Treatment of type 1 diabetes in children

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Type 1 diabetes in children

The treatment of type 1 diabetes consists of controlling blood sugar levels and taking insulin. Insulin allows the cells to absorb the sugar contained in the blood. Type 1 diabetes is a disease that does not pass and the child therefore needs treatment throughout his life. It can mean a major change, but over time it will become a natural part of life.

Check your blood sugar value

The blood sugar value is the measure that indicates how much sugar is in the blood. Controlling it is an important part of the treatment, as the insulin is always dosed on the basis of the blood sugar value. It is also important to understand how the blood sugar value is affected by what the child eats and does.

The blood sugar value is indicated by mmol/l, an abbreviation for millimol per liter. Good guideline values ​​are that the child has a blood sugar value of 4–6 mmol/l in the morning before breakfast, and a value of 4–8 mmol/l approximately two hours after a meal.

There are various tools to measure blood sugar levels:

  • Small sensors that attach to the subcutaneous fat and that measure all the time.
  • Measuring stick and blood sugar meter, the child then needs to be knit in the finger to measure the blood sugar value.

Sensors

It is becoming more and more common for children to receive a sensor that continuously measures the blood sugar value in the subcutaneous fat. The sensor is about a centimeter long and is fastened with a needle in the subcutaneous fat, often on the outside of the upper arm. The sensor is changed about once every two weeks.

The sensor can transfer the values ​​to a small portable monitor or to an app on one or more mobile phones. Then you can see how the baby’s blood sugar values ​​change without having to stab the baby. It can be good for example during the night when the child is asleep.

There are sensors that can alert if the blood sugar value becomes too low. There are also sensors that interact with the insulin pump. They may temporarily turn off the insulin supply if there is a risk that the blood sugar value will be too low. Some sensors can also increase insulin delivery when needed.

The sensor and insulin pump facilitate treatment, especially for children. But it is important to remember that they are aids and that you still need to have control over the baby’s blood sugar value and what they eat.

Blood sugar meters and measuring sticks

You or the child will measure the blood sugar value itself with a measuring stick and blood glucose meter. The baby needs to be knit when blood glucose values ​​are to be measured.

There are several different models of blood glucose meters and measuring sticks. The diabetic nurse can show the different models.

The need for insulin varies

Insulin allows the cells to absorb sugar from the blood and the blood sugar value is kept at a good level.

Insulin is destroyed if it comes into contact with the stomach contents. Therefore, the insulin must be injected into the body using an insulin pump or with insulin syringes. The insulin syringes look like pens and are therefore called insulin pens.

The insulin dose is determined based on the blood sugar value

How much insulin the child needs varies during different parts of the day. This depends, among other things, on how much the child moves, what the child eats and how much.

At the beginning of treatment, it can be difficult to understand how activities and food affect blood sugar levels. It may also take time before you learn how much insulin is needed in different situations. Test yourself by checking your blood sugar levels.

The need for insulin increases as the child gets older

The child needs more insulin as they get older. This is because the child is growing. The need for insulin also increases as the child enters puberty.

Feel free to write a diary

Record the child’s blood sugar values ​​in a so-called diabetes diary. If the child has a sensor, you can download the values ​​from there.

With the help of the diary you can see how the values ​​vary over the day. Then it can be easier to understand how blood sugar levels are affected by insulin doses, food and physical activity.

Here are examples of what you can note:

  • What the child has eaten.
  • How much insulin the child has received.
  • What blood sugar value the child has before and two hours after a meal.
  • How much the child has moved, for example if the child has run.
  • The baby’s blood sugar value in the evening, before the child should sleep.

Measure blood sugar levels frequently if the child gets an infection or gets hurt

The child’s blood sugar value can change if they become ill or injure themselves. Measure blood glucose frequently and dose the insulin thereafter.

Often the child needs more insulin if they get an infection. This can be the case, for example, in colds and urinary tract infections, and it is extra important if the child has a fever.

The child may need to take less insulin if they get a stomach illness with diarrhea and vomiting, as it can be difficult to get enough food. But the body’s reaction to stomach illness can also cause the blood sugar value to rise and that the child then needs more insulin.

Contact the diabetes team if you are not sure how much insulin your child needs. Read more about the diabetes team further down in the text.

Never stop using insulin

Continue to give insulin to the baby, even if the baby eats a little or vomits everything. Measure your blood sugar value more often than usual and adjust your insulin dose based on the value.

Always check your blood sugar level if your baby is vomiting, as there may also be signs of high blood sugar and ketoacidosis. It is a serious condition that can be life-threatening if left untreated.

