Changing Diabetes and the Apis bull logo are registered trademarks of Novo Nordisk A/S

the Growing
Diabetes and

Child
Programme

1 Effects of growth on diabetes

2 School issues

3 Exercise

Changing Diabetes and the Apis bull logo are registered trademarks of Novo Nordisk A/S
4 Smoking, alcohol and drugs

5 Pregnancy

6 Fasting
Effects of growth on diabetes
Growth and diabetes

During childhood and adolescence

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 More education

Increased independence 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
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 correction of hypoglycaemia is
impaired
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
Cardiovascular disease
Micro- and macrovascular complications
Hypertension
Hyperlipidaemia
Marijuana

Excessive or frequent use associated with:

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

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
Spinal
Heart Poor control around
Gastro-intestinal conception
Limb abnormalities
Heart abnormalities 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 mothers 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