ParentingDiabeticKids.com

How is it that one son was diagnosed at 16 months and the other son didn't develop type 1 until he was 20 years old!!?(20 yr old dx 9/27/09)

The likelihood of an autoimmune attack on the pancreas was present in both from birth. The age difference at diagnosis is likely due to when each boy was exposed to the environmental stress (virus, toxin, etc...) that triggered the autoimmune response.

I'm looking to get my 7 yr-old daughter's ears pierced. She is type 1. Any of you aware of any concerns/cautions?

Only major risk is infection. Make sure her blood sugar is well controlled before doing something like this, and watch the skin around the piercing for at least the first couple of weeks. Also, the trauma of the piercing could send her blood sugars temporarily high due to an adrenaline surge.

Where is the best place online to buy insulin pump supplies and accessories?

I’ve had nothing but good experience, and heard nothing but good things from my clients, using Byram Healthcare for ordering diabetes supplies. They have a diabetes specialty division that deals with pumps, continuous monitors, meters, etc., and they have a pharmacy for prescription items as well. They are covered by almost every major insurance plan, and their staff is very knowledgeable. Phone number is 877-902-9726.

Would you please help me understand diabetes and how to deal with ups and downs?

This is one of those "open-ended" questions that are so hard to answer. It would take an entire book to teach them the answer to this. But I would suggest that the consider what their target range is: If they are aiming for too tight a range, they are going to be frustrated. They need a fairly liberal range with a child, and accept that not all readings will be in that range. For example, I try to keep very young kids between 80 and 200 at least 70% of the time, at least pre-meal. If they are concerned about being over 120, they're going to go out of their minds.

Do you think restricting a child's diet in necessary for blood sugar control?

That is an OUTSTANDING question. Having lived with type-1 diabetes for nearly 25 years and worked with thousands of children and adults with type-1, my answer would have to be "no" and "yes". No, I don't think you have to limit the types or quantities of food, as long as you know how to count carb effectively (using insulin-to-carb ratios), time the insulin properly based on the nature of the food (glycemic index), and make appropriate basal insulin adjustments for fat content.

However, "grazing", as many kids (and adults!) have a tendency to do, never seems to work when it comes to controlling blood sugar levels. We all know that blood sugars come up temporarily after we eat. It is necessary to give insulin a chance to bring the blood sugar back down before eating again, or else we run into a situation where the blood sugar stays at a chronically high level.

In other words, eat what you choose, but space out the meals and snacks.

How do you get a 12 year old to give her own shots? We are trying, but she will have no part in it yet!

That's a difficult question to answer, because every kid is different.In some cases, the child has severe anxiety over needle sticks, in which case desensitization therapy with a counselor could be very helpful. Other kids just don't care for sticking themselves so many times a day. An injection port such as the I-Port might be the solution. I've known kids who felt very self-conscious about using syringes in public (due to the image they portray). Use of a pen might alleviate that. But in most cases, kids just like the attention they get from their parents. They figure that as long as they refuse to take the shots, their parents will take care of it for them. When that happens, the parents must take a very firm stance.

"What’s best to use if we want to bring a low BG up quickly? We use glucose tablets and they work well. What other option do you suggest?"

 

The reason glucose tablets and gels work so well is that they contain DEXTROSE, the same stuff given by IV when somebody is unconscious from a low. Dextrose is glucose in its purest form (2 glucose molecules linked together), and thus raises blood sugar the fastest.

Many candies are made with mostly dextrose, and will also work very quickly. These include Smarties (called Rockets in Canada), Sweet Tarts, Nerds, Runts, Spree, Bottlecaps, and a bunch of others. Many are branded under the name “Wonka” candies. Just check the ingredient list: if dextrose is the first thing listed, it should be a winner!

 

Is there a difference between Novolog & Humalog?

The scientific answer:  Slight difference in the amino acid sequence.  In Humalog, lysine and proline are switched.  In Novolog, proline is switched for aspartic acid.  The changes cause the molecules to repel eachother (avoiding aggregation) and accelerating absorption & action.
 
The practical answer:  The insulin action profiles and potency are virtually identical.  But there are some differences in the solutions in which the insulins are dissolved.  Novolog (aspart) has some extra buffering agents that seem to make it more resistant to deterioration and (at least in my experience) less likely to cause site irritation.

