straightBD Getting Started™

For Parents of Childrenwith Type 1 Diabetes

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When your child is diagnosed with diabetes, it

is normal to be frightened, sad and even

depressed. The following conversation is

based on the questions and emotions

many parents experience at the time

of their child’s diagnosis.

We hope these questions and

answers – gathered from diabetes

educators, doctors and parents of

children with diabetes – will help

give you the basic information and

reassurance you need right now as

you begin to cope with your child’s

new diagnosis of type 1 diabetes.

My daughter Jennifer has diabetes! I’m really scared!

It’s okay to be scared. Your fears are normal.

It might help to look at it like this: not only

does Jennifer have diabetes, but your family

does, too!

Do you mean diabetes is contagious?

No. You can’t “catch” diabetes (although it does run more in some

families than in others). What we mean is that Jennifer’s diabetes will

have a big impact on all the members of your family.

But, I’m really scared!

Who wouldn’t be? You’re probably

thinking that you don’t know

enough about diabetes to take care

of Jennifer and are afraid that you

could make a mistake that could harm

her. Maybe you think that you somehow

won’t be able to do what it takes, or your

imagination is taking off with all kinds of

things. But you, your family, and Jennifer’s

caregivers will learn how to help her live a

full and long life.

Welcome toTHE TYPE 1 ‘CHAT ROOM’

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I’m also scared Jennifer could die from diabetes!

Of course, no one knows when a person will die.

But if you take healthful steps, make some lifestyle

changes, and follow Jennifer’s diabetes plan, she

should live the long, healthy life that you expect.

A bonus is that you may also improve

your own and the rest of your family’s

health and longevity with the lifestyle changes

you will be making in your household because

of Jennifer’s diabetes.

But, Jennifer is sick. That is worrisome! How can you say she can be healthy with diabetes?

When children are first diagnosed with diabetes,

they can be very sick. Jennifer may have lost weight,

be dehydrated, or vomiting. With prompt treatment

and insulin, however, a child usually gets back to

normal very quickly.

Why did this happen to us? Did I do something to

cause diabetes?

There is nothing you did that caused diabetes

or that you could have done that would

have prevented type 1 diabetes. Researchers are studying the reasons why

children get diabetes. In type 1 diabetes, the cells that make insulin are

destroyed. Therefore, there is not enough insulin available for energy.

Type 2 diabetes is different. Type 2 is often a result

of children being overweight. Insulin is produced but

doesn’t work properly. Type 2 often runs in families.

Jennifer has type 1, so that’s where our focus will be.

Our hopes and dreams for Jennifer are blown away. I can’t believe it!

It is normal to grieve when your child gets sick. You are probably in

shock. Maybe you are thinking that your perfect child is no longer

perfect. But, hold on a minute! Your doctor or nurse probably didn’t say

anything like that! It’s important to recognize these feelings but realize

that there is a lot of information you need to learn now. Try to stay

focused on learning so you and Jennifer can go home from the hospital as

soon as possible.

Jennifer can live a normal life – yes, normal

– as long as you, your family, and others

learn to help Jennifer manage her blood

sugar (glucose) levels. Your household will

just have a different definition of “normal.”

You will learn to balance healthful eating,

exercise, monitoring blood glucose (sugar)

levels, and adjust insulin as you go

with the help of your doctor and

diabetes educator.

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Okay, I’m a little calmer now. But before I learn more, I have to ask you again –

can Jennifer really have a “normal” life or is diabetes a disability?

Diabetes is a chronic illness, which is classified as a disability

by the Americans with Disabilities Act (A.D.A.). The A.D.A.

and other Federal and State laws protect children with

disabilities from discrimination. Schools must give children

with disabilities an equal opportunity to participate in all

activities and services unless doing so would impose an

undue burden. Don’t be afraid to talk to your school about

what Jennifer needs to manage her diabetes at school.

When her blood sugar levels are well controlled, Jennifer

can do anything anyone else does. Kids with diabetes ride

bikes, play sports, swim, dance, date, grow up, get married, have

children, grow old, have grandchildren – just like everyone else.

