Smart Parenting Guide

Law Of Attraction For Kids

Winsome Coutts, a mother of two and a grandmother, has a teacher's certification in education and she has taught several schools in Australia and Canada. She has also written hundreds of articles concerning self-development. Winsome has a passion for the Law of attraction, meditation, Self-help of Personal development, goal setting, and the secret movie. She decided to engage in the pursuit of knowledge in the mentioned areas throughout her life. Winsome has considerable experience raising children following her studies in Child psychology at University, and as a past teacher, a parent, and a grandparent. She knows that when children learn how to plan for their future and how to achieve their goals, they have a skill that will last them a lifetime. Winsome personally studied with two popular teachers, John Demartini and Bob Proctor and both are featured in The Secret' movie. For several decades since the early 90s, she has been goal setting for kids, visualizing, and applying the law of attraction. The law of attraction for kids is the first book ever to describe the law of attraction and the term goal setting. The language employed is simple for your children to understand and it will answer any question about the life-changing topics in a more detailed parent's guide. Read more here...

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How Diabetes May Affect Your Family

Maybe at first it seems as though you should be able to handle things on your own. After all, your family can't hold your hand and watch you do everything. It is still up to you to manage your diabetes, right Yes. But having diabetes is bound to affect your family. Life can be demanding. Finding out you have diabetes may upset the delicate balance of your juggling act. You can't tend to your 2-year-old when you're in the middle of giving yourself an insulin shot. Your partner may begin to resent having you check your blood glucose and take insulin just as you're getting dinner on the table. And sex can lose some spontaneity if you have to eat a snack just when the mood is striking. One way to enlist your family's support is to look at your schedule and routines. Probably the best way to approach this is to enlist their support right away. Hold a family meeting and explain how important it is to coordinate insulin doses, exercise routines, and meals. Ask for suggestions as to how your...

Your Family and Friends Your Captivated and Caring Audience

Your audience is the people you live with, eat with, and play with. Your family and friends can be a tremendous source of help, but you must clue them to the fact that you have diabetes. If you have type 1 diabetes, you can teach them how to recognize when your glucose is too low, in case you're ever too ill to take care of yourself. If you have type 2, ask them to moderate their diet so that you can follow yours. A diabetic diet is good for anyone. Complying with your diet is difficult enough, and you don't need your family exposing you to high-calorie foods. A family member or friend can also become your exercise partner. Sticking to a program is a lot easier when a partner is counting on you to show up to work out. Your family and friends can also accompany you when you visit the doctor and remind you to ask the doctor a question or to follow the instructions you received.

Encourage Your Child to Play Video Games Really

1 Starbright Life Adventure Series Diabetes comes from the Starbright Foundation, a nonprofit organization that develops programs to help seriously ill children cope with the challenges of their illnesses. This particular program uses interactive adventures to teach children to manage their diabetes properly. There are exercises, quizzes, and arcade games, and the program is available in Spanish. It's available on CD-ROM free of charge for a family that has a child with T1DM between the ages of 5 and 13. Call 800-760-3818 for more information.

Your Childs Changing Role

Just how much you can expect your child to handle with respect to his diabetes care will change as he matures and will depend on his personality. If your child is an infant or toddler when diagnosed, you will be completely responsible for your child's care. But you can and should still keep him involved. You will have to see that your child gets his shots at the right time and you will have to check his blood glucose and evaluate the results, but you can give your child a voice. Let him pick the injection spot or the finger to poke. This is a good way for your child to get used to having a say in his care. It will help him to develop a sense of responsibility so that you can gradually help him assume more and more of his own diabetes care as he grows older. If your child is in preschool, you are still responsible for making sure she is eating based on the plan you have worked out together, doing blood glucose checks whenever necessary, and taking the right type and dose of insulin at...

Dealing with Your Childs Diabetes

The first step in helping your child manage his or her diabetes is to learn all you can. Other chapters in this book and Internet resources are a good starting point (see the Resources section at the end of this book for ideas). You will also want to talk to your child's care provider and diabetes educator. Try to schedule an appointment that is long enough so that all your questions and concerns can be addressed. In general, you will need to know how to check your child's blood glucose, how to give insulin, how to use a meal plan, and how to figure out an insulin dose and give injections. You will also want to know the extent to which your child can begin to take responsibility for her own care. If your child is only 2 years old, it is unrealistic to expect her to give herself insulin or test for blood glucose, but if your child is 10, she may very well be capable of checking her blood. Children mature at different rates. Some may be ready to give their own injections at age 7, but...

Your Childs Rights Are Your Schools Responsibilities

Once you have met with school personnel and discussed your child's needs, as set out by his or her Diabetes Medical Management Plan, hopefully the school will accommodate your child. Almost all schools are required by law to provide aids and related services to meet the needs of children with diabetes. Three federal laws may play an important role at school. Section 504 of the Rehabilitation Act of 1973 protects individuals with disabilities against discrimination in any federally funded program, including public school systems. The Americans with Disabilities Act provides similar protection in all public and private schools, except those schools run by religious institutions. Both laws have been found to protect children with diabetes. The Individuals with Disabilities Education Act (IDEA) guarantees free appropriate public education including special education and related service programming for all children with disabilities. This law only applies to those children whose diabetes...

What Your Family Can Do

Sometimes problems arise among family members when they don't really understand the disease. If your teenager is grumpy because he has to wait for you to take an insulin shot before you drive him to the mall, it may be because he doesn't understand how important it is. And if your spouse is waving potato chips under your nose when you are trying to cut back, she may not understand the importance of your goal to eat healthily. Many people think that treating diabetes is as simple as taking As a first step, each family member needs to understand what diabetes is, how it is managed, and how to handle emergencies. There is lots of help available. Books, magazines, pamphlets, libraries, support groups, on-line message boards and chat rooms, and medical professionals can all be of assistance. Take a family member with you to some of your health care appointments. By keeping a running list of questions or issues with which they may be concerned, your family can get answers to their questions...

Knowing that your child is in good company

So many people have T1DM that there are bound to be some really outstanding scholars, athletes, politicians, and leaders in all walks of life in the mix. They prove that there's no limit to what your child can do in his life with T1DM. In particular, they prove that T1DM doesn't make you uglier, dumber, slower, or weaker. Your child is a person with T1DM. How he lets that fact affect his life will determine the shape of his life, not the diabetes. The people I describe in the following sections are able to live their lives to the fullest regardless of their diabetes. And your child can, too. Right now, your child can't be cured of T1DM, but he doesn't have to let it get in the way of whatever he wants to be and do. In 2007, a cycling team of 11 men with T1DM called Team Type 1 bicycled 3,043 miles across America in five days. This feat would have been impressive had it been accomplished by a group of completely well people what makes it exceptional is that these cyclists had to test...

Help Your Family

If you had cancer, your whole family should be freed of intestinal fluke parasites to protect you They may not be getting cancer (yet ) but your closeness puts you at risk. Kissing on the mouth could reinfect you. Request that family members zap themselves and take at least one 2 tsp. dose of Black Walnut Hull Tincture Extra Strength while living with you.

Helping siblings be understanding

Being the brother or sister of someone with T1DM is a tough assignment. On the one hand, your other children envy all the time and attention that your child with diabetes gets from you (the parent). On the other hand, they may be fearful of getting it themselves. They also may witness a severe hypo-glycemic episode, which can be very scary. It's a good idea to educate your other children so that they know something about diabetes, especially how to manage hypoglycemia. You can certainly take non-diabetic children to diabetes education sessions. It's important that all your children share things as kids together, playing together, going to movies together, and so forth. Their relationship should be based on the fact that they're members of the same family, not a sibling and a child with diabetes. The sibling with T1DM is first of all a person, and the fact that your children share the same parents creates a special bond that lasts a lifetime.

