Type 1 Diabetes in Children

Diabetes in children always causes a shock because it is totally unexpected. It seems life is no longer normal – suddenly there is so much to understand, so much to do that it’s overwhelming to the parents as well as the child. Diabetes in children is essentially no different from Diabetes in adults. Diabetes in children is a condition where the pancreas no longer produces insulin required by the body to process the glucose. Insulin is the hormone that helps the blood glucose to enter the cells to provide energy to the muscles and tissues. Since insulin is no longer produced by the body, you need to replace it and that is where insulin injections come in. Parents have to learn to give injections, count carbohydrates and monitor the blood glucose levels constantly.

What are the Causes of Diabetes in Children?

While the exact cause of Type 1 diabetes in children is not known, it is believed that the immune system of the body attacks and destroys the insulin producing cells in the pancreas. Why the immune system does that is again conjecture; a virus may trigger the condition or genetics could have something to do with it. In Type 1 diabetes in children, there is little or no insulin to let the blood sugar into the cells as a result of which the sugar builds up in the child’s bloodstream causing life-threatening complications.

The cause for Type 2 diabetes in children is different. In case of type 2 diabetes in children, the body becomes insulin resistant or the pancreas doesn’t produce sufficient insulin required by the body.

What are the Symptoms of Diabetes in Children?

Symptoms of Type 1 diabetes in children usually develop over a period of a few weeks. One of the most obvious symptoms of diabetes in children is frequent urination and increased thirst. Extreme hunger and fatigue are two other symptoms which can be observed in children with diabetes. If your child becomes irritable for no apparent reason or shows unusual behavior, it could be a symptom of diabetes. Other symptoms of diabetes in children include sudden, unexplained weight loss and blurred vision. Young girls with type 1 diabetes may develop vaginal yeast infection and babies may get nappy rash.

Complications of Diabetes in Children:

Type 1 diabetes in children can wreak havoc in their lives especially if complications develop. It can affect almost each and every organ in the child’s body. Type 1 diabetes in children may affect their nerves, blood vessels, heart, kidneys and the eyes. The only way to avoid complications getting out of hand is to maintain the blood glucose levels at normal levels as much as possible.

In case blood glucose levels are not controlled, the possibility of life threatening diseases increases. Diabetes in children may cause heart and blood vessel disease, nerve damage, kidney damage, eye damage, skin problems and osteoporosis. However, with consistent care, advanced methods of injecting insulin and monitoring the blood glucose levels regularly, diabetes in children can be managed.

Blood Sugar level

Your Blood Sugar Levels can be tested either by yourself at home using a good quality branded blood sugar testing kit or at a clinical lab. As a rule of thumb, the initial testing of your Blood Sugar Levels is usually done at a clinical lab. Doing so also enables you to benchmark your personal blood sugar testing kit.

Testing your Blood Sugar Levels at a clinical lab or at home

The Oral Glucose Tolerance Test

This is test typically done if you not suffering from any illness (not even a minor cold or taking drugs for some illness) and are active (as opposed to being bed ridden).

The Oral Glucose Tolerance Test is usually done at a clinical lab but can also be done at home. Here’s how: A sugary drink in which the quantity of glucose or sugar in the drink is known, is consumed on an empty stomach (should not have consumed anything 8 hours or more prior to this test).

Next, the Blood Sugar Levels are tested ½ hour, 1 hour, 2 hours, and 3 hours after consuming the drink. The reason this test is usually done at the clinical lab is because the glucose drink given to you is very precise in terms of quantity and its content. The results of the test too are therefore more precise.

The results of Oral Glucose Tolerance Test

If you do not have diabetes, your Blood Sugar Levels will rise rapidly taking the drink. Your lever should then produce insulin to convert the sugar into energy. Gradually over the next couple of hours or so, your Blood Sugar Levels will come down as all the sugar would be converted into energy. Finally after about 3 hours your Blood Sugar Levels should be within the normal range.

If your lever does not produce sufficient quantities of insulin or, your blood cells are unable to utilize the insulin effectively, then the very first Blood Sugar Levels test will indicate higher than expected Blood Sugar Levels. The drop too will take much longer and therefore the Blood Sugar Levels will stay elevated for more than 3 hours.

