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…

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.

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.

www.youtube.com/watch?v=zC_eh34s3aQ

Link to video: Injecting Insulin