Your Young Adult Child Has Diabetes

When your child becomes a young adult, you definitely want to give up the control that has helped your child to thrive up to this point. Your child should be doing his or her own testing. He or she is ready to leave the pedi-atric level and begin to work with doctors who care for adults. This means that you are probably out of the loop. Your child should now have the skill to choose appropriate insulin treatment based upon blood glucose levels and calories of carbohydrate consumed (see Chapter 10). Your child now has new challenges, including finding work, going to college, finding a future mate, and finding a place to live independently. At the same time, the reluctance to admit to diabetes and the desire for a thin body continue to complicate care. Diabetes care must be intensive at this point (see Chapter 10). Multiple shots of intermediate and short-acting insulin are taken. Your child must follow a diabetic diet (see Chapter 8), and an exercise program is essential (see Chapter...

Preventing Long Term Complications

7 his chapter is the bad news-good news chapter. The bad news is that if you don't manage your diabetes or your child's diabetes properly, you or your child will suffer one or several of the serious long-term complications that I discuss here. The good news is that everything is in place now to prevent this from ever happening in Part III, I tell you what you need to know about controlling and treating type 1 diabetes.

Ensuring a smooth journey

Visit vaccines to find out if your child (and you) needs vaccines for any of the countries you'll be visiting. If your child uses an insulin pump, consider switching him to insulin pens that don't require all the extras associated with the pump (like infusion sets). Talk to his doctor about it, and make the switch at least a week before you leave so that your child can transition smoothly in a setting where everything is more or less under your control. i When traveling by air, have your child drink lots of fluids because airplane travel is dehydrating.

Using sugar substitutes

You can use sweeteners for your child with T1DM by substituting one for sugar in a recipe, but you need to know their sweetening power to use them correctly. I give you the scoop in the following sections. Sugar-free food can still have plenty of fat and protein calories. Because total calories are what counts in the diet, there's no great advantage to eating sugar-free products when the result may be that your child's getting as many or more total calories.

Choosing a Vegetarian diet

Your child with T1DM may decide that he wants to follow a vegetarian diet when he reaches his teens. At this point, I recommend that you meet with a dietitian to work out a program that provides the essential nutrients while avoiding meat. The fact that there are so many vegetarians who are doing so well and outliving many meat eaters suggests that the diet is a viable option, even for the person with T1DM who needs a specific balance of carbohydrate, protein, and fat.

More School Resources

Tion for Schools and Child Care Providers. The ADA's packet on school discrimination can be obtained at or by calling 1-800-DIABETES. You can also discuss a specific school or day care problem with ADA's legal advocate. A great deal of information is available on the ADA Web site at www. schooldiscrimination.

The Application Of Physical Activity Assessment Population And Outcome Considerations

Physical activity patterns have traditionally differed between men and women Perhaps due to the historic tendency to conduct epidemiological research on men rather than woman, physical activity questionnaires have been more orientated around the types of leisure-time and occupational activities typically performed by men. Women tend to engage in less intense activity and in child care and household activities, all of which are difficult to assess. The use of commonly used questionnaires in women may be less sensitive to differences in activity levels within populations of women. If this occurs, true relationships between physical activity and disease could be obscured. Work is currently being done to more accurately assess physical activity in women.

Better Kitchen Habits

Teach children to cough and sneeze into a suitable collecting place like a tissue, not their hands. Pathogens live bountifully on hands. Hands not only provide moisture but often food from the last meal. Hands are second only to the dish cloth in contamination level. If you must cough or sneeze and a tissue is not within reach fast enough, use your clothing That's what clothing is for to protect you. Cough and sneeze into your own clothing this protects the cougher and sneezer, as well as eve- Teach children this old rearranged verse

Assembling Your Treatment Team and Support Network

Controlling blood glucose levels successfully takes time and effort. Your illness may affect relationships with your partner, other family members, friends, and colleagues, and you cannot take a holiday from your illness. All of these things can be overwhelming, but with a strong team, you can manage your diabetes. This chapter describes how you can assemble the treatment team and support network that you need for the long-term management of your diabetes.

Genetic Testing For Mody

The genetic characterization of the diverse MODY forms is necessary to decide the patient's therapy and helps to predict the pathogenesis of the syndrome. Therefore, testing can be very beneficial, e.g., if the patient can switch to tablets instead of injections. The predominant question in genetic testing is whether a mutation identified has a functional relevance and therefore a meaning for the clinical phenotype. In most cases an analysis of family members is essential and should be ideally performed for several generations. A clinically relevant mutation must be carried by all affected family members, whereas healthy family members must not be carriers. The interpretation might bare inconsistencies because type 2 diabetes can develop for multiple reasons. If no association can be detected it is reasonable that the questioned mutation is functionally apparent and does not alternate gene expression or functionality. It is tremendously important to have sequence information of the...

Epidemiology And The Prevention Of Type Diabetes

Because of the tremendous burden of type 1 diabetes, the rationale for seeking prevention programs is fairly straightforward. Currently, several large clinical trials have begun to evaluate a variety of primary (i.e., the Trial to Reduce Type 1 Diabetes in the Genetically At-Risk TRIGR (118)) and secondary interventions (i.e., the European Nicotinamide Diabetes Intervention Trial ENDIT (119), the Diabetes Prevention Trial-1 DPT-1 (120)) in family members of affected individuals (see Table 3). Eligible relatives are identified by either genetic screening for high-risk HLA-DQ alleles (i.e., TRIGR) or autoantibody screening for P-cell antibodies (i.e., DPT-1, ENDIT). Those who carry disease susceptibility genes or are autoantibody positive are eligible for randomization.

Options For Renal Replacement Therapy

Once the decision for a preferred option is made, preparation for renal replacement therapy should be started. For instance, for those electing hemodialysis, it is important to establish vascular access in the nondominant arm when creatinine clearance is around 25 mL min. For those who have live kidney donors, family members should be blood typed

Protecting Your Job with FMLA

In addition to the Americans with Disabilities Act, the Rehabilitation Act of 1973, and the Congressional Accountability Act, there is another federal law that can help you and your family deal with diabetes in the workplace. The Family and Medical Leave Act (FMLA) was passed in 1993. This law allows workers to take up to 12 weeks of job-protected unpaid leave during any 12-month period to care for their own serious health condition or to care for family members (spouse, child, or parent). FMLA absences may be taken in a single 12-week stretch or in shorter intervals, such as a short period to deal with a diabetes-related illness or emergency or a scheduled doctor's appointment. Employers who normally pay health insurance premiums must continue to do so for an employee on FMLA leave.

What about the effect of physical activity on hemorrhages

Almost all patients assume that any sort of lifting or straining just has to make the little blood vessels in their eyes pop open. It turns out that it is very unusual for a diabetic patient to routinely hemorrhage due to physical activity usually, hemorrhages occur during sleep or rest.2 As a result, patients are not normally given any sort of restrictions. This is important because it allows them to pursue a normal life that includes vigorous exercise and other activities that are beneficial to their diabetic control and overall health. You may want to mention this specifically, even if they don't ask, because some patients will simply assume they should restrict their activity (or their family members may restrict it for them).

Quality Of Life And Obstacles To Care

The delivery of diabetes care and education has undergone a paradigm shift from giving advice and blaming the patient for failure to providing patients with the choice of aggressive, individualized treatment and an education plan tailored to their needs. This shift has melded health care providers and patients as partners in managing a devastating disease. The demands for daily self-management of diabetes are so formidable that each component of the diabetes education curriculum includes discussion of the psychosocial needs of the patient. The embarrassment of hypoglycemia and resultant fear, the social aspects of eating and dealing with well-meaning family members who comment on food choices, the

Nutritional Advice And Structured Training

Each patient with type 2 diabetes needs individual advice and structured training by his or her physician and other members of the healthcare team, to enable them to translate the principles of nutrition in type 2 diabetes into specific actions in daily life (Table 4). A balance must be achieved among the demands of metabolic control, risk factor management, and the patient's well-being and safety. The therapeutic needs of an individual person will change with time and, therefore, continuing nutritional education must be provided (38,39). To improve compliance, the main aspects of dietary advice given to a person with diabetes should also have a potential benefit for family members and should be acceptable to them.

