Your Child Ebook

Parenting Teens Special Report

Parenting Teens Special Report

Top Parenting Teenagers Tips. Everyone warns us about the terrible twos, but a toddler does not match the strife caused once children hit the terrible teens. Your precious children change from idolizing your every move to leaving you in the dust.

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Smart Parenting Guide

This ebook from Daniel Dwase gives you the very best tips and information about how to raise your children in such a way as to get smart, responsible, caring, and loving children. If you have problems disciplining your children, this is the book for you. You don't have to be concerned about your children running amok; Dwase gives you the insight that you need to make sure that your children turn out well in the end. This ebook lets you give your child the best gift that you ever could: a loving, nurturing, healthy and loving childhood. By building a quality relationship with them, you will be able to raise a child that continues that relationship into adulthood. Building a quality relationship is the best way to give your child a healthy future and a loving family. You will both empower your child to succeed and reduces behavioral problems Start building your child's future today!

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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...

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...

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.

Disease Course And Risk Factors Implications For Clinical Practice

Several other important risk factors for poor diabetes control have been investigated in cross-sectional studies. Auslander and colleagues78'79 found that African-American youths are in significantly poorer glycaemic control than Caucasian youths. Lower levels of adherence in African-American youths contributed to this difference, as did a higher prevalence of single-parent homes. Single-parent families have been linked to poorer diabetes outcomes in several studies78 - 80. In a study of correlates of illness severity at diagnosis, children from single-parent homes tended to have more severe symptoms of diabetes, such as DKA, than those living in two-parent families, suggesting that the stress of single parenting and insufficient

Your Role as a Parent

When you discover that your child has diabetes, you will probably be very upset. Being a parent is hard work in the best of circumstances, and your child's diabetes will add a whole other dimension to being a parent. You will need to learn everything you can about diabetes in addition to all your other parenting duties. This may be overwhelming, but with patience and perseverance and the support of your child's diabetes care team, you will be able to help your child manage the disease so that he or she can have the disease but still do all a child needs to do. Your child's diabe tes care team (ideally a pediatric endocrinologist, diabetes educator, nutritionist, and psychologist) will help you, your child, and your family learn the following survival skills for managing the diabetes How to treat the diabetes when your child is ill How to involve other family members, other caregivers, and the staff at your child's school How to transfer responsibilities as your child grows up

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.

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 www.aahperd.org 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.

Plan in Advance Continued

Suggest that the whole family participate. Play with your children or grandchildren, organize a game of tag or touch football, or go for a walk. Everyone will benefit from the activity, and it's nice to spend time together. Before booking your hotel, ask if it has a health club, swimming pool, or exercise room. Some hotels provide access to a nearby fitness center.

Other Types Of Diabetes

Maturity onset diabetes of the young (MODY) refers to diabetes that occurs in childhood or adolescence (before age twenty-five) and is inherited in an autosomal dominant fashion that is, if you have the condition, half of your children are also likely to have it. About one in one hundred people with diabetes have MODY. There are six known genetic defects for this kind of diabetes. One of the genetic defects (called MODY 2) is in the gene that enables the beta cells to sense the body's glucose level (the glucose kinase gene) and so regulate insulin release. MODY 2 is usually easily controlled with oral medications that stimulate insulin release. People with this type of diabetes are usually not obese.

Dealing with Your Own Feelings

When you first find out your child has diabetes, you may be overwhelmed with feelings of shock, disbelief, sadness, anger, or even guilt. It can seem so unfair. You may experience self-doubt as you wonder whether you can give your child the care she needs. With all the stresses in your life and all the demands on your time and energy, it may seem that you just won't be able to handle it all. It can be overwhelming, especially at first. As you learn more about diabetes, you will also learn how to help your child live like any other kid. It may take a little work as you figure out how to balance your child's meals with insulin injections and physical activities. You may find that your child takes it all in stride and that the hardest part may be coming to terms with your own feelings. Don't forget that your child is looking to you for guidance. Your attitude will have a direct impact on how your child sees himself and how he comes to terms with his new lifestyle. If you take your...

Using an Insulin Pump Properly

Because your child's body requires different amounts of insulin at different times of day and night, you can set the pump to deliver many different amounts of insulin depending on your child's particular pattern. The syringe within the pump contains rapid-acting insulin Humalog, Novolog, or Apidra. The pump delivers insulin constantly over 24 hours at what's called the basal rate. Just before each meal, your child pushes a button to deliver a larger dose depending upon the current blood glucose and the amount of carbohydrates he's about to eat. This larger dose is called the bolus. Going from a syringe and needles to a pump can take some adjustment. When in doubt, call your child's doctor with any questions or concerns about dosages, wearing a pump, and other related issues.

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...

Coming to Terms with the Diagnosis

When your child is diagnosed with type 1 diabetes, he may experience a wide range of emotions, such as shock, sadness, anger, and denial. Having these initial emotions is perfectly normal, but your child needs to accept the diagnosis eventually in order to take charge of his treatment and start living a healthy life. You can use the information in the following sections to show your child that he's not alone in dealing with type 1 diabetes and to help him develop positive coping skills.

Exercising for more control

Exercise helps to reduce the amount of insulin that your child requires and makes it easier to control his blood glucose. Any exercise is better than no exercise, but 30 minutes a day should be your minimum goal for your child. In Chapter 9, I explain how to take care before your child starts an exercise plan by talking to the doctor and adjusting insulin intake, among other tasks I show you how to encourage your child to exercise at any age and help him pick an activity (even a competitive sport ). I also give you my picks for the best exercises around walking and training with weights.

