Type 1 Diabetes: Living With the Disease, if you or
your teen has type 1 diabetes. If you have not read the topic Type 1 Diabetes:
Recently Diagnosed, you may want to read it first.
Type 1 diabetes is a
lifelong disease that develops when the
pancreas stops making
insulin. Your body needs insulin to let sugar
(glucose) move from the blood into the body's cells, where it can be used for
energy or stored for later use.
Without insulin, the sugar cannot
get into the cells to do its work. It stays in the blood instead. This can
cause high blood sugar levels. A person has diabetes when the blood sugar is
too high.
What will it be like for your child to live with type 1 diabetes?
Your child can live a long, healthy life by learning
to manage his or her diabetes. It will become a big part of your and your
child's life.
You play a major role in helping your child take
charge of his or her diabetes care. Let your child do as much of the care as
possible. At the same time, give your child the support and guidance he or she
needs.
How can you manage diabetes?
The key to managing
diabetes is to keep blood sugar levels as close to normal as possible. To do
this, your child needs to take insulin, eat about the same amount of
carbohydrate at each meal, and exercise. Part of your
child's daily routine also includes checking his or her blood sugar levels at
certain times, as advised by your doctor.
The longer a person has
diabetes, the more likely he or she is to have problems, such as diseases of
the eyes, heart, blood vessels, nerves, and kidneys. For some reason, children
seem protected from these problems during childhood. But if your child can
control his or her blood sugar levels every day, it may help prevent problems
later on.
What symptoms should you watch for?
Even when you
are careful and do all the right things, your child can have problems with low
or high blood sugar. Teach your child to look for signs of low and high blood
sugar and to know what to do if this happens.
If your child has low blood sugar, he or
she may sweat a lot and feel weak, shaky, or hungry. But your child's symptoms
may be different. Low blood sugar happens quickly. A person can get low blood
sugar within minutes after exercise or after taking insulin without eating
enough.
If your child has high blood sugar, he
or she may be very thirsty or hungry, have to urinate more often than usual, or
have blurry vision. High blood sugar usually develops slowly over hours or
days.
Young children can't tell if they have low blood sugar as
well as adults can. Also, after your child has had diabetes for a long time, he
or she may not notice low blood sugar symptoms anymore. This raises the chance
that your child could have low blood sugar emergencies. If you are worried
about your child's blood sugar, do a
home blood sugar test. Don't rely on symptoms alone.
Both low and high blood sugar can cause problems and need to be
treated. Your doctor will suggest how often your child's blood sugar should be
checked.
How often does your child need to see the doctor?
See your child's doctor at least every 3 to 6 months to check how well
the treatment is working. During these visits, the doctor will do some tests to
see if your child's blood sugar is under control. Based on these results, the
doctor may change your child's treatment plan.
When your child is
10 years old or starts puberty, he or she will start having exams and tests to
look for any problems from diabetes.
How will your child's treatment change over time?
Your child's insulin dose and possibly the types of insulin may change
over time. The way your child takes insulin (with shots or an
insulin pump) also may change. This is especially true
during the teen years when your child grows and changes a lot.
What and how much food your child needs will also change over the years.
But it will always be important to eat about the same amount of carbohydrate at
each meal. Carbohydrate is the nutrient that most affects blood sugar.
Frequently Asked Questions
Learning about a child living with type 1 diabetes:
Type 1 diabetes develops when your
child's pancreas stops producing enough
insulin. Insulin lets blood sugar-also called
glucose-enter the body's cells, where it is used for energy. Without insulin,
the amount of sugar in the blood rises above a safe level. As a result, your
child experiences high and low blood sugar levels from time to time. High blood
sugar can damage blood vessels and nerves throughout the body and increases
your child's risk of eye, kidney, heart, blood vessel, and nerve
diseases.
Experts do not know what causes type 1 diabetes. But the
cause may involve family history and maybe environmental factors like diet or
infections.