Psychosocial Effects Fear of Hypoglycaemia

Many people with insulin-treated diabetes who have experienced frequent severe hypogly-caemia suffer higher levels of psychological distress, including increased anxiety, depression and fear of future hypoglycaemia (Wredling et al., 1992 Gold et al., 1994a). Fear of hypoglycaemia is also a common source of anxiety for relatives, and may strain marital and family relationships. Spouses have a greater fear of hypoglycaemia, and report experiencing sleep disturbance through worrying about nocturnal hypoglycaemia when compared with the spouses of those who do not suffer severe hypoglycaemia (Gonder-Frederick et al., 1997 Jorgensen et al., 2003). The negative consequences of hypoglycaemia not only affect spouses, but also the parents of children with type 1 diabetes (Clarke et al., 1998), the children of diabetic parents and other family members. Two thirds of a group of 60 spouses of people with type 1 diabetes said that the risk of severe hypoglycaemia was a major source of concern to...

Diabetes Secondary To Chronic Diseases Of Childhood

This group of rare disorders was formerly known as maturity-onset diabetes in the young (MODY) and comprises at least six subtypes of genetically inherited disorders of insulin secretion usually presenting under the age of 25 years and also present in several other family members in different generations (16). It is important to recognise the small number of this unusual and 'mild' type of diabetes in a paediatric clinic (confirmed by special tests in a molecular genetic laboratory) because of the treatment implications. The two commonest types are

Management Of Pregnancy In Diabetes

Pregnancy is in itself an emotionally stressful period, during which the woman is confronted with various psychological and physical challenges. For a woman with diabetes the 'developmental tasks' related to pregnancy are essentially the same as for any woman, i.e. developing attachment to the fetus, preparing for separation, and adopting a realistic relationship with the newborn1617. Pregnancy in a woman with pre-existing diabetes is usually accompanied by a great deal of medical attention, which may lead women with diabetes to feel that their pregnancy is medicalized and being 'taken over' by health professionals, with much of the attention focused on the fetus and its growth. Already existing feelings of ambivalence and fragility in the woman may be strengthened, and complicate the process of developing attachment to the fetus and preparing emotionally for motherhood. The health risks associated with diabetic pregnancy can trigger overprotective-ness in the patient's partner and...

Herbal Parasite Killing Program

Black Walnut Hull Tincture Extra Strength every week or until your illness is but a hazy memory. This is to kill any parasite stages you pick up from your family, friends, or pets. Family members and friends should take 2 tsp. every other week to avoid reinfecting you. They may be harboring a few parasite stages in their intestinal tract without having symptoms. But when these stages are transmitted to a cancer patient, they immediately seek out the cancerous organ again.

Genome Scans for Genes for Proteinuria or Variation in UAE

A partial genome scan for linkage with overt proteinuria was performed in 18 extended Turkish families with 115 members with T2DM (31). Among diabetic family members, there were 61 individuals with normoalbuminuria, 26 with microalbuminuria, and 28 with overt proteinuria. Using parametric linkage analysis, strong evidence of linkage with an elevated UAE (proteinuria only or proteinuria together with microalbu-minuria) was found on chromosome 18q. If a dominant mode of inheritance was assumed, the multipoint LOD was 6.6, and if a recessive mode of inheritance was assumed, the multipoint LOD was only 2.2. A reanalysis of the Pima Indian data found weak evidence for linkage with this genetic region (multipoint LOD 0.7).

Study of Candidate Genes

On the other hand, mutations in PPAR gamma that severely decrease the transactivation potential were found to be co-segregated with extreme insulin resistance, diabetes and hypertension in two families, with autosomal dominant inheritance (96). Interestingly, given the proposed role of PPAR gamma in adipogenesis, no affected family members had any evidence of lipoatrophy or abnormal fat distribution. All together, these data suggest that mutations in transcription factors may contribute to the genetic risk to Type 2 diabetes through various mechanisms dysregula-tion of target genes involved in glucose or lipid metabolism (HNFs, PPAR gamma, IPF1, IB1), abnormal beta-cell development and differentiation (IPF1, NeuroD1 Beta2), dysregulation of beta-cell apoptosis (IB1). Deleterious mutations that significantly impair the transactivational activity of these transcription factors can be responsible in some families for monogenic-like forms of diabetes with late age of onset, which may...

Including delicious extras

Broccoli is one of the most nutritious veggies out there. If you still can't seem to acquire a liking for it though, look no further. Prepare the following elegant recipe for your family or guests, and everyone will be so pleasantly surprised especially when you tell them the rich, savory sauce has barely any fat.

Give up Its just not worth the trouble No matter what I do Ill get diabetes complications

You are not predestined to get diabetes complications. It's true that one study found that, after 20 years of diabetes, 95 percent of the people in the study had some evidence of retinopathy. But early retinopathy can be successfully treated without impairing vision. Like diabetes, heart disease and high blood pressure run in families. If you have genes that make you more susceptible to, for instance, poor circulation, your body might react more to the effects of high blood glucose. Do high blood pressure, obesity, or cardiovascular problems occur in your family These are health conditions that are worsened by high blood glucose levels. If health problems that are aggravated by the effects of diabetes are in your family gene pool, you have even more reason to work hard to lower your blood glucose levels.

Building a Positive Support System

Another key to success is to build a positive support system and surround yourself with people who support you in your weight loss efforts. Take a few minutes to think about your family, friends, and coworkers, and list those on whom you can and can't rely for support. Take some time to think about the attitudes of those around you and how they might affect your weight loss efforts. Make a point of surrounding yourself with people who have a positive attitude about your lifestyle-change efforts. Tell them how they can help the cause (including not encouraging Make a list of specific things that your family, friends, or coworkers can do to support your efforts to eat healthy, be active, and lose weight. Don't hesitate to ask for their support. Here are some specific actions that you can ask your family, friends, and coworkers to take on your behalf

How do you feel about having diabetes

Was diagnosed What was your general coping style Were you calm or nervous Were you persistent or did you give up easily The way you have handled life's problems in general will suggest how well you will cope with diabetes and its treatment. Your age will also have a bearing on how you respond emotionally. Your general physical health prior to the onset of diabetes will also play a role in determining your coping ability, as will your relationships with your family and friends.

Using Expertise Available to

Don't neglect your family and friends as a helpful source. These are the people who love you and know that you would help them if the tables were turned. The problem is that they cannot help you if they do not know what you're dealing with. Tell them that you have diabetes and the risks, such as hypoglycemia, that you face. Tell them how to help you if the need arises. You will find that the result will be a much closer relationship.

Obstacles To Metabolic Control Of Children And Adolescents With Insulin Dependent Diabetes Mellitus

The effects of diabetes mellitus on the school attendance and school achievement of adolescents. Child Care Health Dev 1985 11 229-40 51. Miller-Johnson S, Emery RE, Marvin RS, Clarke W, Lovinger R, Martin M. Parent-child relationships and the management of diabetes mellitus. J Consult Clin Psychol 1994 62 603-10

Case Study Lactic Acidosis

A 74 year old woman presents to the hospital with complaints of recent high blood glucose levels and a feeling of progressively deteriorating fatigue. Her family members report episodes of lethargy and intense sleepiness, as well as confusion during the previous week. The patient suffers from DM (for 12 years), hypertension, coronary heart disease, dyslipidaemia, heart failure and atrial fibrillation. An echocardiogram done three months before showed left ventricular hypertrophy, mitral regurgitation and an ejection fraction of 35 percent. Her medications include glimepiride, 6mg day digoxin, 0.125 mg day rami-pril, 10 mg day furosemide, 20 mg twice a day aspirin, 325 mg day and for the last two months metformin, with a gradual increase of the dose to 1700 mg day. She does not smoke or drink alcohol.

