Question:
I am a T2 diabetic, under good control through exercise and watching my carbs. A co-worker’s 12 year old son was just diagnosed as a T1 diabetic. He already weighs 195 pounds. While he doesn’t eat a lot of sweets, he does eat a pretty high carb diet, lots of breads and potatoes. She asked for my advice, which I summarized from reading so many posts for newbies. I told her to test and retest, 7 times per day, to watch carbs, to start exercising, to track what he eats and how that affects his bg levels. Naturally, I told her to get educated and keep him under doctor’s care. (She is on state assistance, so I don’t know how much help there will be.) Anyway, not being a T1 and never having dealt with insulin shots, what else should I tell her? — Keith Tellinghuisen "My life has been filled with trouble, 90% of which never happened." – Mark Twain
Response:
- Hide quoted text — Show quoted text – >I am a T2 diabetic, under good control through exercise and watching my >carbs. >A co-worker’s 12 year old son was just diagnosed as a T1 diabetic. He >already weighs 195 pounds. While he doesn’t eat a lot of sweets, he does eat >a pretty high carb diet, lots of breads and potatoes. >She asked for my advice, which I summarized from reading so many posts for >newbies. I told her to test and retest, 7 times per day, to watch carbs, to >start exercising, to track what he eats and how that affects his bg levels. >Naturally, I told her to get educated and keep him under doctor’s care. (She >is on state assistance, so I don’t know how much help there will be.) >Anyway, not being a T1 and never having dealt with insulin shots, what else >should I tell her? >– >Keith Tellinghuisen
The children often are not clever enough to manage their own injections or manage the modern powerful insulins. Thus, their medical advice teams concoct Rube Goldberg schemes which "sorta" work but usually subject the child to undesirable highs and lows. For example: a. The child may not be permitted to inject at school. b. The school personnel are not permitted to inject for him. c. Therefore, his mother has to fiddle with mixes of fast and medium insulins to handle both breakfast and lunch. Some parents: a. Inject their child with fast insulin before breakfast to handle the meal b. Drive their child to school, and inject them with NPH in the car at the school door "in hopes that the NPH will kick in just about at lunch time". Often their hopes are not realized and the child suffers from highs or lows, passes out, or suffers from intense craving for food while waiting for the lunch period to arrive. (My friend, a school teacher, just about went nuts trying to deal with such a child one year) Therefore, everybody concerned should learn as much as possible about the modern basal-bolus insulin regimes, the modern insulins Novolog, Humalog and Lantus, and move to self-injection and modern insulin regimes as soon as practical. It is a burden. Regards Old Al .
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As a mother of a T1 and a wife of another T1, I would encourage your friend to take her son to a pediatric endocrinologist and learn as much as possible about everything. Kids with T1 are totally different then adults with T1….their activity levels are more sporadic, they have raging hormones at that age and their friends may be scared of "catching it" until they have things explained to them. Kids can amaze you with what they "can" do when they are ready when it comes to managing their diabetes, my daughter continues to amaze me (in a good way) with what she does or how she handles some situations. A great place to check out is http://www.childrenwithdiabetes.com/index_cwd.htm they have links to everything including dealing with school. Best wishes for the boy and his family, Heather http://www.execulink.com/~craig/diabetictag.html http://www.execulink.com/~craig/pouches.htm
– Hide quoted text — Show quoted text -> I am a T2 diabetic, under good control through exercise and watching my > carbs. > A co-worker’s 12 year old son was just diagnosed as a T1 diabetic. He > already weighs 195 pounds. While he doesn’t eat a lot of sweets, he does eat > a pretty high carb diet, lots of breads and potatoes. > She asked for my advice, which I summarized from reading so many posts for > newbies. I told her to test and retest, 7 times per day, to watch carbs, to > start exercising, to track what he eats and how that affects his bg levels. > Naturally, I told her to get educated and keep him under doctor’s care. (She > is on state assistance, so I don’t know how much help there will be.) > Anyway, not being a T1 and never having dealt with insulin shots, what else > should I tell her? > — > Keith Tellinghuisen > "My life has been filled with trouble, 90% of which never happened." – Mark > Twain
