Type 1 Diabetes

Type 1 diabetes accounts for 5 to 10 percent of all diagnosed cases of diabetes, but is the leading cause of diabetes in children of all ages. Type 1 diabetes accounts for almost all diabetes in children less than 10 years of age. Type 1 diabetes is an autoimmune disease in which the immune system destroys the insulin-producing beta cells of the pancreas that help regulate blood glucose levels. Onset. Type 1 diabetes mostly has an acute onset, with children and adolescents usually able to pinpoint when symptoms began. Onset can occur at any age, but it most often occurs in children and young adults. Children and adolescents may present with ketoacidosis as the first indication of type 1 diabetes. Others may have post-meal hyperglycemia, or modest fasting hyperglycemia that rapidly progresses to severe hyperglycemia and/or ketoacidosis in the presence of infection or other stress.

Symptoms. The immunologic process that leads to type 1 diabetes can begin years before the symptoms of type 1 diabetes develop. Symptoms become apparent when most of the beta-cell population is destroyed and usually develop over a short period of time. Early symptoms, which are mainly due to hyperglycemia, include increased thirst and urination, constant hunger, weight loss, and blurred vision. Children also may feel very tired. The immunologic process that leads to type 1 diabetes can begin years before the symptoms of type 1 diabetes develop. Symptoms become apparent when most of the beta-cell population is destroyed and usually develop over a short period of time. Early symptoms, which are mainly due to hyperglycemia, include increased thirst and urination, constant hunger, weight loss, and blurred vision. Children also may feel very tired.

Risk Factors. A combination of genetic and environmental factors put people at increased risk for type 1 diabetes. Researchers are working to identify these factors so that targeted treatments can be designed to stop the autoimmune process that destroys the pancreatic beta-cells.

Co-morbidities. Children with type 1 diabetes are at risk for the long-term complications of diabetes. Autoimmune diseases such as celiac disease and autoimmune thyroiditis are also associated with type 1 diabetes.

Management. The basic elements of type 1 diabetes management are insulin administration (either by injection or insulin pump), nutrition management, physical activity, blood glucose testing, the avoidance of severe hypoglycemia, and the avoidance of prolonged hyperglycemia or DKA. Algorithms are used for insulin dosing based on blood glucose level and food intake.

Diabetes in Children and Adolescents

Overview of Diabetes in Children and Adolescents

Diabetes mellitus is a group of diseases characterized by high levels of glucose in the blood resulting from defects in insulin production, insulin action, or both. Diabetes is associated with serious complications and premature death, but timely diagnosis and treatment of diabetes can prevent or delay the onset of long-term complications (damage to the cardiovascular system, kidneys, eyes, nerves, blood vessels, skin, gums, and teeth). New management strategies are helping children with diabetes live long and healthy lives. Type 1 diabetes in U.S. children and adolescents is increasing (1) and more new cases of type 2 diabetes are being reported in young people. The American Diabetes Association provides helpful guidance in consensus statements for managing children with type 1 diabetes (2) and type 2 diabetes (3). To update primary care providers and their staff about this evolving area of diabetes care, the NDEP has developed this overview of current statistics and care recommendations.

Statistics

Diabetes is one of the most common diseases in school-aged children. According to the 2011 National Diabetes Fact Sheet, about 215,000 young people in the US under age 20 had diabetes in 2010. This represents 0.26 percent of all people in this age group. (4) Based on data from 2002 to 2005, the SEARCH for Diabetes in Youth study reported that approximately 15,600 US youth less than 20 years of age were diagnosed annually with type 1 diabetes, while 3,600 were newly diagnosed with type 2 diabetes. (5) Type 2 diabetes was rare in children younger than 10 years of age, regardless of race or ethnicity. In youth aged 10 to 19 years, type 2 diabetes became increasingly common, especially in minority populations such as American Indians, African Americans, Hispanic/Latinos, Asians and Pacific Islanders. Among non-Hispanic white youth aged 10 to19 years, the rate of new cases was higher for type 1 than for type 2 diabetes. For Asian/Pacific Islander and American Indian youth aged 10–19 years, the opposite was true—the rate of new cases was greater for type 2 than for type 1 diabetes. Among non-Hispanic black and Hispanic youth aged 10 to19 years, the rates of new cases of type 1 and type 2 diabetes were similar. (5)

Clinical Preventive Services for Normal-Risk Adults

Immunization

Tetanus-Diptheria (Td): every 10 Years, 18 years and older.

Varicella (VZV): Susceptible only two doses, 18 years and older.

Measles, Mumps, Rubella (MMR): Women of childbearing age-One dose, 18-50 years.

Pneumococcal: One dose, 65 years and older.

Influenza: Yearly, 50 years and older.

