1. Diabetes in Pediatrics Understanding Type I and Type II Diabetes in Children and Adolescents By: Erica Glover

2. Type 1 vs. Type 2 n DM-1 n Insulin dependent n No connection to family history n Auto-immune disease n DM-2 n Not insulin dependent (hopefully) n Family history n Strong relation to obesity and IGT –Insulin resistance –Hyperinsulinemia

3. Goals of Medical Nutrition Therapy n Maintenance of near-normal blood glucose (BG) levels by balancing food intake with insulin and activity levels –Hypoglycemia: multiple events can cause impaired brain development in young children –Intensive BG management NOT recommended under ages of 13 years old

4. Goals of Medical Nutrition Therapy n Achievement of optimal lipid levels –Begins with maintaining normal glucose levels –Children at high risk lipid abnormalities should be screened and monitored n Provision of adequate calories for normal growth and development –Height and weight every 3-6 months –Plot growth on NCHS growth chart

5. Goals of Medical Nutrition Therapy n Prevention, delay, or treatment of nutrition-related risk factors and complications. –The rule of 15 n Improvement of overall health through optimal nutrition.

6. Meal Planning Approaches n Carbohydrate Counting –Specific calorie levels not generally recommended –Usually based on the amount of CHO normally consumed n Exchange List for Meal Planning –Helpful in formulating meal plan for specific nutrition needs –Simply not practical

7. Physical Activity n Generally reduces insulin requirements –Better to consume 15g CHO per hour of activity than to adjust insulin n Decreases insulin resistance in type 2 n Check BG levels!! n May have lipid-lowering effect

8. Insulin Regimens n Conventional n Multiple daily injections n Insulin pump –The child/adolescent must take more responsibility for additional BG testing and CHO counting

9. Initial Nutrition Education n Food components that influence BG levels n Meal timing and consistent CHO intake n Meal plan n Prevention & treatment of hypoglycemia n BG control in illness

10. Secondary Nutrition Education n Monitoring & discussion of growth n Review & modify meal plan n Use of BG monitoring to develop CHO to insulin ratios n Problem-solving/troubleshooting

11. Age-specific: Toddlers n Daily variation in meal patterns n Typically graze with small, frequent meals n Food jags, selective eating n Sporadic activity

12. Age-specific: Toddlers n Schedule adequate regular meals and snacks containing carbohydrate n Suggest to parents alternate sources of CHO if food refusal occurs n Avoid withholding food in hyperglycemia

13. Age-specific: Preschool and School-aged Children n More consistent & predictable appetites n Generally eat same amounts of CHO at same time each day n More meals & snacks away from home –Birthday parties –Overnight parties

14. Age-specific: Preschool and School-aged Children n Involve more in food preparation and meal planning n Morning and afternoon snack encouraged n Instruct parents on management during special occasions n Review meal plan often to ensure meals and snacks correspond to changes in activity.

15. Age-specific: Adolescents n Variable meal schedules –Work –School activities –Social activity n More responsibility for food choices n Inconsistent meal timing, frequency, and amounts of CHO

16. Age-specific: Adolescents n Peer influence in food choices and timing n Mismanagement of meal plan common n Growth spurts and variation of appetite n Sports become central in the lives of some adolescents.

17. Age-specific: Adolescents n Assess involvement of activity on a regular basis n Make suggestions for appropriate snacks & supplements n Screen for insulin omission & eating disorders n Instruct on the potential hypoglycemic effects of alcohol

18. Age-specific: Adolescents n Instruct adolescents who drive on the importance of BG monitoring & carrying a source of CHO with them at all times. n Provide practical knowledge as needed on alternative eating patterns (i.e. vegetarianism)

19. Eating Disorders in Adolescents with DM-1 n Pubertal changes in body shape may cause development of unhealthy eating attitudes. n Dx of DM-1 heightens awareness of dietary restraints, weight gain, and food preoccupation. n Insulin misuse to lose weight

20. Eating Disorders in Adolescents with DM-1 n Pay attention to those who express body dissatisfaction –Lead them toward healthy weight control practices n Screen regarding weight –How concerned are you about your weight? –Do you ever skip meals to lose or maintain weight?

21. Eating Disorders in Adolescents with DM-1 –In the past year have you ever tried to lose weight by vomiting, taking pills, using laxatives, skipping insulin, or modifying your insulin dose? n Include Behavioral Health Counselor and Family

22. Practical Advice to Parents n Parents can have trouble dealing with their child’s new diagnosis. Here are points to help: n 1. Don’t Isolate Yourself –Find support, lean on others –Support groups, family, friends, place of worship

23. Practical Advice to Parents n 2. Ask for Help –Bring a friend or relative to help you take notes when you talk to medical providers. n 3. Don’t Blame yourself –Remind yourself that BG monitoring and insulin shots are now a fact of life –You didn’t give your child diabetes

24. Practical Advice to Parents n 4. Mind your Marriage –Make time for your spouse everyday, putting aside your child’s diabetes n 5. Work with Your Ex –Put aside negative feelings to work together for the sake of your child –Seek counseling if needed. –Don’t play good parent, bad parent to drive a wedge between child and other parent

25. Practical Advice to Parents n 5. Be Consistent –Routines make children feel secure n 6. Educate Yourself –Knowledge may help reduce anxiety n 7. Consider counseling –Sometimes you just need a little help n 8. Take a break from diabetes –Take care of Yourself!

26. Do you have questions for me? n Clarifications? n Cultural/Native American Differences? n More Information?