Any advice on school field trips? My 11 yr old son is going to the museum without me for the first time since being dx a year ago August. He is pumping and the school nurse is going. I would really rather go- it's about an hour away and it is fo...r the whole day. But he doesn't want me to - he said he could handle it! I guess it's good for him to feel empowered to manage his diabetes at a young age but it is scary for me. Do you guys pack a seperate backpack with all supplies and how much should I "train" the nurse on pump stuff?

I think it's great that your son is eager to tackle a bit of "life on his own" with diabetes.  It's a very controlled situation given that a school nurse will be there, and it's not overnight.  Treat it as business as usual, but with a few common-sense precautions:  Have him check BG every 2 hours and notify the nurse if he is above or below what you would consider "safe ranges".  Have him bring a syringe and vial of insulin (in case his site comes out accidentally) and glucose tablets (or whatever you normally use to treat lows).  
 
I would supply the nurse with written instructions on specifically what to do in the event he is out of a "safe" range.  Of course, if you can loan your son a cell phone, he can call you if he has questions.  Otherwise, let him enjoy himself!

"I would love to know how to stop worrying ALL the time, especially when Alexis isn't with me, at a sleepover for example."

"A little bit of worry can be a good thing. It keeps us on our toes and keeps us from being neglectful. But worrying too much too often just isn't healthy for anyone.

A good way to minimize worry when your child is not with you is through sound planning and open communciation. The planning should include provisions for blood glucose monitoring, insulin dosing, snacks, adjustments for physical activity, and treatment for mild hypoglycemia. The communication is best provided through web messages (if you carry a blackberry or similar e-accessible device), text messages, or calls to & from a cell phone at regular intervals.

How can you convince fairly recently diagnosed teenagers to consider the pump..?? Our kids want NOTHING to do with pumping.. They are 15 and 17.. don't want "something attached".

My answer to this family is this: Expose the kids to other kids their age who are taking a proactive approach to caring for their own diabetes.  This certainly doesn't guarantee that they will want to go on a pump, but it will allow them to see how other teens are using them and benefitting from them.  
 
There is no place better for doing accomplishing this than at a CWD (Children With Diabetes) conference.  CWD conference group kids of similar age/interests together.  Although not the primary intention, doing so forces the kids to learn from each other and inquire about some of the newer technologies and techniques that are being used to manage.  Regional conferences are held throughout the year in various cities, and a mega-conference is held annually in Orlando.  More information is at www.childrenwithdiabetes.com. 

How come we can't get more clear cut answers about what kinds of damage (percentages?) can be done to the organs from going very high or low, many times in one year over several years?

It's very difficult to quantify blood glucose exursions over a large population of people for scientific analysis.  That's why A1c levels are usually used.  It's a nice "tidy" way of assessing overall control.  There has been some work on the impact of post-meal blood glucose spikes, and they do appear to negatively affect long-term health (as well as short-term performance).
 
Incidentally, don't panic over individual high readings.  Having high blood sugar for 3 hours affects only one tenth of 1 percent of a single A1c measurement.

How do I handle a 12 yr old not testing & bolusing? She almost went DKA last week and just doesn't seem to care. Her latest thing is lying about her number. Saying it isn't as high as it is so I won't get mad.

When your child's life depends on taking insulin, it is your responsibility as a parent to make sure it happens.  Any priviledges your child receives (internet access, cell phone, spending money, transportation, etc...) should be contingent on performing certain diabetes self-care behaviors:  checking BG regularly, counting carbs, bolusing appropriately, etc...  These are NON-NEGOTIABLE behaviors.  
 
If the DKA was related to a potential pump/tubing/infusion set malfunction, you may need some additional education on ketone testing and troubleshooting. 

I am interested in knowing the pro's/con's of pumping vs. administering insulin with a syringe.

Major "cons" to pumping are:  cost (deductibles/copays), inconvenience of having to wear the pump around all the time (albeit this is minimal), minor inconvenience and occasional discomfort of infusion set insertions, and risk of extreme high BGs and DKA in the event of a mechanical problem.
 
The "pros" are extensive:  ability to fine-tune basal insulin to meet the body's needs, ability to make temporary adjustments to basal for unique events; ability to deliver mealtime doses over an extended period of time (for slow-digesting foods); bolus calculator built right into the pump; historical record/download-ability might eliminate need for written records; ability to dose in very small increments; convenience of not having to give a shot at every meal/snack, and so on, and so on.
 