Response:
Old Al..I know that it is different for many people. but I have to comment re how schools (SOME) may treat insulin dependent students.. I have had 2 insulin dependent children in my class. It never even entered our minds not to do whatever we could to help these kiddos.. Whether it was injections while here at school or whatever..In fact, I went to seminars re juvenile diabetes in order to learn a little more (I was not T2′d at the time)… No I was not paid to do this… The other fact is we had to work very hard to encourage the parents to allow the child more responsibility in his care and treatment..(.Here we go again needing to step into the guidance of parents and our advocating for their children…..)Always, of course, with adult supervision and guidance. Our nurse was always there to supervise or administer injections. Schools today and for the 34 years I have taught, ARE expected to deal, handle and care for every facet/aspect of children’s lives. These expectations have increased every year I have taught. Teaching content is a luxury today. We deal with all issues and more and more issues of a child’s life are laid at our doorstep. These issues can’t be ignored .They are a part of each child. It goes for the diabetes, too. I would hope no parent would ever feel compromised in the care of their child because they feel schools can’t be accomodating.. Children come to us with so many more needs…acadademic, emotional, social, physical and many with so much pain in their lives. Of course, I can’t speak for all but to teach and to love to teach…you just do it……Memory I actually cringe to think of a parent having to hurridly inject in a car because they can’t get cooperation from the
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How sure are they that he really is a T1? Just because he’s 12? DKA? Other symptoms? Particular diagnostic tests? If he were 30+ and had a similar height/weight figure, would they have assumed T1 right away? or would they have assumed T2 without further thought? bj
– Hide quoted text — Show quoted text -> A co-worker’s 12 year old son was just diagnosed as a T1 diabetic. He > already weighs 195 pounds. While he doesn’t eat a lot of sweets, he does eat > a pretty high carb diet, lots of breads and potatoes. > ….
Response:
>Old Al..I know that it is different for many people. but I have to comment >re how schools (SOME) may treat insulin dependent students.. I have had >2 insulin dependent children in my class. It never even entered our minds >not to do whatever we could to help these kiddos.. Whether it was >injections while here at school or whatever..In fact, I went to seminars re >juvenile diabetes in order to learn a little . . .(snip). . .I actually
cringe to think of a parent having to >hurridly inject in a car because they can’t get cooperation from the
Most of this is beyond my experience. . .I have to rely on my friend the school teacher and a few bits I picked up on the Juvenile T1 web sites. The NPH-in-the-car is a paraphrase lifted from one of the sites. Some addenda of interest to a school teacher: For a long time, the public schools in my area were prohibited from teaching anything (and I mean anything) about sex, sex education, STD, etc, etc. Therefore, the local churches stepped in and taught all comers. My wife and I were the teachers at our church. On STD day, my wife was caught by an unbreakable committement and I ended up handling the whole 3-hour class by myself. I cannot relate in a short, simple post what it was like to explain syphylis, gonorrhea, herpes, trichomoniasis, chlamydia and yeast infections to a class of 13-year old girls. I remember that it was in February (that’s a Michigan February) but I drove home with windows open because I was still sweating. Regards Old Al
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> I remember that it was in February (that’s a Michigan February) but I drove > home with windows open because I was still sweating.
