The American Diabetes Association recently shared an updated position statement on the management of type 1 diabetes in children and Adolescents. This statement is an update to their previous position statement issued in 2005. Their statement highlights the common sense idea that children are not just mini-adults. Treatment plans for children with Type 1 diabetes need to be tailored to both their current situation and their future growth and development.
The following areas were highlighted in the updated statement of recommendations for children and adolescents with Type 1 Diabetes (T1D):
- Diagnosis of Diabetes
- Blood Glucose Level Management
- Lifestyle Considerations
- Self-Management of Diabetes
- Complications and Comorbidities
- The Transition from Childhood to Adolescence and Adulthood
New Recommendations for Blood Glucose (BG) Management in Children and Adolescents
Most children’s T1D should be treated with insulin regimens with either multiple daily injections or via insulin pump therapy. Healthcare professionals should measure A1C levels of their non-adult patients at 3 month intervals. The target level of A1C should be 7.5 %. Patients or their caregivers should monitor BG levels multiple times a day, typically 6 to 10 times.
Medical devices such as insulin pumps and continuous glucose monitors (CGM) can be very helpful in the management of T1D. The ADA recommends that the CGM be considered in all children and adolescents, even though not using insulin pump therapy. Studies have found that compliant use such devices correlates with better BG control, lower A1C levels and reduction in hypoglycemic events.
Adjunctive Therapies for Children with T1D
One highlight in their recommendations between the management of type 1 diabetes in children versus adults is in regard to adjunctive therapies. They do not recommend the use of adjunctive therapies, such as the medication metformin in children. Clinical trials showed that despite the advantages of such therapies to help with weight loss or other diabetes comorbidities, there are more risks than benefits for children.
Check back next month for our follow-up blog talking about the unique behavioral aspects of managing diabetes in children and adolescents. We’ll focus on the challenges of self-management of their disease and other related health and wellness concerns.
411 on CGM
Exercise for Children with Diabetes
ADA Position Statement
Treating diabetes can be a very time consuming, day-after-day process, but today’s diabetic has a plethora of different treatment options available — more than ever before.
Type 1 diabetics can choose between an insulin pump or administering multiple daily injections (MDI) for their insulin delivery. If you are not on a pump currently, you probably aren’t aware of just how helpful these devices can be. Below are some advantages of both methods.
Advantages of an Insulin Pump
- Insulin delivery is continuous, which helps prevent sudden highs and lows in blood sugar levels
- Blood sugar control is more accurate
- Patients need fewer needle sticks
- Patients have more flexibility
- Dosage can be adjusted easily according to the patient’s activity level: i.e. while exercising or sleeping
Advantages of Multiple Injections
- Injections require less training and education
- MDI is less expensive
- Easier to use
- Not always connected to the body
What Does Research Show? Insulin Pump Versus Multiple Daily Injections
Recent studies suggest that insulin pump therapy may be slightly more effective than MDI when the patients received similar, proper training. However, both methods have been proven to reduce HbA1c levels. An insulin pump can improve quality of life in diabetics and allow them to be a little more carefree than those that use the MDI method. The bottom line is to find the method that fits best in your life while keeping your HbA1c levels in check.
Many of the patients of Active Healthcare are benefiting from pump therapy. We work with manufacturers to get the right pump for our patients, as well as carry all of the necessary supplies.
Please visit our Diabetes Management page for more information on how we can help you, as well as talk to your doctor to see if they think a pump is the right method for you.
Have you thought about what you would do if your insulin pump were to fail? It is important to have a plan in place for when and if this occurs. You can create a fail-safe plan for the rare event of a pump failure by following these four steps.
Pump Failure Action Plan
First and foremost, call your pump manufacturer. Your pump’s warranty will cover repairs. The manufacturer may be able to troubleshoot the pump, arrange for repairs, or even a replacement.
Next, call your endocrinologist. He/she can help you create a plan to manage your blood sugars in the interim and what warning signs to watch for.
Keep the following items with you at all times, making sure all are within the prescription limits and not expired:
- long-acting insulin (in case you will be without a pump overnight)
- short-acting insulin (to inject and repeat for bolus and/or correction)
- ketone strips
- a list of 24-hour pharmacies
Also, keep a record of your pump’s settings, as you may need to program a replacement or loaner pump. On this record, include the following:
- Total basal
- Your basal setting, which determines how much insulin you receive each hour
- Insulin to Carbohydrates (I:C) ratio to help with adjusting pre-meal bolus insulin doses
- Insulin Sensitivity Factor (ISF) — the number of points one unit of rapid acting insulin lowers your blood glucose
- Insulin On Board (IOB) – the calculation telling you how much insulin is still in your body from previous bolus doses
The possibility of a pump failure may give you chills, but remember not to panic. With the help of your manufacturer and endocrinologist, you can be well equipped to deal with this unlikely event. Before you know it, you’ll be pumping again.