But keep in mind that just "going on a pump" does not automatically mean better control and a more flexible lifestyle.  It takes extensive  education and a clinician who knows how to help you fine tune all of the settings.

Gary is a Certified Diabetes Educator who has had diabetes for more than 25 years.  He and his team of CDEs provide diabetes management "coaching" for children and their families via phone and the internet, with an emphasis on pump therapy, CGM, and intensive insulin management.  For information, call 877-735-3648,

What's the deal with Diabetes and feet, my 5 year old was diagnosed 3 months ago, the Dr's didn't mention anything about shoes or feet, but on internet sites about diabetes it seems to be an issue, she hates wearing shoes, does she really need to wear them all the time, or can she go barefoot when at home?

I'm sure I'll get slammed by my colleagues for saying this, but you really don't have to worry about it.  Yes, high blood sugar can increase the risk of infection and will slow healing, but as long as your child's blood sugar is reasonably well controlled, there should not be any foot problems.  The reason people with diabetes develop foot problems is because of many years of neglectful care, which leads to neuropathy (loss of protective nerve sensation) as well as poor circulation in the feet,  Minor injuries tend to become major ones, and the body is unable to heal itself correctly.  Again, as long as you focus on controlling your child's blood sugar as well as can reasonably be expected for a five-year-old, they should be able to play barefoot and do all the other things a five year old likes to do.

Gary is a Certified Diabetes Educator who has had diabetes for more than 25 years.  He and his team of CDEs provide diabetes management "coaching" for children and their families via phone and the internet, with an emphasis on pump therapy, CGM, and intensive insulin management.  For information, call 877-735-3648,

Yes...We have been reading about Insulin and Diabetes, different web sites. The one thing that keeps coming up are the side affects of diabetes and the amount of insulin used. We were wondering, with protein, fruits, veggies, minimal fat, and LOW AMOUNT OF CARBS, (to cut down on the insulin given for the day) what is the recommended amounts of carbs for an adolescent to have during the day, the amount of insulin given for the day? Are we doing the right thing? Also, is there a list of free foods they can eat? If so, where can we find it? Looking for a support group here in Southern N.J. can't find one, where can we look?

For adolescents with type-1 diabetes, insulin needs can be quite high due to rapid growth and insulin resistance created by pubertal hormones.  It is completely NATURAL for teens to need large amounts of insulin -- sometimes 60, 80, even 100 units or more per day.  And if they did not have diabetes, their pancreas would be producing all that insulin for them.
 
Unless you child is significantly overweight, there is not reason to be concerned about how much insulin they are using -- only that their insulin is properly matched to their needs.
 
Incidentally, my office has a list of "free foods" containing less than 5g carb per serving.  It's not the most appetizing list you'll ever see, but if you're interested, call me at 877-735-3648.  Being near Philadelphia, I might also have some insight for you regarding support groups.

My daughter, 13 years old, started to go crazy with a nearly carb-free diet. She refuses to eat properly and lost a lot of weight . She is terrified of going hyper and I think she just doesn't wanna eat to avoid high blood sugar. She is on the pump and her basal rates are already very low and she still goes low a lot especially at night. She also started exaggerate exercising . Thank you for any suggestions, we are really worried about her.

This sounds like the makings of an eating disorder and/or body-image problem.  I would highly recommend that you take your daughter for counseling before it goes any further.
 
BTW, There is no reason to avoid carbohydrates.  In fact, they should be included in the diet of everyone with diabetes.  The key is to match the carbs with the right doses of insulin, given at the right times.

Gary is a Certified Diabetes Educator who has had diabetes for more than 25 years.  He and his team of CDEs provide diabetes management "coaching" for children and their families via phone and the internet, with an emphasis on pump therapy, CGM, and intensive insulin management.  For information, call 877-735-3648,

We are about 19 months into diabetes life, and we see that her insulin requirements are steadily increasing. Just how much insulin is she going to need when her pancreas completely stops making its own. She is currently on about 25 units for morning needle, and about 7 in the evening...this has doubled since last fall. We are just wondering what she may "top out" at...as it already seems like such a lot. I guess I don't understand enough about the progression of this condition....what "changes" can we expect in the next few years even.

