Type 1 Diabetes in Children, Adolescents and Young Adults

TYPE 1 DIABETES in Children, Adolescents and Young Adults
Comments on Type 1 Diabetes from reviewers
Dedication
Title Page
Copyright
Contents
Preface to seventh edition
Foreword by Dr Fiona Campbell
Foreword by Dr Stuart Brink
Acknowledgements
1. Introduction
2. Getting to grips with diabetes
	When you first find out you have diabetes
	Very young children
	Routine check-ups
	Living the life you choose
3. Caring for your own diabetes
	Goals for managing diabetes
	How can you achieve these goals?
	Becoming your own expert
	Can you take “time off” from diabetes?
	Alternative and complementary therapies
4. Diabetes: Some background
	Type 1 diabetes
	Type 2 diabetes
	Other types of diabetes
	How common is diabetes?
	Can you catch diabetes?
	Does eating too many sweets cause diabetes?
5. How your body works
	Insulin
	Your body doesn’t realize it has diabetes
	The anatomy of your body
		Pancreas
		Islets of Langerhans
	Cellular metabolism
		A healthy cell
		Starvation
		Diabetes and insulin deficiency
	Type 2 diabetes
		Untreated type 2 diabetes
		Tablet-treated type 2 diabetes
6. High blood glucose levels
	What happens in the body when there is not enough insulin?
	How to treat a high blood glucose level
	Ketoacidosis
	Blurred eyesight and diabetes
7. Regulation of blood glucose
	Counter-regulation
	The liver
	Glucagon
	Adrenaline
	Cortisol
	Growth hormone
8. Hypoglycaemia
	Blood glucose levels and symptoms of hypoglycaemia
	Symptoms of hypoglycaemia when the blood glucose level is high
	Severe hypoglycaemia
	Seizures
	Does severe hypoglycaemia damage the brain?
	Hypoglycaemia unawareness
	Rebound phenomenon
	Too little food or too much insulin?
	Night time hypoglycaemia
	Dawn phenomenon
	Somogyi phenomenon
	Will low blood glucose levels return to normal if the child doesn’t wake up?
	Can you die from hypoglycaemia?
	Why does awareness of hypoglycaemia occur at different levels of blood glucose?
9. Treating hypoglycaemia
	Practical instructions
	Timing and hypoglycaemia
	Helping someone with diabetes who is not feeling well
	Glucose
	Fructose
	Sweets and hypoglycaemia
	After hypoglycaemia
	Learning to recognize the symptoms of hypoglycaemia
10. Insulin treatment
	Intermediate-acting insulin
	Intravenous insulin
	Short-acting regular insulin
	Rapid-acting insulin
	Ultrafast-acting insulin
	Basal insulin
	Traditional basal insulins
	Basal insulin analogues
	Lantus (glargine)
	Levemir (detemir)
	Tresiba (degludec)
	Biosimilars
	Pre-mixed insulin
	A larger dose lasts longer
	Units and insulin concentrations
	Twice-daily treatment
	Three-dose treatment
	Multiple daily injections
		Injections before meals (bolus insulin)
		When should you take your premeal dose?
		Combining boluses and basal insulin
		Can I skip a meal?
	Basal/bedtime insulin
		When should the injection of basal insulin be taken?
	Insulin pump
		Mixing insulins
		Depot effect
		How accurate is your insulin dose?
		Insulin absorption
		What happens if a child won’t finish a meal?
		What if you forget to take your insulin?
		What if you take the wrong type of insulin?
		Having a lie in at weekends
		Staying awake all night
		Shift work
		Birthday parties
		Sleeping away from home
		Insulin at school and day nurseries
11. Monitoring
	How many tests should I take?
	“Good” or “bad” tests?
	Diabetes or not?
	Are some things forbidden?
	Urine glucose
		Renal threshold
	Blood glucose
		How do I take blood tests?
		Borrowing someone else’s finger-pricking device
		Does the meter show the correct value?
		Children and blood glucose tests
		Is it worth taking tests?
		Does continuous finger-pricking cause loss of feeling?
	Continuous glucose monitoring (CGM)
	Ketones
		Vomiting and ketones
		Blood ketones
12. The HbA1c test
	What level should my HbA1c be?
	How often should you check your HbA1c?
	Can I measure HbA1c at home?