Causes of high blood sugar
Skipping a dose of insulin or eating more than usual
Experiencing emotional stress
Having an illness, such as the flu or an infection
Taking certain medicines that can raise blood sugar levels,
such as medicines that reduce swelling and inflammation (corticosteroids) and
growth hormone
Because your child has
type 1 diabetes, he or she will experience high and
low blood sugar levels from time to time. High blood sugar usually develops
slowly over hours or days, so you can treat the symptoms before they become
severe and require medical attention. On the other hand, your child's blood
sugar level can drop to dangerously low levels in minutes.
Sometimes it's
hard to
distinguish between high and low blood sugar symptoms,
especially if your child is very young. Test your child's blood sugar whenever
you think it may be high or low so that you can treat it appropriately. If your
child has symptoms of very high blood sugar, such as a fruity breath odor,
vomiting, and abdominal pain, seek emergency care. These symptoms may indicate
diabetic ketoacidosis, which is a life-threatening
emergency.
What Happens
Every child experiences
type 1 diabetes differently. What they do have in
common is that having diabetes will not affect their learning ability or school
performance.1
The negative effects of
diabetes are caused by blood sugar levels that are above or below a
normal or near-normal range.
Low blood sugar
Very low blood sugar is a
frightening experience for you and your child. But if low blood sugar levels
are treated quickly and appropriately, your child should have no lasting
effects.
Young children cannot recognize low blood sugar symptoms
as well as adults can, which puts them at risk for low blood sugar emergencies.
Children who develop
hypoglycemia unawareness or are trying to keep their
blood sugar levels tightly within a target range are also at risk for low blood
sugar emergencies.
Make sure your child's caregivers, such as
school nurses, know:
What to do if your child's blood sugar level is low.
Let your doctor know if your child is having frequent
episodes of low blood sugar.
High blood sugar
Very high blood sugar puts your
child at risk for
diabetic ketoacidosis, a life-threatening emergency.
Stress, illness, injury, and puberty can trigger high blood sugar. Because
blood sugar levels usually rise slowly, you can treat symptoms early and, most
often, prevent diabetic ketoacidosis.
High blood sugar can also
lead to:
Adjustment of the body to high levels. For example, if your
child's blood sugar level is consistently at 250 milligrams per deciliter
(mg/dL) and suddenly drops to 100 mg/dL, you or your child may think this level
is too low when it is really not. Your child may even have symptoms of low
blood sugar at normal blood sugar levels.
Delayed growth and maturity. If your child has high blood sugar
levels over a long period of time, he or she may grow and mature more slowly.
During puberty, this can delay normal sex changes and the onset of
menstruation.
Developing complications from the disease (eye, kidney, heart,
blood vessel, and nerve disease). Children seem to be protected from developing
these complications during childhood. But if their blood sugar levels are
persistently high, children are more likely to show early signs of these
complications, particularly eye and kidney disease. In addition, high blood
sugar levels during childhood and adolescence put your child at risk for these
diseases in early adulthood.
What can be done?
The best way to help your child
with type 1 diabetes live a long and healthy life is to keep his or her blood
sugar levels within a normal to near-normal range. Two important studies,
Diabetes Control and Complications Trial (DCCT) and
its follow-up study, showed that keeping blood sugar levels in this range
greatly decreases the chance of developing complications. Work with your
child's doctor, and monitor blood sugar levels frequently.
What Increases Your Risk
Risk factors for very high or
low blood sugar levels in a child with
type 1 diabetes include:
Age. Very young children are at the greatest risk for very low
blood sugar.2
Tight blood sugar control. Although keeping your child's blood
sugar level tightly within a
normal or near-normal range is important, this puts
him or her at risk for frequent low blood sugar levels.3
Persistent high blood sugar levels. Children who have persistent
high blood sugar, indicated by higher hemoglobin A1c test results, are at
greater risk for
diabetic ketoacidosis than children with lower
levels.2
Puberty.
Growth spurts and changing
hormone levels that occur during puberty make it
difficult to keep a child's blood sugar level within a target range.
