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Guidelines for Care of Children With Type One Diabetes
The Different Ranges of Target Levels
Age Pre-Meal Bedtime HbA1C
0-5yrs 6-12 6-12 <8.5%
6-12 4-7 4-7 <7.0%
13-18 4-7 4-7 <7.0%
Home Blood Glucose Montitoring: This is important for all children with type 1 diabetes. Glucose monitoring should be done at least four times per day. This is to make the necessary adjustments of insulin, carbohydrate intake, and exercise, which helps to maintain the target BG levels.
Insulin: Dealing with insulins and the doses can be very overwhelming at times. There are a few children who can achieve BG targets on a 2-dose regimen of intermediate(NPH) and rapid-acting insulin analogue(Lispro or Aspart, for example). Most Children with Type 1 Diabetes require a 3-dose regimen with NPH and a rapid acting insulin in the morning, rapid acting at supper and NPH at bedtime. There is a newer option, which is Glargine. This is for a once daily basal insulin. Its use requires rapid acting insulin at all meals. There are a few parents who choose pump or 4-dose regimen with rapid acting insulin before meals and NPH for bedtime or Glargine once per day. Injection aids are helpful for children who are unable to self-inject, which is usually accomplished by the time they are twelve years old. The insulin pens are popular and reliable. Premixed insulins are not recommended for type 1 diabetic children.
Diet: The goal of diet management for a type 1 diabetic is matching carbohydrate intake with insulin and exercise. You can achieve this the most effectively by using the carbohydrate counting method (grams of CHO), fixed, or variable. It was once thought that the type of carbohydrate was important, but this is no longer the case, just like the protein and fats are not a critical factor in the regulation of BG levels.
Hypoglycemia (low blood sugar): Children should always carry a form of a
simple carbohydrate for treating a mild hypoglycemic reaction. The use of glucagons is for severe hypoglycemia.
Urine Testing: Urine ketone testing should be done on levels higher than 14mmol/Land during illness.
Ongoing Surveillance: Glycosylated hemoglobin known as HbA1C should be done every 3 months. The results are then reported to the child and his/her parent. Parents should be able to interpret the HbA1C levels. The child's height and weight are monitored every six months. Thyroid stimulating hormone (TSH) level is measured annually. A yearly eye examination will be done after the age of fifteen years. Random 24-hour urine samples (to check the kidneys and the blood pressure) will be
done at every clinic vist after the age twelve years, or with children who have had diabetes for more than five years. Perioheral neuropathy will be screened after the age of fifteen years. It tests the muscle strength, vibrations, reflexes, sensitivity to positioning, light, touch, and temperature. Risk factors will be co-ordinated by the diabetes clinic and the results will be communicated at least once a year to the family and to all of the diabetes team members, which also includes the primary care physician.
Written by: MommaSmurf, Shannon
Read more about Other Conditions:
The Difference between Type One and Type Two Diabetes,
The Difference Between HYPERGLYCEMIA and HYPOGLYCEMIA,
How I Feel About Having a 2-Year-Old Diabetic
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