The Viral Connection
Scientists now have evidence that Type I diabetes may be caused by viruses that invade the islets in the pancreas. Then, in some mysterious way, the body’s immune system attacks and destroys the islets.
Dr. H. Peter Chase, of the Barbara Davis Center for Childhood Diabetes in Denver, is studying families who show signs of these anti-islet antibodies. And researchers at the Mount Sinai School of Medicine in New York have found that these antibodies appear several years before the patient develops diabetes. These early warning signs may one day help scientists prevent diabetes by using drugs that suppress the immune system.

A Drug Offers New Hope
One such drug already has “cured” diabetes, in a sense. Dr. Calvin R. Stiller and his colleagues at the University of Western Ontario in Canada treated 30 newly diagnosed Type I diabetics with cyclosporin. This is the drug that prevents organ rejection in heart and kidney transplants. In 16 of the patients, cyclosporin suppressed the body’s destruction of the islet cells. The patients continued to secrete insulin and no longer needed injections.
The researchers believe that if cyclosporin is prescribed soon after diabetes manifests itself -and before all the islets are destroyed – it can arrest the development of diabetes.

Better Control, Tight Control
Thanks to battery-operated blood-reading meters and color-coded testing strips, the diabetic patient today can get an accurate reading of his blood sugar at home within minutes by pricking a drop of blood from a finger. He then can adjust his medication, food intake, and exercise to bring his blood sugar levels back under control.
This new technology comes at a time when doctors are advancing their stand on “tight control.” This means that the diabetic must keep his blood sugar levels as close to normal (between 80 and 120 milligrams) as possible at all times. Doctors believe that tight control can reduce or eliminate the long-term nasty effects of diabetes.
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It’s fairly easy to give a meal a low G.I. twist through dessert. This is because so many of the basic components of dessert, like fruit and dairy products have a low G.I. factor.

In discussions with people about what they eat these days, dessert is seldom mentioned. With busier lifestyles and concerns about overweight, dessert is conveniently missed. While this appears a positive change in eliminating unnecessary kilojoules from the diet there is a negative side. In many instances desserts can make a valuable contribution to our daily calcium and vitamin C intake because they are frequently based on dairy foods and fruits. What’s more, desserts are usually carbohydrate rich which means they help top-up our satiety centre, signifying the completion of eating.

The basis of a perfect dessert—low G.I. fruits and dairy foods.

Citrus. A winter fruit which is an excellent source of vitamin C. Select heavy fruit with fine textured glossy skin. Oranges are good as a snack cut into quarters and frozen. Soak segments of a variety of citrus fruit in orange juice with a slurp of brandy, scatter with raisins or sultanas and serve as winter fruit salad.

Cherries. A true summer fruit Choose plump fruit, bright red/black colour on fresh green stems. A bowl of cherries on the table is a lovely dessert to share.

Stone fruits. Apricots appear earliest in the season. Choose those with as much golden orange colour, avoiding pale or green fruit. Peaches and nectarines should be just beginning to soften. Fresh sliced peaches or nectarines are delicious with ice cream or yoghurt. Sprinkle fresh peach halves with cinnamon and try them lightly grilled.

Pears and apples. At their peak during autumn and winter, but are available all year. Preparation simply involves washing and slicing and they provide the perfect finish to a meal.

Grapes. One of the most popular fruits with children because they are so sweet and easy to eat. Grapes do not ripen after harvest so choose bunches with a deep, uniform colour on fresh green sterna. Put a bowl on the table after a meal or include them in a fruit salad.

Custard, ice cream and yoghurt. Look far low-tat varieties for a cool and creamy treat

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Special foods for people with diabetes

Ideally, people with diabetes eat ordinary foods with their family or friends, omitting only the foods unsuitable because of a concentrated sugar content.

There may be times, however, when they will miss some of the high sugar content foods, particularly as relishes or spreads or sweets. Fortunately, there are many alternatives which have been specially manufactured for persons with diabetes and people who want to lose weight by reducing sugar intake.

Examples of such special foods are tomato sauce, jams, pickles, jellies, soft drinks, chocolate, preserved fruits and some sweets. To be acceptable, they must be clearly labeled on the package, stating their carbohydrate content. In some cases they are not ‘free’ to take but must be measured or taken in moderation. In some cases they contain sorbitol, and if this is taken in excess it may cause abdominal discomfort and diarrhea.

There are some products on the market labeled ‘Suitable for Diabetics’ which are not recommended by dietitians and may be unsuitable for your child. It is always wise to check with your dietitian about any product before buying it.

The main place for special products for persons with diabetes in the diet is as additions to add variety, rather than as the main foods.

