Dear Parent

Your child has been diagnosed as having diabetes (properly speaking, “diabetes mellitus”. The word diabetes comes from the Greek for “fountain”, and the word mellitus means “sweet”. The term refers to the presence of large amounts of sugar in the urine).

You will probably have been taken by surprise, and be experiencing very mixed emotions just now. If your child has been unwell for some time, you may feel relieved that a diagnosis has been made, and that he/she is beginning to get better. You will probably feel worried about the future, and about how well you and your child will cope with life with diabetes. Many people feel numb, and find themselves living “from day to day” until the information has had time to sink in.

The hospital team is here to help you to adjust. There seems to be a lot to learn. Take it slowly. Ask questions (and feel free to ask the same questions again if need be!). You will find that it all falls gradually in to place.

You will be given this information in written form. We will give you some extra information sheets over the next few days – but the basics are covered in the sheet “An Introduction to Diabetes”. You will also find this sheet helpful for grandparents, aunts and uncles, and babysitters.

The Diabetes Team

 

The specialist team supports the ward staff during the course of any admission to hospital, and will be your main point of contact when you go home. It consists of a Consultant Paediatrician with an interest in diabetes (Dr Farmer), a Specialist Nurse, and a Dietitian.

Diabetes clinics for children and young people are held at Raigmore, and in Caithness, Fort William, Skye, and the Western Isles. There are different Specialist Nurses and Dietitians in each area.

When things are going smoothly, we usually see families every three to four months. Problems sometimes do arise between clinic visits. In most cases they can be sorted out by a telephone call. We will keep your General Practitioner informed about any major changes in treatment, and keep in contact with the school nurse and doctor.

We aim to keep your child healthy, active, and living as full a life as possible. Over time you will learn how best to support your child, how to adjust insulin, and how to cope with special occasions and minor illnesses.

Other people with diabetes

Diabetes is becoming increasingly common. Diabetes developing in adult life differs from diabetes in children in a number of ways, and the treatment can be quite different.

In Highland region, diabetes in children seems to be unusually common (about one in every 400 children). You may well find that there are one or two children in your area, or attending your local school, who have diabetes.

If you would like to make contact with other people who have diabetes, you can join the local branch of Diabetes UK. There is even a club for children and young people with diabetes (the “Tadpole Club”). A contact number is given at the end of the sheet “Calling for Help”

 

We look forward to meeting you soon

 

AN INTRODUCTION TO DIABETES.

What is diabetes?

Diabetes is a condition where the body does not produce enough insulin.

What is insulin?

Insulin is a substance produced by the body to help it to use its food properly. In particular, it helps muscles and bones to take sugar from the blood, and use it for energy and growth. When there is not enough insulin produced, sugar builds up in the blood, you become short of energy, and lose weight.

Where does sugar in the blood come from?

The sugar in the blood comes from food. When we eat starchy foods (potatoes, bread, rice and pasta, for example) this is digested in the gut to sugar, which is then absorbed into the bloodstream. These starchy foods (known as 'carbohydrates') are healthy foods  - whether you have diabetes or not!

Sugar is a carbohydrate too. It will increase the blood sugar very quickly. Sugary foods do need to be limited as eating too many upsets the overall balance of the diet.

Why me??

We do not fully understand why some people get diabetes, and not others. We do know that, when children get diabetes, it is not their (or their parents') fault - and nothing at all to do with all the sweets and fizzy drinks they may have eaten in their time!

Can it be cured?

Diabetes is a condition that we can treat very effectively, by giving injections of insulin. We do not at present have any treatment which will get the body to start making insulin for itself again, so treatment with insulin has to be lifelong.

What about tablets?

Some adults who develop diabetes in later life have a form which is in some ways different- they can get by without insulin, just by watching their diet and (sometimes) taking tablets. This form does not occur in children, and all children with diabetes need to take insulin. The only effective way to give insulin is by injection.

Does diabetes make you feel unwell all the time?

Definitely not! At the time of diagnosis, most people will feel listless, moody, and have to run to the toilet a lot. They will also have lost weight. All this will change once the insulin begins to take effect, and they will soon be back on top form.

