Changing Diabetes and the Apis bull logo are registered trademarks of Novo Nordisk A/S

Coping with
Diabetes
 Programme

1 What to tell the family 7 School issues

2 Dispelling myths and false beliefs 8 Exercise

3 Acute illness 9 Smoking, alcohol and drugs

4 Nutritional advice 10 Pregnancy

5 Storing insulin 11 Fasting

6 Effects of growth on 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 dos and donts
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 Food Insulin
Meal frequency
Food and insulin

Twice daily regimen Multiple daily injections

Regular snacks and meals More flexibility
Risk of hypos is missed Less short-acting insulin for
meals/snacks smaller meals
Emphasise regularity and Need to understand effects of
portion sizes at meals food and insulin on glucose
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 2-8C
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
Changing Diabetes and the Apis bull logo are registered trademarks of Novo Nordisk A/S