Doing Key Tests at the Doctors Office

Treating your child's type 1 diabetes (or T1DM for short) means that his doctor must order many tests, but as a responsible parent, you shouldn't depend on the doctor's memory to make sure the tests are done. After all, he's a busy guy with hundreds of patients to worry about. Instead, keep a flow chart for your child's tests and fill in the blanks as time goes by. I've created such a chart for you on the Cheat Sheet at the front of this book. Copy it and use it to make sure that your child's tests get done at the appropriate times. Following are the tests that must be done on a regular basis to evaluate the status of your child's diabetes (I go into detail on them in the following sections) i The doctor should download your child's blood glucose results from the home glucose meter at every office visit into a computer program that he can use to adjust treatment. (I discuss home meters later in this chapter in the section Selecting a Home Blood Glucose Meter.) i You should examine...

Adjusting to sick days and travel

If your child has another illness in addition to T1DM, there are special adjustments that you have to make. He may not feel like eating, and you may think that he needs less insulin as a result. The truth is usually the opposite. Your child's body responds to an acute illness by pouring out hormones that promote the production of more glucose, so his blood glucose rises. He may actually need more insulin during an illness when he can't eat than he'd need when he's healthy. Chapter 15 provides the information you need to manage your child's illness when he also has T1DM. Another special circumstance that affects diabetes care is travel. When traveling, you and your child may go through different time zones. This complicates taking insulin because each type of insulin has a certain duration of action, and you may lose or gain hours as you travel. In Chapter 15, I share suggestions for handling your child's insulin smoothly and traveling with his supplies safely.

Dealing with Sick Days

Three of the basic tools of good diabetes care become even more important when your child with T1DM is sick or traveling frequent monitoring of the blood glucose, careful food choices, and timely medication. During sickness, blood glucose levels tend to be higher than expected and you can't know that unless you measure it. Food may be limited to a few items that your child can tolerate, and he may need surprisingly more insulin than you expect, especially because he's eating little. Discuss how to handle illness with your child's doctor before it happens. Make a sick-day plan and find out the doctor's rules for contacting him in case of illness. Children whose diabetes is under good control (that is, hemoglobin A1c is less than 8 percent see Chapter 7 for details) don't develop illnesses any more frequently than children without diabetes. In any case, preventing illness is much better than treating it. One major preventive measure is making sure that your child gets a flu shot every...

Keeping Problem Foods Out of Sight and Good Foods in Easy View

If potato chips or creamy cookies sit on the kitchen counter, can you blame your child (or yourself) for grabbing a handful every time he or she goes by Don't buy these foods in the first place. If you do, keep them out of sight. You know what happens when you walk up to a buffet table. You can more easily avoid what you don't see. Again, your child follows your example. If you raid the freezer for ice cream, don't be surprised to see your child do the same thing. If you raid the refrigerator for broccoli or asparagus, that is what your child will do as well. The great benefit to you when you set an example for your child is the excellent nutrition that you get.

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...

Adjusting Insulin Doses

Insulin dosages are based on weight of your child in kilograms (1 kg is equal to 2.2 pounds). The doses vary based on whether the child is in the honeymoon phase or not and whether he or she is going through puberty. During the honeymoon phase, your child will need very little insulin, and a simple insulin regimen with two or three injections a day may suffice. The basal insulin needs may be as low as 0.125 units per kilogram. The ratio for carbohydrate might be 1 unit of insulin for 60 to 75 grams carbohydrate, and your child may not need any insulin for corrections. Once the honeymoon phase is over, your child's basal insulin needs may go up to 0.25 units per kilogram, and the insulin to carbohydrate ratio may go up to 1 unit for 15 to 60 grams carbohydrate. He or she may also need insulin for correction, for example, 1 unit for every 50 to 200 mg dl blood glucose over her target. When your child goes through puberty, the insulin needs go up substantially this is principally because...

Understanding hypoglycemic unaWareness

If your child suffers from hypoglycemic unawareness, he doesn't feel the warning adrenergic symptoms that alert him that his blood glucose is too low. He may have a reduced or no adrenaline response as well as a reduced cortisol and growth hormone response this means that nothing is raising his blood glucose as it falls. Without the warnings of palpitations, anxiety, and hunger, there's not much between your child and the symptoms associated with lack of glucose in the brain.

Involving Children in Food Preparation

Preparing food together can be a great bonding experience between you and your child, and it also provides you with the opportunity to teach good nutrition. If your child helps you to prepare vegetables, he will want to try what he has prepared. Have your child create his or her own nutrition plan for a day and discuss every part of it, pointing out what is carbohydrate, protein, fat, the balance among those foods, and how they affect his or her diabetes. Use the food guide pyramid or the child's nutrition plan as a guide for planning, showing the important role that vegetables play in the plan. Never prepare one meal for your diabetic child and another for the rest of the family. Everyone can benefit from the better choices you make with your child's nutritious food. The child also realizes that eating isn't punishment for a person with diabetes because the whole family eats the same way.

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.

Classroom Blood Glucose Monitoring and Self Management

Individuals with diabetes must manage their blood glucose levels through the careful balance of food, exercise, and medication. Blood glucose monitoring is an essential component to good health. It is the only way of making sure blood glucose levels are maintained within your child's target range. Because it is extremely important for your child to be able to monitor his or her own blood glucose levels and respond to levels that are too high or too low as quickly as possible, you may want your child to check his or her blood glucose levels and promptly treat wherever he or she is at school or during a school-related activity. Whether this is appropriate depends on your child's age, level of experience and skill, and personal preference. Your child's immediate access to diabetes equipment and self-care is important so that symptoms don't get worse and so that she or he doesn't miss valuable classroom instruction or other school activities. Unlike many other diseases and chronic medical...

