Differences In Treatment For Children And Adults

By editor | September 11, 2007

A child cannot be treated as a miniature adult. A one-unit change in insulin in a 40-pound child will have much more of an effect than a one-unit change in a 140-pound adult. Children not only have rapidly changing size but also rapidly changing hormones. These changing hormones lead to various changes in emotional responses. In some children with Type 1 diabetes, the disease is more severe; if beta-cell function is preserved, it may be more mild. More food is needed for a child’s active lifestyle as well as for growth and development.

As with any type of diabetes, the goal is to attain and maintain a high degree of control of blood-glucose levels and a quality of life that makes it all worthwhile. If a child does not get enough to eat and enough insulin to help get food into the cells for energy and growth, he or she will not grow at all or will not grow at the rate expected.

If blood sugars are normalized most of the time, the only time a child should ever become ill with diabetes is at diagnosis, when diabetic ketoacidosis (high blood-glucose levels, dehydration, and chemical [electrolyte] imbalance) is present. Learning when it is possible to have a higher blood sugar and to give more insulin before the body gets out of control prevents diabetic ketoacidosis from ever occurring again. Often, diabetic ketoacidosis can be predicted (for example, if there is an infection). More fluids and more insulin, as needed, would keep this problem from occurring. Checking for ketones in the urine would tell the parents whether the body is using fats as an energy source. If the blood-glucose levels are high (300 mg/dl [17 mmol] or greater), the body can become chemically out of balance and the child can become very sick.

Low blood-glucose levels (hypoglycemia) are the other side of the coin. This is a little more difficult to handle. Some people are more afraid of the short-term effects of low blood sugar than the long-term effects of high blood sugar. Some of these times can be predicted for example, if the child is anticipating something special the next day and so is not sleeping well If they can be predicted, then in most cases they can be prevented. If they are not predicted, rapid and early treatment is most helpful If the symptoms or feelings are ignored or are not noticeable enough, a problem could occur.

Blood-glucose testing has been a great help in the early finding of low blood sugar. Small children may not have the words to say that they are “feeling funny.” Or they might be so involved in play that they do not notice that their lowering blood sugars are giving them signals that it’s time to get something to eat. If they feel hunger, there is more of a chance that they will respond by getting something to eat, but this is not always so.

A mild insulin reaction (hypoglycemia) now and then is nothing compared to frequent times of very low blood-glucose. The brain can take only so much, such as the lack of a fuel source, before it will undergo cell damage. This is especially true if the reactions are of the severe type (jerking or unconsciousness). Severe reactions must be prevented at all costs. Occasional mild episodes of shaking and sweating, although some what uncomfortable to experience, are not as serious as are the severe reactions. If the child has not reached the age of full nerve development (six to eight years of age), there is a greater chance that hypoglycemia will result in brain damage.

Allowing anyone-child or adult to have high blood sugar (hyperglycemia) all the time is also not recommended. The person will be dull, less alert, and often more irritable. Teachers and employers will usually report a change in learning or working ability when the blood sugar is either too high or too low. True, the child or adult is not having insulin reactions, but, in the long-term picture, a slight insulin reaction now and then is much less damaging than chronic high blood-glucose levels. Interestingly, if the blood-glucose control is poor, there is often a greater chance of having severe insulin reactions.

The chance of having more severe insulin reactions with higher blood-glucose content has been debated. The Diabetes Control and Complications Trial, a ten-year study to determine what level of control very early on will best prevent or delay complications, stated that the more normal the glucose control, the greater the chance of having severe insulin reactions. In the third year of the study, the intensive control group experienced a 30 to 40 percent increase in low blood-glucose levels compared to the standard control group. Most of the first group’s hypoglycemia was without symptoms, with blood-glucose values in the forties. A year later, at the National Meeting of the American Diabetes Association, it was announced that there had been a change in treatment methods and that hypoglycemia had decreased dramatically. As a side comment, the speaker said he guessed they were learning how to manage diabetes better because there were fewer low blood-glucose reactions in the intensive control group. Our own experience has been that the number of severe hypoglycemic episodes is fewer, or certainly no greater, among children or adults in “tighter” control than among those with wildly swinging or chronically high blood sugars.

As diabetic ketoacidosis is usually associated with infection or prolonged emotional stress, so hypoglycemia is associated with a mistake in the amount of insulin given, a lot of play or exercise without extra food, or manipulation with food (for example, a child’s refusal to eat food in order to get his or her way). This is why parent education and the type of treatment program chosen are so helpful.

Part of the parents education includes the following: The total daily dose of insulin divided into multiple doses per day spreads out the impact of the peak, or top, action of the insulin. If you give all the insulin in one dose, it won’t cover the entire 24 hour time period; in addition, the strongest action time of the insulin might cause the child to be hypoglycemic then and yet hyperglycemic before the next dose is given. Spreading out the doses allows no great impact at anyone time. Multiple doses don’t mean that the diabetes is getting worse. It’s just a method of allowing more flexibility in a child’s lifestyle.

Psychological adjustment to the disease can develop when more flexibility is present. Children who have parents who support them often just take their diabetes in stride. Also, the younger child frequently adjusts more easily than does the teenager or the adult. Parents, on the other hand, may either become too protective or may, either subconsciously or openly, reject the child. If the parents are not educated and supported by health care professionals, the child may become upset to the point at which the diabetes becomes very hard to manage. Discipline becomes an extremely important part in the treatment program for the child. The more lovingly the child is disciplined, the greater the chance that he or she will have a long and healthy life.

When a group of children with diabetes was compared to a group of children without it, it was found that there was no greater number of conflicts or psychological diagnoses in one group than in the other. It was also noted that the diabetes management was in poorer control in the families that did not work as a team.


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