Understanding Diabetes in Children and Youth
A diagnosis of diabetes in a child can seem intimidating whether it comes before or after a child has been adopted. In Canada over 15,000 children aged 12 - 19 are currently diagnosed with diabetes (Statistics Canada, 2014). There are two types of diabetes: Type I diabetes and Type II diabetes. The amount of information on either type of diabetes can be overwhelming, however both Type I diabetes and Type II diabetes can be managed with the proper supports in place.
Types of Diabetes
Type I diabetes is a chronic condition where the pancreas produces little or no insulin, which is a hormone needed for sugar to enter cells to produce energy (Mayo Clinic Staff, August 2017). For unknown reasons, the body’s own immune system destroys the insulin-producing cells of the pancreas. This results in a complete deficiency of the insulin hormone leading to increased blood and urine sugar levels (Mayo Clinic Staff, August 2017). When sugar builds up in the blood instead of going into cells, the body's cells starve for nutrients and other systems in the body must provide the energy needed for many important bodily functions (Mayo Clinic Staff, August 2017). As a result, high blood sugar develops and can cause a variety of health concerns (Mayo Clinic Staff, August 2017).
Type II diabetes is much more common and occurs when the body becomes resistant to the effects of naturally produced insulin or does not produce enough insulin (American Diabetes Association Staff, 2014). This can occur when diet, weight, age or other genetic factors (Mayo Clinic Staff, April 2013) causes the individual’s body to stop responding to insulin that is being made by their body.
Type II diabetes can be prevented or delayed for a number of years in children once they are identified as being at risk of developing Type II diabetes (American Diabetes Association Staff, 2014). Typically, being overweight or obese is the most common way for a child or youth to be identified as being at risk for developing Type II diabetes. Small changes in a child or youth’s diet and exercise routine can be made to reduce the risk of developing Type II diabetes. For example, children or youth should be encouraged to eat a diet of fruits and vegetables, to drink water instead of pop or juice and to limit fast food (Mayo Clinic Staff, April 2017). Children or youth should also be exercising at least 60 minutes a day and screen time should be limited to 2 hours a day, including time spent on the computer, TV and cellphone (Mayo Clinic Staff, April 2017).
Symptoms of Diabetes
There are some common symptoms of both types of diabetes however there are differences in how these symptoms emerge over time. For Type I diabetes, symptoms usually develop quickly over a period of weeks (Mayo Clinic Staff, August 2017). For Type II diabetes, symptoms appear gradually over a period of time or may not even appear at all (as 40% of children diagnosed have no symptoms) (Mayo Clinic Staff, April 2017).
Symptoms common to Type I and Type II of diabetes include:
Some symptoms unique to Type I diabetes are:
Some symptoms unique to Type II diabetes are:
Managing Type I Diabetes
Advances in blood sugar monitoring and insulin delivery have greatly improved the daily management of Type I diabetes. The key to good physical health when living with Type I diabetes is keeping your child’s blood sugar levels within the target range, which can be done with meal planning, exercise and intensive insulin therapy (Wherrett, Huot, Mitchell & Pacaud, 2013). Blood sugar levels must also be checked regularly and adjustments of insulin, food and activities can maintain a normal sugar level. The type of insulin and amount of insulin used will depend on a number of factors, including a child’s age, lifestyle and the child’s preferences (Wherrett, et. al, 2013).
Treatment of Type I diabetes focuses on lowering blood sugar to near normal range, with the ultimate goal of normalizing blood sugar to avoid long-term complications (Mayo Clinic Staff, August 2017). In addition, the treatment plan should not significantly impair normal activities with proper planning and awareness.
If managing your child's diabetes starts to feel overwhelming, consider working closely with your child's diabetes treatment team — doctor, diabetes educator and registered dietitian — and getting to know how diabetes looks in your child’s life. Like many things in life, no two children will present with diabetes in the same way. Even if your child takes insulin and eats on a rigid schedule, the amount of sugar in his or her blood can change unpredictably (Mayo Clinic Staff, August 2017). With help from your child's diabetes treatment team, you'll learn how your child's blood sugar level changes in response to a variety of factors such as food, physical activity, medication, illness, growth spurts, puberty and sleep habits. Don’t be afraid to ask for help!
Managing Type II Diabetes
Type II diabetes differs from Type I diabetes because at times it can be prevented and insulin is not always prescribed with a change is diet and increase in exercise often recommended to help with sugar levels (Mayo Clinic Staff, April 2017).
No treatment plan will remain the same throughout a child’s life (Mayo Clinic Staff, April 2017). As your child grows and develops, their management plan will evolve with them to respond to their changing needs (Mayo Clinic Staff, April 2017). A typical treatment plan for a child diagnosed may involve insulin at the beginning of treatment but the goal will be to slowly reduce the amount of insulin as lifestyle changes are introduced (Panagiotopoulos, et. al, 2013). These lifestyle changes can include a reworking of the entire families diet with the help of a licensed dietitian and the introduction of more frequent exercise into a child’s routine (Panagiotopoulos, et. al, 2013).
There’s no such thing as a “diabetes diet”, your child will not be restricted to a lifetime of boring, bland foods. Instead, they will thrive on a diet high in fruits, vegetables and whole grains — foods that are rich in nutrients and low in fat and calories (American Diabetes Association, 2014). Consuming fewer animal products and sweets is in the best interest of your child and the whole family (Mayo Clinic Staff, August 2017).
