Children and Diabetes



Children with type 1 diabetes can lead a normal life. Nevertheless, they need special attention. What parents, teachers and carers need to know

Strong Band: For Type 1 diabetes the whole family is in demand

Children with diabetes
Diabetes therapy in children
Too high and too low blood glucose levels
movement and sport
Easy in kindergarten and school
Sick child - what to do?
Advisory expert

1. Children with diabetes

When children develop type 1 diabetes, a lot changes in life - for the small patients themselves and for their parents. The participants must pay attention to the diet, regularly measure the blood glucose and inject insulin . The therapy accompanies the small patients over the entire day, at home, in the kindergarten or in the school.

That sounds complicated. And in fact, diabetes management means a considerable increase in the number of affected families. But do not panic! Immediately after the diagnosis, parents and children learn in special training sessions how to master diabetes in everyday life, so that the various measures are quickly passed into flesh and blood. Apart from, few programs are also exist in the market which have developed after the great research just like 7 Steps to Health and Big Diabetes lie program.

Despite this, children with diabetes can predominantly lead a normal life and maintain their habits and activities. They do not have to be packed in cotton wool; on the contrary, when they learn to cope with difficult situations, they gain experience, self-confidence and safety.

For their sake, parents should be as open as possible and educate their environment about diabetes and its treatment. The better informed all parties are, the more confident they will be able to deal with the disease. Some tips for parents, carers and teachers of children with diabetes we have put together in the following.

What is type 1 diabetes?
Most is a Type 1 diabetes occurs when children suffer from diabetes. This is an autoimmune disease . The immune system of the body attacks the beta cells in the pancreas. These produce the hormone insulin, which is necessary to pass sugar from the blood into the cells. If the beta cells are completely destroyed, sufferers do not produce their own insulin anymore and the sugar level in the blood rises. You need to pass the vital hormone from the outside to regulate their values ​​- usually by injecting it. Without insulin, serious metabolic dermatitis can occur, which can be fatal. In addition, increased sugar levels permanently damage numerous organs in the body.

If numerous beta cells are already destroyed, the insulin deficiency often manifests itself with symptoms such as great thirst, frequent urination, fatigue, weight loss and nausea. Type 1 diabetes often occurs within a few days and weeks. Parents should consult a doctor in good time if the symptoms occur.

Rarely in children in Europe is type 2 diabetes , which can be due mainly to overweight and too little exercise. In this case the pancreas still produces insulin, but this is worse. In the case of type 2 diabetes, too, the blood glucose levels increase. It is usually treated initially but not with insulin, but with tablets.

The aim of the treatment of diabetes is to keep the blood glucose in the normal range to prevent acute metabolic disorders and organ damage due to excessive blood glucose levels.

Young woman
Diabetes mellitus type 1
Here you will find information on causes, symptoms, diagnosis and therapy of type 1 diabetes 
measure blood sugar
Diabetes mellitus type 2
In the metabolic disease the hormone insulin is worse. Changes in lifestyle can often improve the course 

2. Diabetes therapy in children

Children with type 1 diabetes have too little or no insulin. As a result, the sugar from the blood does not enter the cells where it is needed for energy production. Instead the blood glucose increases. The treatment of type 1 diabetes aims to get the metabolism back under control and to avoid greatly increased or too low blood glucose levels. For more information on high and low values, see 3.

The treating physician will adjust the target values ​​as well as the therapy according to the metabolism, the circumstances and the individual possibilities of the child. In training, parents and children learn how to master everyday life with diabetes and what they have to look out for. There are also training courses for teachers and carers in which they can get information.

Blood glucose levels lower with insulin

Children with type 1 diabetes need insulin several times a day to lower their blood glucose levels. This can be done either with a syringe or with a penUnder the skin. Increasingly, young diabetic patients in Germany also receive an insulin pump, which continuously delivers insulin into the tissue.

Standard in the conventional treatment is the intensified insulin therapy. In this case the children receive a long-acting insulin, which is supposed to cover the basic requirement - the so-called basal insulin. In addition, short-acting insulins are supposed to intercept the blood glucose increases after eating and to correct acute high blood glucose values.

The dosage should take into account the current blood glucose value as well as the upcoming meal and physical activities. For diet and exercise affect the blood glucose level. In principle, children with diabetes can eat everything. Also sugar is not taboo. She and her parents have to learn how to correctly calculate the carbohydrate content of a meal. Only then do they know how much insulin they have to inject to compensate for the sugar rise after eating. In order to avoid the blood sugar sinking too low, school children with diabetes must also be allowed to eat in the classroom outside the school breaks. Otherwise there is a risk of severe hypoglycaemia .

Insulin pump: alternative to injection

Insulin pumps are small devices that can be worn comfortably on the body. At the touch of a button, they release a dose of insulin to correct blood glucose levels. In addition, they continuously release a small amount of insulin to cover the basic requirement.