Jennifer has some special needs, but with

care, diabetes should not get in the way.

From now on, “normal” will include

diabetes management tasks.

It can’t be that simple, can it?

It is not simple. Balancing it all

is not easy. Sometimes it can

be downright challenging. So,

be patient with yourself and

use the resources available

to you, such as your diabetes

educator and dietitian.

Challenging – I’ll bet it’s challenging! So, what do we need to do?

Great question! Let’s talk about a few things

that you will need to learn, such as:

• What happens in Jennifer’s body when she eats or drinks

• How to monitor her blood glucose levels

• Signs and treatment of high and low blood glucose levels

• Jennifer’s blood glucose target range (your doctor will tell

you what blood glucose value is the best for your child.

It may be a range of 80-140 mg/dl, for example)

• How to give insulin

• How to plan meals, snacks and count

carbohydrates

• How to balance food, exercise, and insulin

• How to work with your diabetes health

care team

I want my child to be a healthy, happy person.

Now there’s a word to consider – person!

From this moment, you must think of

Jennifer as a “person first.” Jennifer

is not “a diabetic.” She is a person

with diabetes.

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I don’t get it! The doctor said Jennifer has diabetes. Doesn’t that make her a diabetic?

Look at it this way. Every person is different. Some wear glasses,

others have musical talent, and some are funnier than others. Jennifer

has diabetes. If we think of her as “a diabetic,” it becomes a label.

She is a person first and a kid who happens to wear glasses and

have diabetes.

Now that makes sense! So from now on I’ll put my whole child first, ahead of the

disease. But will others see her that way?

Some will, and you’ll need to teach the rest. As a

parent you must address physical, mental, and

emotional concerns. Diabetes can sometimes

affect the stages that your child goes through

as she grows and develops, such as issues

with independence, or separation anxiety.

You may need to help Jennifer deal

with her feelings of being different

from others because of diabetes.

So, what do you say? Are you ready

to learn more?

Let’s do it! Can we start with eating and drinking?

Whenever we eat and drink, the food is digested in

the stomach and turned into sugar or glucose. Although

protein also contributes to the amount of glucose, most of the

sugar comes from starches, called carbohydrates.

The sugar or glucose then travels into the blood to feed the cells of your

body. Sugar gives cells the energy your body needs to function.

Sugar needs help to get inside the cell and be able to be used for energy.

Normally, insulin helps the sugar get into the cells for energy. But when

someone has type 1 diabetes, there is not enough insulin. So the sugar

can’t energize cells and the level of sugar in the blood rises.

What happens to all that sugar?

That’s just the problem! The sugar stacks up in the bloodstream. That

is called hyperglycemia or high blood glucose

levels. When blood sugar levels run high,

blood vessels can be damaged. Eventually,

the damage causes complications such as eye,

kidney, nerve, heart and blood vessel problems.

Now wait a minute and don’t panic. This

happens over time if blood sugars stay high.

That’s why you’re learning how to control

diabetes now, so that complications can be

minimized or even prevented later.

What do you feel like when you have hyperglycemia?

People with diabetes who have hyperglycemia

can feel a lack of energy. They get thirsty, and

have to urinate frequently when blood sugar

levels run high. If the blood sugar remains high for a

period of time, the body begins to burn fat for

energy. When the body does this, it makes a

chemical called ketones that can be detected in the urine.

Sometimes they complain of blurred vision and can

have unexplained weight loss.

But you said Jennifer could live a normal life. What kind of life is it when you have to go to the bathroom all the time, always feel thirsty, and have no energy?

Those are the right questions to ask! But the truth

is that all these unpleasant symptoms will go away

when blood sugar levels are brought under control.

You mean Jennifer won’t have to feel those things ever again?

Blood sugar levels normally go up and down all of the time,

so there will be times when Jennifer may feel very thirsty or

have frequent urination. However, even if her blood sugar

is running high from time to time, you will learn how to

correct it quickly.

Your doctor or

diabetes educator

will give you a target

range for blood sugar

levels. If Jennifer’s

sugar is running higher

than that range, she

may experience these signs. They are alerting

you that Jennifer’s blood sugar is out of control.

