deadly, and on the Rise

American Diabetes Association, Nutrition & Recipes

Answer 2

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Answer 3

just noticed an answer from someone else. Juvenile onset diabetes is AN OLD TERM -- very old! Type 1 (or type 2, if that's the diagnosis) is the NEW term. Injections don't have to be a fearful occurrence. Fine gauge needles can make them less painful. Mom (and Dad) should be meeting with a certified diabetes educator for info and tips like this. They may already have, but if not, the sooner the better. Rewards might be helpful but distractions are more practical when you're talking about multiple insulin injections everyday. The stuffed animal tip is good, or having him watch a favorite TV show or video might distract him. He will get more used to the injections pretty quickly. Kids are very adaptable. Also, Godmother, remember to say some prayers for him and the family as they learn to cope with this. Prayers can work miracles.

Answer 4

First, find out if the doctor is defining type 1 diabetes the old way or the new way.

Old definition - patient has a pancreas not producing insulin or not producing enough insulin. Must have insulin administered or death will result.

New definition - juvenile onset diabetes. This could be a type 2 diabetes (insulin resistance), just juvenile onset. If it is a type 2 diabetes, this means the boy's pancreas is producing enough insulin, but the cells are resistant to it, leaving the blood sugar in the blood stream.

If it is an insulin resistance condition, it may be possible to slowly reduce the resistance, thus possibly switching to less intense - and painfully administered - medicine. I assume the doctor has already ruled out oral insulin as a medication.

In later years, if underproduction is the problem, an insulin pump can be implanted, however, that is likely to be when he has reached full growth.

Sorry I cannot be of more help.

Answer 5

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Answer 6

Think positive and give lots of love and hugs and kisses. If your godson is not on a pen, ask for one and use Ultra Fine III needles. My daughter was taking injections for 3 months and is now on a pump. Life was rough until the pump. Minimed through Medtronics is the type we use. It is the size of a small beeper, clips on to wasteband, tiny tube, without a needle stays in to deliver insulin as needed. A 1/4 inch tiny needle pops the site into the skin and then comes out. I wore one around for a day or two and it really was not bad. You can keep it in your tummy, hip, butt - wherever it s most comfortable. My daughter now puts hers in her upper rear end so when swimming her site does not show. The pump comes off when swimming. The exercise when swimming keeps her sugar down while the pump is off. One prick for the new site every 3-4 days. So much easier. Still checking blood 5-6 times a day but life is so much better. Contact your areas Juvenile Diabetes Research Foundation, you can go on line for support. They have been great. Lots of parents in my group have toddlers. My daughter was 10 when diagnosed, this last October.

Educate yourself on carb counting, take nutrition class through a diabetes center. CalorieKing.com lists 1000's of foods and their carbs, restaurant food etc. You can buy pocket books to take with you as well. Work toward the pump - it is a life saver in so many ways.

Think positive and keep living!

Answer 7

Type 2 diabetes, usually referred to as adult onset, is when your body produces insulin but can not use it properly. This type can be treated successfully with the right diet and exercise in most circumstances. If blood sugars are not kept under control at some point insulin will probably be integrated / oral medications are also available.
People with diabetes can live long, happy lives but must be diligent in their care and make sure you see your endocrinologist on a regular basis.

Answer 8

-Use a reward system after every shot
-Never punish him for being fussy about it, this will only make him associate the shot with punishment
-Do something very positive with him right beforehand, so that he realizes the pinch of the shot isn't a negative or meant to be punishing
-Hold and comfort him afterwards
-Give him the shot at the same time, in the same place in the house each day. This way he feels ready (and safer) because he's used to the routine and familiarity.
-Find a kids video about getting shots to let him watch, so it doesn't seem so strange to him. A video for older kids (Kindergarten and up) can be found at http://diabetes.about.com/b/a/192368.htm.
-Consider getting him the Rufus & Rudy Teddy Bears. They are Teddies that "have Type 1 diabetes" and are made to recieve shots, blood sugar checks, have medical alert bracelets, and are very cuddly (they can be ordered at http://www.childrenwithdiabetes.com/d_06_c20.htm). This way he and his bear will get shots and blood sugar tests together and it might be easier for him - especially if he can let the bear go first! :)
-Stories that can be read to him that have characters with Type 1 diabetes can help, and can be found at http://www.childrenwithdiabetes.com/d_06_a00.htm/

Answer 9

My son was diagnosed almost a year ago with type 1. It is hard at first but they will both get through this. On the American Diabetes Association there are message boards, one for the parents of kids with diabetes, it is an amazing source of info! There is atleast one parent who has dealt with it all on there-any questions you or his mom has will get so many answers and it is a great support system. Here is the link for it: http://community.diabetes.org/n/pfx/forum.aspx?nav=messages&webtag=adaparents

Also if there is any questions that I could possibly answer or help with I would be more than willing to do so. My email is [e-mail]. Please email me or check out the message board or have the mother of your godson. The support of someone who has been there is irreplaceable.

God Bless.

Answer 10

Diabetes causes:
Type 1 diabetes is caused by a lack of insulin due to the destruction of insulin-producing beta cells in the pancreas. Type 2 diabetes the most common form of diabetes is caused by a insulin resistance, a condition in which the body’s muscle, fat, and liver cells do not use insulin effectively.

See more : https://biturl.im/treatdiabetes14daysnow

Answer 11

Tell her relax. Give him the injections in his tummy fat. Tickle him before the shot and then after. Don't let him know he is getting the shot.

Also Try the arm, where the older people have flab.

When he gets older have your friend check into an insulin pump. It is the size of a pager and it is able to dose the child without continual shots.

Also have the child give a pretend shot to a teddy bear, that way he can do it too. As the child gets older it will get easier. But 1 week in it is scary. However, it is better than the alternative.