After the Diagnosis
If your child has diabetes, it's critical that her blood-sugar levels stay in a safe range. This will be determined by a doctor, but it will be slightly higher than the normal blood-sugar level range of 70mg/dL to 120mg/dL. Levels that drop too low or spike too high can lead to seizures, coma, and even death. Whenever your child eats or is physically active, you'll need to take a droplet of blood pricked from her finger and check her sugar level using a handheld blood-glucose meter. To cut down on finger sticks, some families have switched to continuous glucose monitoring systems, devices that constantly check a child's sugar levels through a sensor inserted into her skin for up to six days at a time. But these readings aren't as accurate as metered ones, so kids must still endure a few finger pokes each day.
Blood-glucose monitors determine how much insulin your child's body needs, but they don't actually dispense insulin. For that, most newly diagnosed children with diabetes need their parents to inject insulin into their stomach, upper arm, outer thigh, or buttocks. Eventually, many people with diabetes switch to an insulin pump, a pager-size device that straps to the waistband or adheres directly to skin and delivers a steady supply of insulin via a small tube inserted into the skin. "A pump gives kids more freedom, but shots are cheaper, simpler to use, and more likely to be covered by insurance," says David Repaske, M.D., Ph.D., chief of endocrinology at Nationwide Children's Hospital, in Columbus, Ohio. Children of all ages can use insulin pumps; Meredith Buchwald's daughter Lauren was diagnosed with diabetes at age 2 and endured nearly a year of shots before switching to a pump at age 3. "No child likes to be pricked and poked multiple times a day," says Buchwald, of Weston, Florida.
Parents must be vigilant about their child's diet, though it's a myth that kids with diabetes can't enjoy cookies or cake. "No foods are forbidden," says Laurie Higgins, a pediatric nutrition and diabetes educator at the Joslin Diabetes Center. No child should have lots of sweet drinks and treats, and this also goes for children with diabetes. Carbohydrates are a particular concern because starches (like those found in bread and pasta) and natural sugars (including those in fruits and juices) raise blood-sugar levels faster than sugar does. "Parents need to count carbs and adjust their child's insulin to ensure that their blood-glucose levels don't spike too high," says Higgins.
One day soon, children and their families may not need to spend as much time crunching numbers. Researchers have been testing an "artificial pancreas," a combination glucose monitor and insulin pump system that's worn like a pager. "The goal is to have one device that automatically adjusts and administers insulin based on the monitor's readings of sugar levels," says Richard Insel, M.D., chief scientific officer for the Juvenile Diabetes Research Foundation. A recent landmark study from the University of Cambridge, in England, showed that these devices kept blood-glucose levels of sleeping kids in the normal range 60 percent of the time -- a 20 percent improvement over current treatment options.
This is big news; nighttime can be especially perilous for those with diabetes. "Blood-sugar levels can drop dangerously low and cause a sleeping child to have seizures," says Dr. Laffel. This holds especially true at the end of an active day, if a child hasn't received extra carbs or reduced insulin doses. That's why once or twice a night, Buchwald pricks her daughter's finger and arouses her to drink juice if necessary. "There's no rest when your child has diabetes: You deal with it all day and all night," explains Buchwald, who's optimistic there'll be a cure in Lauren's lifetime. "They're making tremendous strides in research every day."
Originally published in the February 2012 issue of Parents magazine.
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