Total daily insulin needs can vary considerably for people who make little or no insulin on their own.  Pubertal hormones can increase overall insulin requirements, and physical activity will decrease it.  For a moderately active school-age child, we typically see total insulin somewhere in the range of .5 to 1.0 units per kg body weight.  For teenagers, it is around .75 to 1.5 units per kg body weight.
 
I would not be overly concerned about these numbers.  Whatever your daughter needs to properly control her blood sugar is the right amount.

Is there a certain length of time you have to wait to get a pump? What are the long term effects of taking insulin?

Insulin is a substance that the body normally produces on its own, so there are really no long-term "side effects".  Since people with diabetes take insulin by injection (or pump), it is delivered into the fatty tissue below the skin.  If the insulin is given in the same local area over many months or years, a condition known as "lipodystrophy" can develop.  This involves a breakdown or inflammation of the fatty layer, resulting in hardening and poor absorption of the insulin.  This can usually be avoided by rotating the injection/infusion sites correctly.
 
In terms of pump usage, there is no set time required before one begins to use one.  I have always found it best to wait until the "honeymoon" is over, since blood sugars are usually easy to control on shots during the honeymoon.  But this should not prevent someone from using one during the honeymoon  phase if they with.  Of more importance is the user's SKILL SET.  Prior to using a pump, a person (or their caregiver) should be adept at carb counting, record-keeping, self-adjusting insulin doses, and checking blood sugar at least four times daily.  It also helps to be on a multiple-daily-injection program prior to starting on the pump, and have an understanding of the "basal/bolus" insulin concept.

Gary Scheiner MS, CDE
Owner & Clinical Director
Integrated Diabetes Services
333 E. Lancaster Ave., Suite 204
Wynnewood, PA 19096
toll free: 877-735-3648
(610) 642-6055
fax (610) 642-8046
www.integrateddiabetes.com
gary@integrateddiabetes.com

My 11 year old daughter was diagnosed @ 6 & has been successfully wearing a pump for about 3 years. Thankfully we have had very few issues other than a visit to the ER for a low just a few weeks after her diagnoses. In the past 2 months she has been hospitalized & put in ICU overnight twice due to "highs" ! She acts as if she is checking/bolusing...when in fact she doesn't! In short she lies about it in order to eat!! Other than watching her like a hawk...what can we do?!?! Is it normal to be rebellious @ some point?!?!?

Is it normal to be rebellious?  It is abnormal to not be rebellious!  Almost every kid goes through a phase like this.  She needs to understand that food is not her enemy and not off limits, as long as she compensates with appropriate insulin.  She also needs to understand that blood sugar values are purely for decision-making; they are not to judge her or the job anyone is doing.  Any readings is a good reading because it helps us to learn and fine-tune.  If a good heart-to-heart talk doesn't resolve the problem, it would be a good idea to have her talk with a mental health professional at the hospital who specializes at working with kids with diabetes.

Gary Scheiner MS, CDE
Owner & Clinical Director
Integrated Diabetes Services
333 E. Lancaster Ave., Suite 204
Wynnewood, PA 19096
toll free: 877-735-3648
(610) 642-6055
fax (610) 642-8046
www.integrateddiabetes.com
gary@integrateddiabetes.com

My son awakes on a daily basis at over 300. He seems to be rising steadily after about 3am. Is there anything you can suggest that may help? He is on Novorapid at mealtimes and levimir at breakfast and lunch and lantus at night. If ever I raise the dosage of levemir he hypos at about 2am.

If you are fairly certain that he is rising after 3am (this can easily be verified by using a continuous glucose monitor for a few days; it could also confirm that he is not dropping low soon before the rise), there are potential solutions.  The obvious one would be to switch to an insulin pump.  The rate of basal insulin delivery on the pump can be increased starting at around 1-2 am to offset the rise that takes place after 3am.  Another option would be to add a small dose of NPH insulin at bedtime (10-11pm).  The NPH peak could effectively offset the middle-of-the-night rise.  We have used this strategy with several of our clients and it has worked quite well.
 
The whole issue of taking 3 injections of long-acting insulin (1 glargine/lantus, 2 levemir/detemir) is another story.  I have never seen a need for taking two different long-acting insulin types and cannot fathom why you might be using this approach. 
 
Anyway, let me know if you would like to discuss this further.  My e-mail is gary@integrateddiabetes.com or visit my website Integrated Diabetes Services.