Type 1 Diabetes in Children, Adolescents and Young Adults

Comments on Type 1 Diabetes from reviewers i Acknowledgements xii Preface Foreword by Dr Peter Swift Foreword by Dr Stuart Brink . xv 1. Introduction . 1 2. Getting to grips with diabetes 4 When you first find out you have diabetes 4 Very young children 6 Routine check-ups 6 Living the life you choose 7 3. Caring for your own diabetes 8 Goals for managing diabetes 8 How can you achieve these goals? 8 Becoming your own expert 9 Can you take time offA" from diabetes? 10 Alternative and complementary therapies 11 4. Diabetes: some background 12 Type 1 diabetes 12 Type 2 diabetes 12 Other types of diabetes 14 How common is diabetes? 14 Can you catch diabetes 16 Does eating too many sweets cause diabetes? 16 5. How your body works 17 Insulin 18 Your body doesn't realize it has diabetes 20 The anatomy of your body 21 Pancreas 22 Islets of Langerhans 23 Cellular metabolism 24 A healthy cell 24 Starvation 24 Diabetes and insulin deficiency 25 6. High blood glucose levels 26 What happens in the body when there is not enough insulin? 27 How to treat a high blood glucose level 28 Ketoacidosis 29 Blurred eyesight and diabetes 30 7. Regulation of blood glucose 31 Counter-regulation 31 The liver 32 Glucagon 33 Adrenaline 36 Cortisol 38 Growth hormone 38 8. Hypoglycaemia 39 Blood glucose levels and symptoms of hypoglycaemia 42 Symptoms of hypoglycaemia when the blood glucose level is high 44 Severe hypoglycaemia 44 Seizures 46 Does severe hypoglycaemia damage the brain? 46 Hypoglycaemia unawareness 48 Rebound phenomenon 49 Too little food or too much insulin? 50 Night time hypoglycaemia 51 Dawn phenomenon 54 Somogyi phenomenon 54 Will low blood glucose levels return to normal if the child doesn't wake up? 56 Can you die from hypoglycaemia? 56 Why does awareness of hypoglycaemia occur at different levels of blood glucose? 57 9. Treating hypoglycaemia 60 Practical instructions 60 Timing and hypoglycaemia 63 Helping someone with diabetes who is not feeling well 63 Glucose 64 Fructose 64 Sweets and hypoglycaemia 65 xiii xiv After hypoglycaemia 66 Learning to recognize the symptoms of hypoglycaemia 67 10. Insulin treatment 68 Regular short-acting insulin 69 Intermediate-acting insulin 69 Basal insulin analogues 69 Intravenous insulin 69 Rapid-acting insulin 70 Basal insulin 71 New basal insulins 71 Pre-mixed insulin 72 A larger dose lasts longer 72 Units and insulin concentrations 72 Twice-daily treatment 73 Three-dose treatment 73 Multiple injection treatment 74 Injections before meals (bolus insulin) 74 When should you take your premeal dose? 75 Insulin pump 77 Can I skip a meal? 77 Bedtime insulin 78 When should bedtime insulin of NPH type be taken? 78 When should the long-acting injection be taken? 78 Mixing insulins 79 Depot effect 80 How accurate is your insulin dose? 80 Insulin absorption 80 What happens if a child won't finish a meal? 82 What if you forget to take your insulin? 83 What if you take the wrong type of insulin? 84 Having a lie in at weekends 85 Staying awake all night 86 Shiftwork 86 Birthday parties 86 Insulin at school and day nurseries 87 Sleeping away from home 87 11. Monitoring 88 How many tests should I take? 88 GoodA" or badA" tests? 90 Diabetes or not? 91 Are some things forbidden? 91 Urine glucose 92 Renal threshold 92 Blood glucose 94 How do I take blood tests? 94 Borrowing someone else's finger-pricking device 95 Does the meter show the correct value? 96 Continuous glucose monitoring 97 Children and blood glucose tests 98 Does continuous finger-pricking cause loss of feeling? 99 Ketones 99 Vomiting and ketones 101 Blood ketones 102 12. The HbA1c test 105 What level should HbA1c be? 105 How often should you check your HbA1c? 108 Can my HbA1c be too goodA"? 109 HbA1c when travelling 109 Is it worth taking tests? 109 Fructosamine 110 13. Injection technique 111 Getting used to injections 111 Injections for parents 111 Taking the pain out of injections 112 Where do I inject the insulin? 