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Diabetes and the Growing
Child
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Effects of growth on diabetes
Fasting
Pregnancy
Smoking, alcohol and drugs
Exercise
School issues
Programme
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Effects of growth on diabetes
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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
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Change Effect Consequence
Growth Increasing weight Increasing doses
Puberty Decreasing insulin sensitivityPsycho-social stresses
Increased dosesMore educationAlcohol and drug useRisk 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 understandingIncreased independence
More educationIncreased autonomy
Effects of changes
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School issues
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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
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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
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Exercise
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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
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Effect of exercise
• Hypoglycaemia• Hyperglycaemia• Ketones
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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
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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
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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
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Smoking, alcohol and drugs
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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
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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
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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
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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
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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
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Pregnancy
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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
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Risks for mother
• Hypertension in pregnancy• Urinary tract infections• Later risk for type 2 diabetes• Preterm labour• Polyhydramnios• Macrosomia• DKA• Progression of microvascular
complications
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Risks for baby (1)
• Congenital abnormalities • Spinal• Heart• Gastro-intestinal • Limb abnormalities• Heart abnormalities
• Macrosomia (big baby syndrome)• Obstructed labour• Intra-uterine death
Poor control around conception
Poor control late in pregnancy
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Risks for baby (2)
• Asphyxia• Birth trauma at delivery• Hypoglycaemia• Hypocalcaemia• Neonatal jaundice• Respiratory distress• Polycythaemia• Increased later risk of type 2 diabetes
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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 mother’s complications• Genetic implications of diabetes
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Fasting
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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
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Questions
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Ch
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the A
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f Novo N
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