Type 1 Parent

What effect does exercise have on glucose levels?

When exercising, muscles use glucose for energy. At first, the body uses glucose converted from glycogen in the muscles. Then, glucose is taken from the bloodstream. During prolonged exercise, in order prevent blood glucose levels from becoming too low, glucagon and additional hormones are released. These hormones trigger the breakdown of stored fat into components the liver can convert into more glucose. With frequent and regular exercise, the body’s sensitivity to insulin improves and better glycemic control is developed.

Why is the effect of exercise on glucose levels important to those with diabetes?

Exercise indeed has a good effect on a patient’s glucose level. This is good news for people who have diabetes. A lot of research indicates that patients of diabetes gain more control over their glycemic as soon as they get used to a regular exercise program. On the other hand, people who do not engage in exercise find no improvement on their glycemic control. Since exercise improves your insulin sensitivity, you will also need less medicines in order to control the levels of your blood sugar.

Should patients with diabetes exercise more often or differently than otherwise healthy people?

Experts recommend that people who have diabetes should exercise around two and a half hours (usually only moderate aerobic activity) three days a week. Alternately, they could also do only vigorous aerobic activity for ninety minutes

What type of exercise is best for diabetes patients?

When it comes to exercise, the kind of exercise that is used is not as important compared to the frequency of the exercise. There are also some studies showing that if you participate in both weight training and aerobic activity, you get even more benefits as a result.

When should patients be discouraged from exercising?

Of course, sometimes patients should not engage in vigorous exercise especially when they have cardiac conditions or they are more prone to developing injuries as a result. It is better if they start of slow and get used to a light intensity program instead.

How might a patient be encouraged to exercise?

You can encourage patients to exercise slowly and surely until they adapt to it.

About the Author – Su Rollins writes for reactive hypoglycemic diet, her personal hobby blog focused on tips to prevent and cure hypoglycemia using the right diet and nutrition.

We have become absolute fans of diabetes camp! What a fantastic adventure and an amazing perspective into the world of Type 1 diabetes.

With our son being eight years old and having been diagnosed with Type 1 diabetes just last summer, we were obviously extremely hesitant as we thought about summer camps for him this year. Not only has he never spent any significant time away from home, but with the added stress of worrying about his health, we were resigned to the fact that he would likely not be able to experience the joys of summer camp until later in life.

But then we were told of camps that specialize in adventures for kids with Type 1 diabetes. I did a little research, finding two camps within a relatively short distance from our home, and reached out. The camp we eventually chose was Camp Conrad Chinnock, located in the San Bernadino Mountains in Southern California.

The camp was excellent and completely inspiring. Being our first time, we chose to go to their ‘transition camp’ which allowed both parents and the child to stay for the weekend before setting the child free for the next week. During the weekend not only did our son immediately gain a sense of independence (“see ya!”) but we enjoyed a series of discussions with the camp staff, counselors, doctors and the other parents learning not only about how the camp is run but also what it is like to live with diabetes (note: almost all the staff and counselors have Type 1 themselves).

Of course the experience was valuable to us as parents, being able to ask young adults about their own lives with this disease and being able to learn about other parents’ experiences, but it was tremendous for our son on two levels.

First he got the great camp experience – staying in a cabin with friends, rock climbing, swimming, archery, hiking, all the great outdoors stuff. That alone was worth the money. By the end of the week he was completely exhausted.

But more importantly (and this may not have dawned on him given his age) but he got to meet a lot of other kids going through the same exact issues he goes through. He no longer was the odd kid out. There was no awkward moments where he had to excuse himself to go to the nurses office to get a shot – his whole cabin did this together. He didn’t need to feel shy about feeling ‘low’ – all his friends at one time or another did and all the counselors had testers and glucose tablets on them at all times to help out.

He also got to learn how other kids manage their diabetes. About half the kids his age were on the pump and the others were taking shots. He got to learn about the pump and see how to operate one. And they all learned about carb counting and bolus and insulin calculations.

We are so happy we found this place and so relieved to know that kids with Type 1 diabetes can not only experience a camp just like every other kid, but that they can grow up to be responsible and inspirational people – all the counselors were perfect models of this.

Our son was so enamored by the experience that he asked to go back, so we’re going to send him again in a couple weeks.

Though we are all hopeful for an eventual cure for Type 1 diabetes, the continued wins researchers are seeing in their quest to create an artificial pancreas is heartening.