Dealing with the Rest of the Family

If you have more than one child, the time you spend taking care of diabetes is bound to cause some tension in the family. Siblings may feel jealous of the child with diabetes because of all the attention that he is getting. On the other hand, siblings may give your child with diabetes too much attention, and your child may feel like his siblings are on his case. He may feel that everyone is breathing down his neck. The best way to deal with diabetes in the family is to treat it openly. Explain what is happening to the other children and other family members, and ask them to be patient as you work things out. Even young children can understand simple information. Try to schedule special times with your other children who may feel left out, or ask if they want a job in the overall care of your child with diabetes. A sibling could help record blood glucose readings, for example. In general, you will want to treat your child's diabetes matter-of-factly. Once your child and her siblings...

Planning for Potential Problems

Planning is key if you're going to keep your child's diabetes under excellent control. Think about what your child will be exposed to in advance, and smooth the way. Consider doing dry runs to prepare for potentially difficult situations. Practicing how you'll handle situations before they arise makes it a lot easier to function when you're faced with the real thing. For example 1 When it comes to food, you can eat at places you know, inform your hostess that your child has diabetes and help her to prepare something he can eat (if possible), bring the food for your child with diabetes, and or check the fast-food recipes on the Internet. If you've been invited to a new restaurant, visit it in advance and simply read the menu. Carefully select the foods that will help your child to stay in control of his T1DM. 1 Plan for the times when your child's blood glucose is low. Have glucose tablets or any of the other treatments recommended in Chapter 4 available to bring the blood glucose up...

Ten Commandments for Good Diabetes Management

7ype 1 diabetes (T1DM) isn't a religion, despite the title of this chapter. In fact, it can be a real pain at times. However, there's a lot that you can do to minimize that pain. Everything you need to get your child started properly with the things he must do to keep his disease under control and minimize its impact is available. Everything discussed here is described much more extensively in previous chapters. I bring it all together here to give you the total picture of essential diabetes care. Keep in mind that nothing in this chapter is more or less important than anything else. Each action is like a piece of a puzzle individually, the pieces don't provide much clarity, but together, they tell you how to get your child to the point that he's able to put the puzzle together on his own. If I were to tell you that all patients with T1DM are destined to be blind or have their kidneys fail (for the record, I'd never tell you that), you'd have little incentive to do much of anything to...

Your Adolescent Has Diabetes

This stage is when your child is most eager to become independent. You don't want to give up all control at this time for several reasons i Your child actually does better if he or she has limits that are clearly stated and enforced. The hormonal changes that occur in puberty are often associated with insulin resistance. This may be a source of loss of control rather than any failure of your child to follow the diabetic treatment plan. Upward adjustment of the insulin may overcome this problem. Strenuous exercise may play an even greater role in the life of your child at this age. The result will be a significant reduction in the amount of insulin required after exercise. Your blood glucose measurements will help you to define your child's need for insulin. If your child plays a team sport, the coach and teammates must be aware of the diabetes and permit your child to eat, go to the bathroom, and take insulin as required. Type 1 diabetes is no reason to prohibit strenuous exercise....

Adjusting the basal dose

At what point do you adjust your child's basal insulin The following adjustments are best done in consultation with your child's doctor. However, if you're unable to see the doctor, you can put your knowledge to use and make the adjustments on your own. 1 Bedtime basal insulin If you find that several mornings in a row your child's fasting blood glucose is too high (above the levels in Table 10-3), you may add a unit or two to his bedtime basal insulin. If it's too low, you may reduce his bedtime basal insulin by a unit or two or get him to eat a small bedtime snack. Several weeks after starting insulin, you may find that you can lower your child's dose (of both bolus and basal insulin) more and more and even go off it for as long as six months. This is the honeymoon phase. It's a period of remission when the insulin in his pancreas is controlling the glucose. He may need little or no insulin for this period, but there usually comes a time when he has to start insulin again. It's...

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...

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...

Dealing with Diabetes in School

If you're the parent of a child with T1DM about to enter school, you're probably concerned about whether your child will get the same education as a child who doesn't have diabetes. The answer is a definite yes if your child goes to a school (public or private) that gets federal funding assistance. In return for these funds, schools have agreed to abide by federal laws concerning the treatment of students with any type of handicap. Three key laws apply to your child entering school In the following sections, you come to understand what a Section 504 Plan is, how to set one up for your child, and how to follow through to make sure that your child gets the excellent education he deserves.

Encouraging positive coping skills

What are some of the tools that your child can use to thrive with T1DM They consist of the coping skills that he may or may not know he possesses. These are the traits that you want to promote by constantly emphasizing them. Praise the child when he does the right thing for his diabetes, whether it's eating properly, taking the injection correctly, or exercising. Also remember to limit the criticisms for mistakes. WEfl To your child, you represent the chief judge in his life. If you constantly reinforce the positive qualities that he possesses, that's how he'll think of himself. On the other hand, if you dwell on his negative qualities, he'll see himself in that light. Some of the key tools for helping your child deal with T1DM include the following Let him be the one in control of his diabetes. As much as your child would like to have his parents, doctor, or diabetes educator handle things for him, he's the one constantly making the important decisions as to what to eat, how much to...

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.

Understanding the glycemic load

In addition to glycemic index, you may want to consider the glycemic load. The glycemic load of a food is based on the glycemic index but also takes into account the amount of carbohydrate in a portion. A food that has a high glycemic index may not be that bad for your child if the portion is so small that the total grams of carbohydrate don't raise his glucose that much. An example is pumpkin, which has a high GI of 75 but few grams of carbohydrate in the small portion that's usually consumed. Another example is cantaloupe, which has a glycemic index of 65 but a low glycemic load in the typical portion size. Many foods that have low glycemic loads aren't necessarily good for your child, like ice cream and beef, so you should emphasize glycemic index rather than glycemic load in making food choices for your child.

