with diabetes takes to improve overall fitness can vides proactive diabetes management tips that will ensure healthful and control of her diabetes …
juvenile diabetes research foundation international
life with Diabetes
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december 2005
Topics in Type 1 DiabeTes
exercise, sports, and Diabetes: Going for the Goal
Physical exercise is important for everyones health and well-being, but its especially important for people with diabetes The steps a person with diabetes takes to improve overall fitness can be greatly beneficial, because regular exercise helps lower blood sugar levels and keep them in target range Exercise physiologist Gary Scheiner, MS, CDE, provides proactive diabetes management tips that will ensure healthful and safe physical activity Included is a helpful checklist and resources for communicating with coaches and school staff click here to read more
ask a meDical professional
pumps Get smarter
Benefiting from more than 30 years of product development, todays insulin pumps are convenient to carry, safe, and easy to use The newest smart pumps actually do the diabetes math for you and your child Certified pump educator Catherine Marschilok, MSN, CDE, details how the newest pumps work and shows how their reliable yet highly flexible insulin delivery offers increased freedom in diet and
lifestyle choices click here to read more
Kate has several things she does to make sure she can enjoy a sports game or gym session without worrying that she is going to get low blood sugar in the middle She checks her blood sugar at least an hour before the physical activity, again immediately before, during if needed, and also a few times afterward That way she can make any necessary corrections She doesnt play if her blood glucose is below the lower end of her normal range During exercise, a high blood sugar episode is just as bad in the long term as a low one Make sure you check with your educator or doctor for the ranges within which it is safe for your son to play or exercise Our daughter has left karate classes early when she felt low or funny, and your son shouldnt feel bad or embarrassed to do the same If he does ever leave during a game, always make sure someone knows why he left early He should never go off by himself if hes feeling low/high or knows that he is Someone else, preferably an adult, should always walk with him to the nurses office if the need arises
WHaTs neW on THe JDrf Web siTe?
Holiday Help
The holidays usually mean many changes to your daily life, and
when you have a child with diabetes, the holiday season can be a challenging time of year With the extra carbs in festive meals, changes in your normal schedule, and excitement that can send blood sugar swinging, extra monitoring of blood sugars becomes essential A positive attitude and some careful extra planning can help you overcome these challenges and have a wonderful holiday season Check out Holiday Tips on the JDRF Web site at http://wwwjdrforg/holidaytips
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Help from JDrfs online Diabetes support Team
Q: A:
Since his diagnosis two months ago, my 12-year-old son has been more and more frequently sitting on the sidelines during his sports games and school gym classes because hes anxious about highs and lows We want to encourage him to participate as he always did before his diagnosis What can we tell him and the school to get him back in the game? from a parent of a child with diabetes: The most important advice I can offer to you or any family facing a childs new diagnosis is that he should take control of his diabetes and not let it control him He shouldnt be afraid to be as active, or even more active, than he was prior to his diagnosis; exercise is very
beneficial to him, as our diabetes educator emphasized when our daughter Kate was first diagnosed Once our daughter took control of her diabetes– and it took a few months–everything was so much better Today, at 12, she is a black belt in karate and plays volleyball, in addition to being an all-around active kid
WHaT a JDrf cHapTer can Do for yoU
Guidance and support
JDRF chapters throughout the US offer resources to support families in the stressful time after a diagnosis of diabetes Our volunteer families, who have been there and know what you are going through, provide guidance and support Special JDRF programs for the newly diagnosed include our Bag of Hope and Teen Pak kits, networking coffees, and fun outings All offer a wealth of comforting help and information Go to the JDRF Web site at wwwjdrforg and click on Locations to find the JDRF chapter nearest you
you can let us know what you think of Life with Diabetes or subscribe today by sending an e-mail to info@jdrforg in subscription request, please include sUbscribe life WiTH DiabeTes in the subject line
life
with Diabetes
december 2005
juvenile diabetes research foundation international
Topics in Type 1
DiabeTes
exercise, sports, and Diabetes: Going for the Goal
Kids with diabetes can play and succeed at sports just like their non-diabetic peers A recent survey of 150 children, ages 3 to 17, attending JDRFs 2005 Childrens Congress provides dramatic proof These kids with diabetes engage in dozens of different activities, from hiking the Grand Canyon to climbing on kitchen counters 3-year-old division They ski and skate and ride bikes, scooters, skateboards, snowboards, wakeboards, knee-boards, and river rafts They wrestle, jump on trampolines, and play varsity football Theyve won first place in competitive roller hockey, sailing, softball, karate, cross-country, soccer, swimming, dirt biking, snowmobiling, and cheerleading Through their achievements, these youngsters send the critical message that kids with diabetes can participate fully in sports and physical education activities of virtually every description And with new and more effective approaches to diabetes management, such as sophisticated, portable testing equipment and smart pumps see Ask a Medical Professional, below, no physical activity should be ruled out The benefits Physical exercise is important for everyones
