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When your child is diagnosed with diabetes, it
is normal to be frightened, sad and even
depressed. The following conversation is
based on the questions and emotions
many parents experience at the time
of their child’s diagnosis.
We hope these questions and
answers – gathered from diabetes
educators, doctors and parents of
children with diabetes – will help
give you the basic information and
reassurance you need right now as
you begin to cope with your child’s
new diagnosis of type 1 diabetes.
My daughter Jennifer has diabetes! I’m really scared!
It’s okay to be scared. Your fears are normal.
It might help to look at it like this: not only
does Jennifer have diabetes, but your family
does, too!
Do you mean diabetes is contagious?
No. You can’t “catch” diabetes (although it does run more in some
families than in others). What we mean is that Jennifer’s diabetes will
have a big impact on all the members of your family.
But, I’m really scared!
Who wouldn’t be? You’re probably
thinking that you don’t know
enough about diabetes to take care
of Jennifer and are afraid that you
could make a mistake that could harm
her. Maybe you think that you somehow
won’t be able to do what it takes, or your
imagination is taking off with all kinds of
things. But you, your family, and Jennifer’s
caregivers will learn how to help her live a
full and long life.
Welcome toTHE TYPE 1 ‘CHAT ROOM’
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I’m also scared Jennifer could die from diabetes!
Of course, no one knows when a person will die.
But if you take healthful steps, make some lifestyle
changes, and follow Jennifer’s diabetes plan, she
should live the long, healthy life that you expect.
A bonus is that you may also improve
your own and the rest of your family’s
health and longevity with the lifestyle changes
you will be making in your household because
of Jennifer’s diabetes.
But, Jennifer is sick. That is worrisome! How can you say she can be healthy with diabetes?
When children are first diagnosed with diabetes,
they can be very sick. Jennifer may have lost weight,
be dehydrated, or vomiting. With prompt treatment
and insulin, however, a child usually gets back to
normal very quickly.
Why did this happen to us? Did I do something to
cause diabetes?
There is nothing you did that caused diabetes
or that you could have done that would
have prevented type 1 diabetes. Researchers are studying the reasons why
children get diabetes. In type 1 diabetes, the cells that make insulin are
destroyed. Therefore, there is not enough insulin available for energy.
Type 2 diabetes is different. Type 2 is often a result
of children being overweight. Insulin is produced but
doesn’t work properly. Type 2 often runs in families.
Jennifer has type 1, so that’s where our focus will be.
Our hopes and dreams for Jennifer are blown away. I can’t believe it!
It is normal to grieve when your child gets sick. You are probably in
shock. Maybe you are thinking that your perfect child is no longer
perfect. But, hold on a minute! Your doctor or nurse probably didn’t say
anything like that! It’s important to recognize these feelings but realize
that there is a lot of information you need to learn now. Try to stay
focused on learning so you and Jennifer can go home from the hospital as
soon as possible.
Jennifer can live a normal life – yes, normal
– as long as you, your family, and others
learn to help Jennifer manage her blood
sugar (glucose) levels. Your household will
just have a different definition of “normal.”
You will learn to balance healthful eating,
exercise, monitoring blood glucose (sugar)
levels, and adjust insulin as you go
with the help of your doctor and
diabetes educator.
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Okay, I’m a little calmer now. But before I learn more, I have to ask you again –
can Jennifer really have a “normal” life or is diabetes a disability?
Diabetes is a chronic illness, which is classified as a disability
by the Americans with Disabilities Act (A.D.A.). The A.D.A.
and other Federal and State laws protect children with
disabilities from discrimination. Schools must give children
with disabilities an equal opportunity to participate in all
activities and services unless doing so would impose an
undue burden. Don’t be afraid to talk to your school about
what Jennifer needs to manage her diabetes at school.
When her blood sugar levels are well controlled, Jennifer
can do anything anyone else does. Kids with diabetes ride
bikes, play sports, swim, dance, date, grow up, get married, have
children, grow old, have grandchildren – just like everyone else.
Jennifer has some special needs, but with
care, diabetes should not get in the way.