Chemoprevention

Discuss aspirin to prevent cardiovascular events:

Men: Periodically, 40 years and older.

Women: Periodically, 50 years and older.

Discuss breast cancer chemoprevention with women at high risk.

Counseling Calcium Intake: Women, periodically 18 years and older.

Folic Acid: Women of childbearing age, 18-50 years. Tobacco cessation, drug and alcohol use, STDs and HIV, nutrition and physical activity, sun exposure, oral health, injury prevention and poly-pharmacy: Periodically, >18 years. Upper age limits should be individualized for each patient.

Weight

Normal body mass index (weight (kg)/height (sq. meters) for Indian Americans is <23

Waist circumference <90 cm or 36 inches (men); <80 cm or 32 inches (women)

Clinical Preventive Services for Normal-Risk Adults

Screening

Blood Pressure, Height and Weight: Periodically, 18 years and older.

Cholesterol:

Men, Every 5 years (and more frequently if at risk or abnormal), 35 years and older.

Women, Every 5 years (and more frequently if at risk or abnormal), 45 years and older.

Diabetes: Periodically, adults with hypertension or hyperlipidemia.

Pap Smear: Women, Every 1 to 3 Years, 18-65 years.

Mammography: Every 1 to 2 Years, 40 years and older.

Colorectal cancer:Periodically, 50 years and older with Stool Guiac &/or sigmoidoscopy colonoscopy.

Osteoporosis: Women, routinely, >65 years old or >60 years at risk for fractures.

Alcohol Use: Periodically 18 years and older.

Vision and Hearing: Periodically, 65 years and older

PSA Screening: In Men periodically

Some other factors that can affect Health!

Include at least 20 gms. of fiber everday. Whole grains, beans & vegetables are rich sources

Many 'fast' foods are high in fat, salt and/or sugar. Limit or avoid frequent use of such foods

If you have high blood pressure, restrict the use of salt, salty foods like regular chips and pickles

Talk to your physician about your multi-vitamin and multi-mineral supplements.

Have a routine check-up blood lipid levels.

DIABETES CAN BE MANAGED! TAKE CONTROL! YOU CAN DO IT!

Foods from different sources can be combined to make up a balanced meal. Your personal meal plan should be designed to suit your lifestyle. Your meal plan will suggest servings of each food group at every meal. The different food groups and examples of one serving in each food group are as follows: (Please note that values are approximate)

1. GRAINS/BEANS/STARCHY VEGETABLES (without added fats or oils) (ex. Rice flour, Beans/Legumes)
2. MEAT & MEAT ALTERNATIVES-VERY LEAN (ex. Chicken Turkey, Tuna in water)
3. MEAT & MEAT ALTERNATIVES-MEDIUM FAT (ex. Egg, Fried Fish)
4. MEAT & MEAT ALTERNATIVES-HIGH FAT (ex. Peanut Butter, Regular cheese)
5. VEGETABLES (no fat added) (ex. Cabbage Cauliflower, White radish)
6. FRUITS (ex. Banana, Mango, Canned fruits, Apple, Orange)
7. MILK AND MILK PRODUCTS (ex. Whole/skimmed/low fat milk)
8. FATS AND OILS (ex. cooking oil, nuts or seeds)

Methods of preparing and cooking

Sprouting legumes increases nutritional value. It can be fun sprouting different legumes!

Steam vegetables with little water Do not drain the cooking water from rice or vegetables

Limit or avoid highly processed foods or high-fat, salty fast" foods

Try to eat small, frequent meals at regular times

Drink plenty of water/liquids

6-8 glasses is the usually recommended amount. Plain water is the best. Avoid excessive use of caffeinated drinks life coffee, tea and caffeine containing drinks.

Use alcohol only after talking to your physician.

What Can I Eat To Manage My Diabetes?

Diabetes is a condition where your body is not able to make enough insulin onr the insulin is not being used properly. Insulin enables your body to get energy from glucose – the sugar broken down from the foods you eat. A poor balance between insulin and blood glucose levels can result in high glucose (hyper-glycemia) or low blood glucose (hypoglycemia ) levels in your blood. Maintaining blood glucose levels around acceptable levels is important and research has shown that it can help prevent complications in your eyes, kidneys, blood vessels and more. Under your physicians guidance, diabetes and blood glucose levels are managed with Medical Nutrition Therapy, an individualized meal plan, exercise and medications as needed. The foods you eat, total calories, activity and body weight are some of the factors that can affect blood levels. Foods that contain carbohydates can raise blood glucose levels. Fats and protein can also affect weight, if eaten in excess. Keep a daily log of your meals and blood glucose levels to better understand fluctuations. Include a daily exercise plan into your regimen (after talking to your physician). Become familiar with food labels and ingredients. Your Dietitian can help you with this.