Adjusting insulin intake in a different time zone

The old saying, Go West, young man could be altered to Go West, young person with type 1 diabetes. When T1DM is involved, it's a lot easier to travel west than east over several time zones. Here are the differences in insulin intake depending on your child's time zone changes i You add hours to your day when you head west, so all your child has to do is check his blood glucose an extra time or two and add short-acting insulin to cover those hours. He doesn't change the long-acting insulin but resumes his usual schedule when he gets to the new time zone. 1 When you head east, you lose hours. Given that, your child may have too much insulin when the long-acting combines with the rapid-acting to lower his blood glucose. He has to be proactive and reduce the long-acting insulin he takes just before the trip. The rule is to reduce it by 4 percent for every hour lost. For example, if his usual dose is 10 units of Lantus and he's traveling east through six time zones, he should take 6 x 4...

Preventing and treating hypoglycemia

Preventing hypoglycemia may be time-consuming, but it's possible and entirely worth the effort Even if prevention doesn't work and your child still has episodes of hypoglycemia, you can treat it in several different ways, as you find out in the following sections. The best way to prevent hypoglycemia is to be constantly aware of your child's blood glucose. Meters are being developed that can measure glucose every five minutes and beep if it falls below a set level. (See Chapter 7 for more on these meters and for general information on measuring blood glucose.) Unfortunately, these meters haven't been perfected quite yet, so it's still necessary to stick your child multiple times a day in order to know his blood glucose. But even periodic testing doesn't get around the problem of not knowing your child's glucose for seven to eight hours while he sleeps (unless you set your alarm to wake you for an occasional middle-of-the-night test). When your child is asleep, he may be unaware of...

Advice for Parents of Children with Diabetes

When you learned that your child has diabetes, you may have experienced disbelief, grief, and guilt. Maybe you asked, Why did this happen to my child Maybe you cried out, It's not fair You must come to grips with these feelings so that you can learn the tasks and techniques of diabetes control. Your whole family needs to make adjustments to your child's condition. How you deal with and accept diabetes affects the way your child deals with and accept diabetes. The more you know about diabetes, the better equipped you are to help your child. Read this section, and get a copy of Children With Diabetes by Linda Siminerios and Jean Betchart, available from your American Diabetes Association state or national affiliate, or from Diabetes Supplies, 8181 North Stadium Drive, Houston, Texas 77054. As a parent, you are naturally anxious, but it's up to you to help your child accept his or her diabetes with a minimum of stress. The American Diabetes Association and the Juvenile Diabetes...

Obesity and Type Diabetes in Children

There are a number of conditions that can cause obesity in children but they represent probably 1 percent of the causes. Most of them can be diagnosed during the course of a good physical examination by your child's pediatrician. By far the major reason for obesity in children is too many calories in and too few burned up by exercise. Prevention of obesity is much preferred over treating the damage that it does. There are a number of things that you can do to prevent obesity in your child i Restrict time for sedentary activities like TV or computers. i Eliminate fundraisers that sell candy and cookies. i Insist on exercise daily and do it with your child. fiEH You must help your obese child to lose weight because most obese children become obese adults. With the assistance of a dietitian, you can figure out the food that your child can eat to maintain growth and development without gaining more weight. One of the most helpful techniques is to take the child into the supermarket and...

Presentations classic silent and diabetic ketoacidosis

Sympathomimetics Classification Table

Classic T1D is usually diagnosed in the outpatient setting when a slightly ill-appearing child presents to the pediatrician for evaluation of weight loss and other nonspecific symptoms. A high index of suspicion for diabetes should be a concern for all physicians. The classic polyuria is not told to the physician, but recurrence of bedwetting, unusually wet diapers in a child who seems to be dehydrated, recurrent monilial infection in the diaper area, and persistent thirst should arouse suspicion. Glucosuria and hyperglycemia are easily confirmed in a physician's office by test strips and glucose meters. Children who have silent (ie, diagnosed early in the course of) T1D are typically diagnosed by families or physicians with a high index of suspicion. Often these children have other family members with T1D and their parents are more likely to have them undergo testing or have them screened in research studies. Children with a silent presentation often require little insulin because...

Taking the right doses

Suppose that your child takes 5 units of rapid-acting Lispro insulin before meals and 5 units of long-acting glargine insulin at bedtime. The total is 10 units. With an insulin pump, he should start with 20 percent less, so his total dose starts at 8 units. i Your child continues the basal insulin at the same time. He may drop his basal rate to 0.15 unit between noon and 6 p.m. for a total of 0.75 unit and keep it to 0.15 unit again from 6 p.m. to midnight for 0.75 unit. The total units from noon to midnight is 1.5. Adding up your child's basal and bolus insulin, he's taking 8.3 units initially. Then it becomes important to check his blood glucose before meals and occasionally one hour after eating and in the middle of the night (see Chapter 7 for details on monitoring blood glucose). With the readings and knowing the amount of carbohydrates he's about to eat, you and your child can adjust the size of his boluses to achieve the levels in Chapter 10. How often should you and your child...

Familial Aggregation Of Phenotypes Of Diabetic Nephropathy

Familial Aggregation

Two different but complementary study designs are used to examine familial aggregation of complex diseases such as DN. Usually, conventional epidemiological designs and methods are used to explore first whether the disease in question clusters in families (8). More formally, the notion of familial clustering or aggregation implies a higher prevalence of disease in family members of cases (index cases) than in the general population or in family members of unaffected individuals (index controls). It should be noted that a disease having no genetic etiology may aggregate or cluster in families owing to a shared environment, such as an infectious agent or a culturally transmitted risk factor such as smoking or dietary preferences.

Maturityonset Diabetes Of The Young Mody

Youth-onset Type 2 diabetes patients are consistently reported to have more affected family members than patients with Type 1 diabetes (28). Inheritance in European-origin MODY families usually follows that of an autosomal dominant pattern, with vertical transmission of disease from one generation to the next, and approximately 50 of siblings affected. Reports of early onset Type 2 diabetes in non-European ethnic groups show vertical transmission in only a subset of such families (4). Recent work in Europeans and US whites has concentrated on the association of MODY with mutations near the glucokinase gene (29), while the HLA-DR and -DQ alleles linked to Type 1 diabetes have not been demonstrated in youth-onset Type 2 diabetes patients.

Underlying Metabolic Abnormalities In Type And Type

Growth And Metabolic Abnormalities

Neurotrophic factors are essential for the maintenance of neurons and their regenerative capacity and for the protection against apoptosis (23,24,40). The major groups of neurotrophic factors are NGF and its receptors, other neurotrophins as well as the IGF family of neurotrophic factors. The latter consist of IGF-I, IGF-II, insulin, and their respective receptors, as well as the IGF binding proteins (22). Various neurotrophic factors are responsible for the gene regulation of neuroskeletal proteins such as neurofilaments and neurotubules, and for the integrity of neuropeptide specific neuronal populations such as substance P (SP) and calcitonin-gene-related peptide (CGRP) dorsal root ganglion cells. Several lines of investigations have in the last number of years demonstrated that insulin and synergistically acting proinsulin C-peptide have direct gene-regulatory effects on both IGF-I and NGF family members of neurotrophic factors (Fig. 1), besides their own neurotrophic actions they...

Maintenance Parasite Program

YOU ARE ALWAYS PICKING UP PARASITES PARASITES ARE EVERYWHERE AROUND YOU YOU GET THEM FROM OTHER PEOPLE, YOUR FAMILY, Family members nearly always have the same parasites. If one person develops cancer or HIV, the others probably have the intestinal fluke also. These diseases are caused by the same parasite. They should give themselves the same de-parasitizing program.