Everyone needs regular aerobic exercise and children who have either type of diabetes are no exception (American Diabetes Association, 2014). Encourage your child to get regular physical activity! They can sign up for sports teams, dance lessons or even participate in activities with you like playing catch or basketball as well as walking or running through your neighborhood. Make physical activity part of your child's daily routine (Mayo Clinic Staff, August 2017).
Parenting a Child with Diabetes
Good diabetes management requires a lot of time and effort, especially in the beginning. However, by working together you and your child will quickly get the hang of it.
A child with Type II diabetes also requires parental support as they make lifestyle changes, such as introducing regular exercise and making healthy food choices. Parents may wish to model this behavior to support their children’s lifestyle changes.
In parenting a child with either type of diabetes, the goal is to help the child learn to manage their own symptoms and fully participate in childhood activities. Younger children will need parental help to ensure they adhere to any diet recommended and regular eating routines. The whole family can be involved in supporting healthy routines and helping a child manage blood sugar levels. Below are further considerations when parenting a child with diabetes.
Your Child's Emotions
Diabetes can affect your child’s emotions both directly and indirectly. Poorly controlled blood sugar can directly affect their emotions by causing behavior changes, such as irritability (Wherrett, et. al, 2013). Diabetes may also make a child feel different from other children, and they may feel resentful at times for having to perpetually incorporate diabetes planning in all of their activities. Arranging activities for your child and other children who have diabetes may help with feelings of isolation.
Mental Health and Substance Abuse
Teenagers in particular may have a hard time dealing with diabetes. A child may rebel in the teen years by ignoring his or her diabetes care with behaviours such as experimenting with drugs or alcohol and eating disorders (Wherrett et. al, 2013).. Without education and support, there is an increased risk of depression and anxiety for those with diabetes, however involving a diabetes specialist, social worker or psychologist in your child’s life can greatly assist them with their emotional needs (Wherrett, et. al, 2013). Teens may also have a harder time telling friends, boyfriends or girlfriends that they have diabetes because they want to fit in. As a parent it is important to learn about the effects of drugs and alcohol on someone with diabetes and to maintain open communication about what is needed to maintain good health. Additionally, let your child's doctor know if you have any concerns.
Talking to a counselor or therapist can help you or your child cope with the dramatic lifestyle changes that often come with either a Type I or Type II diabetes diagnosis. Your child may also find encouragement and understanding in a diabetes support group for children.
As a parent, it may be helpful to connect with other people parenting children with either type of diabetes. There are also numerous support groups available both online and in person (See “Helpful Links” below), that can be good sources of current and helpful information, if you are open to it. Speak to your child’s doctor for a recommendation or to find out about supports and resources in your area or community.
Putting Information into Context
Since reading about the complications associated with poorly controlled diabetes or mismanagement of diabetes can be frightening, it is important to remember that some studies and literature may be out of date with the most recent advances in diabetes care. It is important to continue to work with your child’s healthcare team to ensure your child’s health is being closely monitored.
Helpful links or resources for Diabetes:
Diabetes Canada: http://www.diabetes.ca/
An organization the works Canada-wide to assist individuals and their families living with either type of diabetes.
Diabetes Canada Patient Resources: http://guidelines.diabetes.ca/patientresources
A guidebook for various aspects of either Type 1 or Type 2 diabetes including a breakdown of medication options and healthy eating tips.
Generation D: For young adults living with Type 1 diabetes: http://www.diabetes.ca/getmedia/db5dea24-4498-47aa-81bc-9a762e346a27/d-camps-generation-d.pdf.aspx
A guidebook for young adults living with Type 1 Diabetes covering how they can begin to take over management of their diabetes from their parents.
Sweet Dreams For Chiyo: http://www.cbc.ca/cbcdocspov/episodes/sweet-dreams-for-chiyo
A documentary following a family as they adjust to their daughters Type I Diabetes diagnoses and the effects if has on her parents, siblings and their relationships.
Diabetes Education Online -Type II Diabetes: https://dtc.ucsf.edu/types-of-diabetes/type2/
An outline for those individuals living with Type II diabetes that walks them through the basics, management and treatment options
Stand up to Diabetes: http://health.gov.on.ca/en/public/programs/diabetes/channel.aspx/
A website run by the Ontario Ministry of Health and Long Term Care that provides overviews of diabetes information and links to other helpful resources.
American Diabetes Association Staff (Dec 30, 2014) Preventing Type II Diabetes in Children. Retrieved from: http://www.diabetes.org/living-with-diabetes/parents-and-kids/children-and-type-2/preventing-type-2-in-children.html
Mayo Clinic Staff (Aug 16, 2017). Type I Diabetes in Children. Retrieved from: https://www.mayoclinic.org/diseases-conditions/type-1-diabetes-in-children/symptoms-causes/syc-20355306
Mayo Clinic Staff (April 19, 2017). Type II Diabetes in Children. Retrieved from: https://www.mayoclinic.org/diseases-conditions/type-2-diabetes-in-children/symptoms-causes/syc-20355318
Panagiotopoulos, C., Riddel, M. C. & Sellers, E. A. C. (2013) Type 2 Diabetes in children and adolescents. Canadian Journal of Diabetes. Retrieved from: http://guidelines.diabetes.ca/browse/Chapter35
Wherrett, D., Huot, C., Mitchell, B. & Pacaud, C. (2013) Type 1 Diabetes in children and adolescents. Canadian Journal of Diabetes. Retrieved from: http://guidelines.diabetes.ca/Browse/Chapter34