Most of the focus in the news recently is on recent improvements in combining insulin pump technology with continuous blood glucose monitoring.  Intuitively it would seem simple.  Have a single device that measures blood glucose on a continuous basis and based on readings release insulin into the body.

Ah, but nothing is as easy as it seems.  Numerous challenges exist, but a key one is the lag between food consumption, what a glucose monitor measures, and the ability to get insulin into the system.  What needs to happen is to be able to predict glucose levels based on types of foods being eaten and immediately release the insulin to welcome the food. (Our body’s ability to do this is simply remarkable)

There are folks working on this problem luckily.  A recent article in US News and World Report describes the effort of a team of mathmaticians, let by Boris Kovatchev, that are developing algorithms based on specific individual’s insulin requirements.  So far they’ve had some luck.

Another group attempting to tackle this are out of the University of California Santa Barbara.  They recently released results of a study of a software program that they have developed to do just this kind of anticipation and ensure that not too much insulin is released.

Soon enough (in the next year or two? maybe?) all-in-one devices will be on the market to help manage this disease.

Oranges are great for hypoglycemia

We’ve tried lots of different foods when our son suffers from low blood glucose levels (hypoglycemia).  Depending on how low he is and what activities he’s about to undertake we’ve gotten comfortable with a good variety of different choices.

The obvious goal when treating hypoglycemia is to get some food into the body that will quickly turn into glucose and raise those levels.  If you’re really low (typically below a reading of 60) you want to act quickly and so you’ll go for something with a faster-acting sugar.

If you’re just a little low and you know you’re going to be exercising soon (and so likely to go lower) you may choose to eat a more complex carbohydrate that will digest and turn into glucose over a longer period.  Managing diabetes and sports is complex and this will help sustain you through your exercise.

Old school diabetes treatment was to pop some kind of candy into your mouth and chew.  Obviously, our son loves this.  Post Halloween we caught our son out running on our treadmill (which he’s not allowed to do).  When asked “why?”, his response was that he wanted to get low so he could enjoy one of his candybars.  Pretty saavy for an eight year-old, but we obviously gave him a bit of a scolding and explained to him why that was a bad idea.

We do try to monitor his intake of sugars (including high fructose foods) and so tend to stay away from using the traditional candy and fruit juices to combat lows.  Here are a few of our favorite foods to use:

• Natural Orange Juice – 4-8 oz.  Great for when he is really low and we need to raise his levels quickly.
• Apple – Also good for a relatively quick rise.
• Tangerine – Natural sugars work great.
• Dried Apricots – Good natural sugars.
• Dex 4 Glucose Tablets – 2-3 tablets.  These act quickly and perfect though for a kid they’re not as ‘fun’.
• Whole Wheat Toast – 1/2 slice.  Better for a bit of a longer digestive cycle.  We’ll use this when he’s not too low and is still active in the day.
• Milk – 8 oz.  This is good when he’s not too low but also hungry.  Helps to fill the stomach and is a bit slower acting.

We’re always trying new foods though as we’re eager to have our son enjoy the variety of what the world has to offer.

Tell us about the foods you use…

Here’s a great, brief article that came from the American Diabetes Association’s Parents eNewsletter.

Tips for Sleepovers

The following section was taken from posts on the Place for Parents Message Board on diabetes.org. These tips should not replace advice and/or recommendations from a health care provider but reflect issues that parents deal with day-to-day.

“I know my 7–year old daughter who has diabetes will start to be invited to sleepovers soon. Do you let your kids go on sleepovers? How do you deal with it??”

Parent to Parent -

• We have a policy. If our daughter is going through a wacky BG numbers time period the sleepover has to be at our house. No exceptions. We tell her yes, we know it’s unfair, but it is what it is and we have to do what’s best for her.
• If my daughter’s numbers are OK at night, she can sleepover at someone else’s house, but she has to call me at 11:00pm with her BG number.
• We start with only allowing her to spend the night at close friend’s homes. Between her being able to do the BG tests on her own and a parent who is willing to learn what to do in various situations( make a cheat sheet), we feel one’s safe.
• We actually do what we call 1/2 sleepovers for our eight year-old daughter and friend. We do the dinner, get on the jammies, make the snack, watch the movie and then her parents pick her up when it’s bedtime. Maybe that can be a compromise for your daughter, if it works out that she’s just not able to spend the night, for whatever reason
• You can plan to have most of the sleepovers at your house. Set it up so your house is the coolest!

Expert to Parent:

When your child is ready for sleepovers, the thought of a night away from home may make you nervous. But with a little planning and preparation your child can have fun and be safe at sleepovers.

