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Top 10 Tips for Better Blood Glucose Control
My office used to receive phone calls about once a week asking if we held support groups for kids with diabetes. I had honestly never thought to have one. Why would any kid want to come to a support group when there are cartoons to watch and siblings to torment? But finally, I agreed to give it a shot.
It was an epic failure and a rousing success all wrapped up in one.
The kids were miserable. They ranged in age from 4 to 14, which may have accounted for some of the struggles I and my staff had in getting them focused. As much as we tried to engage them in fun social activities, the younger ones were incapable of holding still, and the older ones slouched in their chairs with looks on their faces suggesting thoughts such as, “This is stupid. I’d rather be on Facebook.” About the only time they would look up was to check the clock.
The parents, on the other hand, had the time of their lives. We had coffee and snacks for them in the other room, and I could hear them laughing and carrying on. Some of the snippets of conversation I overheard stuck in my brain:
“…you wouldn’t believe the food stash I found under his bed…”
“…if she remembered her meter like she remembered her cell phone…”
“…anyone else have bloody test strips all over their house?…”
“…we change his pump while he’s sleeping so we don’t have to sit on him…”
“…exercise? You’ve got to be kidding…”
All things considered, it was some of the best venting I had heard since the HVAC convention was in town. It was then that we decided to give the kids a reprieve and instead start a support group for parents of kids with diabetes.
For years, the group met, shared some things, learned some things, and taught me a thing or two. I already understood how complex it can be to manage diabetes in a growing child, having worked with so many over the years. (I was lucky enough to be diagnosed at age 18.) But I also learned that parenting a child with diabetes is very different from having diabetes. For example, when my blood glucose level is high or low, I deal with it and move on. But when their child’s blood glucose level is high or low, most parents become frustrated, dwell on it, and feel a bit guilty.
One of our most productive parents’ meetings was an impromptu discussion of tips for a family dealing with a recent diabetes diagnosis. From that discussion (and with a bit of refinement on my part), we developed our own “Top Ten” list of techniques for managing blood glucose in kids. (Most of the same principles can be applied by adults managing their own Type 1 diabetes.) It goes something like this:
10. Persistence pays
That’s not to say that the parent who usually oversees the diabetes tasks can never take a break. Ask someone else to help handle your tasks or oversight for a day or two. And give your child opportunities to indulge in favorite foods or ease back on exercise, record-keeping, and frequent blood glucose monitoring once in a while. Just don’t ever miss the basic things that keep him out of immediate danger: taking insulin, and checking blood glucose at least a few times each day.
9. Build structure
8. Support year-round exercise
As mentioned in item 9, above, consistency counts. And that goes for physical activity as well. Encourage your child to stay physically active on a regular basis, year-round, and provide the support he needs to do that. And remember, if all else fails, there is nothing more effective than leading by example!
7. Keep records
In general, I find that people who keep written records are able to achieve better control than those who do not. Records should certainly include blood glucose levels, but they can also include factors that affect blood glucose levels, such as insulin, carbohydrates, and physical activities. Many people find that blood-glucose-only records work fine until a problem comes up. Then, more detailed records enable more effective troubleshooting. A series of log sheets that can help with record keeping can be found at my Web site, www.integrateddiabetes.com/logs.shtml.
6. Think like a pancreas
A person who has Type 1 diabetes (and some with Type 2) accomplishes this by injecting or infusing insulin. To replicate the pancreas’s slow, steady release of insulin around the clock, basal insulin is used, and to handle the glucose from meals, bolus insulin is taken.
When injecting insulin, a long-acting insulin such as Lantus or Levemir may be used to serve as basal insulin. When using an insulin pump, a small amount of rapid-acting insulin is infused all the time to provide basal insulin. Whichever method you use, your basal insulin should hold your blood glucose steady when you haven’t eaten or taken a bolus of rapid-acting insulin for several hours. This is usually best accomplished with an insulin pump.
The amount of bolus (mealtime) insulin should be matched to the amount of carbohydrate being consumed, with appropriate adjustment for the premeal blood glucose level, anticipated physical activity, and amount of insulin remaining (if any) from the previous bolus. (If any of these concepts are unfamiliar to you, talk with your child’s physician or certified diabetes educator about learning more.) Again, this can be accomplished through injections of rapid-acting insulin at each meal and snack, but it is far easier and more practical to do with an insulin pump. Today’s insulin pumps have built-in software that can help calculate correct bolus dose sizes, and they can give doses in very small, precise increments.
5. Demand quality from your health-care team
If your child’s current health-care providers are falling short in these areas, it may be time to seek consultation elsewhere. But before giving up on your current team, make sure you’re doing your part. You must communicate with them, cooperate with them, provide them with necessary information, and keep yourself informed so that you can ask the right kind of questions.
4. Network your kids
There is also the opportunity for your child to set an example and teach or show other kids what he has learned and accomplished. This process, called modeling, helps to reinforce the value of appropriate behaviors and provides a sense of pride. So check into diabetes camp for your child. Bring him to local diabetes fund-raisers and educational programs. Check out the Children With Diabetes conferences and online resources at www.childrenwithdiabetes.com.
3. If it’s broke, fix it
Patterns, however, are a different story. If you detect a pattern of out-of-range blood glucose levels, don’t keep doing the same thing. Look for a potential cause, and try doing things a bit differently. Are adjustments needed to accommodate for physical activity? Are carbohydrates being under- or overcounted? Is insulin being given at the right times and into skin that is absorbing it properly?
Insulin requirements can change rapidly in growing kids, so don’t hesitate to adjust doses to meet your child’s changing needs. Don’t forget that the first step in fixing a problem is detecting it, so make sure you’re keeping and analyzing records on a regular basis (see item 7), staying on top of your child’s control (item 10), and utilizing your health-care team for expert advice (item 5).
2. Involve your child
1. Let kids be kids
One step at a time
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