Setting temporary doses

I Your child's sick and his blood glucose begins to rise. You may want to set his basal rate temporarily higher until he's better (see Chapter 15 for details on handling sick days on a pump). i Your child's going to bed and his glucose is higher than you'd like. A temporary addition of a few tenths of a unit of insulin may be all he needs for the night, and his glucose can return to its usual rate the next night. i Your child is going to do a very strenuous exercise on a once- or twice-a-week basis, so a temporary reduction in the bolus rate by as much as half may be necessary on the day of exercise to compensate.

The Extra Value of Team Care

When your child is first diagnosed with diabetes, the stress can be overwhelming. The guilt that comes with this diagnosis may leave you unable to help your child much at first and certainly unable to learn all that you need to know to master the areas of importance to the health of your child. That is why you must depend upon the help of a diabetes care team throughout the duration of his or her childhood, and especially when the diagnosis is first made. 1 The diabetes educator can explain the short- and long-term complications of diabetes and how your child can avoid them. 1 The mental health worker can help you deal with the psychological issues at each stage of your child's development. 1 One of these professionals can also help you with an exercise program for your child. Another resource that can be tremendously valuable for you and your child is a diabetes summer camp. These camps are located all over the country and provide a safe, well-managed place where your child can go...

Primary school children and preteens

Exercise with your child regularly and also on your own. Your child will follow your example, especially when he's young. The best way to share your exercise time is to select an activity that you can both enjoy together. Begin at the earliest age possible by pushing him for a good long walk in his stroller. As he begins to walk, let him hold onto the stroller as you walk together. When he has his balance, walk together with him. Keep emphasizing that exercise is for a lifetime. Fortunately, most small children love to run around you may be hard-pressed to keep up with your youngster after a while. However, there will come a time when television and the Internet become very attractive distractions for him. It's important that you continue to set an example by exercising yourself, but you also have to place limits on the amount of time your child spends in such sedentary inactivity. The American Academy of Pediatrics recommends no more than one to two hours a day of quality...

Choosing the right pump

Given this wealth of choices, how do you choose the pump that's best for your child You're about to purchase a device that costs more than 6,000 and will require more than 1,500 worth of supplies per year, so take your time and don't select the first pump you look at. Take these factors into consideration Your child's doctor may be very familiar with one or two pumps and feels most comfortable using them. That may be a very important part of your choice unless you want to choose a new doctor with your child's pump. Your insurance company may prefer that you select one particular pump. However, if your child prefers another, don't give up easily on the pump of his choice. Many insurance companies will permit the purchase of an insulin pump that isn't on their preferred list if you provide convincing evidence that your child needs the special features of that particular pump. If you or your child have problems with your hands, some pumps are easier to program than others. Your child may...

Developing a Section Plan

Essentially, a Section 504 Plan stipulates how your child's diabetes will be handled at school it gets into specifics about certain allowances that will be made for your child as well as adults at the school who will be expected to monitor your child's condition and help him if needed. You create a Section 504 Plan together with the school officials and any expert you bring to the meeting. For example, you may want to bring a Diabetes Educator or even an attorney if you sense some resistance on the part of school officials. The following sections tell you what to do to get a Section 504 Plan in place for your child and also what types of clauses the plan should include. A Section 504 Plan doesn't create itself. So how do you get the ball rolling on the road to a safe and accommodating school experience for your child with type 1 diabetes Follow these steps 1. As a parent, you bring the fact that your child qualifies for a Section 504 Plan to the attention of the school's...

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,...

Carbohydrate counting

Using the amount of carbohydrates in a meal to determine your child's insulin dose is called carbohydrate counting. The key to this system is knowing the carbohydrate in your child's food. Here's where you make use of your friendly dietitian, who can go over his food preferences and tell you how many grams of carbohydrate are in them. The dietitian also can show you where to find carbohydrate counts for any other foods that your child may eat. For carbohydrate counting, you also need to know how many grams of carbohydrate are controlled by each unit of insulin your child takes. This is determined by checking his blood glucose one hour after eating a known amount of carbohydrate. For example, one person may need 1 unit of rapid-acting insulin to control 20 grams of carbohydrate, whereas another person needs p iElt By measuring your child's blood glucose frequently, you find out how different carbohydrates affect his blood glucose. He needs less insulin to control the carbohydrate...

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.)

Developing key skills after the diagnosis

In order to help your child to live a long, healthy life free of complications of T1DM, you need a number of skills under your belt. You pick up these skills primarily from the diabetes specialist, the diabetes educator, and the dietitian, but the other professionals listed in the previous section also contribute to your education. The major skills that you must acquire to help your child and that your child must acquire as he grows are covered throughout this book. They include the following

Clearing up fears about having special needs

Managing your child's diabetes requires many products, including the following Type 1 diabetes certainly puts strains on your child that a person without diabetes doesn't have, especially when it comes to planning meals, taking medications, and monitoring blood glucose. But as I point out in the earlier section Knowing that your child is in good company, it also molds character. If your child can overcome the limitations of T1DM, he can overcome many other of the challenges that he'll face in his lifetime. Like Frank Sinatra said, if you can make it there, you'll make it anywhere. jjjMJEft While it's true that your child with T1DM has a lot more special needs than the average person, he's a unique individual with a special role to play in the world. He may become an entertainer bringing joy to many people he'll never know, or he may be a writer teaching people about subjects they want to know more about. He may be an inventor, creating a product that improves the lives of many other...