Although children are protected from developing
complications from diabetes (eye, kidney, heart, blood vessel, and nerve
disease) during childhood, they are at risk for developing these diseases in
adulthood. Risk factors for these complications include:
Persistent high blood sugar over time. The higher your child's
blood sugar levels and the longer they remain high, the greater his or her risk
of developing complications in early adulthood.
Length of time having the disease. The longer your child has
diabetes, the more likely complications will develop, even if blood sugar
levels are controlled.
Eye damage from diabetes, called
diabetic retinopathy, is the most frequent cause of
new cases of blindness in adults ages 20 to 74.4
Kidney damage,
diabetic nephropathy, eventually occurs in 20% to 40%
of all people with diabetes.5 Children who develop
nephropathy usually show the first signs of the condition after puberty.
Nerve disease. Most people with diabetes develop some
diabetic neuropathy over the years, but only about 13%
to 15% have noticeable symptoms.6
Developing one of the complications. If one complication
develops, your child is at risk for developing others.
Drowsy, confused, breathing fast, and your child's breath smells
fruity. Your child may have high blood sugar, called hyperglycemia. A
life-threatening condition called
diabetic ketoacidosis could be present.
Call a doctor immediately if your
child is vomiting and cannot keep down liquids and has a blood sugar of 250
mg/dL or higher.
Call a doctor if your child:
Is sick for more than 2 days (unless it is a mild illness, such
as a cold), and your child:
Has been vomiting or had diarrhea for more than 6 hours.
Is having problems following the meal plan or getting physical
activity, and you want help.
Watchful Waiting
Watchful waiting is a period of time during
which you and your doctor study your health without using medical treatment.
Watchful waiting is not appropriate for a child with type 1 diabetes if blood
sugar levels are frequently high or low. His or her treatment may need
changing. Keeping your child's blood sugar levels within a
normal or near-normal range helps prevent high blood
sugar emergencies and long-term complications, such as eye, kidney, heart,
blood vessel, and nerve damage.
Who To See
Health professionals who may care for a child with
type 1 diabetes include:
A child with
type 1 diabetes needs to visit his or her doctor at
least every 3 to 6 months. During these visits, the doctor reviews your child's
blood sugar level records and asks about any problems you and your child may
have. Your child's blood pressure is checked, and growth and development is
evaluated. A doctor will examine your child for signs of infections, especially
at injection sites. Your child will usually have the following tests at office
visits:
A hemoglobin A1c or similar test (glycosylated hemoglobin or
glycohemoglobin) to check your child's blood sugar
control over the previous 2 to 3 months
A
blood glucose test. This is a good time to check the
accuracy of your child's blood sugar meter.
If your child has a family history of high
cholesterol or heart disease, your child's doctor will
do a
cholesterol (LDL and HDL) test when type 1 diabetes is
diagnosed. If there is no family history of high cholesterol, your child will
have a cholesterol test at puberty. If the
LDL cholesterol is less than 100 mg/dL (2.60 mmol/L)
and there is no family history of
high cholesterol, the doctor will repeat this test
every 5 years.
Diabetes increases your child's risk for dental
problems. Experts suggest dental checkups every 6 months.
Children's nutritional needs change as they grow and develop. See a
registered dietitian at least once a year to review
your child's meal plan.
5 years after diagnosis
Your child will have an
initial dilated eye exam (ophthalmoscopy) by an
ophthalmologist or an
optometrist when your child is at least 10 years old
and has had diabetes for 3 to 5 years. This eye exam checks for signs of
diabetic retinopathy and
glaucoma. Thereafter, your child should have an eye
exam every year. If your child is at low risk for vision
problems, your doctor may consider follow-up exams every 2 years. Your child
should also begin having annual
microalbumin urine tests. This test helps detect
diabetic nephropathy
Other tests
Your child may need a
thyroid-stimulating hormone (TSH) test when type 1 diabetes is diagnosed and then every 1 to 2
years. This test checks for thyroid problems, which are common among people
with diabetes.
Other tests include:
Annual foot exam starting at puberty.