From now on, “normal” will include
diabetes management tasks.
It can’t be that simple, can it?
It is not simple. Balancing it all
is not easy. Sometimes it can
be downright challenging. So,
be patient with yourself and
use the resources available
to you, such as your diabetes
educator and dietitian.
Challenging – I’ll bet it’s challenging! So, what do we need to do?
Great question! Let’s talk about a few things
that you will need to learn, such as:
• What happens in Jennifer’s body when she eats or drinks
• How to monitor her blood glucose levels
• Signs and treatment of high and low blood glucose levels
• Jennifer’s blood glucose target range (your doctor will tell
you what blood glucose value is the best for your child.
It may be a range of 80-140 mg/dl, for example)
• How to give insulin
• How to plan meals, snacks and count
carbohydrates
• How to balance food, exercise, and insulin
• How to work with your diabetes health
care team
I want my child to be a healthy, happy person.
Now there’s a word to consider – person!
From this moment, you must think of
Jennifer as a “person first.” Jennifer
is not “a diabetic.” She is a person
with diabetes.
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I don’t get it! The doctor said Jennifer has diabetes. Doesn’t that make her a diabetic?
Look at it this way. Every person is different. Some wear glasses,
others have musical talent, and some are funnier than others. Jennifer
has diabetes. If we think of her as “a diabetic,” it becomes a label.
She is a person first and a kid who happens to wear glasses and
have diabetes.
Now that makes sense! So from now on I’ll put my whole child first, ahead of the
disease. But will others see her that way?
Some will, and you’ll need to teach the rest. As a
parent you must address physical, mental, and
emotional concerns. Diabetes can sometimes
affect the stages that your child goes through
as she grows and develops, such as issues
with independence, or separation anxiety.
You may need to help Jennifer deal
with her feelings of being different
from others because of diabetes.
So, what do you say? Are you ready
to learn more?
Let’s do it! Can we start with eating and drinking?
Whenever we eat and drink, the food is digested in
the stomach and turned into sugar or glucose. Although
protein also contributes to the amount of glucose, most of the
sugar comes from starches, called carbohydrates.
The sugar or glucose then travels into the blood to feed the cells of your
body. Sugar gives cells the energy your body needs to function.
Sugar needs help to get inside the cell and be able to be used for energy.
Normally, insulin helps the sugar get into the cells for energy. But when
someone has type 1 diabetes, there is not enough insulin. So the sugar
can’t energize cells and the level of sugar in the blood rises.
What happens to all that sugar?
That’s just the problem! The sugar stacks up in the bloodstream. That
is called hyperglycemia or high blood glucose
levels. When blood sugar levels run high,
blood vessels can be damaged. Eventually,
the damage causes complications such as eye,
kidney, nerve, heart and blood vessel problems.
Now wait a minute and don’t panic. This
happens over time if blood sugars stay high.
That’s why you’re learning how to control
diabetes now, so that complications can be
minimized or even prevented later.
What do you feel like when you have hyperglycemia?
People with diabetes who have hyperglycemia
can feel a lack of energy. They get thirsty, and
have to urinate frequently when blood sugar
levels run high. If the blood sugar remains high for a
period of time, the body begins to burn fat for
energy. When the body does this, it makes a
chemical called ketones that can be detected in the urine.
Sometimes they complain of blurred vision and can
have unexplained weight loss.
But you said Jennifer could live a normal life. What kind of life is it when you have to go to the bathroom all the time, always feel thirsty, and have no energy?
Those are the right questions to ask! But the truth
is that all these unpleasant symptoms will go away
when blood sugar levels are brought under control.
You mean Jennifer won’t have to feel those things ever again?
Blood sugar levels normally go up and down all of the time,
so there will be times when Jennifer may feel very thirsty or
have frequent urination. However, even if her blood sugar
is running high from time to time, you will learn how to
correct it quickly.
Your doctor or
diabetes educator
will give you a target
range for blood sugar
levels. If Jennifer’s
sugar is running higher
than that range, she
may experience these signs. They are alerting
you that Jennifer’s blood sugar is out of control.
