Diabetes and Children

Diabetes and Children

The diagnosis of diabetes at a young age is particularly difficult for the child or adolescent and for his or her family. In most cases the diagnosis is type 1 diabetes; but increasingly type 2 diabetes is being diagnosed with a link to childhood obesity. The symptoms are similarly:

  1. Increase thirst
  2. Hunger
  3. Urination
  4. Fatigue weight loss
  5. Blurred vision
  6. or even yeast infections in young girls.

A delay in diagnosis may be fatal, so please know what to look for. Diabetic ketoacidosis results from a build up of ketones in the blood, when the body is unable to make glucose from energy and this may be fatal.
Additional issues for younger persons with diabetes include: 

  • Fear of gaining weight while using insulin which can result in anorexia  or bulimia in extreme cases.
  • Self control issues with meals especially hidden sweets, abuse of alcohol, smoking or both, which may affect blood glucose levels.
  • Peer pressure and wanting to appear like their peers may lead to avoidance of insulin injections and diabetes control may not be a priority. 

Parents often need to learn insulin injection techniques and to know about hypo- or hyperglycaemia. They need to know how to adjust the insulin with meals and physical exercise and what to do on days of illness known as sick days. Family support and access to a health team are important for diabetes and children.  

Diabetes and Stress

(As seen in Business Focus March/April 2015 p100)

The seasons of gift exchange and indulgences, affection and revelry, gave way to the tax season, which may have caused some distress; financial or otherwise. Stress is defined in Psychology as a person’s response to an external stimulus that may be positive or negative. Eustress has been defined as a positive motivator or challenge that keeps a person moving forward in a healthy way. Distress on the other hand, is the opposite of happiness.

The primitive ‘fight or flight’ mechanism induced by stress can manifest itself in the onset or worsening of endocrine disorders such as Diabetes. Diabetes is a metabolic disorder that results in absence or dysfunction of the pancreatic cells that produce insulin, and insulin resistance. While diabetes is not usually diagnosed at times of stress, diabetes is influenced by stress, specifically distress, which increases blood glucose levels via counterregulatory hormones.

Physical or emotional trauma, illness, sleep deprivation or other stresses can result in persistently elevated blood glucose levels, because of the actions of cortisol, adrenaline and growth hormone, among others. This can result in diabetes and its complications. For example, stress can trigger diabetic ketoacidosis (type 1 diabetes) which can be fatal. Other studies show that stress may lead to immunologic surveillance defects which can increase the frequency of infections or tumours. In addition, persons with stressors and diabetes have more risk factors for heart disease than persons without stressors. Cognitive dysfunction and memory loss are greater with diabetes plus stress; memory of transactions, deadlines and appointments can suffer for those who work.

A recently published study indicated that working night shifts increased the risk of diabetes, especially for black women, partly due to the abnormal diurnal hormonal changes. In addition, sleep deprivation on night shifts may cause obesity which is linked to insulin resistance.  Especially for women, a link has been found between work that is high in demand and low in permissible decision making and up to 45% increased risk of onset of type 2 diabetes. High work related stress is also linked to increased health care expenses, long commutes and poorly controlled blood glucose of long duration.

Apart from the workplace there are other special groups of persons to be considered:

  • Hospitalised patients: blood glucose levels in acute illness may predict the risk of type 2 diabetes.
  • Pregnant women: maternal anxiety and stress during pregnancy can increase the risk of miscarriage and decrease birth weight.
  • Children: the Swedish diabetes study suggested that children aged 5 to 9 exposed to stressful events were more likely to develop type 1 diabetes in childhood. In a separate but similar study, psychosocial stress was proposed as a trigger for diabetes-related autoimmunity in infancy.
  • Marginalised groups: lack of acculturalisation and both sociocultural instability and physiological maladaptation (thrifty gene hypothesis) are linked to an increased prevalence of diabetes in these populations.
  • Older persons: stress increases cognitive decline and memory for older persons with diabetes.

The management of established diabetes becomes increasingly stressful with lack of family involvement or other dysfunction in professional or personal relationships, particularly when raising children. Persons with diabetes may feel “different” or “sick”, fearful of hypoglycaemia, and of the complications: amputation, heart disease, blindness, impotence. In addition, anxiety, depression, posttraumatic stress disorder and coping issues are directly related to poor diabetes control due to the hormonal and behavioural effects of stressors. Persons with diabetes may feel lack of control, poor adaptability to change, social withdrawal and “this is not me” denial as well as guilt and frustration over unhealthy crutches such as smoking, alcohol and comfort foods. They are more likely to make wrong decisions about self-management which manifests as persistently elevated blood glucose, high blood pressure and cholesterol, as well as high risk of heart disease.