Routine screening for depression after your child is 10 years
old.
Eating disorder evaluation if your child shows signs
of an eating problem.
Celiac disease testing when type 1 diabetes is
diagnosed and then if your child is not growing or gaining weight as much as
expected.
Treatment Overview
The goal of your child's treatment
for
type 1 diabetes is to always keep his or her blood
sugar levels within a
target range. A normal or near-normal range reduces
the chance of diabetes complications. Daily diabetes care and regular medical
checkups will help you and your child accomplish this goal.
Daily care
Your child's daily care
includes:
Exercise. Experts recommend that teens and children (starting
at age 6) do moderate to vigorous activity at least 1 hour every day.7
Changing appetite and "picky eating." A
registered dietitian can help you develop a flexible
meal plan to meet your child's appetite needs and allow for special events,
such as parties and school activities. If you use rapid-acting insulin, you can
give the insulin dose after a meal based on what your child ate. Some
tips for mealtimes with young children include having alternative meal
choices.
Illness. Follow the
sick-day guidelines that you and your child's doctor
set up to prevent high blood sugar emergencies when your child is ill. Talk
with the doctor before giving your child any nonprescription medicine.
Exercise. If your child is not very active, limit his or her
time playing video games, watching TV, or using the computer. Plan some
activities to do along with your child, such as in-line skating or bicycling.
Keep your child safe during exercise by:
Checking his or her blood sugar levels before and after
vigorous activity.
Always have your child wear medical identification to let
medical personnel know that he or she has diabetes. You can buy
medical identification bracelets, necklaces, or other forms of jewelry at a
pharmacy or on the Internet.
Have your child wear shoes that fit properly at all times,
even in the house. Use the
checklist for foot exams to check your child's feet
every day for signs of injury or infection. Teach your child how to
wash and dry his or her feet thoroughly. If you notice a foot problem, even a
minor one, talk with your child's doctor before treating it.
Keep your child's day care or school plan for diabetes care up
to date. Have written instructions for your babysitter and other caregivers.
Help your child care for his or her
skin and
teeth and gums. Make sure your child has a dental
checkup every 6 months.
Keep your child's immunizations up to date. This includes a
flu shot every year. For more information, see the topic
Immunizations.
Participate in a support group for parents of children with
diabetes. These groups can be very helpful, especially the first few years
after diagnosis. Local groups are available in most areas.
Encourage your child to attend camps for children with
diabetes. Diabetes camps are a good learning experience for your child, and
they will allow you some time to yourself.
Allow your
child with diabetes to help with the treatment, given
his or her age and experience with the disease.
Regular medical checkups
Your child needs to see
his or her doctor every 3 to 6 months. During these checkups, the doctor will
evaluate and adjust your child's treatment. The doctor will do a hemoglobin A1c
or similar test (glycosylated hemoglobin or
glycohemoglobin) to check your child's blood sugar
control over the previous 2 to 3 months, and a
blood glucose test.
When your child has had diabetes for 5 years, the doctor will start
yearly screening tests for protein in the urine, which indicates
diabetic nephropathy. At that same time, your child
needs to see an
ophthalmologist for yearly dilated eye exams (ophthalmoscopy) to check for signs of
diabetic retinopathy.
Treatment for high blood sugar emergency
If your
child does not take enough insulin, has a severe infection or other illness, or
becomes severely
dehydrated, his or her blood sugar level may rise very
high and lead to
diabetic ketoacidosis. Diabetic ketoacidosis is
usually treated in a hospital, often in the intensive care unit, where
caregivers can watch your child closely and give him or her frequent blood
tests for glucose and
electrolytes. Insulin is given through a vein
(intravenous, or IV) to bring blood sugar levels down. Fluids are given through
the IV to correct the electrolyte imbalance. Your child may stay in the
hospital for a few days until blood sugar levels are back in a safe
range.8
What To Think About
A 10-year study, and
its follow-up study, showed that keeping blood sugar levels within a
normal or near-normal range helps decrease the chances
of developing diabetes complications, such as eye, kidney, heart, blood vessel,
and nerve damage. As a result of this study, experts recommend that people with
diabetes carefully control their blood sugar levels. This is often called
strict or tight blood sugar control.