Hyperglycaemia And The Pathogenesis Of Diabetic Nephropathy

Diabetic Nephropathy Pathogenesis

The involvement of PKC in diabetic nephropathy is in accordance with several reports, which provide evidence for a role of glucose-induced activation of PKC in the elevated synthesis of matrix components 62,63 . Application of a PKC P isoform specific inhibitor ameliorated the changes in glomerular filtration rate, albumin excretion rate and retinal circulation in diabetic rats in a dose-responsive manner, in parallel with its inhibition of PKC activities 64 . Moreover, inhibition of PKC activities abrogated the high glucose-induced TGF-P1 promoter activation in mesangial cells 54 . The high glucose-induced activation of PKC isoforms can subsequently upregulate MAPK pathways, thus inducing the transcriptional activity of AP-1 proteins by enhanced gene expression or posttranslational modifications. The transcripts and protein levels of the AP-1 family members c-Jun and c-Fos are elevated in mesangial cells cultured in high glucose 65 . Posttranslational activation is shown by increased...

Headache and Migraines

Begin by killing all Strongyloides and other parasites, bacteria and viruses with a zapper. Hopefully, this will only leave a few stragglers behind in abscesses, gallstones and the colon contents. If the colon bacterium, E. coli, is your headache cause, start the Bowel Program. Search for the source of your E. coli in food or polluted water. Stop reusing water bottles. Most people get their Strongyloides back in a few days from pets, other family members, and themselves Zap every day for three weeks. Try to clean up family members and pets. Never let a horse or pet salivate on you. Never put your fingers in your mouth. Always sanitize your hands with grain alcohol after using the bathroom.

Deciphering lipid panel results

If your doctor wants to know the levels of all the fat particles in your child's bloodstream, your child has to fast for 12 hours before undergoing a test known as a lipid panel, but if he is satisfied with the results of a total cholesterol and the good cholesterol, no fasting is required before the test. Make sure that the doctor performs a lipid panel on your child once a year (or more often if the results aren't normal). A lipid panel is done with a blood specimen in which the various types of fat particles are measured. Your child's risk for coronary artery disease is greater if his HDL cholesterol is low and LDL is high. The famous Framingham study has shown that if you measure the total cholesterol and the HDL cholesterol and divide the total by the HDL, patients who have a ratio of 4.5 or less have a low incidence of heart attacks. Patients with ratios of greater than 4.5 are at higher risk, and the higher the ratio, the worse the risk.

Sometimes requires discontinuation Contraindicated in active hepatic renal and coronary artery disease

PPARs are members of the nuclear receptor superfamily and contain common structural elements that include a ligand-binding domain and a DNA-binding domain 91 . Three PPAR family members have been identified thus far, PPAR-y, PPAR-a, and PPAR-S (also known as PPAR-b or nuc1). PPAR-y, a key mediator in metabolic syndromes such as diabetes mellitus and obesity, was identified first as a part of the transcrip-tional complex that is integral to adipocyte

Risk factors of youth type diabetes mellitus

A strong family history of T2DM is present in most pediatric patients regardless of ethnic background 2,32,33 . Markers of insulin resistance and beta-cell dysfunction are present in adult members of high-risk populations one to two decades before the diagnosis of the disease 56,61,62 and predict the progression to T2DM 63 . In adults, insulin secretion adjusted for the degree of insulin sensitivity is a highly heritable trait, more familial than either insulin sensitivity or insulin secretion alone 64 . Our studies demonstrate that family history of T2DM is associated with approximately 25 lower insulin sensitivity in prepubertal healthy African-American children compared with their peers without a family history of T2DM 65 . Similarly, white children who do not have diabetes but have a positive family history for T2DM have lower insulin sensitivity with an inadequate compensation in insulin secretion, which results in a lower glucose disposition index compared with youth without a...

Busting myths about having a chronic disease

Neither you nor your child or anyone else is to blame for your child's diabetes. As I explain in Chapter 2, T1DM occurs in a susceptible individual who comes in contact with a virus that shares tissue similarities with the person's beta cells. As your child's body attempts to reject the virus, it destroys his beta cells, the ones that make insulin. As a parent, you're not responsible if your child gets diabetes you certainly had nothing to do with that villainous virus. Help your child remember that he's first a person and then a person with diabetes. As a person, a nice haircut, nice clothes, and so forth make him indistinguishable from any other good-looking person. There is no big D printed on his forehead. It's also true that your child is just as intelligent as any other person with or without diabetes. Although there's some suggestive evidence that severe hypoglycemic reactions under the age of 3 may decrease a child's intelligence quotient (IQ), hypoglycemia after that has been...

In How Many Ways Can the pCells Get Killed Killing by Virus

Mediators of P-cell destruction include factors secreted from CD8 T-cell granules (e.g., perforin and granzymes), T-cell surface molecules (e.g., Fas-L, TNF, and other TNF family members), as well as secreted cytokines (e.g., TNF, IFN-y). All of these mediators are known to induce DNA fragmentation and the morphological changes of apoptosis through complex signaling cascades that involve the activation of cystein proteases or caspases (138). It was investigated whether or not the Fas-FasL system was involved in insulitis. Pancreas biopsy specimens showed insulitis in 6 13 of recent-onset patients. In these six patients, Fas was expressed in both the islets and infiltrating cells

Pathological causes of obesity

Single gene defects, including leptin deficiency, leptin receptor deficiency, melanocortin-4 receptor deficiency and pro-opiomelanocortin deficiency, have been described in children but are extremely rare (Farooqi and O'Rahilly, 2000). These children develop severe early-onset obesity in the first 2 years of life. Although these conditions are rare they have enabled us to gain valuable insight in to the potential mechanisms involved in human weight control with potential implications for the development of effective pharmacological interventions in obesity management.

The Family of Glucose Transport Facilitators

The family of GLUT proteins comprises 14 structurally related members, GLUT1-12, HMIT, GLUT14 (29-65 identity). Among these, there are glucose (GLUT1-3, 4, 8, 10, 14), fructose (GLUT5, 7, 11), polyol (GLUT12), and myoinositol (HMIT) transporters 2, 5 . At present, the function of the other family members is incompletely characterized. The presumed secondary structure of all GLUT proteins is similar, with 12 membrane-spanning helices, intracellular N- and C-termini and a large cytoplasmic loop. GLUT proteins carry charged residues at the intracellular surface of the proteins which are believed to provide the proper orientation and anchoring of the helices in the membrane, and to participate in the conformational changes during the transport process. Several sequence motifs, the sugar transporter signatures, are conserved in all family members, and are essential for the function of the proteins 2 .

What are the different types of external insulin

Make sure you get exactly the same brand and type of insulin each time (for yourself or for your child). There are small differences even in the insulins that are grouped together as the same type. To make sure you're getting the right insulin, Table 10-2 lists the brand names for the types listed in Table 10-1. Make sure you get exactly the same brand and type of insulin each time (for yourself or for your child). There are small differences even in the insulins that are grouped together as the same type. To make sure you're getting the right insulin, Table 10-2 lists the brand names for the types listed in Table 10-1.

Multiple Sclerosis Amyotropic Lateral Sclerosis

Cannot return unless you reinfect yourself. Stop eating meats, except fish and seafood. All meats are a source of fluke parasite stages unless canned or very well cooked. Pets and family members are undoubtedly carriers of the same flukes, although they do not show the same symptoms. Give away your house pets. Don't kiss your loved ones on the mouth. Make sure your sex partner has also been freed of fluke parasites.

Determining the cause

1 Too large an injection of insulin When you give insulin to your child (or take it yourself), you have to choose a dose that takes care of the carbohydrates in the meal he's about to eat as well as the level of carbohydrates already in his blood. Choosing the correct dose isn't easy. (I explain the basics of taking insulin in Chapter 10.) 1 Too much exercise using up the glucose Exercise acts like insulin to open the cells to glucose. As your child continues to exercise, he uses up his glucose and may become hypoglycemic. Heavy exercise increases the risk of hypoglycemia for almost 24 hours. As long as your child's glucose doesn't get too low, it's a great way to lower the blood glucose without insulin. I discuss all the benefits of exercise for patients with diabetes in Chapter 9. Poor timing of food and insulin Different types of insulin are active at different times. You must know what type your child takes and when it acts in order to keep insulin and glucose in harmony. Effect...