Treatment with insulin pump

An insulin pump is a small insulin container that dispenses insulin to the body in small doses, around the clock. With an insulin pump, the child gets a steady supply of insulin all the time and does not need to prick himself every time to take insulin.

The insulin pump is filled up differently, depending on the model the child has. Some pumps are refilled before attaching, others by attaching or replacing small ampoules of insulin when the pump is in place.

The basal dosage of the insulin pump is controlled by a schedule programmed into the pump. It is possible to increase or decrease the dose if the child needs less or more insulin. For example, it may be when the baby is eating, or if the blood sugar value is too high.

The child will eventually be able to run the pump himself, but initially an adult needs help.

Many pumps are waterproof and can be disconnected when the child is to shower or bathe.

Two variants of insulin pump

There are two variants of insulin pump:

  • One that the child can wear in a belt without being visible on the clothes.
  • One in the form of a small capsule attached to the skin.

Insulin pump that the child wears in a belt

The insulin is passed from the pump to the body through a thin plastic tube called a catheter. On the catheter is a small needle attached to the subcutaneous fat on the abdomen. The catheter should be changed at least two to four times a week.

The pump is about the same size as a smaller mobile phone, about 5 centimeters wide and 8 centimeters long.

Insulin pump in the form of a small capsule

In the insulin pump, which is in the form of a capsule, the insulin is fed directly into the body through a thin needle. The capsule is first adhered to the skin, then the needle is automatically inserted into the subcutaneous fat using a remote control.

The capsule can be placed on the outside of the upper arm, abdomen, thighs or in the lower back.

The insulin pump, which is in the form of a capsule, is controlled wirelessly with the remote control. The capsule should be changed every three days.

It is important to check the blood sugar value if the child is using insulin pump

Check your blood sugar level frequently if your child is using a pump. The reason is that the baby can get ketoacidosis faster if the insulin supply is broken, for example if the pump’s catheter slides out or if the needle slides out of position.

Ketoacidosis is when the blood sugar value becomes too high due to insulin deficiency. It is a serious condition that can be life-threatening if left untreated.

It is also important to frequently check the pump settings so that the child receives the correct dose of insulin at the right time.

Insulin pen treatment

There are two variants of insulin pen:

  • Disposable pens that are filled with a certain amount of insulin and are discarded when they run out.
  • Insulin pens that you or your child load with ampoules containing insulin. The ampoules are replaced when empty.

At one end of the insulin pen is a needle. Insulin needles are very thin and the injection is therefore almost not felt at all. The needle should be replaced before each new injection.

At the other end of the insulin pen is a dosing button. You or the child turns the knob to set the amount of insulin the child should receive. The pen has a scale that clearly shows how much insulin is injected into the body.

The insulin is usually injected into the subcutaneous fat on the abdomen or thigh. The effect of the insulin usually comes a little faster if the baby takes the syringe in the stomach compared to if it is taken in the thigh.

Take the injection in different places

It is good to take the injections in different places. Otherwise, a fat accumulation can be formed in the subcutaneous skin if the child takes the injections at the same place many times. Fat accumulation makes the absorption of insulin worse.

Often taking the injections in the same place also damages the tissue.

There are different types of insulin

The different types of insulin differ in how fast the effect comes and how long it lasts.

Meal insulin – fast-acting and direct-acting insulin

Meal insulin seems fast. It is taken in conjunction with meals and to lower a high blood sugar value. The insulin has the greatest effect after about half an hour and up to two hours after the child has received the syringe.

Meal insulin can be divided into fast-acting insulin and direct-acting insulin.

Fast-acting insulin contains human insulin, which is the same as the body’s own insulin. Direct-acting insulin contains a so-called insulin analogue. In an insulin analogue, the structure of the insulin is slightly changed, compared to the body’s own insulin.

Basinsulin – long-acting insulin

Basal insulin has a longer effect than mealtime insulin and works more evenly throughout the day. There are different types of basal insulin which have different long duration of action.

Basinsulin is used only for insulin pens and should be taken once or twice daily.

Basal insulin is also called long-acting insulin.

How the insulin is used

The child receives both basal insulin and meal insulin if they use an insulin pen. It is most common for the child to get basal insulin once a day, usually in the evening. Before each meal, the child receives meal insulin.

An insulin pump is always used for direct-acting insulin.

Insulin sensation if the child has received too much insulin

The child may get a so-called insulin sensation if the blood sugar value becomes very low. Symptoms of an insulin sensation include that the child begins to sweat, tremble, become hungry and find it difficult to concentrate.

