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Managing Type 1 Diabetes in Your Child

Online Health Chat with Dr. Michelle Schweiger

November 1, 2011

Cleveland_Clinic_Host: Every day in the United States, nearly 80 people are diagnosed with type 1 diabetes, also known as juvenile diabetes. Nearly half of the individuals diagnosed each year are children. Juvenile diabetes is a chronic condition in which the pancreas produces little or no insulin, a hormone needed to allow sugar (glucose) to enter cells to produce energy.

Michelle Schweiger, DO, is an associate staff member in the Center for Pediatric Endocrinology at Cleveland Clinic Children’s Hospital. She is the director of ESCALAIT (Enrichment Services and Care for Adolescents Living with Autoimmune Insulin Dependent Type 1 Diabetes), a group clinic for adolescents with type 1 diabetes, and she also serves as the Director of Jr. ESCALAIT, a multidisciplinary clinic that aims to provide support and improve the care of children ages 5 and younger with type 1 diabetes. Her areas of interest include adolescent female health and type 1 diabetes.

To make an appointment with Dr. Schweiger or any of the specialists at Cleveland Clinic Children's Hospital, please call 216.444.KIDS (5437) or visit us online at clevelandclinicchildrens.org.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Cleveland Clinic Children's Hospital endocrinologist Michelle Schweiger, DO. We are thrilled to have her here today for this chat. Let’s begin with some of your questions.


Diabetes Basics

jay: What's the difference between type 1 diabetes and type 2 diabetes?

Dr__Michelle_Schweiger: Type 1 diabetes is associated with the pancreas not being able to produce enough insulin. Type 2 diabetes generally is not seen before adolescence, and the pancreas is often able to produce insulin, but the body has a difficult time responding to it. Often, people with type 2 diabetes can be given oral medications that help them use their insulin better.

wondering: What are the signs/symptoms of juvenile diabetes? Is the disease preventable?

Dr__Michelle_Schweiger: Typically, an increase in thirst and urination, and weight loss are early signs of type 1 diabetes. There are many research studies currently underway on type 1 diabetes prevention.

lisa_c: Is there a cure for juvenile diabetes?

Dr__Michelle_Schweiger: There is currently a lot of research being done to help find a cure for juvenile diabetes. Also, the technology has been significantly improving to make it easier to manage diabetes.


Causes

helen_t: We have no family history of diabetes, but my son was just recently diagnosed with type 1. How could he get diabetes? What could have caused this?

Dr__Michelle_Schweiger: More than 80 percent of children who are diagnosed with type 1 diabetes do not have a family history. Type 1 diabetes could be associated with a genetic predisposition and some environmental trigger. There is some speculation to certain viruses.

hawken_f: Is there a specific trigger for type 1 diabetes during childhood?

Dr__Michelle_Schweiger: There is an association with some common viruses that could possibly serve as a trigger in some children with a predisposition for developing type 1 diabetes.

johnnyj: Can a child be born with diabetes?

Dr__Michelle_Schweiger: There are some rare forms of diabetes. So yes, a child can be born with what is called 'neonatal diabetes,' which does occur but is uncommon. Typically this is unlikely to be classified as type 1 diabetes.

go_2: I know that type 2 diabetes is hereditary. Is type 1 also? My wife has had diabetes since she was 11. If we decide to have children, is it likely that they will have type 1 diabetes?

Dr__Michelle_Schweiger: There is a slight increased risk of your children developing type 1 diabetes, about 5 percent increased risk.


Teens with Diabetes

lisamchil: How does managing type 1 (physically and emotionally) change in the teen years?

Dr__Michelle_Schweiger: Usually, the teenage years are associated with an increase in growth and increase in pubertal hormones, which can make diabetes management more challenging. Emotionally during the teenage years, the challenge of establishing some autonomy with diabetes management can be a challenge for some families. We have been trying to address this in our adolescent shared medical appointments.

jenny: I have a 13-year-old daughter diagnosed six years ago with type 1 diabetes. In the past two years she had several episodes of very high BM (meter readings) and ketones, occasionally gone into DKA (diabetic ketoacidosis), and has had eight hospital admissions this year! Initially, this was put down to puberty/hormones, so she tried an insulin pump for 18 months, with little improvement, and now our consultant has put her back onto multiple injections, again little improvement. Any help/advise, greatly appreciated.

Dr__Michelle_Schweiger: I understand how difficult it can be to manage type 1 diabetes during adolescence. Growth, pubertal hormones and periods, and daily stress can all have an effect on blood sugars. Typically, the more often you check your blood sugars, the more information you have, and then you are better able to evaluate trends in readings and make adjustments.