Distinguishing the severity levels of hypoglycemia

If moderate or severe hypoglycemia occurs while the person is driving a car or using complex machinery, the result can be devastating. Check your blood glucose before driving, especially if you're driving more than an hour, and stop and check your levels again every few hours. Keep glucose tablets handy in the car (see the later section Trying other helpful tips for more about these tablets). If your child has T1DM and is of driving age, make sure that he follows these recommendations.

Behavioral And Psychosocial Considerations In Children With Diabetes

Emotional stress for the parents is related to the loss of a child's health, guilt, and the uncertainty of short-term problems and long-term complications associated with the disease. These components can be seen both in the child's and parents' perception of their quality of life. Emotionally stressed families must develop positive coping skills to become successful in managing the disease and, therefore, need access to support from health care providers, other family members, and community resources (41).

Mutations In The Glucokinase Gene Mody

Accepting in advance the function of GCK as key regulator in glucose sensitivity and the insulin secretion of the P-cell, the mild and non-progressive outcome of MODY2 is somehow surprising. Probably, a physiological adaptation of the P-cell to the mild but relatively stable and unaltered hyperglycemia by increasing insulin secretion occurs, limiting the existing hyperglycemia. So the P-cell can compensate by slightly increasing insulin secretion. In MODY2, diabetic complications can be expected to only a minor degree, but cannot be completely excluded. Patients should be monitored routinely at least twice a year for stable blood glucose levels or further markers like HbA1c-levels. In a family suspected of MODY2, a genetic investigation should be considered to exclude other MODY subtypes and to sensitize the patient for the positive family history, thus taking more care in identifying affected family members at an early age. One further major aspect should not be neglected. Female...

Type Diabetes Mellitus

Type 2 DM is one of the most commonly seen genetic disorders, yet its exact mode of inheritance has remained elusive and is likely to be polygenic. The rate of concordance is high in identical twins, but is much lower in non-identical dizygotic twins. Patients with type 2 DM show an increased frequency of diabetes in other family members compared with the non-diabetic population. Only a small proportion of patients ( 3 ) with type 2 DM have a monogenic disorder. No unequivocal, reproducible associations with type 2 diabetes have been found for candidate genes studied so far. Furthermore, no genome scans in type 2 DM have identified any region with an effect as large as the HLA region in type 1 DM.

Sonic Hedgehog And Diabetic Neuropathy

Mechanism Diabetic Neuropathy

Humans or mice lacking Shh develop holoprosencephaly and cyclopia because of a failure of separation of the lobes of the forebrain (12). Shh organises the developing neural tube by establishing distinct regions of homeodomain transcription factor production along the dorsoventral axis (13). These transcription factors, including Nkx, Pax, and Dbx family members, specify neuronal identity. Shh acts directly on target cells and not through other secreted mediating factors, to specify neuronal cell fate (14). It also has important known patterning roles in the formation of other tissues including the brain (15) and the eye (9). In addition to the many functions of Shh in determining cell fate, it also has roles in controlling cell proliferation and differentiation in neuronal and nonneuronal cell types.

Navigating the Health Insurance System

If you or your child has diabetes, you can count on several things being true when you interact with the medical insurance system in the United States. You will pay more out-of-pocket than families without diabetes even when you have coverage. And you may be denied coverage more often.

Using a typical data management system

You can use a data management system on just about any home blood glucose meter to plot your child's blood glucose and determine where changes need to be made. Figure 7-3 plots the results before changes were made in the treatment, and Figure 7-4 shows the results after those changes. You can see the difference very clearly. Here are the elements of each figure You can also use the data management software to show every permutation of the blood glucose values. For example, it's easy to produce a graph that shows the average blood glucose for each day of the week. From such a graph, your child's doctor can see what time of day requires more or less insulin, more or less food, and more or less exercise to improve control.

Switching from the pump in special cases

There will be times when your child needs to use a syringe and needles (or another injection method) instead of the pump. For example, if the pump breaks down, if it's lost or stolen, or if he runs out of supplies for it. How do you figure out how much insulin he should take to replace the insulin in the pump Assuming your child's using rapid-acting insulin in the pump, the doses before meals remain the same with injections as they were in his boluses. The basal insulin is replaced by glargine or detemir insulin. Just calculate how much basal insulin he was taking, and replace it with a dose of glargine or detemir of the same amount. You'll probably find that you have to increase the dose over the next few days by about 20 percent because these insulins don't lower the glucose as efficiently as continuous insulin. Adjusting the insulin is always done by measuring the blood glucose. A number of companies make insulin pumps, and each one promotes its product's own good points. In...

Mitogenactivated Protein Kinases

MAPKs are a family of enzymes involved in transducing signals derived from the extracellular environment. There are three main subtypes of MAPKs extracellular regulated kinases (ERKs), c-Jun N-terminal kinases (JNKs), and p38 MAPKs. All family members are activated by dual phosphorylation of a consensus sequence, Thr-Xxx-Tyr by MAPK kinases. Upstream of these are the MAPK kinase kinases, thereby forming a three kinase cascade. There are fewer different kinases at each subsequent level of the cascade, resulting in refinement of the signal. Specificity may be achieved by stimulus-selective pathways, distinct cellular pools of kinases, or the presence of scaffold proteins required for the interaction of certain kinases. Activated MAPKs can phosphorylate targets within the cytoplasm, such as cytoskeletal proteins and other ERK1 was identified as a kinase activated by insulin, having a pivotal role in transducing mitogenic signals by converting tyrosine phosphorylation into the serine...

Psychological Aspects of Diabetes

Most people diagnosed with diabetes experience anger. It is perfectly normal to feel this way at times, but you won't help yourself by remaining angry and hostile all the time. Try talking to family members, friends, or others with diabetes to get these feelings out. And consider directing the energy you're using on anger to something positive by volunteering or fund raising for diabetes organizations.

Preventing kidney disease

1 Control your child's (or your) blood glucose. If you keep your child's blood glucose close to normal, he won't develop diabetic neuropathy. Part III is all about controlling blood glucose with testing, a healthy diet, regular exercise, and more. t Keep your child's (or your) blood pressure below the 95th percentile for age and height. If you have microalbuminuria, you can use a class of drugs called angiotensin converting enzyme inhibitors. These drugs reverse microalbuminuria while lowering blood pressure. t Avoid other kidney damage. People with diabetes tend to have urinary tract infections that can further damage the kidneys, so your child needs to drink plenty of fluids and acidify the urine with cranberry juice (the bugs don't like an acid urine) to avoid these infections. Nerve damage is also a risk, resulting in a neurogenic bladder with poor emptying of urine and a tendency to develop more urinary tract infections. (I discuss nerve damage later in this chapter.)

Handling the Physical and Emotional Consequences of Type Diabetes

As you may expect, people with T1DM also have significant psychological and emotional needs. It's important, first of all, to realize that T1DM has been present in some very high achievers. (I name names in Chapter 6.) In addition, T1DM is not only a disease of the particular patient but also a disease of the entire family. All family members are affected in one way or another. In Chapter 6, you find out ways that family members can help themselves and help the patient to maintain his self-esteem and a high quality of life. If you're the patient with T1DM, the people around you need to know that you have diabetes and how to help you when you can't help yourself. Often people with T1DM try to keep their disease secret, as though it's a blot on their character. T1DM isn't your fault. There will be times when you may need the help of others, and it will be a whole lot easier for them to help you if they know about your condition and what to do in different circumstances. (All this is...

Monitoring the blood glucose

You may think that a sick child should have lower blood glucose, especially if he has nausea and vomiting. This isn't the case, however. Don't assume that your child's blood glucose falls because he can't eat. Illness provokes the body to secrete hormones such as cortisol and glucagon that tend to raise the blood glucose. Illness also increases insulin resistance, so a given amount of insulin doesn't lower the blood glucose as much as usual. When your child is sick, allowing looser control of his diabetes is perfectly okay a slightly higher blood glucose reading is safer than a reading that's too low. That said, it's also true that the more the blood glucose is kept within the normal range, the more rapidly a child (or an adult, for that matter) can recover from any illness. White blood cells, which fight bacteria and viruses, function much better when the blood glucose is normal. Measure the blood glucose every two hours when your child is sick, and give extra rapid-acting insulin if...