High blood sugar levels can damage blood vessels and organs over time
if left untreated. That’s a good reason to try to keep them as close to
the target range as possible. Keep in mind that there may be times,
no matter how hard you may try, that blood sugars will go high or low.
When you are having a difficult time, keep in touch with your diabetes
team for help.
Then, what can I do to keep Jennifer’s sugar under control?
Control comes from balance. You have to learn about
balance so you can teach your child. You will most likely
need to teach other family members, too! But first, we
need to talk about blood glucose monitoring.
Make Blood Sugars Go Up
• Food
• Stress
• Illness
UPMake Blood Sugars
Go Down
• Exercise
• Medicine
DOWN
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Okay, I’m all ears! Tell me about blood glucose monitoring.
You and Jennifer will learn how to use a blood glucose meter. You’ll put
a tiny drop of blood on a little strip and the meter will tell you how much
sugar is in the blood. You’ll do this before every meal and at bedtime.
You may sometimes need to check the blood between meals and bedtime
or even in the early hours of the morning if Jennifer has signs of
running too low or too high.
Please tell me I don’t have to stick my child all the time!
The straight answer, unfortunately, is “yes, you do.” Let’s face it –
nobody likes that. But honestly, the lancets are so small and fine that
they hardly hurt at all. It is usually the idea that is more objectionable
than the actual poke.
I feel so sorry for Jennifer.
Try to prick your own finger and see how
painless it really is. Of course, no one
wants to stick one’s finger all the time, but
your child will learn to handle it. Hugs are
important for you both! Remember that
you’re doing what you have to do to keep
Jennifer healthy. Don’t forget that she needs
regular rules too. If talking back wasn’t OK
before diabetes then it’s not OK now. If
Jennifer doesn’t understand regular rules she
won’t understand rules about taking care of diabetes.
Okay, but tell me this: once we know the glucose level is too high or too low, what do we do about it?
More great questions! If a glucose level is too
low (hypoglycemia), Jennifer may need to eat
something sweet. If the blood sugar is too
high (hyperglycemia), Jennifer may have to take
more insulin or exercise to bring the blood sugar
down. Check with your doctor for advice on
how to treat low and high blood sugar. Your
diabetes educator will also teach you how to
check your child’s urine for ketones. If ketones
are present, you will need to call your doctor
for further instructions.
Your diabetes educator will provide blood sugar numbers for your action
plan of treatment. For example, if your target is to keep blood sugar
levels over 80 and Jennifer has a blood sugar of 70, your action plan
might say to give her 1/2 cup of juice, or 2 to 4 glucose tablets. If blood
sugar is below that, your plan may say that you can add 6 crackers. The
specific treatment for Jennifer will depend on her age,
size, type of insulin and when her next scheduled
meal or snack is due.
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So, what if the blood sugar is low. You said, “eat.” Eat what?
Children with diabetes should never be without glucose tablets or some
other form of sugar. You and Jennifer will carry them all the time for
just this use. Glucose tablets taste good, and come in various flavors.
Juice is another great way to get the blood sugar up
where it belongs. Or the child can eat any of a
number of fast-acting carbs (carbohydrates) like
hard candy or raisins.
Jennifer can eat candy?
Actually, yes! Jennifer can have candy
occasionally, as long as she exercises or takes
insulin. Naturally, your dentist won’t like the
candy idea. The secret is balance. A small
piece of candy or an occasional cookie is
not usually a problem. But this is where
the family meal
plan comes
in. Remember
we said, “in a
way, you all have
diabetes.”
Well, let me take the worst case first! I suppose taking insulin means another stick.
Unfortunately, yes. But again, the stick
isn’t too bad. Try taking an injection
with an empty syringe to see what it
feels like so that you know what your child is experiencing.
This will encourage Jennifer to take the insulin. Don’t tell her
“this isn’t so bad” when you took just one shot and she will
take thousands. The current needles are extremely small and
comfortable. Jennifer may need to take insulin before meals
and bedtime.
You might use a special pen that delivers insulin,
or a pump might also be an option.