When a child has diabetes,
keeping blood sugar levels within a normal or near-normal range helps the child
grow and develop normally, but it increases the risk for frequent low blood
sugar episodes. Your doctor will figure the safest range for your child's blood
sugar level.
For some children, using an
insulin pump may help keep their blood sugar levels
within a target range.
If your child has frequent low blood sugar levels,
especially at night (nocturnal hypoglycemia), the doctor may
suggest continuous ambulatory blood glucose monitoring. This means your child
wears a special monitor that tests his or her blood sugar level continuously
for 24 to 72 hours. The monitor stores the results, allowing you to look for
patterns of high or low blood sugar levels.9
Scientists are looking for pain-free ways to give insulin and test blood
sugar levels. Under development are improved insulin pumps, and better needles
and lancets. New glucose monitors may be worn continuously and be able to
signal insulin pumps when the rate of insulin needs to be changed. Scientists
are also studying ways to prevent or decrease complications from diabetes. If
you're interested, talk to your child's doctor about participating in any of
these studies.
Your child with
type 1 diabetes will have high and low blood sugar
levels from time to time. You can help avoid many immediate problems and
long-term complications, such as eye, kidney, heart, blood vessel, and nerve
disease, by:
Helping your child develop a healthy attitude toward having
diabetes. As your child grows and develops, let him or her assume appropriate
responsibility for treatment.
Encouraging and supporting your child to keep blood sugar levels
within a
normal or near-normal range. Starting tight control of
blood sugar levels as soon as possible after diagnosis of diabetes gives your
child the greatest chance of avoiding complications from diabetes later on in
life.
Checking your child's blood sugar level several times a day and
whenever you think it may be high or low.10
Recognizing and treating high and low blood sugar quickly. Make
sure everyone who cares for your child knows how to treat high and low blood
sugar episodes.
Discussing the dangers of smoking, drinking alcohol, and using
other drugs. Smoking affects the blood vessels and can lead to developing
diabetes complications later on in life.11 Alcohol and
other drugs can mask symptoms of low blood sugar, which may lead to an
emergency situation.
Keeping your child's
immunizations up to date. Diabetes affects the
immune system, increasing the risk of developing a
severe illness.
Keeping your child's doctor aware of behavior changes in your
child.
Emotions and behavior can affect how well you and your
child manage diabetes treatment.
Home Treatment
The daily care for your child with
type 1 diabetes can seem overwhelming, leading to
conflicts between you and your child. Here are some tips that may help:
Make mealtimes less stressful
Mealtimes can become
a battleground when you want your child to get a certain amount of
carbohydrate. You can:
Meet regularly with a
registered dietitian. A registered dietitian can help
set up a flexible meal plan to meet your child's appetite needs and allow for
special events, such as parties and school activities. Some
tips for mealtimes with young children include having alternative meal
choices.
Use rapid-acting insulin so you can give the insulin dose after
a meal based on what your child ate.
If you test several
times a day (before breakfast, with meals, and at bedtime), you can tell how
well your child's blood sugar levels stay within a target range. You need to
test more often when your child is sick. Follow the
sick-day guidelines that you and your child's doctor
set up, or call for help. Do not give your child nonprescription medicines
without talking with the doctor.
Experts recommend
that teens and children (starting at age 6) do moderate to vigorous activity at
least 1 hour every day.7 And 3 or more days a week,
what they choose to do should:
Make them breathe harder and make the heart beat much
faster.
Make their muscles stronger. For example, they could play on
playground equipment, play tug-of-war, lift weights, or use resistance
bands.
Make their bones stronger. For example, they could run, do
hopscotch, jump rope, or play basketball or tennis.
It's okay for them to be active in smaller blocks of time
that add up to 1 hour or more each day.
