DiabetesDiabetesYour child has

A parents guide formanaging diabetes in children

When you first found out that your child has diabetes, how did you feel? Scared? Angry? Sad? Guilty? Many parentshave these feelings at first, and they are normal. Finding outyour child has diabetes is tough. But did you feel this waybecause you didnt think your child could live a normal lifewith diabetes? Well, that does not have to be the case.

Children with diabetes are just like other children. They can grow up to lead happy and active lives. The onlydifference is children with diabetes have to keep their bloodglucose (sugar) in a certain range to stay healthy. Whilechildren who dont have diabetes dont have to worry abouttheir blood glucose at all.

You and your child will have to learn how to manage his or her diabetes. But this will take time. So you may haveto take the lead in managing it. Learn as much about diabetesas you can. It can help you and your child cope with anynegative feelings you may have. No matter how old your child is, learning about diabetes takes a team effort.

Introduction toyour child has diabetes

This book was written to teach you the basicsabout diabetes and managing it. It is not asubstitute for what your doctor, nurse, certifieddiabetes educator (CDE) or any other healthcareprofessional advises you about your childs diabetes.

1

Children need lots of energy to grow and be active. Thisenergy comes from food. Once inside the body, food ischanged into glucose. Then it goes into the blood and iscarried to the cells of the body.

Insulin is a hormone that opens the cells to allow theglucose inside. Insulin is made in the pancreas (a gland near the stomach). There are certain cells in the pancreas called beta cells. These cells release insulin into the bloodstream to help glucose get into the bodys cells.

With diabetes, the body either does not make insulin, does not make enough insulin or the cells cant use insulin the way they should. When there is not enough insulin, the cells dont open up to use the glucose.

Childrenneed energy

2

Diabetestypes of

3

The two most common types of diabetes are:

Type-1 Diabetes

Type-2 Diabetes

With Type-1 diabetes, the beta cells in the pancreas make little or no insulin. This means there is notenough insulin to help glucose get into the cells. The extra glucose stays in the blood and does not get used.Instead, it is dumped into the urine and the body gets rid of it. This can rob a child of energy and starve the body because the cells cant get glucose. Because of this, children with Type-1 diabetes have to injectinsulin to help move glucose into thecells. Most children have Type-1diabetes but some have Type-2.

You may wonder what caused your child to get diabetes. There is no known cause. But it is believed that one or more of these havesomething to do with it:

a virus attacks the pancreas

problems with the bodys self defense system (auto-immune response) that damage the beta cells in the pancreas

a family history of diabetes

Type -1 Diabetes

4

5With Type-2 diabetes, the body makes insulin but it doesnt make enough or the cells cant use it the way they should. Type-2 diabetes is much more common than Type-1. Butmost people who get it are 40 years old or older. However,children are now getting Type-2 diabetes more than everbefore. This is often caused by:

being overweight (can be caused by eating lots of fast food and junk food)

lack of activity and regular exercise

Some children with Type-2 diabetes have to inject insulin. But some can control it by:

eating healthy meals

exercising daily

taking medicine (oral agents)

losing weight (some children who lose weight dont need to take medicine)

If your child has Type-2 diabetes, now is the time to help him or her start and keep healthy habits.

Type -2 Diabetes

Children often see things in a different waythan adults. Your child may not understandwhy he or she has diabetes. Young childrenwho have diabetes might think:

they caught diabetes from someone else

they will die because diabetes begins with die

diabetes is a punishment for something they did

Of course, none of this is true. So to help your child better understand diabetes,explain this to him or her. Older children mayunderstand why they have diabetes, but stillhave a hard time dealing with it. They may getangry, depressed or you might notice other changes in their behavior. These feelings are normal at first. With your help, your child can learn more about diabetes and begin to manage it so that many of these feelings go away.

Learning about people with diabetes who have hadsuccessful lives can be helpful. You may want to tell your childabout celebrities, sports figures or people you know who havediabetes. Some examples are Thomas Edison (famous inventor)and Nicole Johnson (Miss America 1999).