If the Oral Glucose Tolerance Test indicates that you might be diabetic, the doctor will usually recommend a repeat on two different dates usually several days apart. This is done to ensure the accuracy of the results and remove any external influences.

What are the tolerances levels for Oral Glucose Tolerance Test?

If you have been administered the Oral Glucose Tolerance Test then your Blood Sugar Levels two hours after the test should less than 110 mg/dl. If the Blood Sugar Levels are between 110 and 126 mg/dl, then you would be diagnosed as having a impaired or weakened glucose tolerance (subject to additional two tests on separate days) and would be required to monitor your diet and physical activity.

Ideally, I recommend you do the Oral Glucose Tolerance Test at a clinical lab because the glucose liquid you consume needs to be carefully calibrated and this is not possible at home. Also, you need to be seated during the entire 3 hour period – something that usually does not happen at home.

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There are actually two ‘normal’ Blood Sugar Levels. One is pre-meal and the other is a post-meal Blood Sugar Levels. Ordinarily, your Blood Sugar Levels as soon as you wake up should be the lowest. The ‘highs’ would happen post meal and would depend on the individual meals. The normal range of Blood Sugar Levels would be between 3.6 and 5.8 mM (mmol/L) or 70 and 150 mg. Anything over 150 mg would indicate high Blood Sugar Levels (diabetic or hyperglycemia) whereas anything below 3.6 (mmol/L) or 70 mg would indicate low Blood Sugar Levels know as hypoglycemia.

Impact of low Blood Sugar Levels

It is vital for human to stay within normal range of the Blood Sugar Levels as the high’s and low’s could prove to be fatal. For example if your Blood Sugar Levels are below 3.6 (mmol/L) or 70 mg, you would start to feel lethargic, be irritable, suffer from impaired brain function and ultimately your body would shut down i.e. go into comma.

Impact of high Blood Sugar Levels

High Blood Sugar Levels (hyperglycemia) are just as fatal. Untreated Hyperglycemia or diabetes mellitus causes extensive kidney, eye and nerve damage.

Causes of low or high Blood Sugar Levels

You could suffer from high or low Blood Sugar Levels either due to the adverse life style you might be following (irregular sleeping hours, irregular meals, unbalanced diets, unhealthy diets) or due to recent surgery, illness, stress, pregnancy, trauma etc. Only your family physician or specialist can tell you the cause of your abnormal Blood Sugar Levels. However, if the reason for abnormal Blood Sugar Levels is recent surgery, illness, stress, pregnancy or trauma, then chances are the abnormality will rectify itself as soon as you recover. In the interim period however, your doctor might prescribe some medication to ensure you do not suffer due abnormal Blood Sugar Levels.

Checking your Blood Sugar Levels

Essentially, there are two ways to check your blood sugar levels – at home by using a glucose meter or at a clinical lab. The usual norm is to first do a series of tests at a clinical lab. If the Blood Sugar Levels are abnormal then you would want to buy a blood sugar testing kit (usually costs under $60). A blood glucose or blood sugar testing kit consist of a box that contains a blood glucose meter, a lancing device that looks like a pen and is used to extract a small drop of blood and, a small (usually) cylindrical white box that contains blood glucose testing strips.

Checking your Blood Sugar Levels at home is simplicity itself – just follow the instructions of the leaflet that comes with the kit and you should be able to test your Blood Sugar Levels in less than 5 minutes. Of course, there will be a minor degree of error as compared to tests done at a clinical laboratory. But unless you have a faulty blood glucose testing kit, the margin or error is usually negligible. It would be like saying the time is 16:53:18 verses “oh its 4:55”.

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What are blood sugar levels?

Your blood sugar levels or blood sugar concentration refers to the amount of sugar (glucose) in your blood. Normally, your blood sugar levels should be in the range of 3.6 and 5.8 mmol/L (millimoles/liter) and this range is tightly regulated. The human body is so complex and each organ so interdependent on the other that any deviation in the blood sugar levels can lead to a catastrophic chain of consequences.

How critical are the blood sugar levels to our well being?

