2011-01-28 / Columnists

PHC Health Talk

Commentary by Dr. Constance Stewart, MD - Pediatric Endocronoligist, Peninsula Hospital Center

Dr. Constance Stewart Dr. Constance Stewart Dr. Constance Stewart is a Pediatric Endocrinologist who heads the Pediatric Diabetes Treatment Center at Peninsula Hospital Center in Far Rockaway. Dr. Stewart trained at the Joslin Diabetes Center in Boston and leads a staff of nurses and nutritionists trained to assist parents and children in the treatment of diabetes and provide a source of information and support for the children and their families. Dr. Stewart treats children in the Family Health Center at Peninsula Hospital Center on the first Wednesday of every month.

The number of children and adults diagnosed with diabetes in recent years has risen significantly. The disease now affects more than 7% of the world’s population and is considered a true epidemic. As the prevalence of diabetes has grown, so has our knowledge of the illness and our ability to manage the disease.

Proper diagnosis and treatment of juvenile diabetes is essential for the long term health of the patient. Issues of care include daily blood sugar monitoring, (levels in newly diagnosed children can be as high as 500 while wellmanaged sugar levels are between 80 and 90), proper nutrition, proper activity levels and the involvement of the child’s home environment and school environment.

Diabetes is a silent illness that needs constant care and maintenance. With appropriate care and maintenance, a child can live a remarkably normal life and a very healthy one. Support services are critical for both the diabetic patient and the family. Specialized services such as kidney, dental, vision and foot care are essential in the care of a child who has diabetes.

Healthy eating for a child with diabetes is of paramount importance before any adjustment of insulin can be decided. However, you might be surprised to learn that healthy eating for a child with diabetes is the same as healthy eating for everyone. Five servings a day of fruits and vegetables “of all colors” provide the proper amount of vitamins and minerals necessary for good health. A protein at each meal provides the essential nutritional component to minimize hunger and maintain energy. A protein is anything that is derived from an animal that can swim, fly or walk, (fish, chicken, beef, turkey, cheese, eggs). Further meal planning should be worked out with a nutritionist customized to the patient’s specific tastes.

Of the utmost importance for the child with diabetes is his/her role within the family-not as “the diabetic child”, but as a child with unique needs. A major issue with children and teens is that they do not want to “be different”. While the family must be sensitive to the child’s special requirements regarding “sugars”, they should not be treated any differently than a child with any other specific developmental issues. The family should be supportive in giving helpful reminders without being overbearing.

It is essential to maintain a close relationship at the school with the nursing staff, principal, assistant principal, and teachers. The child may require special needs such as trips to the nurse’s office for glucose monitoring, bathroom privileges and/or special snacks, etc. Frequently, schools require instructional documentation for a diabetic child to be on hand. This in no way should keep the child away from school until all the papers are available.

Your child’s physician should be able to suggest ways to improve and manage diabetes so that the family’s lifestyle can be maintained. A monthly visit to your child’s physician should include an open discussion of the issues which the family or patient may face and how to handle them. There are emotional stresses which can also occur when dealing with a diabetic family member for example, a child wanting to fit in and not be singled out as “different”, wanting to lead a regular life, wanting to understand how their bodies work or, denial that anything is different .

Basic things such as knowing how to pack healthy school snacks, what type of meals to serve at home, how to monitor daily blood sugar levels and how to prepare school staff for any type of diabetic emergency your child may face can certainly help reduce the stress a parent and child could face.

Many parents are not familiar with the options which may be appropriate for a diabetic child such as insulin pumps. This is a sophisticated device and each child, along with their family, must be evaluated for their ability to properly handle its use. Parents must play a very active role in the use of an insulin pump.

The future holds different glucose monitoring systems, some of which are already attached to insulin pumps. Bottom line today is that good glucose control is essential to prevent later diabetes complications. It is here within the family that the child needs to reach out for emotional support. Working closely with the medical team in a friendly manner can provide the greatest benefit to the child. With the diabetes management techniques available today, it is a very realistic goal for a child to lead a normal, well-balanced life, participate in sports, be involved with the community and participate in school trips, projects and in specialized diabetes camps as either a camper or counselor.

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