Some specific fastfood recommendations

1 A hamburger at Burger King isn't a bad choice for lunch. It contains 330 kcalories (kilocalories is the correct measurement, not calories, which is a much smaller number) and about 30 grams of carbohydrate, 20 grams of protein, and 12 grams of fat. The Burger King hamburger contains 530 milligrams of sodium. If your child goes up to the bacon double cheeseburger, he consumes 640 kcalories with 1,240 milligrams of sodium, so keep him away from those. i Denny's menu offers some healthy choices, such as the Grilled Chicken Dinner. It has about 200 kilocalories, 25 percent of which are fat calories, 25 percent carbohydrate calories, and 50 percent protein calories, which isn't a good balance. But your child can have some carrots and a baked potato to add carbohydrates. Without any extras, the Grilled Chicken Dinner contains about 824 milligrams of sodium, so the dish is not ideal as far as sodium is concerned. This dinner choice also contains 30 grams of carbohydrate. i At Domino's...

Undergoing Essential Tests and Monitoring Blood Glucose

Doing essential tests at the doctor's office regularly Checking your child's blood glucose several times daily Picking a home blood glucose meter ZM s the parent of a child with diabetes, I have no doubt that you want to use every available method to keep your child healthy and prolong his life. Doing the tests in this chapter will make the difference between a long life and a shorter one. Most of them are designed to discover diabetic complications early in their development, when you can use all the great tools available to slow or reverse them. Some tests are part of the doctor's physical exam each time your child visits him. Most of the tests should be performed at least annually, but certain tests must be done quarterly. Others, like self-monitoring of blood glucose, are done several times a day. Taken together, these tests provide information that you and your doctor can use to make the adjustments in your child's treatment plan necessary to ensure not just a long life but a...

Calculating the bolus dose

Some patients, especially thin ones, find that 1 unit of insulin can bring the blood glucose down by more than 150 mg dl. Others find that 1 unit only brings the glucose down 75 mg dl. This fine-tuning permits you and your child to achieve your goal of excellent glucose control. In order to adjust the insulin dose before the meal to take into account the amount of carbohydrate to be consumed, you must know how much carbohydrate your child is about to eat. Chapter 8 contains an extensive discussion of carbohydrate counting. You can only adjust your child's bolus insulin for the carbohydrates in the meal if you know how many there are. The amount of adjustment varies for different people at different ages. One person may find that he can handle 15 grams of carbohydrate with 1 unit of insulin, whereas another may need 1 unit for every 20 grams of carbohydrate. Again, this is a matter of trial and error. If your child starts with a blood glucose around 100 mg dl before a meal and consumes...

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...

Changing the needle and insulin

Most of the time, you put the pump's needle or cannula in your child's abdomen, taking care not to put it where it will be under pressure, such as at his belt line. In particular, you shouldn't place the needle or cannula within a 2-inch circle around the belly button. Change the needle or cannula early in the day so that you have a few hours to verify that it's working properly. You don't want your child to go to bed and miss a night of insulin. If you suspect a severe infection, contact your child's doctor for advice. If in doubt, take it out is a good way of avoiding serious infections associated with your child's insulin pump. Put the infusion set in another site, and start pumping again. With all this information on changing the needle, you may forget to switch the insulin, too. The reservoir of insulin in the pump needs to be changed every three days or so to keep the insulin fresh. If your child's in a hot climate, he may need to change it even more often. Every pump requires a...

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...

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.

Testing away from the finger

Some glucose meters can perform the test away from the fingers. This gives the fingers a rest and offers a huge number of other sites for testing, such as the forearm and the thigh. If you want to test your child away from his finger, there are a few things to consider If there's any question of your child having hypoglycemia, the finger should be used. It reflects the true blood glucose much more rapidly than other sites in the body.

Selecting a Home Blood Glucose Meter

All home meters now on the market are accurate enough to measure your child's glucose correctly. They're generally plus or minus 10 percent of the reading done in a laboratory. For example, a lab reading of 100 mg dl may be anywhere from 90 to 110 mg dl on your child's meter. This is sufficiently accurate to help you decide on treatment and evaluate the results of treatment. Get a new meter for your child every two years at the very least. They're like cars in that a new model with new features is available practically every year. With each new meter, the batteries last longer, and the testing procedure becomes simpler. With recent meter developments, manufacturers have been trying to do away with coding the meter each time you use new test strips. Here are some practical tips to consider when purchasing a glucose meter for your child i Make sure that you can download your child's meter information to a data management program. (Some doctors have a preference for a particular meter...

Ensuring a smooth journey

Visit www.cdc.gov 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.

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...

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.

Keeping a Few Considerations in Mind before Using an Insulin Pump

Studies comparing the control that patients achieve with multiple injections versus the pump show little difference, which means that your child can use a pump to get the right amount of insulin without having to worry about using needles. Here are five additional reasons that people who like the pump cite for using one 1 Your child can adjust the amount of insulin by fractions of a unit and have many different amounts at different times of day. The insulin pump easily adapts to a patient's lifestyle. 1 Your child can be more flexible with meals because he's constantly getting a small dose of insulin. That's great news for today's active youngsters. 1 There's less risk of hypoglycemia because your child is getting small amounts of insulin at a time (see Chapter 4 for details about this complication). 1 The pump is visible, especially when your child wears less clothing on hot days. Also, if there's a blockage, an alarm goes off. Essentially, it makes diabetes more obvious to others. 1...

Your Primary School Child Has Diabetes

In some ways, type 1 diabetes care gets a little easier with a primary school child, but in other ways, it gets more difficult. Your child can finally tell you when he or she has symptoms of hypoglycemia, so this is easier to recognize and treat. But you must begin to control the blood glucose more carefully because your child is reaching the stage where control really counts. Your child is going to do more to separate from you. He or she may insist on giving insulin shots and doing blood tests. Studies again indicate that this is not a good time for you to give up these tasks, certainly not completely. Your child may not be physically capable of performing them and, in an attempt to hide the disease from peers, may not perform them at all during school. Diet may also suffer at school as the child tries to fit in and not stand out by eating the things that diabetes requires. i Be sure your child does not skip meals. i Have your child eat carbohydrates before exercising. At least one...