Knowing what youre getting into

The reason these establishments are called fast-food restaurants is that they've mastered food preparation, ordering, and serving so that they take the least amount of time possible. Because people are in a hurry when they're out and about, they don't want to stop for a long time. There's nothing wrong with enjoying that convenience, but you need to make sure that the food you choose is right for your child with T1DM. One advantage of franchise restaurants is that a hamburger in a Denny's in California is almost exactly the same as a hamburger in a Denny's in New Mexico or Oregon. You know exactly what your child is getting, which makes the meal easier to fit into your child's diet. On the other hand, the quick serving and eating often doesn't allow the brain enough time to recognize that the body has eaten enough calories, and you may be tempted to order more food. Don't. No one should say that a person with T1DM can't go to a fast-food restaurant and remain on his or her nutritional...

Driving Safely with Type Diabetes

When your child has diabetes and is of driving age, he can't just hop in the car and hit the open road like someone without the disease. T1DM shouldn't hold him back it just requires that he take a few extra steps and monitor himself along the way. (If you're the patient, the same goes for you ) Share these keys to driving safely with diabetes with your child

Deciding on the frequency of testing

The minimum frequency to test your child is before each meal and at bedtime. You can test his glucose more frequently depending upon the situation. The minimum testing frequency must be met because you're constantly using this information to make adjustments in his insulin dose. No matter how good you think his control is, he can't feel the level of the blood glucose without testing unless he's hypoglycemic (see Chapter 4). And even then, he knows the glucose is low but doesn't know just how low it is. You should occasionally test your child one hour after a meal and in the middle of the night to see just how high his glucose goes after eating and whether it drops too low in the middle of the night. These results guide you and his doctor to make the changes your child needs. Just be sure not to make more than one change at a time and to give it a couple of weeks to make a difference.

Eating Disorders And Depression Screening And Treatment

In women with diabetes, several warning signs may suggest the presence of either depression or an eating disorder. These include the following overall deterioration in psychosocial functioning (including school attendance and performance, work functioning and interpersonal relationships) worsening in metabolic control increasing neglect of diabetes management, including blood sugar monitoring, insulin titration and adherence to other medications erratic clinic attendance significant weight gain or weight loss increased concern about meal planning and food composition and somatic complaints, including low energy, fatigue, disrupted sleep and increased worries about physical health. In some cases, family members will raise concerns about depression or disturbed eating before the individual with diabetes does so. If worsening metabolic control is due to intentional insulin omission, the individual may appear surprisingly unconcerned, and may initially deny that she has engaged in this...

Medical Nutrition Therapy Your Meal Plan

Keep in mind that a healthy meal plan for you is just a healthy meal plan. You don't have to worry about following some strange diet involving weird foods that no one else in your family will want to touch. You will be developing a healthy living strategy that will benefit all the members of your household. Often, family members will not even realize that they are eating a diabetes meal plan.

Blood Lipid Abnormalities

Abnormal lipid profiles are quite common in diabetes, especially type 2 diabetes. Lipid abnormalities, hypertension, obesity, and type 2 diabetes seem to go hand in hand. That has led researchers to ask whether lipid abnormalities are the result of obesity, and ultimately, type 2 diabetes. If you and other family members have severely high levels of cholesterol and other blood fats, you may have a lipid disorder that is not related to diabetes.

Treatment Of Hypoglycemia

Parenteral treatment is necessary when a hypoglycemic patient is unable or unwilling (because of neuroglycopenia) to take carbohydrate orally. While subcutaneous or intramuscular glucagon (1.0 mg in adults) is often used, by family members, to treat hypoglycemia in type 1 diabetes, glucagon is less useful in many patients with type 2 diabetes because it stimulates insulin secretion. Thus, intravenous glucose (25 g initially) is the preferable treatment for severe hypoglycemia in type 2 diabetes. Because sulfonylurea-induced hypoglycemia can persist for hours and even days, prolonged glucose infusion and frequent feedings are often required. This may require hospitalization. Clearly, it is critical that the absence of recurrent hypoglycemia is established unequivocally before the patient is discharged.

Be A Health Detective

After curing your own diseases, teach your friends and family how it's done. Families are related and their problems are related. This should make the task easier. Keep a small notebook to become part of the treasured family legacy as much as photographs do. If your aunt, father and brother had diabetes as well as yourself and all were cured after introducing them to this concept and technology, isn't this worthy of notes in your family's history Many problems can be disinherited. Cure yourself of retinitis pigmentosa, Muscular dystrophy (the inherited kind), and break down your family's faith in the gene-concept for these diseases. Bring hope to your family by proving diseases' true etiology. Bring respect back for your loyal genes that bring you hair color, and texture, not hair loss. That bring you eye color, not eye disease. Your genes brought you the good things about your ancestors, not the bad things. Parasites and pollution brought you the bad things.

Treatment Issues For Schoolaged Children

The goals of diabetes therapy for school-aged children are to avoid severe metabolic decompensation (diabetic ketoacidosis) maintain normal height and weight minimize the debilitating symptoms of either severely high or severely low blood glucose levels establish and maintain a healthy psychosocial environment for the child and family and maintain the involvement of family members in carrying out daily injections and blood sugar monitoring. At this age, children may be more able developmentally and intellectually to recognize and appropriately treat hypoglycaemia. Thus, as the child exits the

Undergoing regular testing

There are a number of tests that your child's doctor should be doing on a regular basis. Chapter 7 outlines all these tests, explains what they mean, and discusses how often they should be done. These tests include the following Don't leave it up to your child's doctor to order these tests. On the Cheat Sheet at the front of this book, I provide a chart that lists the tests that need to be done and the frequency for each test it also has spaces for you to enter the test results. Make copies of the blank chart, fill out a copy, and take it to your child's doctor at every visit to remind him or her to do these tests. Regular testing outside the doctor's office is crucial, too. Daily self-monitoring of blood glucose may be the most important thing that you and your child can do to control his blood glucose. The available meters are simple to use, highly accurate, and require tiny amounts of blood. The more you know about your child's blood glucose under all circumstances, the easier it...

Replacing highGI foods with lowGI foods

Table 8-2 shows some simple substitutions you can make in your child's diet (or your own) to emphasize low-GI foods. If you do this consistently, you'll find the result in terms of blood glucose levels and hemoglobin A1c very gratifying. Table 8-2 confirms that it's relatively easy to make a switch from high- to low-GI foods. Just choose grainier foods and foods that are less processed. If possible, rather than switching, feed your child low-GI foods from the start. It will make the task of controlling his blood glucose that much easier. Low-GI foods aren't a good choice when you're treating hypoglycemia. In that situation, you want to give your child foods that provide a glucose load as quickly as possible. See Chapter 4 for more about hypoglycemia.

Overcoming Short Term Complications

M iving with type 1 diabetes can be very challenging. You or your child One potential short-term complication of type 1 diabetes is low blood glucose, otherwise known as hypoglycemia. You may think that you wouldn't have to worry about this given that the problem that sent your child to the doctor in the first place was high blood glucose. Unfortunately, doctors don't yet have the tools to manage blood glucose perfectly, so in an effort to get as close to normal blood glucose levels as possible, which is known to prevent long-term complications of diabetes (see Chapter 5), doctors overshoot the mark on occasion and get levels too low. You find out how to prevent, recognize, and treat hypoglycemia in this chapter. I also take up diabetic ketoacidosis (very high blood glucose) in this chapter. There are all kinds of events like trauma, infections, and severe stress that precipitate this condition, so you need to be able to recognize it and practice proper management of the diabetes...

