To achieve good control, you and your child need to work with your diabetes team to gain the information needed to deal with
diabetes from day to day. People with good diabetes control should expect to generally feel healthy. This means:
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no
symptoms of high blood sugar levels such as increased urination (peeing) and thirst
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only mild and infrequent low blood sugar reactions
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normal growth and physical development
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lots of energy
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interest in friends and activities
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regular school attendance
Factors that affect blood glucose balance
Insulin and food have a major impact on blood sugar levels. Food contains carbohydrates that increase our blood sugar. Insulin
lowers the blood sugar level by allowing sugar to enter the cells, where it’s used for energy. For people with type 1 diabetes,
taking daily insulin and meal planning are the most important tools for keeping blood glucose in balance.
Insulin
In people without diabetes, the pancreas delivers a very small amount of insulin throughout the day. The pancreas releases
extra insulin when food enters the body. This is done in response to the increase in blood glucose released from the digested
food into the bloodstream. In people with diabetes, the injected insulin replaces the missing insulin from the pancreas. If
your child is young, she may start with 2 or 3 injections of insulin each day, either before breakfast and supper, or before
breakfast, supper, and bed. Older children and adolescents may take 3 or 4. The extra injection is taken before lunch. It
also makes sense to have injections more often, or receive insulin continuously under the skin with a pump -- which is called
a continuous subcutaneous insulin infusion pump. These methods more closely imitate the natural insulin supply from the pancreas
in a person without diabetes.
Food
It’s important for your child to keep her level of blood sugar as near the normal range as possible by matching the amount
of food she eats with the right amount of insulin. This can be done by eating similar amounts of food at the same time each
day, balanced by a daily pattern of insulin. This can also be done by learning, over time, how much insulin is needed to balance
a certain meal or snack. It’s impossible to know how much insulin to take when meals and snacks are very different from day
to day. If there isn’t enough glucose in the body to work with the insulin, the child runs the risk of hypoglycemia. This
is also called an insulin reaction. On the other hand, if there is too much food for the amount of insulin the child has had,
hyperglycemia will result.
Most parents agree that meal planning is one of the biggest challenges in managing diabetes. A dietitian will help you devise
a meal plan. She will keep family habits and favourite foods in mind. The goal is not to limit food or calories, but to ensure
your child is eating well and to figure out the insulin dosage.
Other factors affecting glucose control
We talk about insulin and meal plans so much because you and your child have control over how much insulin is taken and how
much food is eaten. But no matter how hard you try to match a regular diet with your child’s insulin schedule, blood sugar
readings may be different each time. Why? Because injected insulin can’t match the automatic response of a normal pancreas.
Also, there are other factors that affect blood glucose which are difficult to control, particularly in children, such as
activity and stress.
Activity
When your child is active and has enough insulin, her blood sugar level drops. This is because the body uses more sugar when
a person is active. It provides the energy to do the exercise or activity. An active lifestyle is an important part of good
health. It improves physical fitness, helps us relax, and promotes general well-being. Your child’s diabetes routine should
take into account the amount of exercise or activity she does each day. You and eventually your child will learn to adjust
your routines for special activities.
For people with diabetes, exercise has another benefit. Regular exercise also seems to make muscles and other tissues respond
better to the injected insulin. The body then needs less insulin to move glucose from the blood into the muscles. As well,
regular exercise may help lower the risk of diabetes complications.
However, exercise and activity must not be considered part of diabetes treatment. Children generally lead active lives. If
exercise is prescribed, it takes the fun away. Set a positive example. Make exercise and activity an enjoyable part of your
family routine. You might start with family walks and go on to other social activities, such as bicycling, swimming, or tennis.
Let your child join in sports and physical activity at her own level.
How exercise affects blood sugar
In general, physical activity has the following effects in people without diabetes:
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The muscles take in more glucose from the blood.
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The pancreas makes and releases much less insulin.
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The liver produces more glucose for the body to use.
Overall, the level of glucose in the blood remains steady.
In children with diabetes, the injected insulin is unable to shut off. The muscles continue to use up the glucose that is
available in the blood. If the insulin is injected into an arm or leg in someone who has been particularly active, playing
tag or bicycling, for example, there may be an increase in the flow of insulin absorbed from the injection site into the blood.
This insulin has the following effects:
Most activities make blood glucose levels go down. However, some very stressful or competitive activities, such as ice hockey
or soccer, may increase the glucose levels. This is because the stress of the game increases stress hormones that work against
the insulin. Examples of stress hormones are epinephrine and glucagon, but also cortisol and growth hormone. Also, sometimes
the glucose level doesn’t fall during the activity, especially if it occurs immediately after a meal. However, the glucose
may then drop for up to 6 to 12 hours after the activity is over. This means that children doing high-energy activity in the
late evening may have late-night “lows.”
When exercise doesn’t lower high blood sugars
In general, exercise does help lower the blood sugar level. But once blood glucose is very high — for example, over 17 mmol/L
(300 mg/dL) — don’t count on exercise to bring it down. The only thing sure to bring it down is insulin. Energetic exercise
without enough insulin prompts the liver to release stored sugar. This in turn increases blood glucose. In someone who has
high blood sugar and not enough insulin, the glucose just keeps building up. Your child shouldn’t exercise if she is ill and
urine ketones are present.
When blood sugars go very high after exercise
There are 2 reasons that blood sugars may go sky-high after exercise. First, the child’s diabetes may be poorly controlled,
so that she has frequent high blood sugar readings. In this case, exercise will be a further stress causing even higher sugar
levels. Secondly, in some children with well-controlled diabetes, very heavy exercise can cause stress and increase glucose
levels. Such children may not need extra food to cover the exercise, but may need more insulin. In such situations, beware
of late-night lows.
Stress
Stress generally makes the blood sugar level go up. Stress is the body’s physical response to danger. It is left over from
the days when we had to fight natural predators for survival. The causes of stress may have changed over the ages, but the
body’s reaction hasn’t. Stress causes a surge of hormones whose job is to raise blood sugar levels in order to boost our energy.
These hormones include adrenaline and glucagon. The hormones then cause stored sugar to be released into the blood. Children
with diabetes do not automatically make more insulin to deal with the release of stored sugar.
There are many causes of stress:
Whatever the cause, sometimes stress makes the blood sugar go up for a short time. During a stressful event like an illness,
you and your child will need to check blood sugar levels more often and take action as needed.
You do not need to make any special attempt to create a stress-free environment for your child. All you need to do is to check
blood sugar regularly and make adjustments based on the results. This will help maintain the blood sugar balance.
Checking blood glucose balance
Checking blood glucose levels several times each day is the best way to see how well your child is balancing insulin, food,
and activity.
The diabetes health care team will work with your family to determine a blood sugar range that fits your child’s age and stage
of development. No matter how hard you may try to keep track of meals and snacks, or stick to insulin schedules and activities,
not every glucose reading will fall into this range. In the beginning, very few may. It is not unusual for parents or children
to feel they have done something wrong or bad if levels are off target. Avoid looking at each blood sugar check as if it were
a report card. Rather, see it as part of a road map that helps you make good decisions about diabetes management.
