coping with diabetes
Post on 18-Feb-2016
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Changing Diabetes® and the Apis bull logo are registered tradem
arks of Novo Nordisk A/S
Coping with Diabetes
Programme
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2
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What to tell the family
Effects of growth on diabetes
Storing insulin
Nutritional advice
Acute illness
Dispelling myths and false beliefs
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8
10
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11
School issues
Fasting
Pregnancy
Smoking, alcohol and drugs
Exercise
What to tell the family
At diagnosis• First contact is crucial• Can achieve the following:
• Explain diabetes symptoms• Enroll the family into care of the child• Specifically invite the father and mother• Initial diabetes education• Dispel myths and false beliefs
• Family bewildered and shocked• Be supportive, empathic and caring• Answer comprehensively and respectfully
Symptoms
• Explain symptoms and signs• Diagrams useful• Demonstrate glucose values and urine dipsticks• Explain mechanism
• Insulin deficiency• Unknown cause
• Raise questions for future discussion
Dispelling myths and false beliefs
Myths and false beliefs
• Cause of diabetes/ genetics/ environment
• Cure for diabetes• Use of alternative medications• Toxicity of insulin• Use of pills for treatment• Infectiousness of diabetes
Acute illness
Acute illness
• Acute illness may cause:• High glucose (hyperglycaemia)• Low glucose (hypoglycaemia)• Ketones
• Ketones may occur during, before or after the illness• Children with diabetes do not have more frequent
illness• Know how to advise families on management of acute
illness
Management (1)• Do not stop insulin delivery• May increase or decrease dose• Need frequent monitoring
• Glucose 3-4 hourly• Ketones 1-2 times per day• Admit if:
• no home monitoring• it is not getting better despite
doing all you can at home• Treat illness
• Sugar-free medication• No steroids
Management (2)
• Supportive care• Easily digested food• Adequate fluid intake• Antipyretics (paracetamol)• Consider admission
• Adjust insulin doses – never stop insulin• Educate family on management of illness• Provide written guidelines for family
Nutritional advice
Nutritional advice (1)• Food provides energy for growth and day-to-day
functioning
• Food intake influenced by• Family functioning• Psychological and emotional factors• Societal factors• Socio-economic factors
• Food (carbohydrate) intake to be balanced against insulin
• Food intake to be balanced against activity • Glucose monitoring used to balance food intake, activity
and/or insulin dose
Nutritional advice (2)
General dietary guidelines
• Use meal plans rather than a diet• Try not to have do’s and don’ts• Keep plans simple and practical
Meal plans
• Depend on local factors• Calorie restriction for obese patients• Allow for individual choice• Allow flexibility and variety in food selection• Balance financial needs and availability of foods and
snacks• Depends on what is available locally
Food and insulin
• Balance food and insulin• Adapt insulin to suit meal• Different regimens allow
change in• Meal plans• Meal frequency
Food Insulin
Food and insulin
Twice daily regimen• Regular snacks and meals• Risk of hypos is missed
meals/snacks• Emphasise regularity and
portion sizes at meals
Multiple daily injections• More flexibility• Less short-acting insulin for
smaller meals• Need to understand effects of
food and insulin on glucose
Teaching about food• Plan for balanced meals• Aim for:
• 50-60% carbohydrates• 15-20% protein• <30% fats
• Teach food groups and reading food labels• Teach entire family – especially the father and
grandparents• Energy requirements change with growth
Storing insulin
Storing insulin
• Insulin is a ‘fragile’ protein medication• Denatured if frozen or in excessive heat• Stored at 2-8°C• Use before expiry date• Once opened, may last
• 1 month if not refrigerated• 3 months if refrigerated
• Storage of insulin is important
Storage of insulin
• Clinic and home• Power refrigeration
• Not freezer• Back-up generator
• Passive/water refrigeration• Underground• Clay pots
• Rotate stock by expiry date
Questions
Changing Diabetes® and the Apis bull logo are registered tradem
arks of Novo Nordisk A/S
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