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Outline

Type-I Diabetes Basics

Objective To provide the best care for our new diabetic patients and their families. Accuracy Safety Compassionate Care It Starts With Us

Accuracy Correct information Correct dosage Accurate timing Accurate testing

Safety Safe nurses: Double check all meds Double check meals and snacks Watch for hypoglycemia (and know how to treat it!)

Compassionate Care The diagnosis of Type-I Diabetes is devastating to the child and their families.  It alters their life forever.

There are Different Diabetes Gestational – Insulin resistance during pregnancy Type-II – Most common form of Diabetes.  Caused by insulin resistance. Type-I –  Only 10% of all Diabetics.  Caused by an autoimmune reaction.

Development of Type-I Diabetes It takes 3 things to develop Type-I diabetes: A genetic pre-disposition:  DR3/DR4 HLA Viral or chemical trigger Autoimmune destruction of 80-90% of all islet cells (insulin producing cells)

Islet Cell Destruction

Myth Busters Type-I Diabetes: Is NOT caused by lifestyle! Is NOT preventable! Is NOT curable… but is DEFINITELY controllable! Our job is to give accurate information to the patient and family.

Pathophysiology  (or what’s wrong with the Type-I Diabetic) Type-I Diabetics do not make insulin.  Insulin has three actions: Allows sugar to enter the cells for fuel Stops the breakdown of fat for fuel Stops the liver from making “internal” sugar

Treatment of Type-I Diabetes Type-I Diabetics make no insulin. The goal of treatment is to regulate the blood sugar by balancing the insulin given (which lowers blood sugar) against the intake of food (which increases blood sugar).  If there is an imbalance, blood sugars will be too high or too low.

Insulin Administration We try to give insulin in a manner that imitates the natural production of insulin in a non-diabetic. A long-acting (basal) insulin controls the production of internal sugar A short-acting insulin controls large upswings in blood sugar (as when we eat a meal)

Insulin Administration We usually start children on a two shot per day regimen using NPH (basal) and Regular or Humalog (fast acting) However, the best regimen for imitating natural insulin production require at least four shots per day

Insulin Activity

Activity Graph

The Importance of Food In Type-I Diabetics food intake is as important as insulin. Peak action times of insulin must be balanced by food intake. The rule for food is “THE RIGHT AMOUNT AT THE RIGHT TIME”

Timing Food Intake Peak action time of insulins must be balanced by food. Meals and snacks MUST ALWAYS be provided at these times.

Blood Sugar Testing We can only know if we are balancing food and insulin correctly by checking blood sugar levels. Testing MUST be done at the right time to accurately reflect the effects of insulin and food. Insulin dosage is based on blood sugar values. It is essential to get accurate test values.

Testing Times It is best if Type-I Diabetics test at least four time each day. In the hospital we test BEFORE breakfast, lunch, dinner, PM snack and at 2:00 AM. You must also test if you observe symptoms of low blood sugar.

Putting it All Together See the following: Daily Schedule Diabetes Guidelines

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Hypoglycemia Hypoglycemia (low blood sugar) occurs when the patient doesn’t eat enough or has had too much insulin. Hypoglycemia MUST be treated immediately! If you suspect low blood sugar, test and treat with four ounces of any juice and notify the doctor. A hand out is available for more information.

The Diabetic Team Fountain Valley upholds the highest standard of care with a treatment team including doctors, educators, dieticians, social workers and child life specialists in the management of Type-I Diabetes. You are NOT alone !!! This is your team, too.  They are here for you!

Child Life Specialist Fountain Valley has a Child Life Specialist available to work with new Diabetics and families. Her role is to: Help the child and family to cope with this demanding condition. Prepare siblings for the new situation. Assist with re-integration back into school.

Social Services The role of the Social Worker for a new Diabetic is to: Provide critical support Assess the family’s ability to care for the Diabetic child. Make referrals when necessary

Dietician Fountain Valley provides the best dietary consulting and education for Type-I Diabetics in Orange County.  They work with the families so that the diabetic child can enjoy normal foods and activities. Please contact Dietary Services immediately upon arrival of a new Type-I diabetic.

Compassionate Care Type-I Diabetes is an incurable and life threatening condition.  Control requires treatment every three or four hours 24 hours-a-day, 365 days-a-year.  No vacation days allowed. Children and their families will be in shock!  Your compassionate care can make a tremendous difference as they prepare to handle this alone.