A pen is a
device that looks like a pen that you
use to write. It contains a cartridge filled
with insulin and a needle is attached to the end of it. The needle is
changed every time the pen is used. You dial in the insulin dose, place
the needle into the skin and press the button. The insulin is given. The
pen makes giving insulin easier and more convenient for your child,
especially if several injections of insulin are needed.
The pump delivers a continuous flow of insulin through
a very small tube that looks like a tiny straw placed
under the fatty layer of skin. The tube, called a
catheter, is introduced into the skin with a needle
that is then removed. The catheter stays in place and
insulin can flow to the fatty layer of the skin without further
injections. The catheter can stay in place for up to three days. You
program the pump to deliver insulin before meals and snacks. It takes
some practice, but even a youngster can do it with adult supervision.13
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What do you mean?
Kids just don’t want to be different. It is usually
hard for a youngster to eat healthy foods when
the rest of the family is chowing down on sweets
and high fat snacks. If you think about it a
minute, we’re sure you’ll agree. You simply can’t
have cookies, chips, candy, and sweet desserts
around and expect your child not to eat them.
Jennifer will develop healthy eating habits from
the way your whole family eats. So, the
other family members might have to
face some lifestyle changes, particularly
the way they eat – and what they eat!
So Jennifer can’t ever have a cookie?
Now don’t put words in our mouths or
pull the cookie out of her mouth! Sure kids
with diabetes can eat a cookie. But it
needs to be planned and included
in a healthy meal plan. You will
learn to be smart about it. By that
we mean there’s a smart time to
have something sweet. Just before
exercise, for example, is a smart time.
It’s a good idea to eat a snack prior to a ball
game so Jennifer doesn’t have low blood
sugar and run out of energy in the middle
of the game.
You said something earlier about balance.
We really have been talking about balance all along.
Food, exercise, and insulin have to be balanced.
Exercise consumes energy. Food produces sugar.
Insulin makes sugar work right in the body. Too
little exercise and the blood sugar will become too
high. Too much food will have the same effect.
Too much insulin will make the blood sugar too
low. You get it, don’t you? Balance!
How am I ever going to learn all this? How can Jennifer, and everyone else in the family, even grandma?
That’s where your diabetes health care team comes in. They will
teach you and guide you. Hopefully, you’ll have a doctor, nurse,
dietitian, and a diabetes educator on the team. Sometimes one
person will fill several of those roles, but you’ll need plenty of help.
Other helpful resources are
the Juvenile Diabetes Research
Foundation (JDRF), and the
American Diabetes Association
(ADA). You can find support,
information about activities and
summer camp there. Don’t
forget websites on the Internet
as well, like the BD website at
www.bd.com/us/diabetes.
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Doctor:
Phone #
24 Hour Emergency Phone #
FAX Blood Glucose Records to:
Nurse Educator Phone #
Registered Dietitian Phone #
School Nurse Phone #
Resources in Community
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You can! You will! You must! After all, it’s your child we’re talking
about! Your child with diabetes can live a normal, healthy, and
happy life. These lifestyle changes we’ve been discussing will help
you and your family live a more healthy lifestyle, too.
One thing that is important for you to do is to form a network
of people who can help and support you. You know – folks
you can call on, cry with, laugh with, and count on!
Thanks. This has really helped a lot!
You’re most welcome. We know you’ll
take good care of Jennifer!
I HopeI CAN DO IT!
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10D06412354SAPBROBD and BD Logo are trademarks of Becton, Dickinson and Company. ©2010 BD.
BD provides this brochure for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this brochure.
1 Becton Drive Franklin Lakes, NJ 074171.888.BDCARES (232.2737) www.bd.com/us/diabetes
Written by: Jean E. Betschart Roemer, CPNP, MSN, MN, CDE Pittsburgh, PA
We wish to acknowledge the following health professionals for reviewing this publication and providing their valuable insights:
Jodi Moore, RN, BSN, CDE New Brunswick, NJSusi Johnson, RN, CDE Houston, TexasJennifer Lavoie, RN, BSN, L LT San Diego, CA
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