112 Is it necessary to disinfect the skin? 117 Storage of insulin 117 Syringes 118 Injections with syringes 119 Pen injectors 119 Why aren't all insulins available for pens? 120 Replacing pen needles 120 Different pens for day and night time insulin 121 Air in the cartridge or syringe 121 Insulin on the pen needle 122 Used needles and syringes 122 14. Injection equipment 123 Automatic injectors 123 Jet injectors 123 Insuflon 123 15. Adjusting insulin doses 128 Starting insulin treatment 128 How much does insulin lower the blood glucose level? 131 What to do if your blood glucose level is high 133 Different ways of adjusting insulin doses 135 What about the food you eat? 135 vii Changing the content of the meal to affect blood glucose 136 Changing insulin doses 137 Keeping good records 139 What is the best order for changing the doses? (multiple injection treatment) 139 Premeal bolus doses 140 Insulin for breakfast 140 Insulin for lunch and dinner/tea 140 Insulin for evening snack 140 Holiday or weekday? 141 Physical exercise or relaxation? 141 Using rapid-acting insulin analogues 141 Adjusting the basal insulin 143 High blood glucose levels 143 Hypoglycaemia 144 Exercise 145 Pre-mixed insulin 145 Switching to rapid-acting analogues 145 Can you eat the same things as before? 148 Bedtime NPH insulin 149 What should you do next? 152 Blood glucose levels at nght 154 Night time hypoglycaemia 156 Basal analogues: Levemir 156 Basal analogues: Lantus 156 Puberty 158 Insulin adjustments during the remission phase 159 Hypoglycaemia 161 Experiment! 162 16. Insulin pumps 163 Starting the pump 165 The basal rate 167 Temporary change of the basal rate 168 Premeal bolus doses 169 Change of insertion site 172 More frequent home monitoring 174 Insulin depot with a pump 176 Ketoacidosis 176 Disconnecting the pump 178 Taking a bath or shower 178 Pump alarm 179 Occlusion or blockage alarm 179 Leakage of insulin 181 Air in the tubing 182 Sick days and fever 182 Pump removal doses 184 Admission to hospital 185 Physical exercise 185 Using the pump at night only 86 Is the pump a nuisance? 187 Does using a pump cause weight gain? 187 Having a lie in 187 Travel tips 188 Toddlers using pumps 188 Pregnancy 189 Rapid-acting insulin in the pump 189 Which type of treatment do the health professionals prefer? 190 17. Side effects of insulin treatment 192 Pain 192 Insulin leakage 192 Blocked needles 192 Bruises after injections 192 Fatty lumps 193 Redness after injections 194 Insulin antibodies 194 Lipoatrophy 195 Insulin oedema 195 18. Insulin requirements 196 How much insulin does your body need? 196 Puberty and growth 196 Remission ( honeymoonA") phase 197 How much insulin does the pancreas produce? 198 Insulin sensitivity and resistance 199 Ideal insulin doses? 202 19. Nutrition 204 Absorption of carbohydrates 205 Emptying the stomach 207 Sugar content in our food 209 Taking fluids with food 210 Dietary fats 210 Dietary fibre 212 Glycaemic index 213 Milk 214 Vegetables 214 Potatoes 215 Bread 215 Pasta 216 Meat and fish 217 Pizza 217 Salt 217 Herbs and spices 218 Fruit and berries 218 Mealtimes 218 Snacks 218 Can mealtimes be changed? 219 Hungry or full? 219 Infant feeding 220 Carbohydrate counting 221 Different methods of carbohydrate assessment 221 School 224 Party-time 225 Special diabeticA" food? 225 Fast foodA" 226 Food at educational camps 226 Vegetarian and vegan diets 226 Different cultures 227 20. Sweeteners 228 Sugar-free? 228 Non-nutritive sweeteners 228 Nutritive sweeteners 230 Diet drinks and lightA" foods 231 21. Sweets, treats and ice cream 232 How much extra insulin should you take? 233 Ice cream 235 Chocolate 236 Sweets 236 Weekend sweets 237 Taking a break from eating sweets 238 Potato crisps 240 Chewing gum 240 22. Weight control 241 Satisfied or feeling fullA"? 241 Reducing weight 242 The little extras 243 High HbA1c and weight loss 243 23. Eating disorders 245 24. Physical exercise 247 Exercise and insulin action 248 Exercise and hypoglycaemia 249 Can the blood glucose level increase through exercise? 