Be sure that the parent of your child’s friend knows your child has type 1 diabetes and is comfortable with a sleepover.

You can help the parent be prepared to care for your child overnight by:

• Providing your contact information so the parent can reach you with questions.
• Making parents aware of your child’s diabetes regimen including food requirements. (A short written summary may be helpful.)
• Making the parent and your child’s friend aware of your child’s signs and symptoms of low blood glucose as well as how to respond to lows.
• Agreeing on an emergency care plan both you and the parent are comfortable with.

Along with their toothbrush and pajamas, be sure your child packs their diabetes supplies. Don’t forget to remind your child to always wear their medical ID bracelet or necklace!

Include:

• Insulin
• Syringes or Pens (and pen needles)
• Blood glucose (BG) testing supplies
• Pump/CGM supplies
• Glucose tablets or other fast acting sugar to treat low BG
• Snacks

Harold Starkman, MD is Director of the BD Diabetes Center for Children and Adolescents at the Goryeb Children’s Hospital in Morristown, NJ.

Mellitus comes from the Latin for 'honey'.

Diabetes Mellitus is a term often used to describe Type 1 diabetes or even diabetes in general. As we became exposed to the condition, the different names and types of diabetes was an initial source of confusion. Let us give you a little history lesson on the origin of the word and hopefully it will help to clear things up.

The term Diabetes is Greek and means ‘that which passes through’. It was originally used in the 2nd century to describe a patient of a Greek physician who was exhibiting the symptoms of excessive urination.

Later, in the 17th century, the term Mellitus was attached to the disease. This term has its origin in Latin meaning ‘honey’ or ’sweet’ and was used to distinguish between those with sweet-tasting urine (diabetes mellitus) from those with urine with no taste (diabetes insipidus).

Today, the two predominant forms of diabetes – Type 1 and Type 2 – are both considered forms of diabetes mellitus. As such, the term diabetes mellitus has become somewhat synonymous with the general term diabetes.

Confused? Don’t be. If you simply ignore the ‘mellitus’ at the end of the term you’ll basically be back to simply ‘diabetes’. Because the vast majority of people suffering from diabetes have a form of diabetes mellitus, you’ll be ok with this generalization.

Once you’re back to simply reading things as ‘diabetes’, then all you have to do is understand the differences between Type 1 and Type 2 diabetes.

Hyperglycemia is primary reason behind long-term complications of diabetes

Hyperglycemia occurs when blood glucose levels rise beyond normal levels. Unlike hypoglycemia there are typically no immediate negative side-effects, however it is hyperglycemia that tends to be the long-term battle of most people with diabetes.

Because those with Type 1 diabetes are not able to produce insulin, there is the constant danger of rising blood glucose levels, especially after meals. Over the long run (years) if you suffer consistently from hyperglycemia you are at more danger of nerve and organ damage. All of those nasty side-effects of diabetes (blindness, heart disease, amputation of limbs, etc) are all a result of long term hyperglycemia.

On a more immediate front, if someone is suffering from extreme hyperglycemia over the course of days, they are very likely to contract ketoacidosis, which can have very serious complications.

Hyperglycemia in people with Type 1 diabetes is almost always a result of either missing a dose of insulin or miscalculating the number of carbohydrates they just consumed and thus taking an insufficient dosage of insulin.

How can you identify Hyperglycemia in your child?

Everyone will be slightly different in their symptoms. However, hyperglycemia is typically associated with either headaches or stomach aches. What we’ve found in our son is that if he starts to complain of an upset stomach, it is likely a case where we’ve mis-calculated our recent insulin injection. He’ll come to us and say that he feels like he wants to throw-up, but in all other aspects is feeling fine – no headache, no aches or pains, no fever.

If you recognize these kind of symptoms it is best to test their blood glucose levels and get a reading on where they are at that moment.

How to manage Hyperglycemia

Because there are no immediate negative impacts, you need to first determine how high your child really is. With all the different insulins you’ll find that there are different potency curves and at times after a meal your child will just naturally have a high blood glucose reading. This is due to the fact that their glucose has risen quicker than the potency of the insulin. If you think the insulin has not yet kicked in and they are not extremely high, it is probably best to wait things out and look at how you need to adjust your insulin dosage calculation for the next meal.

On the other hand, if you feel your insulin should have already balanced out their carb intake, and they are significantly higher than what you would expect (e.g. over 200 on a blood glucose level), you may want to provide them with another small dose of insulin to bring them back down. If you do this make sure you keep this in mind when they next consume food. Should you adjust your insulin dosage down?