From a childs point of view diabetes

6

7For now, diabetes cant be cured. But it can be managed.Learning how to manage diabetes can help your child grow up healthy. It can also help him or her develop good habits for the future. Managing diabetes means checking blood glucose levels and balancing:

the amount and type of food eaten

exercise and activity levels

insulin and/or oral medicines

stress levels

Food and stress raise blood glucose levels, while exercise, insulin and medicine lower it. Keeping a balance between all of these will help keep your childs diabetes in check. Checking your childs blood glucose will help you know if his or her management plan is working.

Managingdiabetes

Your child may feel he or she has todo a lot to manage diabetes. So be awareof this. You should stay involved in yourchilds life and step in at times. But, onceyour child is able to handle it, he or sheshould be involved in his or her owncare. Being involved can help your child:

have more confidenceand higher self-esteem

feel like he or she reached a goal

start good habits for the future

become more responsible

For younger children, helping manage diabetes, little by little, will get them into the habit of good management.Older children want to be independent, and letting them be in control is a good way to see if they can handle it. But trynot to rush your child into doing things that he or she is notready to handle. No matter how independent your child iswith diabetes management, you should still be involved.

8

9Team*management

Raising a child can be hard. Trying to manage diabetes can make it harder. When you learned your child has diabetes, youmay have felt that you would have to deal with it on your own.That is not the case. Your childs diabetes management team canhelp you. The team will work closely to get your childs diabetesunder control.

You and your child are the most important members of the management team. You can teach your child to help out in his or her own care.

A Pediatric Endocrinologist/Diabetologist is a doctor specially trained to work with children who have diabetes.

My childs endocrinologist/diabetologist is .

A Certified Diabetes Educator (CDE) or a Nurse Educator is aperson who is specially trained to work with children withdiabetes. Your childs CDE teaches you and your child all aboutdiabetes and how to manage it.

My childs CDE is .

A Registered Dietitian (RD) is a person who will help you andyour child plan meals and make healthy food choices.

My childs RD is .

* Your childs diabetes management team may or may not have all of these members. And you may have some people work with you who are notlisted here.

team members continue on next page

An Ophthalmologist is a doctor who specializes in diseases of the eyes. If diabetes is not managed, it can cause problemswith the eyes. But with good management, this should not be a problem. Five years after diagnosis, your child should get his or her eyes checked every year.

My childs Ophthalmologist is .

A Podiatrist is a doctor who specializes in care for the feet. Ifnot managed, diabetes can cause problems with the feet. But withgood management, this may not be a problem.

My childs podiatrist is .

A Social Worker (SW) is a person who specializes in findingand giving information on diabetes related services that you andyour child may need to better manage diabetes.

My childs social worker is .

Other members of my childs diabetes management team:

management

* Your childs diabetes management team may or may not have all of these members. And you may have some people work with you who are notlisted here.

10

Team*

11

Having diabetes does not mean your child can only have bland and boring meals. A healthy meal plan for a child withdiabetes is almost the same as a healthy meal plan for a childwho doesnt have diabetes. This means your child can enjoy a variety of foods.

To have enough energy and to grow up healthy, a childsmeal plan needs the right mix of fats, proteins, carbohydrates,fiber, vitamins and minerals. Avoiding a meal plan high in fat,salt, cholesterol and sugar is also important. Work with adietitian to come up with a healthy meal plan that your childwill enjoy. Keep in mind that to balance meals and insulin,your child needs to:

eat at about the same time each day

avoid skipping meals or snacks

eat the right amount of foods at each meal

Eatinghealthy meals and snacks

93

6

12

MealTime!

Try to involve your child in meal planning. The amount of planning depends on your child. An older child might beable to plan all of his or her meals everyday. Youngerchildren may not be ready for this. They could also be pickyeaters. So offer them a few different choices at mealtime and let them choose.