Stress management has been found to improve long term glycaemic control. Education about all areas of diabetes and self management, including provision of tools such as glucometers and pedometers, improve overall health and quality of life. Mindfulness based stress reduction is the newest complementary medicine solution, but simple things like prayer, social support – communication with family, friends and your diabetes physician, normal healthful routines- exercise to elevate endorphins, getting enough sleep, eating healthy meals, are equally beneficial. Health education programs should be encouraged in the workplace. Most of all, a positive outlook and motivation are essential, no matter what the season.

References:

BMJ-British Medical Journal. “Shift work linked to heightened risk of type 2 diabetes.” ScienceDaily. ScienceDaily, 24 July 2014.

Diabetologia. “Black women working night shifts have an increased risk of developing diabetes.” ScienceDaily. ScienceDaily, 11 January 2015.

University of Edinburgh. “Stress raises risk of mental decline in older diabetics, study shows.” ScienceDaily. ScienceDaily, 27 February 2010.

Ranabir, Salam, and K. Reetu. “Stress and Hormones.” Indian Journal of Endocrinology and Metabolism 15.1 (2011): 18–22. PMC.

Persons With Diabetes (PWD)

There is no stigma when we are all in the same situation and the exception is rapidly becoming good health. Diabetes does not have to define you but if it must, use it for good..

Leonard Thompson, at age 14, was the first person injected with insulin in 1922 and this prevented his imminent death. At the time, insulin was a hormone isolated from the pancreas of dogs by Dr. Banting, who subsequently won a Nobel Prize for his work, and his medical student, Charles Best. Insulin was purified by the assistance of Professor Mc Leod of Toronto University and Biochemist J.B. Collip. Present day insulin used recombinant DNA technology, and continues to save the lives of persons with type 1 and type 2 diabetes, for which oral medications are insufficient. Leonard Thompson died of pneumonia in 1935 at age 27.

Part 2

‘It’s not what you have its how you deal with it.’

Members of the Medalist Study at Joslin Diabetes Centre, Boston, US, are fifty-year survivors of type 1 diabetes, which is caused by autoimmune destruction of the beta cells that produce insulin. In spite of a paucity of available medications and monitoring devices so many years ago, these survivors had low overall rates of complications, and graciously agreed to be part of the research study to determine which genetic factors are likely to decrease rates of complications.

Brothers Robert and Gerald Cleveland have lived with diabetes  for over seventy years. They are grateful to have had caring family members and note that having diabetes encourages a life-long health focus, early coping and maturity, and empathy for others.

Diabetes and Exercise

The benefits of exercise:
30 minutes a day with an increased heart rate of 60-80% of maximal peak heart rate.

  • reduces the risk  of heart attack and stroke.
  • improves the body’s use of insulin
  • can delay or prevent type 2 diabetes
  • increases HDL cholesterol
  • improves hypertension
  • causes weight loss
  • improves function if you have peripheral arterial disease.
  • lowers the risk of certain cancers including breast cancer
  • reduces anxiety and depression
  • reduces constipation
  • reduces osteoporosis
  • helps to improve post-menopausal symptoms

Current research suggests that “walkable” neighborhoods can decrease obesity and the incidence of diabetes. Let’s start walking!

If you have complications of diabetes speak to your diabetes physician before you begin to exercise.

Diabetes and Smoking

Cigarette smoking is a risk factor for diabetes, respiratory disease, strokes and heart disease. One in ten persons smoke; the prevalence of smoking among persons with diabetes is not significantly different compared to the general population. Non-smokers live an average of eight to ten years longer than smokers with diabetes, mostly due to heart disease.

Smoking may decrease overall body weight but increases obesity around the abdomen which increases insulin resistance.  Cessation of smoking may cause weight gain of five to ten pounds due to a small decrease in metabolism, psychological factors and reversal of appetite suppression, but the benefits of cessation are greater than this inconvenience.

When you smoke you damage the cells of your pancreas in more than one way. There is also an increase in insulin resistance in a dose-dependent manner. In other words, more cigarettes smoked results in greater insulin resistance and higher blood glucose. Smoking can cause problems with fat metabolism causing raised lipids, elevate blood pressure and can worsen complications of diabetes such as kidney disease. Among persons with diabetes, smoking raises the risk of heart attack eleven-fold.

For optimal management of your diabetes health, we advise that you stop smoking and avoid weight gain with exercise and a healthy meal plan.

Diabetes and Your Meal Plan

 

EAT WISELY

 

When you have been diagnosed with pre-diabetes or diabetes you will receive essential advice about your meal plan. The goal is to maintain blood glucose control while maintaining your nutritional needs, sometimes known as medical nutrition therapy. Other goals will include to lower cholesterol and triglyceride levels, adequate blood pressure control and weight loss.

The meal plan is individualised, but generally consists of regular meals and snacks with consistent carbohydrates especially if using insulin; reduced portion sizes for weight loss; reduction of saturated and trans fats, processed foods; reduction of sodium (salt) intake, while increasing vegetables and high fibre whole grain cereals and bread, and legumes, if specific food sensitivity is absent.