their own kids?!!! k
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– Hide quoted text — Show quoted text -> As a mother of a T1 and a wife of another T1, I would encourage your friend > to take her son to a pediatric endocrinologist and learn as much as possible > about everything. Kids with T1 are totally different then adults with > T1….their activity levels are more sporadic, they have raging hormones at > that age and their friends may be scared of "catching it" until they have > things explained to them. Kids can amaze you with what they "can" do when > they are ready when it comes to managing their diabetes, my daughter > continues to amaze me (in a good way) with what she does or how she handles > some situations. A great place to check out is > http://www.childrenwithdiabetes.com/index_cwd.htm they have links to > everything including dealing with school. > Best wishes for the boy and his family, > Heather > http://www.execulink.com/~craig/diabetictag.html > http://www.execulink.com/~craig/pouches.htm > I am a T2 diabetic, under good control through exercise and watching my > carbs. > A co-worker’s 12 year old son was just diagnosed as a T1 diabetic. He > already weighs 195 pounds. While he doesn’t eat a lot of sweets, he does > eat > a pretty high carb diet, lots of breads and potatoes. > She asked for my advice, which I summarized from reading so many posts for > newbies. I told her to test and retest, 7 times per day, to watch carbs, > to > start exercising, to track what he eats and how that affects his bg > levels. > Naturally, I told her to get educated and keep him under doctor’s care. > (She > is on state assistance, so I don’t know how much help there will be.) > Anyway, not being a T1 and never having dealt with insulin shots, what > else > should I tell her? > — > Keith Tellinghuisen > "My life has been filled with trouble, 90% of which never happened." – > Mark > Twain
Thanks for the links, I’ll check them out. Keith Tellinghuisen
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– Hide quoted text — Show quoted text -> As a mother of a T1 and a wife of another T1, I would encourage your friend > to take her son to a pediatric endocrinologist and learn as much as possible > about everything. Kids with T1 are totally different then adults with > T1….their activity levels are more sporadic, they have raging hormones at > that age and their friends may be scared of "catching it" until they have > things explained to them. Kids can amaze you with what they "can" do when > they are ready when it comes to managing their diabetes, my daughter > continues to amaze me (in a good way) with what she does or how she handles > some situations. A great place to check out is > http://www.childrenwithdiabetes.com/index_cwd.htm they have links to > everything including dealing with school. > Best wishes for the boy and his family, > Heather > http://www.execulink.com/~craig/diabetictag.html > http://www.execulink.com/~craig/pouches.htm
The mother told me the child would be on insulin, although I don’t know for a fact that the doctor told her it was T1. His bg level was 180, which is high, but we’ve all seen higher. Anyway, he is going for a glucose tolerance test Friday morning. I’ve never done that, would that help to distinguish between T1 and T2? Keith Tellinghuisen
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: > As a mother of a T1 and a wife of another T1, I would encourage your : friend : > to take her son to a pediatric endocrinologist and learn as much as : possible : > about everything. Kids with T1 are totally different then adults with : > T1….their activity levels are more sporadic, they have raging hormones : at : > that age and their friends may be scared of "catching it" until they have : > things explained to them. Kids can amaze you with what they "can" do when : > they are ready when it comes to managing their diabetes, my daughter : > continues to amaze me (in a good way) with what she does or how she : handles : > some situations. A great place to check out is : > http://www.childrenwithdiabetes.com/index_cwd.htm they have links to : > everything including dealing with school. : > Best wishes for the boy and his family, : > Heather : > http://www.execulink.com/~craig/diabetictag.html : > http://www.execulink.com/~craig/pouches.htm : > : : The mother told me the child would be on insulin, although I don’t know for : a fact that the doctor told her it was T1. His bg level was 180, which is : high, but we’ve all seen higher. Anyway, he is going for a glucose tolerance : test Friday morning. I’ve never done that, would that help to distinguish : between T1 and T2? : : Keith Tellinghuisen Usually for a child, I don’t think they send them for a OGTT, unless they suspect T2. Is this child overweight? Because 180 really isn’t high for a T1 Child onset. Though I can’t really comment on a child, I was an adult onset. But I thought children got hit alot faster and harder then adult T1’s. JAT.. RK T1 – 5/00 : :