Sometimes, things come up that may not fit into your childs meal plan. A group of friends want to go to a fast food restaurant after school. Or a friend is having a birthday party with lots of cake and ice cream.What should you do?

While it is important that your child sticks with his or her management plan, it is also important to let a child be a child. If things happen from time to time it is OK. Explain that it helps to know about parties and other group activities in advance. Often, food from parties can be worked into the meal plan without too much trouble.

Meal Planning

12

13

There are different meal planning methods. You and your childmay decide that either exchanges or carbohydrate (carb) countingwill work best. The exchange system places foods into threegroups based on the number of carbohydrates, proteins and fatsthey have. These groups are called exchanges because you cantrade any food in a group for a different food in the same group.

Counting carbs is another way to help plan meals. Carbsbreak down into glucose quickly. So, monitoring the number of carbohydrates in your childs diet can help control bloodglucose levels. Talk to your childs doctor or dietitian about carb counting.

Exchanges* and Carbohydrate Counting

By spreading your childs carbs out over the course of the day, you can keep his or her blood glucose from getting too high or too low.

To do this, you need to knowhow many carbs to let yourchild have at each meal orsnack. In the side chart, ask your childs diabeteseducator or RD to fill in how many carb grams your child should have each day.

How Carb Counting Helps

* You can contact the American Diabetes Association (ADA) for an exchange list.The exchange list servings may differ from those suggested with the pyramid.

Breakfast _______Snack _______Lunch _______Snack _______Dinner _______Snack _______

Total _______

The food pyramid helps create a meal plan that keeps your childs blood glucose in a healthyrange. The pyramid is divided into groups of foodtypes. How much of each type your child needseach day is based on the number of calories neededfor a healthy weight at different activity levels forboth boys and girls.

Food Pyramid

14

Grains

Vegetables

Milk

Fruits

Oils

Meat & Beans

Visit www.mypyramid.gov for more information.

15

Grains include all foods made from wheat, rice, oats, cornmealor barley. At least half of all grains eaten should be from high-fiberwhole grains.

Vegetables include all fresh, frozen, canned or dried vegetablesand vegetable juices. Vegetables are sub-divided into dark green,orange, legumes (beans), starches and all others. A variety of vegetabletypes should be eaten each week. Canned vegetables and vegetablejuice have a lot of sodium, so eat less of them.

Fruits include all fresh, frozen, canned or dried fruits and fruit juices. Fresh and frozen is best. Canned or dried fruit and juicescontain a lot of added sugar, which can affect blood sugar.

Oils include fats from many different plants, fish and fats that areliquid at room temperature, such as canola, corn, olive, soybean andsunflower oil. Some foods are naturally high in oils, like nuts, olives, fish and avocados. Other foods that are mainly oil include mayonnaise, some salad dressings and soft margarine.

Milk include all fluid milk products, yogurt and cheese. Other foods made from milk like, cream cheese, cream and butter, are not part of the group (they have little to no calcium in them). Choose fat-free or low-fat.

Meat and Beans includes 1 oz of lean meat, poultry or fish, 1 egg, 1 Tbsp peanut butter, 14 cup cooked dry beans or 12 oz of nuts or seeds (equal to 1 oz of meat or beans).

16

Vegetables 1 cup

Meat & Beans

2 oz

Fruits 1 cup

Oils 3 tsp

Milk 2 cups

3 ozGrains

Calories 1,000

1 cup

3 oz

1 cup

4 tsp

2 cups

4 oz

1,200

112 cups

4 oz

112 cups

4 tsp

2 cups

5 oz

1,400

2 cups

5 oz

112 cups

5 tsp

3 cups

5 oz

1,600

212 cups

5 oz

2 cups

5 tsp

3 cups

6 oz

1,800

212 cups

512 oz

2 cups

6 tsp

3 cups

6 oz

2,000

23

1,000

Calories

ageBoys

I, M, AI

345

1,200M, AI

4568

1,400MI

4568910

1,600AMI

91011121,800

MI

8911

13142,000

AMI

activity level

23

ageGirls

I, M, A

47 I

456810

M, AMI

5679

1113

AMI

7910111418

AMI

10111218

AM

activity level

How many calories your child needs are based on activity levels bygender. Activity levels are: I = inactive; M= moderately active; A = active

How many calories are right

17

To help know your childs activity level, follow these rules:

Inactive means your child gets less than 30 minutes ofphysical activity each day. This includes riding a bike (lessthan 10 mph), hiking, yard work or walking briskly (over312 miles an hour), etc.