The child may get an insulin sensation if they have received too much dose of insulin, have eaten less than usual or been very physically active. Therefore, ensure that the child always has grape sugar with him, in order to be able to quickly raise too low blood sugar value.

Talk to your child’s doctor if the child often gets low blood sugar and you do not understand why.

Insulin sensitivity is also called hypoglycemia.

The diabetes team provides care and support

Children who suffer from diabetes receive care in hospitals. There are so-called diabetes teams consisting of healthcare professionals with specialized knowledge and experience of the disease. Often the following people are part of a team:

  • A doctor responsible for the treatment.
  • A diabetes nurse who shows, among other things, how the child should take insulin and blood tests.
  • A psychologist that both you and the child can talk to.
  • A dietician who tells how food affects blood sugar value and gives advice on food issues.
  • A curator who answers questions about financial and social support.
  • A play therapist who helps the child process things that may feel difficult with the illness, such as fear of syringes and sticks.

The diabetes team will assist you in the adjustment that the disease may entail. They answer questions and give advice on how to handle different situations in everyday life.

They can also help the child understand and accept the treatment. It is important for the child to be able to participate. How the treatment goes depends largely on the child’s participation.

You can always get support from the diabetes team and ask them for advice when it feels difficult. But you, as the custodian, have the main responsibility for managing the child’s diabetes.

The child is examined regularly

When the child is discharged from the children’s clinic, you have regular contact with the diabetes team. You go back to the doctor and the diabetes nurse several times a year. The others in the diabetes team will meet you when needed. In addition to return visits, you have contact with the diabetes team in various ways, for example through e-mail, telephone or video calls.

At the return visits, the doctor assesses how the treatment works and the child’s blood sugar levels are checked. The child is weighed and measured to see how they grow. You can also talk about what everyday life looks like, about eating habits and physical activity.

About once a year, the child is allowed to have blood and urine tests, including to check the kidneys, thyroid and to see if the child has developed celiac disease. The baby’s blood pressure is also measured.

From the year the child turns ten, his eyes will be examined at least every two years with so-called eyebrow photography.

The diabetes team can follow the treatment through the computer

The data from the child’s blood glucose meter and insulin pump can be transferred from home and the diabetes team can then see it, without having to meet the child. In this way, the diabetes team can find out about the child’s blood glucose values ​​and see how insulin treatment goes between visits.

It is important that you and the child understand the care staff

It is important that you and the child, based on the child’s age, understand the information you receive from the care staff so that you can be involved in the care and make decisions.

If you do not speak English, you may have the right to receive interpreting assistance. You may also have the right to receive interpreting assistance if any of you have a hearing impairment.

The child needs to learn and understand

For the child to get used to the treatment, it is good to tell what insulin is and why they need it. Explain to the child that the body needs the insulin to feel good and to be able to play and do other things.

Talk to the child about how they feel when their blood sugar levels are low. Then the child can eventually recognize how it feels and say to an adult, or treat it himself.

The barge therapist can help

Together with the play therapist you can help the child get a relaxed attitude to taking the insulin. Different toys can make it easier for the child to learn how to use the insulin pens. For example, the child can practice knitting a teddy bear or doll.

Often the child becomes less afraid when they are allowed to practice in a safe environment. It is important for the child to feel that it is possible to influence and change the fear, if they are afraid and worried.

The child can protest when something happens in existence

Although the child learns to take the insulin and check their blood sugar levels, problems and protests can sometimes come later.

How the child protests depends, among other things, on his age and what happens in life. It may be that the child starts in a new school or gets a sibling, or if they have it is difficult in school or with friends. You can then get support and help from the diabetes team.

If you find yourself uncomfortable with syringes

How you react to the syringes yourself affects the child’s attitude. The child feels if you are scared or insecure. It is good if you can then process your own fear or uncertainty. Then talk to another adult and not to the child.

How much responsibility the child can take depends on the age

The child needs different help and support in their treatment, depending on their age. Some children also need to continue to receive support, encouragement and strategies to manage their treatment, even as they grow older.

The child’s right to decide for himself in various care situations is related to his maturity. The older the child, the more important it is for them to be involved in their treatment.

Younger children need more help

If you have a younger child with diabetes, you need to make sure that there is food and insulin where the baby is. It must always be possible to measure the sugar and ketone levels in the blood. There must always be an adult who can check the baby’s blood sugar value and provide insulin if you cannot be there.