health and well-being, but its especially important for people with diabetes For everyone, regular exercise produces such important benefits as cardiovascular fitness, improved muscle tone and strength, lower blood pressure, help with weight control, positive effects on mood and stress, and the development of self-confidence and self-esteem But physical fitness and a sense of well-being may be even more essential for people with type 1 diabetes than they are for anyone else, says exercise physiologist Gary Scheiner, MS, CDE, head of Integrated Diabetes Services in Wynnewood, Pennsylvania The steps you take to improve overall fitness–even if theyre only small steps–will often result in improved diabetes management The reason? Regular exercise helps lower blood sugar levels and keep them in a target range In working harder, the body uses more glucose to produce energy and improves the way insulin works Blood glucose levels are lowered and insulin requirements are reduced The benefits are great, but there are challenges Kids with diabetes must be careful about when, how long, and how intensely they exercise, and they must take steps to avoid hypoglycemia– going too low–during or
after the activity achieving the Goal Success in any physical activity for a person with diabetes begins with proactive diabetes management Avoiding hypoglycemia is a goal kids can realize through good planning and constant vigiclick here to return to page 1
checklist: actions for the coach and physical education instructor
encourage exercise and participation in physical activities and sports for students with diabetes as you would for other students Treat the student with diabetes the same as other students, except in meeting his or her medical needs remember to respect the students right to privacy and confidentiality make sure blood glucose monitoring equipment is available at all activity sites, and encourage the student to keep personal supplies readily accessible always allow the student to check blood glucose levels Understand and be aware that hypoglycemia can occur during and after physical activity and that a change in the students behavior could be a symptom of blood glucose changes be prepared to recognize and respond to the signs and symptoms of hypoglycemia and hyperglycemia, and when a blood sugar event occurs, take initial actions in accordance with the
students school plan To treat hypoglycemia, provide the student with immediate access to a fast-acting form of glucose consider taping three or four glucose tablets or hard candies to a clipboard or include them in the first aid pack at physical activities, practices, and games communicate with the school nurse and/or trained diabetes personnel regarding any observations or concerns about the student
Adapted from the National Diabetes Education Program publication, Helping the Student with Diabetes Succeed: A Guide for School Personnel
For Further Information: Have a question about your childs physical activities? Contact JDRFs Online Diabetes Support Team at http:// wwwjdrforg left side of page, which is made up of JDRF volunteers who live with diabetes and are available to offer you immediate, one-on-one support Certified Diabetes Educators at http://wwwintegrateddiabetescom can answer your questions about diabetes and its care Information can also be obtained from the Diabetes Exercise and Sports Association at http://wwwdiabetes-exerciseorg/ indexasp To learn how to create a 504 or other educational plan, go to http://wwwjdrforg/diabetesinschool
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life
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Diabetes
december 2005
juvenile diabetes research foundation international
lance, says Scheiner Good planning means monitoring glucose both before and after exercise, always having glucose tablets or a high-energy snack on hand for unexpected lows, and drinking extra water to prevent dehydration The young athlete must coordinate exercise with diet and insulin therapy, making adjustments in insulin dosing or snacking Keeping a record of exercise and physical reactions is important, says Scheiner, because each child has his or her own unique response to exercise that can be observed through daily treatment adjustments, and because different types of exercise have different effects on blood sugar Information to record includes blood sugar readings, foods eaten, the amount of insulin taken before exercising, the nature and length of the activity, and how the person performed and felt during and afterwards Scheiner says that it is usually not dangerous to exercise with a moderately high blood sugar level He notes that adrenaline, which jumps during short bursts of competitive, high-intensity activity, can push blood sugar levels up However, if pre-exercise testing reveals an
unexplainable high blood glucose number over 250, it may indicate there is not enough insulin in the body to allow for a safe exercise session In that case, it is important to test for ketones in the blood though a simple urine or blood test Exercise is fine as long as ketones are negative, says Scheiner, but if ketones are positive, exercise should be postponed until insulin is given and the blood glucose number comes down See Ask a Parent, for more exercise-related tips If your child has recently been diagnosed with diabetes, achieving ideal control may take some time as you, your child, and your health care team develop and adjust an individualized treatment program But soon your child will be safely exercising, whether in sports, physical activities, or just being an energetic kid Remember, while many people with diabetes have reached high levels of performance, not every kid is a natural athlete or an avid competitor But as our Childrens Congress delegates told us, being active covers a range of activities, from walking the dog to hopping on a skateboard Wherever your childs interest or ambition lies, the message is simple: get going
include your doctor and healthcare team,