Moderately active means your child gets between 30 and 60 minutes of physical exercise each day.

Active means your child gets 60 or more minutes ofphysical activity each day. This includes running, riding a bike (more than 10 mph), swimming laps, etc.

Exercise is good for everyone especially children with diabetes.Exercise helps the heart pump more blood with less effort, itimproves circulation and keeps muscles strong and toned. For children with diabetes, exercise offers added benefits such as:

lowering blood glucose levels

helping the body use insulin better (if it is used)

losing weight*(if needed)

being physically fit

* Most children with Type-2 diabetes

are overweight.

Exercise and Activity

18

Since exercise lowers blood glucose levels most of the time,extra steps have to be taken to avoid hypoglycemia (low bloodglucose)*. This means:

regular blood glucose checks before and after exercise

prepare for longer exercise periods with a snack

glucose checks during longer exercise periods

Children dont always plan out their activities, they just like to go out and play or hang out with their friends. But when a child has diabetes, making a habit of checking blood glucose before activity and always carrying a sugar source snack will help him or her avoid problems.

* see pages 33-35

19

Some children who have diabetes need to take insulin. Like exercise, insulin lowers blood glucose levels. So balancing it between exercise and eating is very important.

You and your childs doctor will decide upon which type of insulin your child should use. A member of the management team will teach you and/or your child:

when it starts to work

when it works hardest

how long it lasts

how to inject it

Insulin

20

Talk to your childsdoctor or nurse aboutthe type of insulinyour child needs. Usethe chart below to fill in this information.

Type of insulin your child uses:

How many units your child needs:

How many times your childshould inject per day:

How long after injecting before the insulin begins to work:

How long it takes for the insulin to work its hardest:

How long the insulin lasts:

One of the first things you may have to learn is how to injectinsulin. This may seem a bit scary for both you and yourchild. Try to be positive when you inject the insulin. A youngchild will not really understand why you are sticking him or herwith a needle. You may feel bad or guilty about doing it. But ithas to be done for your childs health.

At some point, you or your childs diabetes educator willhave to teach your child how to inject insulin. Each child isdifferent. Dont force a child to learn to inject insulin before heor she is ready. An older child may learn how to do it quickly.It might take a bit longer to teach a younger child how.

Your child may need several injections each day. Or, two types of insulin may need to be mixed and injected to make sure your child has enough for a full day. It all depends on your childs needs.

21

Injecting insulin

22

An insulin pump is another way for your child to get insulin. The pumps:

are about the size of a beeper

must be programmed (You will have to learn how to do this. Your child may also have to learn this, depending on his or her age.)

give a steady flow of insulin

have to be worn at all times (except for bathing and swimming)

may allow more flexible meal times

may allow your child to exercise or do other activitieswithout worrying about glucose levels going too low

Insulin pumps do not check blood glucose. So, regularblood glucose checks are still very important. And, following a healthy meal plan is still needed with a pump.

Talk with your doctor or nurse about the pump. Yourmanagement team can help you decide if it may be right foryour child. Pumps can be expensive. So check with yourinsurance carrier to see if an insulin pump would be covered.

Insulin Pumps

Medicinesoral agents

23

In addition to insulin and exercise, oral agents may be used tolower blood glucose in children who have Type-2 diabetes.Oral agents are not the same as insulin. There are severaltypes of oral agents and they work differently. Some:

cause the pancreas to make more insulin

slow down the breakdown of carbohydrates

keep the liver from releasing too much glucose

make the muscle cells more sensitive to insulin

Oral agents can be given alone or used with other oralagents or insulin. But they still have to be balanced withmeals and exercise. Talk with your childs doctor about oralagents. Together you will decide if your child needs to take an oral agent. If so, fill in the chart below.