Will it change my life?

Yes. Living with diabetes is undoubtedly an inconvenience - but it is not a catastrophe, Diabetes need not stand in the way of success at school, sports, jobs, making friends, marriage, childbirth and the like.

There is more about the kind of changes you can expect on the next page, 'Life with diabetes'.

 

Eating

If you do not have diabetes, your body produces the right amount of insulin exactly when it is needed - it all happens automatically! Most people do not need to think too hard about what they are going to eat, or when. People with diabetes, on the other hand, should have a regular eating routine. It wouldn't do if you took your morning insulin to help you to use your food - and then didn't eat any! The blood sugar would go too low, and you'd feel funny (this is called a "hypo"). You could even pass out. It is usually best to eat three main meals a day, with snacks in the middle of the morning, the middle of the afternoon, and before bed. The dietitian will help you work out an eating plan.

Taking insulin

Insulin is given by injection, usually twice each day. You should never miss a dose of insulin, even when you are unwell. More about that later!

Measuring blood sugar

The normal blood sugar in people who do not have diabetes is between 4 and 7. It is not usually possible for people with diabetes to keep the blood sugar between these limits all the time, and we are usually very pleased if most of the results are between 4 and 10.

The dose of insulin your body needs will not always be the same. We discover what the right dose is by trial and error. Regular measurements of the blood sugar will guide your doctor about when the dose needs to be changed. Most people learn how to make these changes themselves after a while.

The most useful times to check the blood sugar are before breakfast, before lunch, before tea, and before the bedtime snack. Just after diagnosis, and during any illness, it should be checked 4 times each day. When things settle down, once or twice each day will be enough. Every time a blood sugar is checked, the date, the time, and the result should be written down in the diary provided - this will give you and your doctor a clear guide as to how things are going, and whether any changes are needed.

'Hypos'

A hypo (hypoglycaemia, to give it its full name) occurs when the blood sugar is too low (that is, 4 or less). It can affect:

            how you feel (shaky, tingly fingers or lips; queasy tum; fuzzy head; or just plain hungry!):
            how you look (pale, sweating, or trembling); or
            how you behave (quiet and vague - or very naughty!).

People with diabetes should always have something sugary close at hand (drinks or sweets) to take if they feel hypo. If you feel 'hypo', take a small sugary drink, eg Lucozade or Coke), or 4-6 Dextrosol sweets, and sit quietly for 10 minutes. If you still don't feel right, take some more to drink, or a few more sweets.

Exercise

Physical activity lowers the blood sugar, so you are more likely to have a 'hypo' during or after exercise. To prevent this you should take some extra carbohydrate immediately before exercise - something like a  Fun-Sized bar (Mars, Milky Way or Snickers), a small packet of sweets (Opal Fruits or Fruit Pastilles, or a sugary drink. If the activity is going to last more than 45 minutes, an extra sugary drink or snack should be taken half way through.

When you are ill

People with diabetes need a regular supply of carbohydrate - even if they are ill, and even if the blood sugar is high. If you feel sick or can't eat, the carbohydrate is best taken as regular sips of sugary drinks. You will also need to do more blood tests than usual.

This is stop-gap advice for you to follow until you can see the dietitian who will plan your personal diet with you.

Eat Regular Meals

You should eat three meals each day, with snacks between meals and at bedtime. Fresh fruit, plain biscuits (rich teas, digestives or oatcakes), a sandwich or diet yoghurt would be suitable.

Base your meals on “starchy” foods

• Breakfast cereals - All Bran, porridge, Weetabix, Corn Flakes, and Rice Crispies.
• Bread - wholemeal or white
• Potatoes - preferably boiled, baked or mashed
• Rice
• Pasta

Select one or more of the above to go with the main course and vegetables of your choice.

Avoid sugar and sweet foods

Choose low calorie ('no added sugar'), 'sugar-free' or 'diet' drinks.

Avoid sweet biscuits, cakes and chocolate until you see the dietitian.