advantages like tighter glucose control and greater flexibility have led increasing numbers of children to go on the pump Once you become familiar with pump therapy, youll see that there are many different reasons to consider this popular choice of insulin delivery a primer on pumps With over 30 years technological development behind them, todays insulin pumps are convenient to carry, safe, and easy to use A pager-sized computerized device that can be clipped to the belt or a pocket, the pump delivers insulin continuously to its user through a small tube, or cannula, easily inserted into the abdomen, buttocks, thigh or arm and held in place by an adhesive dressing This insertion site must be changed once every 48 to 72 hours Delivering insulin in precise amounts that can be closely matched to the users needs, pumps can hold enough insulin for two or three days They use rapid-acting insulin, which has more predictable absorption than intermediate or long-acting insulin A boon to adults and young people alike, pumps also give you or your child the freedom to vary what, when, and how much she eats by enabling insulin delivery rates to be adjusted for different times of day Pumps
deliver insulin at two rates Basal also known as background insulin delivery is the continuous dose of rapid-acting insulin that the pump delivers 24 hours a day, 7 days a week, with adjustments to accommodate special situations It is the way most pump users receive approximately half their total insulin, supporting their bodys needs between meals Basal insulin amounts are preprogrammed Bolus delivery is a single dose calibrated to match the size and content of a meal, taking into consideration the amount of carbohydrates consumed and the users blood sugar level Delivered when the user pushes a button on the pump, the bolus dose offers flexibility in meal quantity and meal timing Insulin dosages are calculated after taking into consideration such factors as your childs total daily insulin dose while taking injections, how well his diabetes is currently controlled, the frequency and awareness of low blood sugars, and a variety of lifestyle and nutritional issues With this more flexible form of delivery, your child can not only adjust insulin delivery to accommodate meals and snacks, but also reduce it when he exercises so that blood glucose does not drop too low, or increase it
during an illness so that blood glucose does not go too high, among other daily variables What smart pumps can Do The latest-model pumps, including those from the companies listed below, are referred to as smart pumps and are designed to simplify diabetes management They have built-in dosage calculators that manage the complex diabetes math that users
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ask a meDical professional
pumps Get smarter
by catherine marschilok, msn, cDe, board certified in advanced Diabetes management For millions of people with diabetes, insulin pumps offer a safe and viable alternative to the standard needle and syringe for injecting insulin Clinical studies have demonstrated that pumps can achieve improvements in blood sugar control, with fewer low blood sugar episodes and better long-term control While the decision to start your child with diabetes on the pump must click here to return to page 1
life
with Diabetes
december 2005
juvenile diabetes research foundation international
previously had to perform themselves This enables the user to program different basal insulin delivery rates for different times of the day, depending on changing needs for example, reducing the basal rate before
exercise, or changing the rate at night to help prevent overnight lows Once the different rates are programmed into the pump, the user can switch rates by pressing a few buttons Among other important features, the newest pumps can calculate how much insulin is still working from the previous bolus dose a feature called insulin on board This facilitates more accurate calculation of the next bolus dose, and can prevent blood sugar from dropping low Other smart features offered by some manufacturers include: programmable reminders and alerts, personalization features, information download capabilities, a carbohydrate database, variety in styles of infusion sets, and child lockout features Overall, smart pumps offer a consistency and accuracy of insulin delivery that was not possible in the past, since all calculations other than counting carbohydrates and inputting the numbers accurately are done by the pump The end result: people like me as a diabetes educator and parents no longer have to worry about the accuracy of a childs insulin dose depending on math and calculation skills Finally, if you, your child, and your doctor decide that pump therapy is appropriate, remember that
frequent communication with your healthcare team will be essential Pump candidates must be willing to check blood sugars frequently, count carbohydrates accurately, and learn new ways to manage diabetes If youre the parent of a younger child, its also important to remember that youll have to learn the ropes alongside your child To read more
about what pumps can do, I encourage you to check out the manufacturers websites: wwwanimascorpcom, wwwdelteccozmocom, wwwdisetronic-usacom, wwwminimedcom, wwwmyomnipodcom
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Help from JDrfs online Diabetes support Team,
continued from page 1
Make sure your son always has a few snacks or some juice with him keep a container of juice tucked away in each of his classrooms, and that his gym instructor or coach knows your son has diabetes and how to recognize symptoms of low or high blood sugar Your son may not always recognize his own symptoms Always make sure that there is a glucagon kit in the nurses office and if possible one in the gym, and that the appropriate personnel know how to administer it Once your son realizes that there are other adults besides you that can help, hell feel safer Above all, encourage your son not to feel
afraid and to go ahead and enjoy any sport he wants to participate in Hes definitely not benefiting socially, emotionally, or physically by sitting on the sidelines Hes probably feeling very different from other kids right now Finally, have you tried to see if there is any group provided by the school or through your local JDRF chapter for kids dealing with chronic illnesses? We have one in our chapter Have a question? Go to the JDRF Online Diabetes Support Team at http://wwwjdrforg
click here to return to page 1
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Source:alz.org