Name of oral agent Time your child Amount your childshould take it should take

24

Exercise, diet and medicine (insulin and oral agents) have to be balanced to keep your childs blood glucose within anormal range. These levels have to be checked often everyday. This means measuring the amount of glucose in yourchilds blood.

Your childs doctor or diabetes educator can help youchoose a blood glucose testing kit. This kit may include:

a lancet (a finger stick device)

testing strips

a meter that reads the test strip to tell the blood glucose level each time

a booklet to write down each reading

other reading materials about diabetes

Blood Glucosechecking

meter

test stripblood sample

25

To check your childs blood glucose level:

1. Wash your hands with soap and water.

2. Prick his or her finger with the lancet to get a drop of blood (it may hurt less if you prick the side of the finger).

3.* Put the drop of blood onto the testing strip.

4.* Insert the test strip into the meter.

5. After a few seconds, the meter shows the blood glucose level.

6. Record the test score in the booklet.

The prick may scare a young child. Be honest. Say that theprick will hurt. But also explain that the prick will help keephim or her healthy. This may ease your childs fears. As yourchild gets older, he or she will need to learn how and when totest blood glucose levels.

* Steps 3 and 4 may be reversed depending on your childs meter. Follow the meter instructions.

26

Despite good management, your child may haveblood glucose levels that are high or low from time to time. When this happens, you might think you did something wrong. If your child checks it, you maythink he or she did something wrong. But this maynot be the case.

Emotions and hormones can sometimes cause high or low blood glucose levels. This is often the case with teenagers who are going through puberty.But sometimes high or low blood glucose levels occur because children, especially teenagers, becomefrustrated with managing their diabetes. Thisfrustration could cause them to:

eat off schedule

not eat at all

not exercise

not take their insulin

Healthy Blood Glucose Range

27

Knowing your childs normal blood glucose range can help bothof you know if you are managingdiabetes well. Fill in the box belowso you or your child can refer to itwhen needed.

You cant be with your child every minute of every day. So, remind your child why managing diabetes is soimportant. And encourage your child to follow the plan. You may need the team to work more closely with you and your child during unstable times.

childs name s target blood glucose range is:

Before meals: _________ to _________

2 hours after meals: _________ to _________

At bedtime: _________ to _________

healthy blood glucose rangename

28

Problems with blood glucose will come up from time to time.Sometimes they are caused by not following the managementplan. But even with good management, high or low bloodglucose levels may happen. You and your child (if old enough)need to know the symptoms of these and how to treat them toavoid complications. The two main problems that canhappen with blood glucose are:

Hyperglycemia(hi-per-glie-see-mee-uh)high blood glucose

Hypoglycemia(hi-poe-glie-see-mee-uh)low blood glucose

Problemsblood glucose

29

The symptoms of high blood glucose often include:

being very thirsty

going to the bathroom a lot

being tired a lot

Teach your child these symptoms and what causes them so he or she can avoid high blood glucose. Also teach anyone who will look after your child (teacher, coach, babysitter, etc.) about the symptoms and what to do about them.

Hyperglycemia (or high blood glucose)

30

High blood glucose may be the result of:

over eating

being sick

not taking enough insulin

taking other medicines that affect blood glucose levels

not exercising enough

stress

High blood glucose maybe a result of two ormore of these.

31

When there is a lack of insulin, there is a buildup of glucosein the blood. If the cells cant get enough energy, they maystart to break down fat for energy. When fats are broken down,the body produces acids called ketones. Ketones are passedout of the body through the urine. But quite often the bodycant get rid of them all.

When ketones are in the body for too long, it can lead toketoacidosis (key-toe-acid-o-sis). This can be very serious. A urine test is the main way to test for ketones. Your childsdoctor can tell you how to do this.