Getting a grip on general guidelines for parents

Try to maintain a balance between good diabetes care of your child and overbearing control. If you try to control every blood glucose result in an attempt to achieve perfection, you'll rapidly find that your child rebels. He'll refuse his insulin, eat foods that aren't appropriate, and refuse to exercise. Be aware that neither you nor your child is to blame for the fact that he has diabetes. T1DM doesn't result from consuming too much sugar, failing to exercise sufficiently, or any other failure that you may imagine. (Turn to Chapter 2 to find out how T1DM actually develops.) Don't overreact to a temporary loss of control over your child's glucose level. Control of the blood glucose may be lost temporarily when your child gets sick with a virus or encounters one of many other problems. When it happens, move on and try to restore the control as soon as possible without being judgmental and implying that the child was bad or did the wrong thing. A child who's really trying but gets...

Shop for Food Together

Although your child may initially think that all food originates in the supermarket, having him join you there can be a very valuable lesson in choosing good foods and avoiding bad foods. Start this practice at age 4 or 5 because he'll soon have to make his own food choices at school. It's best to eat before you and your child hit the store. A full stomach will lessen but not entirely eliminate his requests for all the goodies that are available at the supermarket. Show your child the foods that are part of his healthy diet, going from the things he eats the most to the things he should avoid. Teach him what's what as follows Make food shopping a great adventure. And make it more fun by taking your child along with you the next time and letting him guide you through the store and point out the best choices that you've taught him. Check out Chapter 8 for the full scoop on eating a healthy diet. If you have a little space in your backyard, plant a garden with your child. He'll be amazed...

Screening For Complications

Still, your child should get a foot examination yearly starting at puberty. The younger your child, the more involved you will to be in the day-to-day management of the diabetes. Make sure you know how to deal with the diabetes when your child is sick Children with type 1 diabetes are at increased risk for other autoimmune diseases, and your child will be screened for celiac disease and autoimmune thyroid disease.

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

Talking to the doctor

Your child with T1DM can do any exercise he prefers (as you find out later in this chapter). As an adult with T1DM, though, you should probably see your doctor before beginning a vigorous exercise program, especially if T1DM has been present ten years or more. You also should schedule a doctor's visit before starting vigorous exercise

Preventing and treating diabetic ketoacidosis

The treatment of DKA is left in the hands of the experts, but you should know what's being done, in general, so that you understand what your child is going through. In the following sections, I explain what happens during treatment and give you a few pointers for preventing DKA entirely. Although you can't take care of your child with diabetic ketoacidosis on your own, it's important that you recognize the signs and symptoms (see the previous section). Like most illnesses, the earlier you begin to reverse the abnormalities with treatment, the quicker the patient recovers and the lower the chance of further complications or death. first step is realizing that just because your child's sick and not eating doesn't mean that he doesn't still need insulin and perhaps needs more than usual. Performing more testing of glucose more frequently, especially on sick days, is another key step. It's also important to be very aware of the signs and symptoms of DKA. Traditionally, DKA has been...

Using other medications and treatments

At the other end of the spectrum are drugs that make it even more difficult to control your blood glucose (or your child's). Alcohol and nicotine in cigarettes top the list, but there are a number of illegal drugs that also complicate diabetes management. Avoid these drugs at all costs. In Chapter 12, I explain how they make glucose control so difficult.

Triggering type diabetes

If your child has the necessary HLA complex, he needs something in the environment most probably a viral infection to trigger T1DM. The viral infection causes his body to produce antibodies, protective proteins that try to destroy the virus. Cells that circulate in the blood, called T cells, make these antibodies. T cells can kill foreign invaders both by producing antibodies and by acting on them directly. It appears that the beta cells that make insulin in the pancreas share some antigens with the virus. Therefore, the T cells in the blood begin to attack and destroy the beta cells that make the insulin because the T cells mistake the beta cells for the virus. So how does a person reach the point where type 1 diabetes has officially developed Here's a typical scenario Your child is born with the HLA complex, and he gets a viral infection when he's 2 years old or at any other age. Over the next six to eight years, the T cells slowly destroy his beta cells. However, he has no symptoms...

Breaking down types of fat particles

Most of the fat your child eats is in a form called triglyceride. For example, the fat you see surrounding a piece of steak is triglyceride. Chylomicrons, the biggest fat particles, carry the fat from the meal your child just ate. They don't remain in the blood and don't cause arteriosclerosis (the hardening of the arteries). They disappear rapidly from the blood and usually aren't measured in a lipid panel.

Carrying the necessities

Whether you travel by car, train, plane, or boat, make sure that the essentials of diabetes care are easy to access. If you're flying, all diabetes medications and equipment must be in carry-on baggage. You definitely don't want your child's insulin to end up in Chicago when you and he are in New York. In addition, checked luggage may be in an exceedingly cold part of the airplane, and freezing destroys insulin. Although it's not essential, a letter from your doctor stating that your child has diabetes and needs to carry the following list of medication supplies and testing equipment may be helpful and especially useful should he get sick while traveling. Carry twice as much of each item as you think you'll need supplies can get lost, or you may be delayed or decide to stay longer. If your child uses an insulin pump, take an alternative form of insulin administration (such as an insulin pen or a bottle of insulin and a syringe) in case the pump breaks. i Carry the telephone numbers...