Especially in small children the therapy with the insulin pump has some advantages. Spraying with the pen is no longer necessary. With this, the small amounts of insulin that infants need can often be poorly dosed, which can be a cause of blood glucose fluctuations. With the pump folds better. Also for parents or carers the insulin delivery by the push of a button is easier than with a pen or syringe.

Parents must apply for an insulin pump at the health insurance. You should work hand in hand with the attending physician. The funds do not always pay the costs for the pump.

Check the blood glucose level

The blood glucose level must be measured regularly in order to detect too high or too low values ​​in time. In the case of the very small and kindergarten children, the parents or carers take over, schoolchildren can take over the measurement as a rule already. The help of adults is, however, often still necessary to interpret the results of the measurement and to calculate the amount of insulin required for injection.

Most children and adolescents with diabetes are supposed to measure their blood glucose levels approximately five to eight times a day. In individual cases, it may be useful to control the values ​​more frequently. This is especially true:

In case of labile metabolism (with severe blood glucose fluctuations)
To prepare for sports activities
On suspicion of an onset of hypoglycemia
The measuring itself is today simple: with a lancing device on the side (less painful) in the fingertip piksen, the blood drop with a test strip and the blood glucose meter can be evaluated within a few seconds. A guide and tips on the right trade fair can be found here .

React if the values ​​are too low or high

Depending on the result of the blood glucose measurement, it may be necessary to do something immediately: if the value is too low for example, a snack with fast carbohydrates prevents the blood sugar from dropping further (see below). If the values ​​are too high, it may be useful to inject insulin.

Record all test results best - for example in a blood glucose test book . This is important in order to adapt to insulin therapy. As a rule, blood glucose meters have an electronic memory from which the values ​​can be retrieved.

3. Too high and too low blood glucose levels

Slight hypotension is relatively common, but harmless if detected in time. It is risky when the blood sugar falls too low. Highly elevated blood glucose levels can also be dangerous.

In case of hypoglycemia the blood glucose level drops sharply. Frequent reasons are:

Too much insulin injected
Meal forgotten or carbohydrate content of the meal too low
Sports without lowering the insulin dose
Error in blood glucose measurement and therefore injection of too high an insulin dose
Gastrointestinal infections (with the result that carbohydrates do not get into the blood)
Children in the school age can often already recognize early signs of hypoglycaemia and react correctly. Kindergarten children can already tell that they feel symptoms, but do not always perceive them reliably. Like small children, they depend on parents or carers to look for warning signs and to act properly.

Early Warning Signs:

Pallor around mouth and nose
Fast pulse
behavioral changes
difficulty concentrating
Changed font
The symptoms occur when the blood glucose level drops to about 70 mg / dl. However, the threshold for hypoglycaemia is different. The signs also differ from person to person. Parents usually get a quick feel for their child to suckle, and should give educators or teachers in the case of the appropriate information.

Advanced stage:

a headache
Visual and speech disorders
Confusion, sleepiness
A hypoglycaemia can quickly be eliminated with carbohydrates, which pass quickly into the blood: grape sugar tablets, cola / limo (no light products!) Or gummy bears.

Important : Eat carbohydrates at the first sign of a lower sugar. Under no circumstances should a schoolchild wait until the next break. In addition, it is important to stop any physical activity at the beginning of hypoglycemia so that the sugar does not fall further.

If a child becomes unconscious with diabetes as a result of hypoglycaemia, it should not be given any fluids because of the risk of swallowing. Hypoglycemic disorders can be quickly resolved by the ambulance using a glucose injection.

In addition, there is the possibility to have an emergency syringe (glucagon set) prescribed. This syringe can also be administered by amateurs. Glucagon causes the corporeal sugar stores to empty and the blood glucose level rapidly rises again.

During hypoglycemia, mental performance may also be impaired. After the affected child has carbs carbohydrates, this condition usually improves within a few minutes. In no case may a child with diabetes be sent with a hypoglycaemia from the class or even home!

High blood glucose

Not always insulin injections reliably prevent the blood glucose increases. Possible reasons are, for example, mistakes during injections, incorrect diet, lack of exercise or infections. Also psychological stress such as anger and excitement can increase the blood glucose.

A persistently high blood glucose can cause a series of symptoms in children as well as adults with diabetes (see below), which are mainly characterized by strong thirst and acetone odor in the air, reminding of nail polish remover or overripe fruit. If such signs occur, this indicates an initial metabolic derivate, a so-called ketoacidosis . This occurs with absolute insulin deficiency at approximately 250 mg / dl.

An acetone test provides information on whether the blood is over-acidified. If this is positive, it is absolutely necessary to follow the measures agreed with the pediatric diabetologist. It is important that the child drink a lot of liquid immediately, for example mineral water, and insulin. If the metabolism does not improve, diabetic coma can occur. This is life-threatening and must be handled in a hospital.

With a little care in insulin therapy and mindfulness, these metabolic dislocations can generally be well prevented. The most important warning signs are:

Strong thirst
Frequent urination
Rapid fatigue
Nausea, vomiting
Acetone odor (sweetish-fruity)

4. Exercise and sports

Children with diabetes can and should be physically active. You can participate without restriction in gymnastics in the kindergarten and sports lessons in the school. They are just as powerful as their healthy old-age companions.