When large amounts of ketones are present in the body, they can be poisonous and can lead to:

lethargy (tired all the time)

being very weak

coma (this normally only happens to children who have type 1 and have really high blood glucose levels)

Ketones

32

Ketones are measured in 3 levels: small, moderate andlarge. Ask when you should call the doctor or nurse aboutketones. Many only want to be called if the ketones aremoderate or large.

Poor diabetes management can lead to ketones. So you have to make sure your child is following his or her management plan. If your child is following the plan and ketones are present, changes may have to be made to the plan. Talk with your childs team about making changes in the plan when needed. If your child is not following the plan, see why this is happening. You may need to step in.

33

The symptoms of low blood glucose often include:

feeling irritable, nervous or shaky

being hungry

feeling dizzy

sweating too much

feeling weak

being confused or not thinking clearly

having trouble seeing

seizures

Hypoglycemia (or low blood glucose)

34

Low blood glucose is often caused by:

eating off schedule

not eating enough

exercising a lot and not eating enough food

taking too much insulin

not eating a snack during exercise

35

Low blood glucose needs to be treated right away. If untreated, it can lead to seizures or passing out. To treat low blood glucose, give your child 15 grams of a fast acting carbohydrate, such as:

12 cup of juice (apple juice, orange juice, grape juice, etc.)

12 cup of regular (non-diet) soda

3-4 glucose tablets

Re-check your childs blood glucose levels after 15 minutes. If it is still low:

give him or her another 15 grams of a fast acting carbohydrate (juice or non-diet soda)

if your child is not going to eat for a while, give him or her a long actingcarbohydrate like crackers

Your childs doctor or diabetes educator can tell you about other ways to help your child avoid lowblood glucose problems.

Treating hypoglycemia

36

Now you know that managing diabetes involves a balance of diet, exercise and medicine (insulin or oral agents) as well as dailyblood glucose monitoring. If this balance is kept, it can help yourchild delay or avoid long-term problems caused by diabetes.

If diabetes is not managed, it can lead to:

heart problems

stroke

visual problems

circulation problems

kidney problems

Balance is the key

meals

medicine

exercise

Is not managedwhen diabetes

37

Being a child can be hard. Learning new things at school, making friends and trying to fit in are all parts of growing up. But having diabetes may make these things harder.

Teach everyone who will look after your child (teacher, coach, principal, bus driver, babysitter) about your childs diabetes. It may be helpful to schedule a meeting at the beginning of the school year to talk about your childs diabetes and to let them ask any questions they may have. It may also be helpful to write a letter* that explains:

what diabetes is

what to do about hyperglycemia, hypoglycemia and ketoacidosis

when your child should eat mealsand have snacks

who to call in case of an emergency

*See sample letter on page 39

Schooltaking diabetes to

38

Explain to teachers that yourchild may need to eat snacksthrough the day and check his or her blood glucose. This is especiallytrue before any activity (recess orgym class) or whenever your childfeels his or her blood glucose is low.

Also tell them that your child may need to take medicineduring class time (inject insulin ortake an oral agent). Teachers alsoneed to know that your child mayneed to use the restroom more often than other children. If ateacher knows about this ahead of time, it might be easier for yourchild to stick to his or hermanagement plan. And, it mayprevent jealousy among the otherstudents who may think your child is getting special treatment.

Keep in mind that under section 504 of the RehabilitationAct of 1973, your child has a right to education. Your childalso has the right to a discrimination free environment. Ifyou have any questions about this Act, talk to your childsteam about it.

Lettersample

Dear _____________

____,

My child, ___________

______, has Type ___ di

abetes.

My childs diabetes manageme

nt plan includes:

1. Taking medicine (either inje

cting insulin or taking oral agen

ts).

The type of medicine my child

takes is:

________________

____________.

2. Eating meals and snacks a

t the same time each day.

3. Exercising everyday.

4. Checking blood glucose.

Please allow time for my child t

o do this.