Overall, hyperglycemia is not as immediately dangerous as hypoglycemia, however, over the long run it is the primary reason why those with diabetes contract more serious health issues. As such, it is critically important that you manage blood glucose levels so that your hyperglycemia episodes are subtle and infrequent.

A nice introductory video about the different forms of insulin and how to administer it. Good luck to ‘HardtobeSweet’ with all of her videos.

Link to video: Injecting Insulin

Yesterday, November 21, the California Superior Court overturned an earlier agreement between the California Department of Education and the American Diabetes Association allowing unlicensed school personnel to administer insulin.

The California Nurses Organization obviously was quite pleased with the decision as it now appears that only licensed nurses will be allowed to administer insulin injections in California public schools (except in cases where either the individual self-administers or a parent administers).

What do you think about this?

Our own opinion is that this not only severely limits choices that a school and parent has for medical treatment, but it also binds schools to another layer of fiscal costs in a time when our schools (especially in California) are truly suffering.

In our own school, nurses are only on campus and available about 20 minutes each day during lunch. That’s all! Also, the actual nurse who arrives changes each day and we do not have a clear understanding of their schedule so we don’t know who to expect on any given day. Though some of the nurses have been fantastic – caring for our son and another child with diabetes and being proactive to ensure they eat everything in their lunch – others have been downright irresponsible. We have had a number of occasions where my wife (who has been showing up to train all these nurses) has had to hunt the nurse down or has had to keep them there in the office rather than running out “to a meeting”. It has been clear that if my wife was not there these individuals would have left campus without administering insulin.

The reason why there is such a turnover of nurses and limited coverage has not clearly been explained to us, but it is clearly a result of the difficult financial state of our district (the largest in the State) along with a rise in diabetes incidences.

Though we certainly appreciate a well-trained and caring nurse, it has become very evident that just because one holds a nursing license it does not explicitly equate to “well-trained” and “caring”. We would actually be much better off training a single, responsible, caring individual on how to calculate dosage and how to administer insulin rather than rely on the bevy of inconsistent nurses we have now.

Our own view is that this decision is simply a means of maintaining job security for the nurses rather than in any interest for the well-being of our children. Given that there is clearly a lack of adequate nurses in our country these days, this decision can only be seen as narrow and wrong.

I am sure that both the American Diabetes Association and the California Department of Education will be fighting this. We should lend our support.

Read more here: California School Nurses Org Applauds Court Ruling

Traveling with diabetes and taking insulin on a plane was something we experienced right away. Our son was diagnosed while he was visiting Thailand and so only a week after getting out of the hospital we were on our way back to the U.S.

Not only were we still shell-shocked with the diagnosis and not really understanding of how to manage our son’s condition (turns out what we learned in Thailand was pretty lacking), but we had certainly never had to carry needles onto a plane.

We survived all 17 hours of the flight however and here’s how we did it:

1) Organized: We were very organized with all of our gear and snacks. We separated out all of our needles and insulin (pens and syringes) and we separated out a couple cartons of juice and some snacks. We had all of this in an individual bag.

2) Prepared with Documentation: We had 2 copies of a note from our physician there in Thailand, both in Thai and in English. The note clearly explained that our son had diabetes and that it was necessary for him to take insulin via injection at regular intervals. This note was absolutely necessary getting through security and on-board.

3) Open: We were very open at each stage of boarding our plane. Before getting to the airport we called the airline and alerted them. When we checked in, they saw the note in our file and we once again reminded them of our need to carry needles onto the plane. At security, before getting in line, we alerted the officials and they worked with us to move through the line and the bag checks. When we arrived at the gate we told them once again of our situation.

4) Persistent: When we got to the gate, the cabin crew required us to surrender our insulin and syringes, explaining to us that they would hold the medication with the head crew member. We accepted this, but before the doors of the plane closed, we sought out the cabin crew manager and had her physically show us that she had possession of our insulin. Soon after takeoff, she actually came by our seats and gave us all the medication to hold onto.

Once we were in possession of everything we needed, we simply managed as normal, giving our son his injections right in his seat. And with all long flights, we made a point of getting up and walking around in order to keep our legs and minds fresh.

There were a lot of steps to go through to get our insulin on a plane, explain our situation to the airline, and ensure we could manage our son’s diabetes in a normal fashion. But with a little forethought and persistence, we found that traveling with diabetes on a plane was not that difficult.