Date post: | 11-Jan-2016 |
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Nutrition & Type I Diabetes
Goals of therapy Type I diabetes:• Promote normal growth & development• Encourage good nutrition• Prevent (minimize) complications• Maintain near-normal blood glucose levels• Preprandial BG goals– Infants and toddlers: 100-180 mg/dL– Children: 90-180 mg/dL
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Delegation of Responsibilities
• Functionally able to do things long before cognitive understanding.
• Length of teaching sessions based on developmental age
• Learning theory
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Developmental Issues: Infancy• High caregiver
responsibility• Growing brain is
greedy: wants glucose!!
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Toddler
• Inconsistent dietary intake• Give choices when possible• Rituals and routines
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Developmental Issues: preschooler
• Understands simple explanations• Play therapy• More predictable appetite• Learn to identify CMs hypoglycemia– Avoid calling results “bad”
• High energy activities
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Developmental Issues: School-age
• Dislike being “different”• School personnel – fingersticks• Less parental control• Field trips, parties, athletic events• Eating habits more predictable; more
independent• Present oriented
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Developmental Issues: Adolescent
• Challenge: growth spurt & blood sugar • Body image, peer group acceptance• Risk-taking behaviors• Control shifting to adolescent• Not motivated by future complications
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Type 2 Diabetes
• Increased incidence in children• Metabolic syndrome (insulin-resistance
syndrome) = high risk factor• Sedentary lifestyle• Overeat• Family hx of diabetes• Metformin: only oral agent approved for
children
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Exercise
• Exercise decreased insulin need r/t insulin more efficient
• Avoid active exercise when insulin peaking• Maintain proper hydration• Watch for hypoglycemia after exercise• Avoid exercise if insulin level is too low
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ExerciseMcKinney:
• 15-30 Gm carb for each 45-60 min of exercise
• Check BG before, during & after• Be prepared w/additional carbs– BG up to 2 hours after exercise
• Coaches & teammates
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“Honeymoon Period”
• After new dx, 10-20% beta cells function for a time (ucsfhealth.org)
• Less insulin required• Potential denial of disease
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