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Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S Diabetes and the Growing Child Programme Effects of growth on diabetes 2 School issues 3 Exercise 4 Smoking, alcohol and drugs 5 Pregnancy 6 Fasting Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S 1 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 Increased independence More education 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 impaired correction of hypoglycaemia is • 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 Gastro-intestinal Limb abnormalities Heart abnormalities Poor control around conception 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 mother’s 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