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– Hide quoted text — Show quoted text -> As a mother of a T1 and a wife of another T1, I would encourage your > friend > to take her son to a pediatric endocrinologist and learn as much as > possible > about everything. Kids with T1 are totally different then adults with > T1….their activity levels are more sporadic, they have raging hormones > at > that age and their friends may be scared of "catching it" until they have > things explained to them. Kids can amaze you with what they "can" do when > they are ready when it comes to managing their diabetes, my daughter > continues to amaze me (in a good way) with what she does or how she > handles > some situations. A great place to check out is > http://www.childrenwithdiabetes.com/index_cwd.htm they have links to > everything including dealing with school. > Best wishes for the boy and his family, > Heather > http://www.execulink.com/~craig/diabetictag.html > http://www.execulink.com/~craig/pouches.htm > The mother told me the child would be on insulin, although I don’t know for > a fact that the doctor told her it was T1. His bg level was 180, which is > high, but we’ve all seen higher. Anyway, he is going for a glucose tolerance > test Friday morning. I’ve never done that, would that help to distinguish > between T1 and T2? > Keith Tellinghuisen
My daughter didn’t go for a glucose tolerance test either but her BG was 26 mmol (or around 470 US) with large amounts of keytones. She had also lost weight shortly before being diagnosed. Let us know how he’s doing & ask lots of questions, there is allot of great info available in this group. Heather http://www.execulink.com/~craig/diabetictag.html http://www.execulink.com/~craig/pouches.htm
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Too funny dear OldAl..:) memory
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>. . . .(snip). . . >The mother told me the child would be on insulin, although I don’t know for >a fact that the doctor told her it was T1. His bg level was 180, which is >high, but we’ve all seen higher. Anyway, he is going for a glucose tolerance >test Friday morning. I’ve never done that, would that help to distinguish >between T1 and T2? >Keith Tellinghuisen
I agree with previous posters, nothing they have related to you allows one to guess whether the son is a T1 or a T2. One of the better tests is a fasting insulin blood test. The patient should not have shot any Regular, Humalog or NPH insulin for at least 12 hours, he should not have shot any Lantus for at least 36 hours.. T1 will have low levels of fasting insulin, T2 will have high levels. (That only works for the newly diagnosed, BTW). One very clever test is the HOMA test. HOMA = Fasting Insulin x Fasting Blood Glucose/22.5 (bG in mg/dL, Insulin in mille-International Units per Liter, mIU/L) HOMA below about 29 usually means normal HOMA above 80 usually means Glucose intolerant or T2. I don’t know what a typical number for a T1 would be but I’ll bet it isn’t 80 or higher. The problem the doctor faces is that they don’t know if metformin, Actos or Avandia are safe for adolescents. That means they are just about stuck with insulin until he is definitely out of adolescence. I think the bolder docs are researching the subject but most docs aren’t bold. Regards Old Al
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– Hide quoted text — Show quoted text – >I am a T2 diabetic, under good control through exercise and watching my >carbs. >A co-worker’s 12 year old son was just diagnosed as a T1 diabetic. He >already weighs 195 pounds. While he doesn’t eat a lot of sweets, he does eat >a pretty high carb diet, lots of breads and potatoes. >She asked for my advice, which I summarized from reading so many posts for >newbies. I told her to test and retest, 7 times per day, to watch carbs, to >start exercising, to track what he eats and how that affects his bg levels. >Naturally, I told her to get educated and keep him under doctor’s care. (She >is on state assistance, so I don’t know how much help there will be.) >Anyway, not being a T1 and never having dealt with insulin shots, what else >should I tell her?
first, the advice given to adult type 1s is a bit different than for type 1 children especially when they are in puberty. The ideal situation would be to insist the kid is seen by a pediatric endocrinologist. Being 195 lbs at 12 years old means he needs doctor’s care and a dietician to work with him. Many cities have "diabetic clinics" one or twice a month hosted by local hospitals for those who need reduced cost care. If there is a teaching hospital in the area the chances of such a clinic are even higher. Look into it. If she is already on public assistance she will probably qualify for more help where the child is concerned. Contact the local agencies and the hospitals and see what they have available. ALSO contact the American Diabetes Association, and the Juvenile Diabetes Foundation and see if they can offer help or at the very least offer referrals to doctors and clinics that offer financial help to those in her situation. also look into http://www.childrenwithdiabetes.org Mack Type 1 since 1975 http://www.alt-support-diabetes.org http://www.insulin-pumpers.org In tribute to the United States of America and the State of Israel, two bastions of strength in a world filled with strife and terrorism.
