Diabetes in Pediatrics

Understanding Type I and Type II

Diabetes in Children and Adolescents

By: Erica Glover
Type 1 vs. Type 2
DM-1
Insulin dependent
No connection to
family history
Auto-immune
disease
DM-2
Not insulin dependent
(hopefully)
Family history
Strong relation to
obesity and IGT
Insulin resistance
Hyperinsulinemia
Goals of Medical Nutrition
Therapy
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

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

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

Meal Planning Approaches
Carbohydrate
Counting
Specific calorie
levels not
generally
recommended
Usually based
on the amount of
CHO normally
consumed
Exchange List
for Meal
Planning
Helpful in
formulating
meal plan for
specific
nutrition needs
Simply not
practical
Physical Activity
Generally reduces insulin
requirements
Better to consume 15g CHO per
hour of activity than to adjust
insulin
Decreases insulin resistance in
type 2
Check BG levels!!
May have lipid-lowering effect

Insulin Regimens
Conventional
Multiple daily injections
Insulin pump
The child/adolescent must take
more responsibility for additional
BG testing and CHO counting
Initial Nutrition Education
Food components that influence
BG levels
Meal timing and consistent CHO
intake
Meal plan
Prevention & treatment of
hypoglycemia
BG control in illness
Secondary Nutrition Education
Monitoring & discussion of growth
Review & modify meal plan
Use of BG monitoring to develop
CHO to insulin ratios
Problem-solving/troubleshooting

Age-specific: Toddlers
Daily variation in meal patterns
Typically graze with small, frequent
meals
Food jags, selective eating
Sporadic activity
Age-specific: Toddlers
Schedule adequate regular meals
and snacks containing
carbohydrate
Suggest to parents alternate
sources of CHO if food refusal
occurs
Avoid withholding food in
hyperglycemia
Age-specific: Preschool and
School-aged Children
More consistent & predictable
appetites
Generally eat same amounts of
CHO at same time each day
More meals & snacks away from
home
Birthday parties
Overnight parties

Age-specific: Preschool and
School-aged Children
Involve more in food preparation
and meal planning
Morning and afternoon snack
encouraged
Instruct parents on management
during special occasions
Review meal plan often to ensure
meals and snacks correspond to
changes in activity.
Age-specific: Adolescents
Variable meal schedules
Work
School activities
Social activity
More responsibility for food choices
Inconsistent meal timing,
frequency, and amounts of CHO
Age-specific: Adolescents
Peer influence in food choices and
timing
Mismanagement of meal plan
common
Growth spurts and variation of
appetite
Sports become central in the lives
of some adolescents.
Age-specific: Adolescents
Assess involvement of activity on a
regular basis
Make suggestions for appropriate
snacks & supplements
Screen for insulin omission &
eating disorders
Instruct on the potential
hypoglycemic effects of alcohol

Age-specific: Adolescents
Instruct adolescents who drive on
the importance of BG monitoring &
carrying a source of CHO with them
at all times.
Provide practical knowledge as
needed on alternative eating
patterns (i.e. vegetarianism)
Eating Disorders in
Adolescents with DM-1
Pubertal changes in body shape
may cause development of
unhealthy eating attitudes.
Dx of DM-1 heightens awareness
of dietary restraints, weight gain,
and food preoccupation.
Insulin misuse to lose weight
Eating Disorders in
Adolescents with DM-1
Pay attention to those who express
body dissatisfaction
Lead them toward healthy weight
control practices
Screen regarding weight
How concerned are you about your
weight?
Do you ever skip meals to lose or
maintain weight?
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?
Include Behavioral Health
Counselor and Family
Practical Advice to Parents
Parents can have trouble dealing
with their childs new diagnosis.
Here are points to help:
1. Dont Isolate Yourself
Find support, lean on others
Support groups, family, friends, place
of worship
Practical Advice to Parents
2. Ask for Help
Bring a friend or relative to help you
take notes when you talk to medical
providers.
3. Dont Blame yourself
Remind yourself that BG monitoring
and insulin shots are now a fact of life
You didnt give your child diabetes
Practical Advice to Parents
4. Mind your Marriage
Make time for your spouse everyday,
putting aside your childs diabetes
5. Work with Your Ex
Put aside negative feelings to work
together for the sake of your child
Seek counseling if needed.
Dont play good parent, bad parent to
drive a wedge between child and other
parent
Practical Advice to Parents
5. Be Consistent
Routines make children feel secure
6. Educate Yourself
Knowledge may help reduce anxiety
7. Consider counseling
Sometimes you just need a little help
8. Take a break from diabetes
Take care of Yourself!
Do you have questions for me?
Clarifications?
Cultural/Native American
Differences?
More Information?