Considering an individualized education program

If T1DM makes your child unable to learn with the rest of his class (because he suffers from frequent hypoglycemia or frequent hyperglycemia, for example), he may need an individualized education program. This is a detailed program for his education based on the requirements of his diabetes as well as his special education needs. It's more of an education program than a health program, which is why I don't get into it extensively in this book. The need for this type of program is determined by parents and school officials working together. For a complete guide to the individualized education program and a program document template, visit www.ed.gov parents needs speced iepguide index.html form.

Knowing the Right Sized Portion

A 2-year-old child requires a lot less than a 20-year old adult. The recommended serving size of vegetables for a toddler is a tablespoon per year of age. If you want to get your 2-year old to eat five of his servings of vegetables, all you have to do is get him to eat ten tablespoons during the course of the day. That's a lot easier than you thought. If your child wants more, don't stop him

Training of School Personnel

2) Training for other school staff members who have primary responsibility for a student with diabetes. Such staff members need to understand how to recognize when your child Appropriately trained school personnel will help to ensure a safe school environment for your child and will enable her or him to participate in all school-sponsored events and to achieve optimal academic performance.

Training with Weights

In addition to exercises for cardiovascular fitness, encourage your child to lift weights. Have him select lighter weights that he can lift repetitively. This is called weight training. (He should avoid very heavy weight lifting, which is anaerobic refer to the earlier section Developing (And Sticking to) an Exercise Plan for an explanation of aerobic versus anaerobic exercise.) Your child's choices of exercises are numerous. I like seven specific upper body exercises because they get most of the different arm muscles. These exercises are the bicep curl, shoulder press, lateral raise, bent-over rowing, good mornings, flys, and pullovers. (I like these exercises for adults with T1DM, too.)

Competing against others

If your child with T1DM wants to compete against others (or if you're an adult interested in competitive sports), he should be permitted to do so. Chapter 6 shows you that there are many world-class athletes who have T1DM. So if it's your child's goal to join in on competitive sports, you and he need to make several important changes to his diet and insulin program. Here are some suggestions for making his competition not only fun but safe You and your child need a way to count your steps. Enter the pedometer, a little device worn on your belt that adds a step every time you do (see Figure 9-1). Some fancy pedometers are able to convert your steps into miles after you enter into the pedometer the distance you go with each step, but you really don't need more than a step counter. Here's how you and your child can use your pedometers to get up to 10,000 steps a day

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.

Handling Emotional Effects

Iscovering that your little girl or little boy has a chronic disease called type 1 diabetes (or T1DM) that you know little about but have heard can cause premature death can be devastating, to say the least. I hope that in the course of reading this book you realize that much of what you've heard is myth. With the tools that are currently available, your child should be able to live a long, quality life, though it's true that he'll spend a lot of time doing things that his friends without diabetes won't have to do. On the other hand, the attention that your child will devote to taking care of himself will probably prolong his life beyond that of someone who isn't careful about eating, drinking, smoking, and exercise.

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...

Caring for children of all ages

As your child gets closer to 6 years old, think about enrolling him in a diabetes camp or a children's diabetes group. There he'll be surrounded by kids like him and will realize that everyone has similar concerns and limitations. It turns out that diabetes isn't a punishment after all but something to be managed. (For information on camps for children with T1DM go to the Web site of the American Diabetes Association at www.diabetes.org community As the child begins school between 6 and 12 years of age, he wants to know more. This is the time for you and the child to go to a diabetes education program and to sit down together with a dietitian to work out the best diet to promote continued growth and good diabetic control. It's also the time to hand over some of the control (don't give up control of the insulin just yet), especially because you're not at school to monitor the child all the time. Establish that the school has food that's healthy for your child and also has a program...

Your Mental Health Counselor

Having a child or teen with diabetes can be a challenge. Make sure your child's health care team includes a mental health professional. This team member will work with your child and you to identify the behavioral, emotional, and social issues confronting your child and offer support and help for the whole family.

Other tips for managing carbohydrate intake

1 When your child eats carbohydrates that tend to be swallowed in larger pieces like rice and pasta, absorption is slowed by the need to break down those pieces in the intestine. His blood glucose rises more slowly. 1 When your child eats carbohydrates with fat, the fat slows down the movement of food through the intestine, so the blood glucose rises more slowly. These effects help to explain why the blood glucose rises as much as it does after some meals and rises very slowly after others. Being aware of them allows you to adjust the timing of your child's insulin to match the absorption of the glucose. For example, if he takes rapid-acting insulin and you know that a particular meal will result in slower absorption of glucose because it's high in fat, you may want to give his insulin after the meal rather than before. That way the insulin is active when the food is being absorbed. Flip to Chapter 10 for full details on using insulin properly.

Exercising to Improve Control of Type Diabetes

The fact that your child has type 1 diabetes (also known as T1DM) just makes it more important that he develops a fitness program that's part of his everyday activities, like eating and sleeping. Chapter 6 draws your attention to world-class athletes who have T1DM, and although the average child with T1DM isn't likely to become a world-class athlete, he can certainly use physical activity not only to help to control diabetes but also to help to live a long and full life. Everyone should exercise regularly, not just people with diabetes. In this chapter, you find out why exercise is important in T1DM, how you can get started and get your child started, and what exercise may be best for you both. Stop finding excuses and begin enjoying the body that carries around your brain and heart The Diabetes Exercise and Sports Association is an organization that you can turn to for help, instruction, and friendship as you add exercise to your child's good diabetes care. Check out the...

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.

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.

Handling Eating Disorders

An eating disorder is particularly dangerous in a child with T1DM because she tends to reduce or stop her insulin, knowing that insulin is required to store fat. She can rapidly get into ketoacidosis (see Chapter 4). If you suspect that your child has an eating disorder, take her to her endocrinologist for a discussion, and get a recommendation for a therapist who handles eating disorders. They can be very complicated and very dangerous.