However, energy consumes energy and therefore lowers blood glucose. To prevent hypoglycemia, children with type 1 diabetes must therefore either inject less insulin or take extra carbohydrates. Before sporting activities, always measure the blood glucose and hold glucose. Children, parents and caregivers agree with the treating physician how to adapt their therapy in sport.

Insert breaks for intermediate meals

It is critical when the energy consumption increased in sport is not absorbed by a decreased insulin dose or increased carbohydrate intake, or the physical exercise is more strenuous than planned. For longer activities, such as several hours of walking, short breaks for additional intermediate meals may be necessary. Even if the school hours are unexpectedly shifted, children with diabetes must be given the opportunity to eat something to prevent hypoglycaemia.

In case of very high blood glucose values, sport is prohibited. Because these are a sign of insulin deficiency. The result may be that the blood glucose level does not drop despite physical activity - since no insulin is present - but on the contrary even increases. In sports, stress hormones such as adrenaline are released, which increase the blood glucose level. The result may be a metabolic derailment. In the case of very high blood glucose values, make a ketone test beforehand in case of doubt.

In principle, diabetes can also benefit from sport. How far affected children and adolescents can participate in particularly intensive activities and what precautions they should take should be coordinated with the supervising physician and the diabetic team.

5. Easy in kindergarten and school - tips for parents

Speak openly with educators and teachers

Inform kindergarten and school about the diabetes of your child at an early stage. Bring information materials for educators and teachers to the conversation. If you feel insecure: Ask your diabetes consultant to accompany you.

Arrange in writing with the guidance that you will not hold educators or teachers responsible for mistakes. And make sure you are always reachable by phone.

Ask your diabetes counselor, supervisor and teacher to train

Diabetes centers provide training for teachers and caregivers of children with diabetes. Professional education helps to reduce anxiety and prejudice: the more educators, teachers and classmates know about diabetic therapy, the more willing they are to support your child.

Even before excursions and class trips, a conversation with the diabetes counselor can create trust with parents, teachers and school friends. For longer class trips a parent should travel.

In special cases, an outpatient nursing service can be used, which comes to the nursery school or the school for blood glucose metering and injection. If the child diabetologist or dentist prescribes a prescription for this, the health insurance company usually assumes the costs. Supervisors and instructors have to take care of their child anyway - and in the event of a severe hypoglycaemia.

If this is not enough: try to get an integration aid

In rare cases the care provided by the nursing service is not sufficient. Then you can apply for an integration or integration aid with the social welfare office. This is a trained specialist, for example a nursery who takes care of the whole kindergarten and school day around your child and is there for other children. The social workers of your diabetes center will help you with the application.

Excursions and class trips

A child familiar with his or her diabetes can take part in trips and several-day classes as naturally as in sports. Depending on the age and independence of the child, the child needs a little more attention and good preparation. Particularly in younger children, it can be useful for a parent to be a companion.

The excursion program should discuss the caregivers and parents together in advance with the child. Unaccustomed physical stress such as hikes, ski or bathing days will require a change of the therapy plan. Insulindosis and nutrition must be adapted to the physical strain and the changed daily course.

It is the responsibility of the caregivers on the ground to ensure that the child keeps his time for meals and syringes. For safety, they should always have a packet of glucose for hypoglycaemia.

6. Sick child - what to do?

Infections cause the blood glucose levels in children to get mixed up very quickly. Therefore, it is important to control the blood glucose more frequently than usual. In addition, children develop a fluid shortage more quickly, which is why parents must pay attention that their child drinks enough.

Fever increases insulin requirement

Febrile illnesses increase insulin requirements. The bolus should therefore be increased by ten to thirty percent for a febrile infection. If this is not sufficient, the dose of basalinsulin may need to be increased. The exact procedure, please do not hesitate to consult with the doctor and always call him if you have any doubts.

In diarrhea and vomiting, the body can not properly utilize the carbohydrates. This increases the risk of hypoglycaemia. Therefore, it may be necessary to first reduce the dose of basal insulin - by how much, clarify with the treating physician. Do not leave the basal insulin completely. Even if a child vomits or does not eat anything, it needs insulin. The dose of the meal insulin should be reduced by about one third to about half. Here, too, you can consult the doctor individually.

Eat and drink during illness

Give your child to eat small portions of salt bars or white bread without fat spread. If it can not hold anything solid, give him sweetened drinks in small swallows. So bend a hypoglycaemia.

If the child does not want to eat or drink, always offer him a spoonful of patience. In gastrointestinal infections with vomiting, a refraction-inhibiting suppository can help, for example with the active ingredient dimenhydrinate. There is no prescription in the pharmacy, but you should talk to the pediatrician beforehand if it is appropriate in your case. Immediately after vomiting, the vomiting stimulus is the least. Take advantage of this to offer something to your child.


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