Most humans enjoy a love-hate relationship with food. We need food because the sugar (glucose) released from the food is used to create energy and blood lipids (i.e.  fats and oils). As with any chemical reaction, to create energy from glucose, our body needs insulin in very precise quantities. Any school going child will tell you that if the chemical equation is unbalanced, the chemistry fails. Too much insulin or too little of it leads to a similar chemistry failure within our body i.e. the quantum of sugar in the blood would be too high or too low because in proportion to the quantum of insulin available. In simple terms, we say that our blood sugar levels are high or low.

Should the blood sugar levels always be at a constant level?

No. Unlike our body temperature that always stays steady, our blood sugar levels will fluctuate through out the day. Essentially, the blood sugar levels stay depressed before a meal and go up after a meal. These are normal fluctuations. However, your blood sugar levels should be within the ‘normal’ range for your gender, age and activity level. There are two ‘normal’ ranges for blood sugar levels – one is called the fasting range i.e. these are the levels before you’ve had a meal and the other are post-meal blood sugar levels.

Relationship between hyperglycemia and Blood sugar levels

If your Blood sugar levels are constantly higher than the prescribed normal range for your age, gender and activity levels, then you could be suffering from hyperglycemia i.e. Diabetes. However, rather than jump to conclusions, you should get yourself clinically evaluated by your family physician because temporary elevated Blood sugar levels need not always indicate hyperglycemia.

Can hyperglycemia be temporary?

Yes. If your hyperglycemia or elevated Blood sugar levels was due to stroke, surgery, severe stress or trauma, pregnancy, myocardial infarction or some major illness then the elevated Blood sugar levels will automatically rectify itself when you become better the illness or stress no longer exists.

If you are an adult, I would recommend at least one clinical examination for Blood sugar levels per year. If the test for Blood sugar levels reveal borderline diabetes than further regular examination might be necessary. Diabetes if caught early (i.e. Diabetes Type II), can be treated with minor life style modification such as diet control and exercise. If elevated Blood sugar levels are left unchecked, you develop into Diabetes Type I which is quite sever and requires major life style modifications and regular doses of insulin injections.

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Contrary to expectations, not all of are comfortable around digital or electronic devices. Having barely mastered the art of receiving and making calls on the cell phone, the last thing we want to do is learn to use yet another digital gizmo – this one a Blood Glucose Monitor. Fortunately, the modern day Blood Glucose Monitor is extremely easy to use. Today I shall explain how to use your new Blood Glucose Monitor.

Using the Blood Glucose Monitor

1. Ensure you hands are clean.
2. Open the package containing your new Blood Glucose Monitor.
3. Remove from the package and keep ready the lancing device, the box containing the glucose monitoring strips and the Blood Glucose Monitor.
4. Insert a fresh unused lance in the lancing device, set it to 3 (by rotating the base of the lancing device) and prime it (usually achieved by pressing the top once).
5. Extract the code chip (a small white rectangular plastic) from the box containing the blood glucose strips and insert the chip into the receptacle (usually located on the side of the Blood Glucose Monitor). This needs to be done each time you open a fresh box of blood glucose strips (not each time you take a blood glucose test).
6. After inserting the code chip into the Blood Glucose Monitor, switch on the Blood Glucose Monitor and wait until a code number appears – this ensures that the Blood Glucose Monitor and the blood glucose test strips are synchronized.
7. Extract a fresh glucose strip from the box and keep ready.
8. Hold the lancing device vertically on the tip of any finger and release the trigger (usually a small round button on the side of the lancing device. A very tinny almost invisible hole will be created in your skin.
9. You may need to press the around the hole so that a small drop of blood becomes visible on the surface of your skin.
10. Switch on the Blood Glucose Monitor and wait for the blood icon to flash (takes about 10 seconds).
11. Take the glucose strip and swipe (the end with the round hole) across the drop of blood. You would want to ensure the blood is evenly spread across the hole of the glucose strip.
12. Insert the glucose strip into the receptacle of the Blood Glucose Monitor and wait for the results (takes a few seconds).
13. Note down the time, the contents of your meal and the blood glucose result in a diary or notebook specially set aside for this purpose.
14. Push out the cover from the lower end of the lancing device – this exposes the lance.
15. Carefully remove the used lance from the lancing device and also the used glucose strip from the Blood Glucose Monitor and bag it separately before discarding.
16. Switch off the Blood Glucose Monitor and put the kit away in a safe place so your children do not have access to it.