	Can my HbA1c be “too good”?
	HbA1c when travelling
	Fructosamine
13. Injection technique
	Getting used to injections
	Injections for parents
	Taking the pain out of injections
	Where do I inject the insulin?
	Is it necessary to disinfect the skin?
	Storage of insulin
	Syringes
	Injections with syringes
	Pen injectors
	Why aren’t all insulins available in pens?
	Replacing pen needles
	Different pens for day and night time insulin
	Variations in insulin concentration
	Is it dangerous to inject air?
	Insulin on the pen needle
	Used needles and syringes
14. Injection equipment
	Automatic injectors
	Jet injectors
	Indwelling catheters
15. Adjusting insulin doses
	Starting insulin treatment
	How much does insulin lower the blood glucose level?
	What to do if your blood glucose level is high
	Different ways of adjusting insulin doses
	What about the food you eat?
	Changing the content of the meal to affect blood glucose
	Changing insulin doses
		Keeping good records
		What is the best order for changing the doses using MDI?
	Premeal bolus doses
		Insulin for breakfast
		Insulin for lunch and dinner/tea
		Insulin for evening snack
		Holiday or weekday?
		Physical exercise or relaxation?
	Using rapid-acting insulin analogues
		Always insulin before the meal!
		Adjusting the basal insulin
		High blood glucose levels
		Hypoglycaemia
		Exercise
		Pre-mixed insulin
		Short-acting regular insulin
		Switching to rapid-acting analogues
		Do you need regular insulin when using analogues?
	Basal insulin
		Night time insulin action
		What should you do next?
		High blood glucose in the evening?
		Blood glucose levels at night
		Night time hypoglycaemia
	NPH basal insulin
	Levemir
	Lantus
	Tresiba
	Puberty
	Insulin adjustments during the remission phase
		Hypoglycaemia
		Experiment!
16. Insulin pumps
	Starting the pump
	The basal rate
	Temporary change of the basal rate
	Premeal bolus doses
	Change of insertion site
	More frequent home monitoring
	Pumps and sensors
	Insulin depot with a pump
	Ketones and ketoacidosis
	Disconnecting the pump
	Taking a bath or shower
	Pump alarms
	Occlusion or blockage alarm
	Leakage of insulin
	Air in the tubing
	Sick days and fever
	Pump removal doses
	Admission to hospital
	Physical exercise
	Using the pump at night only
	Is the pump a nuisance?
	Does using a pump cause weight gain?
	Having a lie in
	Travel tips
	Toddlers using pumps
	Pregnancy
	Rapid-acting insulin in the pump
	Which type of treatment do the health professionals prefer?
17. Side effects of insulin treatment
	Pain
	Insulin leakage
	Blocked needles
	Bruises after injections
	Fatty lumps
	Redness after injections
	Insulin antibodies
	Lipoatrophy
	Insulin oedema
18. Insulin requirements
	How much insulin does your body need?
	Puberty and growth
	How much insulin does the pancreas produce?
	Remission (honeymoon) phase
	Insulin sensitivity and resistance
	Ideal insulin doses?
19. Nutrition
	Absorption of carbohydrates
	Emptying the stomach
	Sugar content in our food
	Taking fluids with food
	Dietary fats
	Dietary fibre
	Milk
	Vegetables
	Potatoes
	Bread
	Pasta
	Meat and fish
	Pizza
	Salt
	Herbs and spices
	Fruits and berries
	Glycaemic index
	Mealtimes
	Snacks
	Can mealtimes be changed?
	Hungry or full?
	Infant feeding
	Carbohydrate counting
	Different methods of carbohydrate assessment
	How many (or how few) carbs should we eat?
	School
	Daycare
	Special “diabetic” food?
	Party time
	“Fast food”
	Food at educational camps
	Vegetarian and vegan diets
	Different cultures
20. Sweeteners
	Sugar-free?
	Non-nutritive sweeteners
	Nutritive sweeteners
	Diet drinks and “light” foods
21. Sweets, treats and ice cream
	How much extra insulin should you take?
	Ice cream
	Chocolate
	Sweets
	Weekend sweets
	Taking a break from eating sweets
	Potato crisps
	Chewing gum
22. Weight control
	Satisfied or “feeling full”?