250 Hypoglycaemia after exercise 252 Physical education 254 Top level competitive sports 255 Keeping fit with diabetes 258 Camps and skiing trips 259 Marathon efforts! 260 Adventure travel 260 Anabolic steroids 261 Diving 261 25. Stress 264 Stress in daily life 265 26. Fever and sick days 267 Nausea and vomiting 268 Gastroenteritis 270 Wound healing 272 Surgery 272 Drugs that affect blood glucose 273 Teeth 273 Vaccinations 274 27. Smoking 275 Passive smoking 276 Giving up smoking 276 Snuff 277 28. Alcohol 278 Alcohol and the liver 278 Why is it dangerous to be drunk with diabetes? 278 Basic rules 279 What if you've had too much to drink? 280 Can you drink at home? 280 29. Illegal drugs 281 UppersA" 281 Benzodiazepines 282 Cannabis 282 Hallucinogenics 282 30. Pregnancy and sexual issues 283 Pre-pregnancy care 285 Caring for the mother 285 How will the child develop? 286 Will the child have diabetes? 286 Infertility 287 Does the need for insulin change during menstrual periods? 287 Sexuality 287 Contraceptives 288 Forgotten to take a pill? 290 Emergency contraception 290 31. Social issues 291 School 291 Day nurseries and child care 293 Child care allowance 294 Adoption 294 Choice of job or employment 294 Military service 295 Licence to drive 295 Driving and diabetes 296 Insurance policies 298 Diabetes ID 298 Juvenile Diabetes Research Foundation International 299 Children with Diabetes 299 Diabetes Associations 299 The National Service Framework for Diabetes (NSF) 301 Sponsor families 301 Diabetes camps and educational holidays 301 Diabetes and the Internet 302 When does a young person become an adult? 303 Reimbursed accessories 303 32. Travel tips 304 Vaccinations 305 Ill while abroad? 306 Diarrhoea problems 306 Passing through time zones 307 33. Associated diseases 310 Coeliac disease 310 Thyroid diseases 311 Skin diseases 311 Infections 312 Fungal infections 312 34. Complications in blood vessels 313 What causes complications? 313 Large blood vessels 315 Small blood vessels 316 Complications affecting the eyes (retinopathy) 317 Treatment 317 Disturbed vision at unstable blood glucose levels 318 Glasses 319 Contact lenses 319 Complications affecting the kidneys (nephropathy) 319 Treatment 321 Complications affecting the nerves (neuropathy) 321 Treatment 323 Other complications 323 35. Lowering the risk of complications 324 The DCCT study 324 The Oslo study 327 The Stockholm study 327 The Berlin eye study 327 The Linkoping studies 328 The HvidA re study 328 36. Research and new developments 329 New treatments for diabetes 329 Implantable insulin pumps 329 Blood glucose meters 329 Glucose sensors 330 C-peptide 330 Vaccinations 330 Salicylic acid 331 Amylin 331 GLP-1 (glucagon-like peptide) 332 What causes diabetes? 332 An autoimmune disease 332 Heredity 333 Environmental factors 334 Cows' milk 335 Climate 336 AGE 336 Blocking the immune process 337 Immune treatment 337 Light treatment 337 Diazoxide 338 Nicotinamide 338 Transplantation 339 Pancreas 339 Islet transplantation 339 Engineered cells 340 Other ways of administering insulin 340 Nasal spray 340 Inhalation of insulin 340 Tablets 341 Insulin as suppositories 341 Chemical alteration of the insulin molecule 341 37. Psychology 342 The onset of diabetes 342 Diabetes rules or family rules? 343 Making friends with your diabetes 345 Diabetes affects the whole family 346 Being a relative or friend of someone with diabetes 347 Telling your friends 348 How do you change your lifestyle? 348 Diabetes at different developmental stages 349 Infants (0-1.5 years) 349 Toddlers (1.5-3 years 350 Preschool children (3-6 years) 351 Primary school children 352 Intermediate-level children 353 Puberty 354 Healthy siblings 356 Divorced families 357 Fathers' involvement 358 Brittle diabetes 358 Quality of life 359 38. Needle phobia 360 39. Well-known people with diabetes 362 Halle Berry 362 Gary Mabbut 362 Tara Moran 363 Steve Redgrave 363 Epilogue 365 Artwork and other credits 365 Glossary 368 Units 368 Terms 368 References 377 Index 392