Treating Type Diabetes

Treating T1DM requires a lot of effort, as you find out in this part, but I know you and your child can do it. What's involved For starters, you have to do a great deal of monitoring, which at this time still requires sticking your child's finger four or more times a day. He also has to get certain laboratory tests on a regular basis and go to the doctor for regular checkups. What your child eats and when he eats is a big part of managing his diabetes. Unlike the person without diabetes, your child needs to arrange his meals and his insulin so that the insulin is in his body when the food is. Then there's exercise, an important part of treatment that lowers the blood glucose because the muscles need sugar to work. As I explain in this part, many patients use exercise in place of insulin and end up taking very few units of insulin. Recently, other drugs have become available for treating T1DM. In this part, I make sure that you know about these and the role they can play in controlling...

Encouraging exercise at all ages

You'll probably be surprised to hear that exercise should begin with your newborn. Although T1DM doesn't usually begin at this age, starting a child's exercise at such a young age makes it easier to progress his exercise regimen throughout childhood, adding more time and new tasks, than to suddenly impose an exercise regimen at some later stage. In the following sections, you discover what you and your child should do at each stage to make (and keep) exercise a priority. i The National Association for Sport and Physical Education, made up of more than 25,000 professionals in the fitness and physical activity fields, offers excellent resources at naspe. Here you find National Standards for Physical Education, the Shape of the Nation Report on the status of physical education in the United States, and Tools for Observing Your Children's Physical Education.

Determining how hard to exercise

The Perceived Exertion Scale is very useful in determining whether an activity is making a difference in your fitness (or your child's). To use the scale, you rate the degree of your exertion while performing a certain activity from extremely light to extremely hard, according to your personal physical ability level. Here's the scale

Public Schools and Diabetes Training

In the United States, the schools or day care centers that receive public funds are legally required to provide training to school staff on treating diabetes. The ADA has literature for teachers and child-care providers. Your health-care team can also help ensure that the staff members at your child's school are adequately trained. The degree of supervision by the staff of the school will vary with your child's age and abilities. Late adolescence ages fifteen to nineteen At this age your child will manage his or her diabetes fairly independently. You can help by guiding your teen to improve his or her coping skills and transition to full independence for college or work. With diabetes intruding into the teenager's struggle to separate from parents and the need to be accepted by peers, depression can occur, and if your child shows any signs of depression, he or she should get professional help.

Type Diabetes in Children

Your child might be diagnosed with diabetes during routine screening or because she may be unwell. The American Diabetes Association recommends screening any overweight child (more than 120 percent ideal body weight, body mass index greater than 85 percent) who has two of the following features Strong family history of type 2 diabetes (parents, siblings, uncles, aunts, grandparents, nephew, niece, half sibling)

Testing For Autoimmune Diseases

When your child is diagnosed with type 1 diabetes, he should also be screened for autoimmune thyroid disease. His doctor will do these thyroid tests at intervals or if there is a problem with your child's growth, because low thyroid hormone levels can slow down growth. In celiac disease, eating foods containing gluten (that is, those derived from wheat, oats, rye, and barley) cause an autoimmune damage to the wall of the small bowel. This damage leads to diarrhea, abdominal pain, tiredness, problems absorbing vitamins such as vitamin B12, poor weight gain, and decreased growth. It can also affect the absorption of carbohydrates, causing hypoglycemia. The treatment is a gluten-free diet. Screening for celiac disease is done when a diagnosis of type 1 diabetes is made, and then again if the child has problems such as growth failure or weight loss or gastrointestinal problems. The blood test that is done is called tissue transglutaminase IgA autoantibody. If the blood test is positive,...

Children Ages Three to Seven

Quite often, children this age participate in their diabetes management by helping with glucose monitoring and choosing foods. This is also the age when parents will need to involve other caregivers or school staff in the diabetes management. The ADA has set out recommendations on how schools and day care centers should respond (see Resources) and how to set up a Diabetes Health Care Plan for your child. In addition to providing all the supplies (insulin and syringes, log book, glucose meter, testing strips, glucagon injection, ketone testing strips, and glucose tablets or gel) for caring for your child's diabetes, you should also provide the following information to the caregivers at your child's day care or school How and when your child's blood glucose should be monitored When your child should eat (meal and snack schedule) and how much insulin should be given before these meals if there are parties and special events at school, provide instructions on how much extra insulin should...

Is Intensive Management Right for

Adopting an intensive management program does not happen overnight. It works better if you have the help and support of your family and your health care team. Intensive diabetes management takes commitment on your part. If you find that your current diabetes plan interferes with living the kind of life you would like, you may be more likely to stick with an intensive program. When you and your health care team decide to forge ahead, they will probably recommend that you attend classes or a series of training sessions to learn how to make adjustments in your diet, exercise, and insulin doses.

Because I have gestational diabetes my child or I will get diabetes

The risk of your child someday developing diabetes is low. This risk seems to go up with the birth weight of the baby. Studies have shown that the larger your baby is at birth, the greater the chance that he or she will develop obesity. Signs of obesity can be seen as early as 7 or 8 years of age. If your child develops obesity during childhood or adolescence, there's also a chance that he or she will develop glucose intolerance, and possibly diabetes, as an adult. Your best bet to keep your child's risk of diabetes as low as possible is to keep your blood glucose levels close to normal while you have gestational diabetes.

Familial Factors In Diabetic Nephropathy

Reports of nephropathy developing in some patients with apparently well controlled diabetes and not developing in some patients even after years of severe hyperglycemia lead to the conclusion, expressed by several researchers 1-5 , that some, but not all, individuals are predisposed to the development of diabetic renal disease. This chapter reviews some of the data, which indicate that there are familial differences in the predisposition to diabetic renal disease. If this familial predisposition is genetic, there must be an interaction between the genes and the environment, and it is often difficult to differentiate between genetic inheritance and the effect of a common environment shared by family members.

Kidney Transplantation

In the United States, African Americans undergo renal transplantation less often than whites, in part because they are less likely to want a kidney transplant, but also because African Americans who do want a kidney transplant are less likely to be referred to transplant centers, even after adjusting for coexisting morbidity (149). Moreover, once referred, African Americans are less likely than whites to complete the evaluation necessary before being listed for transplant (150,151). Barriers to completion include limited access to transportation, child-care responsibilities, and lack of available time away from work factors that affect transitional and disadvantaged populations disproportionately. After receiving a kidney transplant, African Americans have shorter graft survival than whites (152).

Before You Become Pregnant

As you plan your pregnancy, you and husband should both be aware that it will be more expensive for you than for women without diabetes. You will need special care during pregnancy and special precautions during delivery, and your child may require special attention at birth. Choose your medical team before you become pregnant. Your obstetrician, pediatrician, diabetologist, and diabetes educator will work together to provide you with the best care and advice. They will help you choose a hospital that has the latest monitoring and testing equipment and a high-risk nursery.

The impact of diabetes upon the family

Diabetes may become an open, accepted part of family life, a weapon or defence, or an enemy which causes disability or financial disaster. The person with diabetes needs the full support of his or her family. If the patient agrees, close family members should be encouraged to meet the diabetes team and learn more about diabetes. The GP and practice team can provide diabetes education, and support family members as well as the patient.

The Details of Insulin Doses

When your child takes insulin (or you do), the objective is to duplicate the secretion of insulin by the normal pancreas. This secretion has two parts The pancreas secretes a larger amount of insulin at the time of the meals called the bolus secretion. This amount is duplicated by taking rapid-acting insulin (like aspart, glulisine, or lispro) just before the meal or regular insulin 30 minutes before meals. These days, the convenience of taking insulin just at the time your child is eating results in more frequent use of rapid-acting insulin. Insulin is manufactured in strengths of 100 units per milliliter. The first time a patient takes insulin, the dosage is based upon a calculated total daily dose consisting of a basal dose and a bolus dose. Your child's doctor will make this determination, but he'll usually follow these steps Your child takes the basal dose and the bolus dose at different times of day. The final determination of the insulin dose your child (or you) takes at any...

Single Parenting Becoming the Best Parent For Your Child

Single Parenting Becoming the Best Parent For Your Child

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