Children with type 1
diabetes can participate in sports just like children without diabetes. But
children who use insulin are at risk for low blood sugars during and after
exercise. Some
tips for exercising safely for your child with type 1 diabetes can help
prevent low blood sugar levels.
If your child has a tendency to be
inactive, you may need to:
Limit his or her time playing video games, watching TV, or
using the computer. The American Academy of Pediatrics advises parents to limit
TV time to 2 hours a day or less.
Plan some activities to do along with your child, such as
skating or bicycling.
Catch the ups and downs
Because blood sugar levels
can drop to dangerous levels very quickly:
Have your child always wear medical identification so medical
personnel can give the right care. You can buy
medical identification bracelets, necklaces, or other forms of jewelry at a
pharmacy or on the Internet.
Make sure everyone who cares for your child knows how to treat
low blood sugar quickly. For more information, see:
Join a support group for parents of children with diabetes.
These groups can be very helpful, especially the first few years after
diagnosis. Local groups are available in most areas.
Encourage your child to attend
camps for children with diabetes. It's a good learning experience for your
child and will give you some time to yourself.
Insulin is the only medicine that can treat
type 1 diabetes, and your child is most likely taking
more than one
type of insulin. Your child may take several
injections a day or use an
insulin pump. The insulin pump provides insulin with
fewer injections and is as effective as multiple daily injections for
maintaining
normal or near-normal blood sugar levels.
The amount and type of insulin your child takes will likely change over
time, depending on changes that occur with normal growth, physical activity
level, and hormones (such as during adolescence). Your child may also need
higher doses of insulin when feeling sick or stressed.
Know the dose of each type of insulin your child takes, when your
child should take the doses, how long it takes for each type of insulin to
start working (onset), when it will have its greatest effect (peak), and how
long it will work (duration).
Don't let your child skip a dose of insulin without a doctor's
advice.
A rapid-acting insulin is given
with a meal or immediately afterward. The dose is based on what your child
actually ate, not what the meal plan required. If your child is a "picky
eater," this provides flexibility that may reduce mealtime battles.
Scientists are looking at new types of insulin and better ways to give
it.
Surgery
Surgery is not a routine treatment for
type 1 diabetes, and children do not meet the criteria
for the surgeries that are available. Surgeries for type 1 diabetes are:
Surgery to replace the pancreas (pancreas transplant),
possibly while receiving another organ, such as a kidney.
Surgery to insert working pancreas cells (islet cell
transplant). This procedure is still experimental.
Other Treatment
You'll hear about products that
promise a "cure" for
type 1 diabetes. Avoid them. No such cure exists.
Also, avoid products for diabetes that are advertised only by "satisfied
customers." These products or remedies may be harmful and costly. They also
might cause you to delay or avoid getting treatment for your child that really
works. If you have questions about a product for diabetes, check with your
local American Diabetes Association office, your doctor, or a diabetes
educator.
Other types of meal plans
You may hear of people
with diabetes following other types of meal plans or using low
glycemic index foods to prevent high blood sugar
levels after meals. Talk with a
registered dietitian before trying a new meal
plan.
Complementary therapies
Complementary therapies
such as relaxation techniques may help relieve stress and muscle tension and
improve your child's overall well-being and quality of life. None of these
complementary therapies are proven to effectively treat diabetes. But children
may benefit from safe, nontraditional therapies that complement their current
treatment.
Do not use complementary therapies alone to treat your
child's diabetes.
Talk with your child's doctor if you are using
any of the following or other complementary or alternative therapies to treat
your child's diabetes:
Herbal medicines and natural substances, such as
antioxidants, vanadium, magnesium, or chromium.
Studies indicate that soluble fiber, along with insulin, may help you keep
blood sugar levels within a target range.
The American Diabetes Association (ADA) is a national organization
for health professionals and consumers. Almost every state has a local office.
ADA sets the standards for the care of people with diabetes. Its focus is on
research for the prevention and treatment of all types of diabetes. ADA
provides patient and professional education mainly through its publications,
which include the monthly magazine Diabetes Forecast,
books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also
provides information for parents about caring for a child with diabetes.