	Reducing weight
	The little extras
	High HbA1c and weight loss
23. Eating disorders
24. Physical exercise
	Exercise and hypoglycaemia
	Can the blood glucose level increase through exercise?
	Hypoglycaemia after exercise
	Physical education
	Top level competitive sports
	Keeping fit with diabetes
	Camps and skiing trips
	Marathon and other extreme sports
	Adventure travel
	Anabolic steroids
	Diving
25. Stress
	Stress in daily life
26. Fever and sick days
	Nausea and vomiting
	Gastroenteritis
	Wound healing
	Surgery
	Drugs that affect blood glucose
	Teeth
	Vaccinations
27. Smoking
	Passive smoking
	Giving up smoking
	Snuff
28. Alcohol
	Alcohol and the liver
	Why is it dangerous to drink too much if you have diabetes?
	Basic rules
	What if you’ve had too much to drink?
	Can you drink at home?
29. Illegal drugs
	“Uppers”
	Benzodiazepines
	Cannabis
	Opium
	Hallucinogenics
	Risk-taking behaviour
30. Pregnancy and sexual issues
	Pre-pregnancy care
	Caring for the mother
	How will the child develop?
	Will the child have diabetes?
	Infertility
	Will diabetes affect menstrual periods?
	Sexuality
	Contraceptives
		Forgotten to take a pill?
		Emergency contraception
31. Social issues
	School
	Day nurseries and child care
	Child care allowance
	Adoption
	Choice of job or employment
	Military service
	Licence to drive
	Driving and diabetes
	Insurance policies
	Diabetes ID
	Juvenile Diabetes Research Foundation International
	Children with Diabetes
	Diabetes Associations
	The National Service Framework for Diabetes (NSF)
	Sponsor families
	Diabetes camps and educational holidays
	Diabetes and the Internet
	When does a young person become an adult?
	Reimbursed accessories
32. Travel tips
	Vaccinations
	Ill while abroad?
	Diarrhoea problems
	Passing through time zones
33. Associated diseases
	Coeliac disease
	Thyroid diseases
	Addison’s disease
	Skin diseases
	Infections
	Fungal infections
	Hearing deficits
34. Complications in blood vessels
	What causes complications?
	Large blood vessels
	Small blood vessels
	Complications affecting the eyes (retinopathy)
		Treatment
		Disturbed vision at unstable blood glucose levels
		Glasses
		Contact lenses
	Complications affecting the kidneys (nephropathy)
		Treatment
	Complications affecting the nerves (neuropathy)
		Treatment
	Other complications
35. Lowering the risk of complications
	The DCCT study
	The Oslo study
	The Berlin eye study
	The Linköping studies
	Other studies
36. Research and new developments
	New treatments for diabetes
		Implantable insulin pumps
		Blood glucose meters
		Glucose sensors
		Glucagon
		C-peptide
		Vaccinations
		Salicylic acid
		Amylin
		GLP-1 (glucagon-like peptide)
		Sodium transport in the kidney
	What causes diabetes?
		An autoimmune disease
		Heredity
		Environmental factors
		Cow’s milk
		Climate
		Insulin and cancer
		AGE
		Blocking the immune process
			Immune treatment
			Light treatment
			Diazoxide
			Vitamins
		Transplantation
			Pancreas
			Islet transplantation
			Engineered cells
		Other ways of administering insulin
			Nasal spray
			Inhalation of insulin
			Tablets
			Insulin as suppositories
			Chemical alteration of the insulin molecule
			Insulin additives
37. Psychology
	The onset of diabetes
	Diabetes rules or family rules?
	Making friends with your diabetes
	Diabetes affects the whole family
	Being a relative or friend of someone with diabetes
	Telling your friends
	How do you change your lifestyle?
	Diabetes at different developmental stages
		Infants (0-1.5 years)
		Toddlers (1.5-3 years)
		Preschool children (3-6 years)
		Primary school children
		Intermediate-level children
		Puberty
		Healthy siblings
		Divorced families
		Fathers’ involvement
		Brittle diabetes
		Quality of life
38. Needle phobia
39. Well-known people with diabetes
	Nick Jonas
	Gary Mabbutt
	Tara Moran
	Steve Redgrave
40. Epilogue
	Artwork and other credits
41. Glossary
	Units
	Terms
42. References
43. Index