Low blood sugar can occur. Th

e symptoms include feeling ner

vous, irritable,

dizzy, confused, weak, sweaty

and hungry. To treat low blood

sugar:

Give my child 15 grams of a fa

st acting sugar source (like

12 cup of juice or

non-diet soda). Check his or he

r blood glucose after 15 minute

s. If it is still

low, give my child another 15 g

rams of fast acting sugar. Plea

se call me.

High blood sugar can also occu

r. High blood sugar symptoms in

clude going to

the bathroom a lot, being thirst

y and feeling tired. To treat

high blood sugar,

give my child water. Please ca

ll me.

High blood sugar can lead to k

etones and ketoacidosis. The

symptoms of

ketoacidosis include heavy bre

athing, fruity smelling breath

and passing out.

If my child shows signs of ketoa

cidosis, call me or my childs do

ctor right away.

My name ___________

______

My work number ________

_____

My home number _______

______

Other number I may be at __

____________

My childs doctors name ___

___________

Doctors office number ____

__________

* You can use this letter or make your own. 39

40

Keep in mind that managing diabetes is a team effort. You, your child and your whole family should work together.

Even though managing diabetes is a lot of work, let your child be a child.

A child with diabetes needs lots of attention. If you have other children, they may be jealous of this attention. Talk to your other children and maybe involve them in the management so they dont feel left out. Make time for them too.

Always make sure your child carries extra snacks, especially when traveling.

Look into sending your child to a camp for childrenwith diabetes. At these camps, your child will learnhow others deal with diabetes. Your child will alsolearn that they are not alone.

If your child has high or low blood glucose because of something he or she did, try not to be too hard onhim or her. But remind your child how important itis to balance food, exercise and medicine.

Having your child wear Medic Alert ID can also behelpful. This will let people know about your childsdiabetes in case of an emergency. Help your childchoose the type of ID that works best for him or her.

Helpful Tipsother

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Copyright 2002, 2005by Pritchett & Hull Associates, Inc.All rights reserved. No part of this book may be photocopied, reprinted or otherwise reproduced without written permission from Pritchett & Hull Associates, Inc.

Throughout this book, where Pritchett & Hull Associates, Inc. was aware of names of products for which a trademark has been claimed, such names have been printed in initial capital letters (for example, Medic Alert).

Published and distributed by:Pritchett & Hull Associates, Inc.

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ResourcesAmerican Association of Diabetes Educators 100 West Monroe Street4th FloorChicago, IL 60603-1901(800) 338-3633www.aadenet.org

American DiabetesAssociation1701 Beaureguard StreetAlexandria, VA 22311(800) 232-3472www.diabetes.org

American Dietetic Association216 West Jackson BoulevardChicago, Il 60606-6995(800) 877-1600www.eatright.org

Juvenile Diabetes Foundation International120 Wall StreetNew York, NY 10015-4001(212) 785-9500www.jdfcure.org

National Diabetes Information Clearinghouse1 Information WayBethesda, MD 20892-3560(301) 654-3372www.niddk.nih.gov

Canadian Diabetes AssociationNational Office 15 Toronto Street, Suite 800Toronto, Ontario Canada M5C 2E3(800) BANTING (416) 363-3373www.diabetes.ca

Pritchett & Hull Associates, Inc.3440 Oakcliff Road, NE, Suite 110 Atlanta, GA 30340-3079

1-800-241-4925

e believe that you have the right to know as much as you can about yourhealth. Our goal is to give you enoughfacts to get the main points clearly inmind. We do this with medical accuracy,warmth and humor. The result for you:less tension, more healing and a good idea of what to ask your doctor, nurse or others.

WW

We also have other health information materials on a variety of topics. Call for a free catalog ofproduct descriptions.

Reviewers:

Erin Cooper, RDTalbert Medical Group

Thanks to previous reviewers:

Janet Haas, RN, CDELisa Waller, RN, CDEWynola N. Wayne, RN

ISBN 0-939838-98-2