High blood sugar levels can damage blood vessels and organs over time

if left untreated. That’s a good reason to try to keep them as close to

the target range as possible. Keep in mind that there may be times,

no matter how hard you may try, that blood sugars will go high or low.

When you are having a difficult time, keep in touch with your diabetes

team for help.

Then, what can I do to keep Jennifer’s sugar under control?

Control comes from balance. You have to learn about

balance so you can teach your child. You will most likely

need to teach other family members, too! But first, we

need to talk about blood glucose monitoring.

Make Blood Sugars Go Up

• Food

• Stress

• Illness

UPMake Blood Sugars

Go Down

• Exercise

• Medicine

DOWN

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Okay, I’m all ears! Tell me about blood glucose monitoring.

You and Jennifer will learn how to use a blood glucose meter. You’ll put

a tiny drop of blood on a little strip and the meter will tell you how much

sugar is in the blood. You’ll do this before every meal and at bedtime.

You may sometimes need to check the blood between meals and bedtime

or even in the early hours of the morning if Jennifer has signs of

running too low or too high.

Please tell me I don’t have to stick my child all the time!

The straight answer, unfortunately, is “yes, you do.” Let’s face it –

nobody likes that. But honestly, the lancets are so small and fine that

they hardly hurt at all. It is usually the idea that is more objectionable

than the actual poke.

I feel so sorry for Jennifer.

Try to prick your own finger and see how

painless it really is. Of course, no one

wants to stick one’s finger all the time, but

your child will learn to handle it. Hugs are

important for you both! Remember that

you’re doing what you have to do to keep

Jennifer healthy. Don’t forget that she needs

regular rules too. If talking back wasn’t OK

before diabetes then it’s not OK now. If

Jennifer doesn’t understand regular rules she

won’t understand rules about taking care of diabetes.

Okay, but tell me this: once we know the glucose level is too high or too low, what do we do about it?

More great questions! If a glucose level is too

low (hypoglycemia), Jennifer may need to eat

something sweet. If the blood sugar is too

high (hyperglycemia), Jennifer may have to take

more insulin or exercise to bring the blood sugar

down. Check with your doctor for advice on

how to treat low and high blood sugar. Your

diabetes educator will also teach you how to

check your child’s urine for ketones. If ketones

are present, you will need to call your doctor

for further instructions.

Your diabetes educator will provide blood sugar numbers for your action

plan of treatment. For example, if your target is to keep blood sugar

levels over 80 and Jennifer has a blood sugar of 70, your action plan

might say to give her 1/2 cup of juice, or 2 to 4 glucose tablets. If blood

sugar is below that, your plan may say that you can add 6 crackers. The

specific treatment for Jennifer will depend on her age,

size, type of insulin and when her next scheduled

meal or snack is due.

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So, what if the blood sugar is low. You said, “eat.” Eat what?

Children with diabetes should never be without glucose tablets or some

other form of sugar. You and Jennifer will carry them all the time for

just this use. Glucose tablets taste good, and come in various flavors.

Juice is another great way to get the blood sugar up

where it belongs. Or the child can eat any of a

number of fast-acting carbs (carbohydrates) like

hard candy or raisins.

Jennifer can eat candy?

Actually, yes! Jennifer can have candy

occasionally, as long as she exercises or takes

insulin. Naturally, your dentist won’t like the

candy idea. The secret is balance. A small

piece of candy or an occasional cookie is

not usually a problem. But this is where

the family meal

plan comes

in. Remember

we said, “in a

way, you all have

diabetes.”

Well, let me take the worst case first! I suppose taking insulin means another stick.

Unfortunately, yes. But again, the stick

isn’t too bad. Try taking an injection

with an empty syringe to see what it

feels like so that you know what your child is experiencing.

This will encourage Jennifer to take the insulin. Don’t tell her

“this isn’t so bad” when you took just one shot and she will

take thousands. The current needles are extremely small and

comfortable. Jennifer may need to take insulin before meals

and bedtime.

You might use a special pen that delivers insulin,

or a pump might also be an option.