Diabetes Management

cheryl_k: I need some help, tips, or advice. My son is 2 and diagnosed three months with diabetes. Since then, we have had to change our dialysis routine and diets. Now they say he has celiac disease. I have to restrict his diet even more, and I don't even know what foods have gluten in them, but I'm told a lot of them do. I'm feeling very overwhelmed with all these changes and upset that my son has to go through life this way. Any words of encouragement, as this is all new to me.

Dr__Michelle_Schweiger: I understand how overwhelming it can be to have a child with type 1 diabetes and celiac disease. There are now a lot more food choices available to children with celiac disease. Speaking with a dietician who deals with children with celiac disease might be helpful in providing increased food choices.

josh_h: My 12-year-old son is very reluctant to help manage his diabetes. How can I get him more involved in his own management to help transition him into high school and, later, into adulthood?

Dr__Michelle_Schweiger: I recommend setting established guidelines in the house regarding checking at least four times per day -- before meals and at bedtime and also as needed. This should be established like other chores or tasks that you require, such as cleaning his room, taking out the trash, etc. We address this at each of our ESCALAIT clinics for adolescents here at the Cleveland Clinic Children's Hospital.

H_justine: My 4-year-old daughter with type 1 diabetes will be entering school for the first time. How do I prepare her and her teachers for this transition?

Dr__Michelle_Schweiger: I think education is always the key. Making sure that her teacher is familiar with the diagnosis and answering any questions would be helpful. Your child’s diabetes team can help you with this as well. A specific school plan, which has your child’s insulin regimen and specific instructions on how to treat high and low blood sugars, would be essential as well.

Pippa: I work at a recreational summer camp in the health office. We are beginning to see more kids come to camp with diabetes, some with insulin pumps. What questions should we ask the parents when screening the child to come to camp? Is there anything at all that you can suggest regarding camp and kids with JD1 (juvenile diabetes)?

Dr__Michelle_Schweiger: I think looking at trends in blood sugar readings prior to camp and the level of physical activity are two things that are important to look at. If the family is having any specific problems with the pump would be another important question. Any recent episodes of severe hypoglycemia (low blood sugar associated with change in mental status, loss of consciousness, seizure activity) would also be useful information when setting pump settings for camp.

Pippa: Follow-up question about camp. Last year we had an adolescent who decided to go off of the pump during the 10 days of camp and adjust her dose by her blood sugars. Only thing is that she would come in several times a day to tweak if she decided to eat more carbs or sweets. Shouldn't she have just stayed on the pump and not played around with this?

Dr__Michelle_Schweiger: I think this would be specific to each child. I would want to find out from the child and her family why they would desire for them to come off the pump during camp. If there was concern regarding pump failure or low blood sugars, that could be addressed beforehand. Typically, I would recommend a similar diabetes regimen at camp.


Blood Glucose

country_roads: What is the optimal blood sugar range for a child with type 1 diabetes?

Dr__Michelle_Schweiger: This depends on the age of the child. I typically recommend blood sugar for children under the age of six years before meals to range somewhere between 80-200 mg/dl. For children 6-12 years 70-180 mg/dl and 13-19 years 70-150 mg/dl.

jelly_fish: Is it normal for blood sugar levels to be higher after exercise? Should we be doing something to prevent this, if there is anything?

Dr__Michelle_Schweiger: Some children with type 1 diabetes could have higher blood sugars after exercise. I would first make sure your child is well hydrated. Dehydration is a common cause of elevated blood sugars after exercise. Excitement (adrenaline) can also cause high blood sugars. I would work closely with your child’s diabetes team and evaluate trends in blood sugar readings to see if they would recommend insulin to treat high blood sugars after exercise.

debra_n: I've heard about the "honeymoon phase" after being diagnosed with type 1 diabetes. Can you explain what this means?

Dr__Michelle_Schweiger: The honeymoon period refers to the time period shortly after being diagnosed with type 1 diabetes when the pancreas is able to produce some insulin, and so usually your child would need less insulin during this time.


Complications

mom_to_be: What complications can arise from juvenile diabetes?

Dr__Michelle_Schweiger: Long-term, poorly controlled type 1 diabetes could be associated with increased risk for retinopathy (eye disease), nephropathy (kidney disease), elevated cholesterol levels, and neuropathy (nerve damage).

jjc: What are the major complications associated with juvenile diabetes, even when the teenager is taking care of their diabetes?

Dr__Michelle_Schweiger: Good diabetes management is essential and can help prevent some of the complications associated with type 1 diabetes. Yearly eye examinations are recommended, as well as routine dental care. Children with type 1 diabetes are also at an increased risk for other autoimmune diseases and so should be followed by a health care provider who is comfortable managing type 1 diabetes.

fall_mums: Are juvenile diabetics more prone to mood disorders?