One highly recommended meal plan type is the Mediterranean diet which is a meal plan originating from the countries surrounding the Mediterranean Sea (Greece, southern Italy and Spain). Healthy eating, moderate exercise, self monitoring of BG and a positive outlook will help to decrease your diabetes risk, decrease your need for medications and reduce your risk of complications.

General Advice:

1. Eat breakfast. This is especially important when taking medications for treatment of diabetes.

Breakfast ideas: Oatmeal, whole grain cold cereal, whole grain toast with low-fat milk/ yoghurt, peanut butter on toast, smoothie (fresh fruit of choice); French toast with whole grain, egg white with cinnamon.

2. Three meals per day.

3. At least four servings of vegetables, three servings of fruit per day. Steam/lightly cook vegetables. Add fruit to your cereals/yogurt.

Non starchy vegetables: Onion, cucumber, broccoli, cauliflower, beets, tomatoes, spinach, carrot, lettuce, cabbage, okra, turnip, peppers, mushrooms.

Starchy Foods: Whole grain bread, high fibre cereal, oatmeal, crème of wheat, brown rice, potatoes, pasta, cooked peas & beans, low-fat crackers.

Meat/ Protein: chicken/turkey without skin, fish (salmon, tuna) & seafood.

Lean cut: beef, pork and low-fat cheese.

Add a piece of fruit and 8oz Low fat milk or 6oz yoghurt.

Snack on vegetables at anytime and incorporate into every meal. Eat fruits in moderation.

4. Eat whole grains: Whole grains contain more vitamins/minerals than refined foods, increase bulk, increase satiety and keep blood sugar levels more stable. 20-35g of fibre recommended daily.

5. Healthy Fats:  Olive oil, vegetable oil (canola), Avocado, nuts, nut butters, sunflower seed.

Fats are high in calories; consume healthy fats consumed sparingly for adequate weight management. Trim fat from meats.

Avoid saturated fat and trans-fat: these are found in meats, whole fat dairy (butter and cheese), margarine, lard, cocoa, butter, egg yolk, coconut and vegetable shortening (often found in baked goods).

Choose fat-free dressings, oil vinegar dressings.

6. Combine your healthy meal plan with 30 minutes of exercise every day. 10 minutes x 3 of brisk walking can produce the same benefits as a 30 minute session.

Take the stairs, walk to your car, watch TV or read while on a treadmill or exercise bicycle. Get started, start slowly and persist.

7. Avoid foods with corn syrup, dextrose, sucrose, glucose, fructose, high fructose corn syrup or molasses as first few ingredients. Avoid alcohol if your blood sugar is not under control. Avoid Low calorie artificial sweeteners.  Finally, also avoid eating at restaurants.

 

 

Update October 2014

Up to date research has shown that two large meals per day – breakfast and lunch –  can help with weight loss and blood glucose control. This meal plan was compared to six smaller meals per day with similar caloric content (calories). 
The study included persons with type two diabetes of varying weights and blood glucose control. There were only 54 participants in the study and none of them used insulin therapy.
This study reinforces previous advice of having a large breakfast everyday and light meals in the evening. However advice may vary if you have certain stomach disorders or complications of diabetes so please ask your diabetes physician before changing your meal plan.

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Diabetes and Alcohol

There are often questions about alcohol use when you have diabetes. Alcohol intake is not encouraged for the following reasons:

  • Alcohol use may result in hypoglycaemia especially if you use insulin or drink alcohol without eating food.
  • Alcohol can increase triglyceride levels, leading to hyperlipidemia.
  • Alcohol may impair your ability to recognise hypoglycaemia and may cause unhealthy eating behaviours due to impaired judgement.
  • Alcohol adds empty calories that are caloric intake devoid of nutritional value, causing weight gain particularly around the abdomen.
  • You should avoid alcohol if you have addiction tendencies, pancreatitis, problems with your cholesterol or triglycerides or nerve damage.
  • You should avoid alcohol if you are starting a program for getting your blood glucose controlled.
  • If you are known to drink alcohol this could be a concern because others may mistake an episode of hypoglycaemia for alcohol intoxication.

If your blood glucose is under control (and has been for more than one year) and you have no complications, and you choose to drink alcohol:

  • Check your blood glucose before and after drinking alcohol.
  • Have the alcohol with food to slow the absorption of the alcohol.
  • Do not drink in excess (12oz beer, 5oz wine, 1 ½ ounces liquor)
  • Do not drink when you are alone
  • Have glucose tablets or gel on hand for to treat hypoglycaemia.
  • Do not add exercise to alcohol use.

Alcohol intake is not recommended when your blood glucose is not well controlled.

The recommendation is no more than two drinks for men and no more than one for women per day.
However, in a recent study, drinking alcohol more than twice a week was found to increase the risk of death from stroke. Diabetes also increases the risk of stroke. See Diabetes News

Talk to your diabetes physician about what is safe for you.