Difficulty in extracting blood

The depth to which the needle of the lancing device enters the skin can be controlled. For children, the lancing device can be set to a depth of 1 or 2. This results in shallow penetration but should be okay for kids. For adults, the lancing device needs to be set to a minimum depth of 3. If this does not produce the desired result, try 3.5 or 4 or more.

Once you use the lancing device is used, the drop of blood (usually) does not automatically appear on the skin; it needs to be coaxed out by pressing the area surrounding the prick. Usually, a light squeeze does the trick.

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Blood Glucose Monitor is a term that most adults come to associate with their personal lives by the time they reach 40! Sooner (or later if you’re lucky), the doctor says you will need a Blood Glucose Monitor.  So today let us examine what a Blood Glucose Monitor is and does.

What is a Blood Glucose Monitor?

Simply put, a typical Blood Glucose Monitor is (usually) a digital device that measures the quantum of sugar (glucose) in your blood. The popular Blood Glucose Monitor’s available in most medical and super stores, require a small drop of blood.

The tech behind the typical Blood Glucose Monitor

Typically, there are two types of Blood Glucose Monitors. Both require a small drop of your blood. The blood is extracted using a small pen like device called the lance. The lance and the Blood Glucose Monitor are usually sold together. The lance has a tiny needle inside and when you press the button that is usually located on the top of the lancing device, the needle pricks the skin making a tiny hole through which you can extract a drop of blood.

One type of Blood Glucose Monitor uses glucose test strips while the other Blood Glucose Monitor does not require any test strips. The test strips (also sold with Blood Glucose Monitor), has two chemicals impregnated; Glucose Oxidase and Ferricyanide. Initially, the drop of blood reacts with Glucose Oxidase to form Gluconic Acid which in turn reacts with Ferricyanide to form Frrocyanide. The glucose test strips that came with your Blood Glucose Monitor also contain electrodes through which a small current is passed. The more the glucose present in your blood, higher the conductivity and hence higher the reading.

How accurate is a Blood Glucose Monitor?

How accurate is your watch? I mean, do you really need an atomic clock? For most of us, a watch that is accurate to say within a couple of minutes is good enough. So also the Blood Glucose Monitor will give you results that are not as good as those you get at a clinical lab but good enough for purpose of monitoring your blood glucose. All you really need to know is whether your blood glucose level is high or low and how high or how low it is. If the results are off by a couple of notches, it isn’t going to make all that big a difference. All the same, when buying a Blood Glucose Monitor, buy the best there is – especially since the best usually doesn’t costs more than $60.

Each Blood Glucose Monitor kit comes with a blood glucose measuring device, a lancing device, a few spare needles for the lancing device and a few blood glucose test strips. You should plan to buy additional needles for the lancing device and box of additional glucose test strips. You will require one needle and one glucose test strip per test.

What do I do with the test results of the Blood Glucose Monitor?

Your family doctor or diabetic specialist would have given you a ‘pre’ and ‘post’ meal number. These would be the ideal blood glucose level for your gender, age and activity level. Compare the reading from the Blood Glucose Monitor with these numbers and take whatever action prescribed by your doctor or specialist.

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Blood glucose control and Americans are poles apart. Millions of Americans are diagnosed with type 2 diabetes each year; a condition related to high levels of blood glucose. Extensive research in the field of diabetes management has proved that intensity of blood glucose control predicts the beginning and the severity of diabetes related issues. This simply means that if are diagnosed with diabetes and you can maintain proper blood glucose control, you can have a normal lifestyle with as little complications as possible.

Short Term Benefits of Blood Glucose Control

Blood glucose control acts as a preventive measure against diabetes complications. There are short term and long term benefits that you would experience. Blood glucose control ensures that you feel better, stay healthy and have more energy to complete your daily routine tasks.  The common signs of the onset of diabetes include frequent urination, feeling thirsty, tired, losing weight and blurred vision. Cuts and bruises take longer to heal. All these symptoms can be kept at bay with effective blood glucose control.