Considering the Consequences of Type Diabetes

Uncontrolled T1DM has consequences, both short-term, which occur within days or even minutes of loss of control of blood glucose, and long-term, which occur after 10 to 15 years of poor glucose (sugar) control. This part goes in-depth on the topics of short- and long-term complications and also lets you know that your child doesn't have to suffer any of these consequences.

Handling school work and other daily activities

A number of laws mandate the accommodations that schools must provide for your child with diabetes. Chapter 14 tells you how to get the school authorities on your side with the use of Section 504 Plans and individualized education programs. I also discuss how to handle T1DM in college.

Ten of the Latest Discoveries in Type Diabetes

5o much is being discovered every day in T1DM that I could write this whole book on that aspect rather than limiting it to a chapter of ten items. It's a very exciting time I'll even go so far as to predict that you'll see your child cured of T1DM in your lifetime. In this chapter, I provide you with ten of the latest discoveries in T1DM. Knowing that you're most interested in a cure, I discuss the most likely directions from which that cure will come. Not every approach will bear fruit, but you only need one to work in order for your child to be free of his least desired role a person with T1DM. (See Appendix B for a list of resources that can help you keep up with the latest discoveries.) Doctors are well on the way to major advances in type 1 diabetes prevention and treatment. It's definitely a good move for you to keep your child as well controlled as possible (or to do the same for yourself if you're the patient). After all, you want your child's body to be in perfect condition...

Getting a grip on the glycemic index

1 Just because the GI is low doesn't mean that the food is good for your child with diabetes if it contains a lot of fat. Chocolate is one example. i Some diabetes educators feel that the concept is too confusing for people with diabetes to understand. I think that if you're smart enough to read this book, you're smart enough to understand the GI. You need to use every available tool to keep your child's blood glucose level under control, and the GI can be a valuable tool for people with T1DM. It has been shown that people whose overall food history incorporates more foods with low GI have lower incidences of diabetic complications.

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

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

Understanding Diet Challenges at Every

Children with T1DM should follow the nutritional guidelines that I provide earlier in this chapter, but as with all children, diet challenges can arise. Here are some issues that you may face as your child grows (for any serious diet issues, be sure to consult a dietitian) behavior. Never force-feed your child if you think he isn't getting enough calories. It's usually best to give a preschooler insulin after eating because you know how much carbohydrate he has eaten. Someone at the school has to be able to determine how much insulin should be given and give it (see Chapter 14 for more on handling diabetes at school). It's better to err on the side of too little than too much insulin. At this age, your child is increasingly active, and this has to be taken into account when determining the insulin dose. It may be easier to control his diabetes if the meals are smaller and the snacks more numerous, thus reducing the amount of insulin needed at any one time. 1 Puberty from 13 to 19...

Excluding Other Types of Diabetes

Ro paraphrase Senator Lloyd Bentsen in a famous vice presidential debate when he told Senator Dan Quayle that he was no Jack Kennedy, I know type 1 diabetes, and type 2 diabetes is no type 1 diabetes. It's unfortunate that type 1 diabetes and type 2 diabetes have the same name except for one digit. One always seems to be confused for the other despite the fact that their differences are numerous. If uncontrolled, both diseases are associated with high levels of blood glucose, leading to the same long-term complications, but even their long-term complications differ in some respects. To mix up matters even more, a form of diabetes called latent autoimmune diabetes in adults (LADA) has features of both type 1 diabetes and type 2 diabetes. This chapter describes type 2 diabetes, latent autoimmune diabetes in adults, and how they differ from type 1 diabetes so you can make sure that you (or your child) are diagnosed with and treated for the correct disease.

Ten Myths about Type Diabetes

In this book, you find everything of importance that you need to know to help your child (or yourself, if you're an adult patient) live a long and healthy life with type 1 diabetes (or T1DM for short). If you don't read about something in one of the chapters on diagnosis and treatment, it's unlikely that it plays an important role in diabetes care. So if you hear about some great breakthrough in T1DM and it isn't in this book, consider it a myth until proven otherwise. You can even drop me an e-mail and tell me about it at diabetes drrubin.com. I'm happy to either confirm or deny it.

Surveying the symptoms

If you suspect that your child has DKA, there are a couple of quick tests you can do at home to verify the diagnosis After you verify DKA with a home test, or if you suspect that you or your child has DKA even without a diagnosis of type 1 diabetes, dial 911, and then call your doctor to tell him or her that you're on the way to the hospital.

What about children with diabetes

It is very common for parents and families to have trouble coping with a child's illness and therefore good rapport and communication with the health-care professionals involved in your child's diabetes care is essential. Support groups and educational materials targeted towards families of very young children can help parents and families to feel less alone and can normalise feelings of guilt, anxiety and fear. It is important to accept the fact that diabetes won't just 'go away', but remember that diabetes management must not take over your family's life. Love, guide and discipline your child as if diabetes were not a factor and tell yourself that a diagnosis of diabetes does not have to be totally negative people grow and change not only when things are going well, but also when they are not

Changing or Losing a

The Consolidated Omnibus Budget Reconciliation Act (COBRA) stipulates that your employer must keep you on your current health insurance for as long as 18 months after your job ends and longer if you are disabled. If your child is at the age when he or she is no longer covered under your policy, the child's coverage can continue for up to three years. You, rather than your employer, have to pay the premiums for this continued insurance.

Controlling Type Diabetes in the Elderly

If you're growing older with T1DM or are the spouse or child of an elderly person with T1DM, there's a lot to know about managing the disease at this stage in life. For many reasons that I explain in this chapter, it's very different from managing T1DM when your child is 10, otherwise healthy, and has his whole life ahead of him.