Relatives and preschool staff need to know that your child has diabetes, and how the child responds when they have low and high blood sugar levels. They should also know what to do and who to contact if they need help.

School-aged children can usually take insulin themselves

When children reach school age, some themselves can check their blood sugar levels and take insulin. But they may need help interpreting the value and knowing how much insulin to take. They also need to be reminded when to take insulin and to measure blood sugar levels.

At this age, friends become important, and it is then good if your friends know little about diabetes. If the child is often at home with friends, it is good if the adults there know about the child’s diabetes.

School-aged children need support and encouragement

Most teenagers take insulin and check their blood sugar levels themselves. But they still need support and encouragement. As a teenager, living with a disease that does not progress can be extra stressful. Teens usually want to be like others, so managing their diabetes is not always easy. It is valuable to have friends who can support and who know some about diabetes.

At puberty, hormone changes occur that cause the child to need more insulin and it can be difficult to adjust the right amount of insulin. It may also happen that teens rebel against their illness. For example, they may ignore taking insulin or neglecting the food. During these years, it is extremely important to get support from their diabetes team. After puberty, insulin is no longer needed.

The staff at preschool and school need to know

A child with diabetes needs extra supervision in preschool and school.

In some municipalities, a preschool can have an extra resource person, or the child group can be reduced. But in many municipalities it is not possible to get extra help. Children with diabetes must then be assisted by the staff who are at the preschool or school.

Inform the staff about the child’s diabetes

The staff must have knowledge of what it means to have diabetes. It is good if you as a custodian have contact with some individual people in the staff who are responsible for the child. For example, they must be able to:

  • Know what to do if your child gets too low or too high blood sugar.
  • Make sure the child eats and drinks.
  • Tell the parents and other adults if the child has eaten a new dish, played intensively or done anything else that may affect blood sugar value.
  • Check blood sugar levels and help with insulin therapy, in consultation with parents.

The diabetes team can help teach staff, but it is the responsibility of the preschool manager or principal to ensure that after-school staff can take responsibility for the child.

Have a written agreement with the staff

It is important that the staff at the child’s preschool or school, the parents and the diabetes team have a good cooperation. There are templates for written agreements that you can use. The following are examples of what can be written in the agreement:

  • Who is responsible for what.
  • What to do if the child gets a feeling of insulin.
  • Where the child should go if something happens.

You are welcome to renew these agreements once a year.

Please tell the class

When your child is in primary or middle school, it can be good if you and the child tell the class about the disease. You may be able to tell along with the school nurse. At the high school and high school, the teen can tell the illness himself.

Health and lifestyle in type 1 diabetes

Type 1 diabetes is a disease that depends to some extent on the child’s habits. Below you can read about what the child can do to feel as good as possible.

The child can eat as usual

In principle, children with diabetes can eat anything, as long as the insulin dose is adjusted to what the food consists of. What is good food in diabetes is no different from what is good food for everyone.

It is good to eat regularly and try to distribute the meals as evenly as possible throughout the day. The child should preferably eat food before eating sweets.

Shot the teeth

It is important to care for the teeth and to go to the dentist regularly. The baby can more easily get holes in the teeth if the blood sugar value has been elevated for a long time. Inflammation of the gums can also raise blood sugar levels.

Tell your dentist or dental hygienist that your child has diabetes. The dentist can then give you information about what to think about.

The child can participate in all activities

A child with diabetes can participate in all activities in preschool or school, and in recreational activities.

Physical activity is especially good for a child with diabetes. It lowers blood sugar levels without insulin, and the child can reduce the insulin dose. The child also needs to eat extra, so that the blood sugar value will not be too low. How much the dose can be reduced and what the child needs to eat depends, among other things, on what activity the child is doing and how long the child is engaged in the activity.

Talk to your diabetes team about how the child should handle the insulin dose and what the child may need to eat extra in conjunction with physical activity.

Talk to your child about the risks of alcohol

Children and adolescents under the age of 18 should not drink alcohol, but it happens. It is then important that teens with diabetes know that alcohol lowers blood sugar levels. Sometimes alcohol can lower blood sugar greatly and cause the teen to feel insulin. In the worst case, the teenager may become unconscious. Then a syringe with glucagon is needed which raises blood sugar levels.

If the teen is intoxicated, it is important to eat something with a lot of carbohydrates before going to bed for the night.

A teenager who has diabetes and drinks alcohol should preferably not be left without company. It is also very important that relatives and friends of the teen know what to do and who to contact if they need help. Otherwise, situations can arise that can be life threatening for the teenager.

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