Long Term Benefits of Blood Glucose Control

The normal amount of blood glucose ranges from about 70 to 120 mg/dL in people who don’t have diabetes. The blood glucose levels go up after eating but will return to normal within one to two hours. Blood glucose control in normal people can help prevent the devastating effects of diabetes like limb amputation, heart disease, blindness and kidney failure.  In other words, effective blood glucose control will improve your quality of life in the long run.

How to Maintain Blood Glucose Control

Controlling blood glucose levels is of utmost importance to everyone, but more so for those suffering from diabetes. Very often, people in the pre-diabetic stage are not aware of the problem until they are diagnosed with the condition and by then it is too late to take any preventive measures. It is a good practice to get your blood sugar levels checked regularly so that you have the opportunity to take proper care to prevent the onset of the disease. Here are some tips for blood glucose control:

• Maintain the ideal body weight according to age and height which is an important factor in maintaining blood glucose control. Regular exercise and a proper diet help in achieving this goal.
• Diet plays an important role in maintaining blood glucose control. Eat lots of fruits and vegetables, whole wheat bread and brown rice – these are the richest sources of fiber. Simultaneously, reduce or avoid processed foods because they have zero nutritional value.
• Sweets and desserts or foods containing high quantities of sugar are to be avoided. You can indulge in a dessert or have a scoop of ice cream once in a while, but don’t make it a habit after every meal.  For someone used to binging on sweets, this may be a difficult rule to follow; however, eliminating sweets is the most important part of blood glucose control.
• Keep your food recipes simple – they are easy to prepare and are easy to digest, thus aiding blood glucose control.

Last, but not the least, be active and follow a daily exercise regimen. This will not only help with blood glucose control, but will also make you feel better and lead a healthy lifestyle.

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Follow these 3 easy steps to make sure the shoes you buy will fit comfortably.

You will need:

1.      A ruler- that measures in inches and fractions like 1/8 in (tape measure works)

2.      A sheet of paper- larger than your foot; example newspaper sheet

3.      A pen, pencil, marker, etc.

4.      A credit card- or something as thin and stiff

Step 1: Measure the Length and Width of Your Feet

Since your feet swell by the end of the day measure your feet at the end of the day.  Wear your thickest socks.

• Take a blank piece of paper/newspaper and a pen/marker. Lay the piece of paper on the floor (non-carpeted).
• Stand on the paper with your socks on your feet
• Place the credit card flat against your heel.  Draw a short line.
• Place the credit card flat against your longest toe.  Draw a short line.
• Repeat this for the second foot.
• For the width:
  • Place the credit card flat against the joint at the side of your big toe.
  • Draw a short line.
  • Place the credit card flat against the joint of your pinky toe (or the widest point of your feet).
  • Draw a short line.
  • Repeat this for the second foot
• Take your foot off the paper.
• With the Ruler:  Draw a straight line from the heel mark to the toe mark for both feet. Measure each length.
• Circle and note larger size
• With the Ruler:  Draw a line from the joint of the big toe to the joint of the pinky toe for both feet. Measure each width.
• Circle and note larger size

Step 2: Confirm Your Shoe Size (use the larger foot length with the examples below)
To ensure a very comfortable fit, use your longer foot length and increase your shoe length to the next ½ size from what you measured.

For example:

If your feet measured 10 1/4 inches; that  equals to size 10
Order a size 10.5 shoe size

Table 1:  Women’s US Shoe Length Conversion Chart

Step 3: Find Your Perfect Width:  Match your new shoe size with your larger foot width (like example below)

Table 2:  Women’s US Shoe Width Conversion Chart

Now you have the perfect size and width with which to order for your perfect fit!

With any major foot issues, like extreme foot swelling, have your feet measured by a professional using a “Brannock” device.

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Follow these 3 easy steps to make sure the shoes you buy will fit comfortably.

