What to tell the family At diagnosis First contact is crucial

Coping with Diabetes

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

Nutritional advice (2)

• 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

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 and insulin

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