Dr__Michelle_Schweiger: Dealing with any chronic disease such as type 1 diabetes could be associated with increased daily stress and increase chances of depression and other mood disorders. We try to provide a support network in our ESCALAIT clinic and address some of these stressors for both the parents and child with diabetes.

glee: Are there worse effects for teens with diabetes who smoke pot or do any other drugs? I have suspected that my son has been smoking marijuana recently, and I need to know if I need to be even more worried and upset about it than I am.

Dr__Michelle_Schweiger: I think suspecting drug abuse is always concerning, and I would recommend speaking with your child’s primary care provider or diabetes doctor to address this. Drugs alter your mental state, and could also make it more difficult to sense low blood sugars, which would also be concerning.


Nutrition

mflanagan: My daughter just got diagnosed with diabetes, and I am at a loss as to what I should feed her, especially as kids are so picky with their food. Help!

Dr__Michelle_Schweiger: I recommend that children with diabetes eat a healthy well-balanced diet that I recommend for all of my patients regardless of having diabetes. Meeting with a pediatric dietician who works with children with diabetes might be helpful.

good_idea: My niece has an insulin pump, but she has very poor dietary habits. I’ve seen her binge on junk food, saying that the insulin pump will take care of everything. My sister has little control, as she often (usually) does this when her mother is not around. What kind of damage is she doing to herself?

Dr__Michelle_Schweiger: I think establishing healthy eating habits at a young age is important for all children, especially those with type 1 diabetes. We discuss the importance of this during our ESCALAIT clinics. I would agree that poor food choices can often make it more challenging to manage type 1 diabetes.


Weight

txstew: I am a mother of an overweight child and have been told that he must lose weight or he will have to go on insulin. My son has an eating disability, as in he sneaks food and has for over a year now. It has become so bad that we have now put a lock on the refrigerator and our food closet per instructions from a counselor that he is seeing. I feel like the worst mother in the world, but we could not do anything with him and he continues to gain weight, and I did not know what else to do. I was an overweight child and do not and did not want him to have to be ridiculed as I was as a child, so I have always tried to watch his diet, but I cannot watch him 24/7, and it got to the point we were finding food wrappers all over the house, hence the locked cabinets and refrigerator. Do you have any advice on how to handle this issue? We have tried to explain to him that if he continues this course that he will have to begin insulin, but it does not seem to faze him.

Dr__Michelle_Schweiger: I understand how challenging it must be to have a child who is overweight and has a difficult time overeating. There are some rare conditions that could be associated with overeating, and so it would be worthwhile to speak with your doctor to make sure that is not a concern.

I am concerned that mentioning that he might end up on insulin could possibly frighten him and so would not recommend that. Often times, children overeat for behavioral reasons and so you might want to consider meeting with a behavioral specialist as well.


Insulin Options

online: Can you please discuss the pros and cons of the insulin pump?

Dr__Michelle_Schweiger: Some of the pros of the insulin pump are convenience, needing fewer injections, and the ability to set a different 'basal rate' for different times of the day. One of the potential cons would be pump failure. Sometimes, the infusion sets get kinked or have air bubbles and do not deliver the insulin. This makes it important to check blood sugars for those on the pump.

I_am_Sam: Is there a natural substance that can be used in place of insulin, say in case of emergency when insulin may not be available? Is this safe?

Dr__Michelle_Schweiger: There is no natural substance that can be used in place of insulin for type 1 diabetes. I recommend always keeping some extra insulin at home. If on vacation, you could take a prescription for insulin with you.


General Questions

soccer_mom22: Are there support groups or other people with type 1diabetes or parents I can talk to about everyday issues?

Dr__Michelle_Schweiger: Here at the Cleveland Clinic Children's Hospital we have a shared medical appointment for adolescents and children five years and younger called ESCALAIT and Jr. ESCALAIT that we also use as a forum for a support group. JDRF (Juvenile Diabetes Research Foundation) or diabetes partners might be good sources to contact for support.

Cleveland_Clinic_Host: For more information about Cleveland Clinic Children's Hospital ESCAILAIT program please go to clevelandclinicchildrens.org and visit the endocrinology page under 'what we treat.'


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Schweiger is now over. Thank you again Dr. Schweiger for taking the time to answer our questions today about the management of Juvenile Diabetes.


More Information

To make an appointment with Dr. Schweiger or any of the specialists at Cleveland Clinic Children's Hospital, please call 216.444.KIDS (5437) or visit us online at clevelandclinicchildrens.org.

You may request a remote second opinion from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit eclevelandclinic.org/myConsult.

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This chat occurred on November 1, 2011

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. ©Copyright 1995-2011 The Cleveland Clinic Foundation. All rights reserved.