You will need:

1. A ruler- that measures in inches and fractions like 1/8 in (tape measure works)
2. A sheet of paper- larger than your foot; example newspaper sheet
3. A pen, pencil, marker, etc.
4. A credit card- or something as thin and stiff

Step 1: Measure the Length and Width of Your Feet

Since your feet swell by the end of the day measure your feet at the end of the day.  Wear your thickest socks.

Take a blank piece of paper/newspaper and a pen/marker. Lay the piece of paper on the floor (non-carpeted).

• Stand on the paper with your socks on your feet
• Place the credit card flat against your heel.  Draw a short line.
• Place the credit card flat against your longest toe.  Draw a short line.
• Repeat this for the second foot.

For the width:

• Place the credit card flat against the joint at the side of your big toe.
• Draw a short line.
• Place the credit card flat against the joint of your pinky toe (or the widest point of your feet).
• Draw a short line.
• Repeat this for the second foot

Take your foot off the paper.

1. With the Ruler:  Draw a straight line from the heel mark to the toe mark for both feet. Measure each length.
2. Circle and note larger size
3. With the Ruler:  Draw a line from the joint of the big toe to the joint of the pinky toe for both feet. Measure each width.
4. Circle and note larger size

Step 2: Confirm Your Shoe Size (use the larger foot length)

Table 1:  Men’s US Shoe Length Conversion Chart

To ensure a very comfortable fit, use your longer foot length and increase your shoe length to the next ½ size from what you measured.

For example:

If your feet measured 10 9/16 inches; that  equals to size 10
Order a size 10.5 shoe size

Step 3: Find Your Perfect Width:  Match your new shoe size with your new foot width (like example below)

Table 2:  US Men’s Shoe Width Conversion Chart

Now you have the perfect size and width with which to order for your perfect fit!

With any major foot issues, like extreme foot swelling, have your feet measured by a professional using a “Brannock” device.

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Diabetic or not, most adults in the US (and these days teens too) have at some point in time or the other done a blood glucose test. We all know that blood glucose test is meant to test for ‘sugar’ in the blood. But is blood really sweet? In my blog today, allow me to give you a ball park overview of what exactly is a blood glucose test.

A blood glucose test can be done at home with a good quality blood glucose tester (sold over the counter by most drug stores) or at a medical testing facility or clinic.

If you are visiting the clinic for a blood glucose test then I recommended that you fast – eat or drink nothing other than water for at least 8 hours prior to the test (hence it is called the fasting blood glucose test). Obviously therefore, the best time to do a blood glucose test at a clinic would be early morning.

Is the blood sweet?

We need energy for everything – even when we are asleep and busy dreaming we need energy. Energy is primarily obtained from Glucose. Glucose in turn is manufactured by our body from the food that we eat. Each organ in our body needs glucose and so the body uses the blood stream as the best way to transport glucose around.

Too much electrical current or too little of it can ruin your precious digital gadget. As with everything in life, in blood too, there is an optimal level of glucose. Anything above or below the optimal level causes severe problems. Think of the blood glucose test as a meter that indicates the current level of glucose in your blood.

Once you arrive at the medical clinic, a small blood sample is drawn from a vein in the arm. The standard practice is to put 50% in one tiny sterile bottle and the remaining in another tiny sterile bottle. This is so two tests can be done to verify the results. In reality, most clinics that do a blood glucose test only perform a single test. A second test is done only if the supervisor feels the results of the first test are unrealistic.

A second blood glucose test is done an hour after your lunch. The procedure is identical to one done in the morning.

The results

70 ~ 99 mg/dL (3.9 to 5.5 mmol/L) would be the normal reading for fasting blood glucose test

100 ~ 125 mg/dL (5.6 to 6.9 mmol/L) would indicate impaired fasting blood glucose (an indication of pre-diabetes stage).

126 mg/dL (7.0 mmol/L) and more would usually call for at least one more round of testing before pronouncing the person as a diabetic.

Blood Glucose Test is also known as : Fasting blood sugar (FBS), Blood sugar; Fasting blood glucose (FBG), Blood glucose, Fasting plasma glucose (FPG), Oral Glucose Tolerance Test (OGTT), and Urine glucose.

About Author: I’m Deborah Susan, a dietician and personal trainer specializing in nutrition and physical fitness for diabetics.