A pen is a

device that looks like a pen that you

use to write. It contains a cartridge filled

with insulin and a needle is attached to the end of it. The needle is

changed every time the pen is used. You dial in the insulin dose, place

the needle into the skin and press the button. The insulin is given. The

pen makes giving insulin easier and more convenient for your child,

especially if several injections of insulin are needed.

The pump delivers a continuous flow of insulin through

a very small tube that looks like a tiny straw placed

under the fatty layer of skin. The tube, called a

catheter, is introduced into the skin with a needle

that is then removed. The catheter stays in place and

insulin can flow to the fatty layer of the skin without further

injections. The catheter can stay in place for up to three days. You

program the pump to deliver insulin before meals and snacks. It takes

some practice, but even a youngster can do it with adult supervision.13

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What do you mean?

Kids just don’t want to be different. It is usually

hard for a youngster to eat healthy foods when

the rest of the family is chowing down on sweets

and high fat snacks. If you think about it a

minute, we’re sure you’ll agree. You simply can’t

have cookies, chips, candy, and sweet desserts

around and expect your child not to eat them.

Jennifer will develop healthy eating habits from

the way your whole family eats. So, the

other family members might have to

face some lifestyle changes, particularly

the way they eat – and what they eat!

So Jennifer can’t ever have a cookie?

Now don’t put words in our mouths or

pull the cookie out of her mouth! Sure kids

with diabetes can eat a cookie. But it

needs to be planned and included

in a healthy meal plan. You will

learn to be smart about it. By that

we mean there’s a smart time to

have something sweet. Just before

exercise, for example, is a smart time.

It’s a good idea to eat a snack prior to a ball

game so Jennifer doesn’t have low blood

sugar and run out of energy in the middle

of the game.

You said something earlier about balance.

We really have been talking about balance all along.

Food, exercise, and insulin have to be balanced.

Exercise consumes energy. Food produces sugar.

Insulin makes sugar work right in the body. Too

little exercise and the blood sugar will become too

high. Too much food will have the same effect.

Too much insulin will make the blood sugar too

low. You get it, don’t you? Balance!

How am I ever going to learn all this? How can Jennifer, and everyone else in the family, even grandma?

That’s where your diabetes health care team comes in. They will

teach you and guide you. Hopefully, you’ll have a doctor, nurse,

dietitian, and a diabetes educator on the team. Sometimes one

person will fill several of those roles, but you’ll need plenty of help.

Other helpful resources are

the Juvenile Diabetes Research

Foundation (JDRF), and the

American Diabetes Association

(ADA). You can find support,

information about activities and

summer camp there. Don’t

forget websites on the Internet

as well, like the BD website at

www.bd.com/us/diabetes.

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Doctor:

Phone #

24 Hour Emergency Phone #

FAX Blood Glucose Records to:

Nurse Educator Phone #

Registered Dietitian Phone #

School Nurse Phone #

Resources in Community

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You can! You will! You must! After all, it’s your child we’re talking

about! Your child with diabetes can live a normal, healthy, and

happy life. These lifestyle changes we’ve been discussing will help

you and your family live a more healthy lifestyle, too.

One thing that is important for you to do is to form a network

of people who can help and support you. You know – folks

you can call on, cry with, laugh with, and count on!

Thanks. This has really helped a lot!

You’re most welcome. We know you’ll

take good care of Jennifer!

I HopeI CAN DO IT!

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10D06412354SAPBROBD and BD Logo are trademarks of Becton, Dickinson and Company. ©2010 BD.

BD provides this brochure for informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read in this brochure.

1 Becton Drive Franklin Lakes, NJ 074171.888.BDCARES (232.2737) www.bd.com/us/diabetes

Written by: Jean E. Betschart Roemer, CPNP, MSN, MN, CDE Pittsburgh, PA

We wish to acknowledge the following health professionals for reviewing this publication and providing their valuable insights:

Jodi Moore, RN, BSN, CDE New Brunswick, NJSusi Johnson, RN, CDE Houston, TexasJennifer Lavoie, RN, BSN, L LT San Diego, CA