Juvenile Diabetes Research Foundation
International
120 Wall Street
New York, NY 10005-4001
Phone:
1-800-533-CURE (1-800-533-2873)
Fax:
(212) 785-9595
E-mail:
info@jdrf.org
Web Address:
http://www.jdrf.org
The Juvenile Diabetes Research Foundation International is dedicated to finding a cure for type 1 diabetes and its complications. The organization funds research on type 1 diabetes, including research on prevention and treatment. This
organization publishes a wide variety of booklets, magazines, and e-newsletters on complications and
treatments of type 1 diabetes.
National Diabetes Information Clearinghouse
(NDIC)
1 Information Way
Bethesda, MD 20892-3560
Phone:
1-800-860-8747
Fax:
(703) 738-4929
TDD:
1-866-569-1162 toll-free
E-mail:
ndic@info.niddk.nih.gov
Web Address:
http://diabetes.niddk.nih.gov
This clearinghouse provides information about research
and clinical trials supported by the U.S. National Institutes of Health. This
service is provided by the National Institute of Diabetes and Digestive and
Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).
McCarthy AM, et al. (2002). Effects of diabetes on
learning in children. Pediatrics, 109(1). Available
online: http://www.pediatrics.org/cgi/content/full/109/1/e9.
Rewers A, et al. (2002). Predictors of acute complications in children with type 1 diabetes. JAMA, 287(19): 2511-2518.
Allen C, et al. (2001). Risk factors for frequent and severe hypoglycemia in type 1 diabetes. Diabetes Care, 24(11): 1878-1881.
Begg IS, et al. (2001). Eye disease. In HC Gerstein,
RB Haynes, eds., Evidence-Based Diabetes Care, pp.
396-428. Hamilton, ON: BC Decker.
American Diabetes Association (2008). Standards of
medical care in diabetes. Clinical Practice Recommendations 2008.
Diabetes Care, 31(Suppl 1): S12-S54.
Zochodne DW (2001). Peripheral nerve disease. In HC
Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care,
pp. 466-487. Hamilton, ON: BC Decker.
U.S. Department of Health and Human Services (2008).
2008 Physical Activity Guidelines for Americans (ODPHP
Publication No. U0036). Washington, DC: U.S. Government Printing Office.
Available online:
http://www.health.gov/paguidelines/pdf/paguide.pdf.
American Diabetes Association (2004). Hyperglycemic
crises in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S94-S102.
American Diabetes Association (2004). Tests of
glycemia in diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S91-S93.
Levine BS, et al. (2001). Predictors of glycemic control and short-term adverse outcomes in youth with type 1 diabetes. Journal of Pediatrics, 139(2): 197-203.
American Diabetes Association (2004). Smoking and
diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74-S75.
Other Works Consulted
American Diabetes Association (2008). Diabetes care in
the school and day care setting. Clinical Practice Recommendations 2008.
Diabetes Care, 30(Suppl 1): S66-S73.
Campbell A (2006). Glycaemic control in type 1
diabetes, search date December 2005. Online version of BMJ Clinical Evidence. Also available online:
http://www.clinicalevidence.com.
Campbell AP, Beaser RS (2007). Medical nutrition
therapy. In RS Beaser et al., eds., Joslin's Diabetes Deskbook, pp. 81-125. Boston: Joslin Diabetes Center.
Cheng AYY, Zinman B (2005). Principles of insulin
therapy. In CR Kahn et al., eds., Joslin's Diabetes Mellitus, 14th ed., pp. 659-670. Philadelphia: Lippincott Williams and
Wilkins.
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Credits
Author
Caroline Rea, RN, BS, MS
Editor
Susan Van Houten, RN, BSN, MBA
Associate Editor
Tracy Landauer
Associate Editor
Pat Truman, MATC
Primary Medical Reviewer
Michael J. Sexton, MD - Pediatrics
Specialist Medical Reviewer
Stephen LaFranchi, MD - Pediatrics and Pediatric Endocrinology
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