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– Hide quoted text — Show quoted text ->I am a T2 diabetic, under good control through exercise and watching my >carbs. >A co-worker’s 12 year old son was just diagnosed as a T1 diabetic. He >already weighs 195 pounds. While he doesn’t eat a lot of sweets, he does >eat >a pretty high carb diet, lots of breads and potatoes. >She asked for my advice, which I summarized from reading so many posts for >newbies. I told her to test and retest, 7 times per day, to watch carbs, to >start exercising, to track what he eats and how that affects his bg levels. >Naturally, I told her to get educated and keep him under doctor’s care. >(She >is on state assistance, so I don’t know how much help there will be.) >Anyway, not being a T1 and never having dealt with insulin shots, what else >should I tell her? >– >Keith Tellinghuisen > The children often are not clever enough to manage their own injections >or manage the modern powerful insulins. Thus, their medical advice teams >concoct Rube Goldberg schemes which "sorta" work but usually subject the >child to undesirable highs and lows.
where in the hell do you get that crap from? Children are often more capable of adapting to life with diabetes than adults are. And often start injecting without help as early as 5 years old. If the child can hold the syringe they can and will learn to inject. Hell it was a 5 year old who taught me how to inject in my upper arm without the help of someone holding my arm for me back when the needles weren’t all the comfortable. Children adapt to pumps easier than adults. and these same kids are away from their parents in school amongst untrained teachers and under trained school nurses, if there even is a school nurse. These kids deal with meals and exercise and dating etc AND being an insulin dependent diabetic. Some like me, will be forced to figure most of this out alone. > For example: > a. The child may not be permitted to inject at school.
law suit. if a school is dumb enough to do this, and some are, they can be sued big time. > b. The school personnel are not permitted to inject for him.
if they are not a school nurse with written permission from the parent damn skippy they won’t. And that’s nota bad thing. > c. Therefore, his mother has to fiddle with mixes of fast and medium >insulins to handle both breakfast and lunch.
depends on the insulins actually being used, which may have more to do with cost than availability. No insurance and you can’t get novolog and lantus in most places and I know novolog is about 60 dollars a bottle here. Haven’t priced lantus here, though my endo just gave me a free bottle. > Some parents: > a. Inject their child with fast insulin before breakfast to >handle the meal > b. Drive their child to school, and inject them with NPH in >the car at the school door "in hopes that the NPH will kick in just about at >lunch time".
better training and education of the parents is obviously needed. > Often their hopes are not realized and the child suffers from highs >or lows, passes out, or suffers from intense craving for food while waiting >for the lunch period to arrive. (My friend, a school teacher, just about >went nuts trying to deal with such a child one year)
that teacher should have done something to force the parents to become better educated and to insure the school made it possible for the child to get what he/she needed as far as snacks between meals when needed. I would guess there were some serious failings on the part of the school and the parents. Not uncommon though. My own parents knew next to nothing about diabetes. >Therefore, everybody concerned should learn as much as possible about the >modern basal-bolus insulin regimes, the modern insulins Novolog, Humalog >and Lantus, and move to self-injection and modern insulin regimes as soon as >practical. It is a burden.
spot o there. If this child were in a position to get a pump I would encourage the parents to look into it. Sadly I know this particular child is not in such a position. I have not read where the state has picked up the cost for pumping in children on state assistance yet. >Regards > Old Al
These issues are addressed by the ADA, JFD and childrenwithdiabetes.org Mack Type 1 since 1975 http://www.alt-support-diabetes.org http://www.insulin-pumpers.org In tribute to the United States of America and the State of Israel, two bastions of strength in a world filled with strife and terrorism.
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Cheri – Hide quoted text — Show quoted text – >Today I have made a setup for an air >conditioner, picked up a sheet of plywood >from Home Depot, had three business calls >moved some trees is five gallon cans, and in >rest periods came in for some entertainment.