Other factors affecting care needs of children with insulin dependent diabetes
Any condition which makes controlling dietary intake and delivering timely insulin treatment more difficult will increase care needs -:
- Any diagnosed behavioural condition or developmental condition which makes compliance with treatment on a daily basis difficult or prolonged will increase time spent providing treatment.
- Any diagnosed behavioural condition or developmental condition that impairs the ability to learn how to manage treatment independently at the age expected will prolong care needs beyond the age expected.
- When diabetes is one of a number of conditions which in combination require extra care and attention on a daily basis.
Diabetes may be caused by use of oral steroid drugs, these are necessary in a number of childhood conditions including kidney disease, childhood cancer and asthma. Diabetes and insulin treatment will add an extra dimension of care required to the parents of affected children.
Children who develop the longer term complications of diabetes such as kidney failure and visual problems may have care needs related to these in addition to those of unaffected children.
Care needs of a typical diabetic child on insulin treatment
Insulin can be given intermittently through the day as individual injections or by means of a pump which the child wears on their person and adjusts whenever food is eaten. Whether a pump is used or injections are used the principles of managing blood sugar levels with insulin treatment are the same. Insulin is administered to control blood sugar each time food is eaten.
The steps involved in the administration of insulin include -:
- Monitoring blood glucose
- Assessing carbohydrate content of meals
- Calculating dose of insulin required based on carbohydrate content of food to be eaten and blood sugar level
- Safe storage and use of insulin and medical equipment
- Preparation of appropriate amount of insulin for injection
- Injection of insulin
- Safe disposal of needles
It will take some time for a child to learn how to carry out these steps with guidance and supervision from parents. The child is likely to administer their own injections from diagnosis but prompting, supervision and guidance will be required for all of the above steps for some time depending on the age of the child. Delivering treatment as prescribed every day is necessary to avoid hyperglycaemia and hypoglycaemia.
Adjusting to a diagnosis of diabetes and incorporating blood sugar management into daily life is a significant challenge for any child. Gaining experience of insulin dose adjustment for different types of food and during inter-current illness takes time. Significant parental help, guidance, prompting and supervision of treatment and emotional support accounts for the extra care required.
Type 2 diabetes
Children with type 2 diabetes are unlikely to have significant care needs unless they are receiving insulin treatment. If insulin treatment is being used, follow the above section on ‘care needs of a typical diabetic child receiving insulin treatment’.
Children with type 2 diabetes may be following a calorie restricted diet if they are overweight. They may require encouragement to take physical exercise. They may require supervision for a few minutes each day whilst taking their tablet treatment. Attention to diet and physical exercise is a normal part of parenting.
Tablet treatments for type 2 diabetes
These children are likely to be overweight and weight reduction can improve insulin sensitivity. Blood sugar levels can be improved by weight loss, increased physical activity and careful diet. Where diet, exercise and weight loss fail to improve blood sugar control tablet treatments that reduce blood sugar can be tried. It should be used in addition to those measures. The main drug used is Metformin, it is a tablet taken 1-3 times daily. Blood sugar monitoring on this treatment is required but does not have to be done on a daily basis.
This drug can be combined with an insulin injection regime, usually one or two injections per day. Blood glucose monitoring is required but does not have to be done on a daily basis.
Other tablet treatments rarely used include glibenclamide, gliclazide and tolbutamide.