It is not really necessary to buy any special diabetic products. It is certainly not necessary to spend a lot of money on diabetic products. Fortunately many of these are available for a similar price to sugar containing products.

The co-operation of other relatives and friends

Relatives and friends may need to be told about the diet

Although you will be familiar with details of your child’s diet, and understand the reason for restrictions on certain foods, you will realize that sometimes other people may not be so well informed, or understand the need for the diet. Occasionally friends or neighbors may, with the best intentions, offer your child food, or perhaps a grandparent may not agree with the diet system.

It may be useful to tell some neighbors and friends that your child is not allowed extra foods and sweets, and this may save them embarrassment and your child disappointment. It will certainly be important to explain as fully as possible the need for the diet to relatives who have close contact with your child.

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Bruising

Bruises sometimes develop when an injection is given. Don’t worry. They don’t matter and won’t affect the insulin. They are more likely to occur if your child tenses up during the injection. Try to have him relax.

The plunger gets stuck

Occasionally the plunger gets stuck as you are giving the insulin before it is all injected.

This can happen but it is rare. It is more likely to happen if you give the injection of insulin too slowly. Try rotating the plunger in the barrel of the syringe and then pressing further. Try withdrawing a little and then pressing further. If you put pressure on the plunger and force the insulin, be sure to steady the needle on the syringe if it is a type of syringe that does not have the needle set into the hub.

You may have to take the needle out and push the rest of the insulin into another spot.

A broken needle

The needle breaks off while injecting. Do not panic. It is not so very serious.

Keep your child still, not moving the part you injected. If a small bit of the needle is poking out of the skin, grasp it with forceps and pull it out.

If you fail, put an antiseptic on the skin, make a mark where the needle is and note the direction it was pointing when you were injecting.

Contact your doctor. He may decide to leave it, as there are some places when a small particle of needle does not matter. However if you marked where the needle is and the direction it was pointing it will be easier for him to find it.

Soreness

A tender red lump develops during the day following the injection.

This means there is inflammation, possibly due to infection. Put an antiseptic on the area, and avoid injecting there for a few days. If it does not settle down in the next day, contact your doctor.

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Meals should not be too rigid

At this age precise adherence to diet will probably be impossible, so it’s better to be flexible. Remember also the inevitable loss of appetite with infections. It’s not fair to make a child eat when she is feeling sick and it can provoke vomiting.

On the other hand your child won’t understand why you say ‘no’ when she wants more to eat, even though she has had all her exchanges. If you feel that she does need a little more on this occasion, it probably won’t hurt to give her a small amount of the exchange though you will tend to rely on low energy foods in this situation. Some extra food may make for peace without adversely affecting the diabetes.

Be prepared to adjust exchanges in consultation with your doctor and dietitian as your child’s appetite changes.

If all else fails and meals develop into a battle, discuss it with your doctor and dietitian. It may be better to go through a few days of reducing exchanges and lowering the insulin dose so your child gets hungry – then she will eat all her food and demand more. When this happens the battle is largely over.

Insulin injections and blood tests

Most toddlers accept needles as part of their lot in life. Some even like to help with their needles or are impatient to have the needle done so they can have breakfast.

Others have difficulty in accepting needles and get angry and try to fight you off. Explanations aren’t much use at this age – an upset toddler isn’t very susceptible to rational argument. It’s always of course important to explain what you are going to do and also to explain why in simple terms. It’s usually best, if your child is carrying on, to be firm and get the needle over with quickly. If she sees you get upset it tends to make her own feelings worse.

It may be helpful to let your child inject a doll or teddy to make it better, using an old syringe without its needle. Give them lots of opportunities to re-enact the injection scene with toys and play. Give time for reassurance and a cuddle after the injection is over even if your child did behave rather badly.

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Good control means good health

We try to keep diabetes in good control for a number of reasons. The most important ones are as follows:

1.     With good control of diabetes a person feels well and can enjoy life to the full.

2.     With good control a child grows normally and puts on weight appropriately, neither becoming fat nor getting thin.

3.     With good control the body overcomes infections quickly, wounds and sores heal well and certain other infections are avoided.

4.     With good control a child can do any sport and succeed as well as if she didn’t have diabetes.

5.     With good control a person can have a driving license.

6.     With good control a person can carry out almost any career and hold almost any job with confidence.

7.     Good control minimizes – perhaps prevents – the chance of late complications of diabetes.

This last reason is perhaps the most important reason to attempt good control of diabetes. It is often possible to feel well and to grow adequately and lead a full life as a young person even though diabetic control is not perfect. It seems that for the prevention of the long-term medical problems of diabetes control has to be really quite good.

Good control can be difficult at times

Sometimes good control is very hard to achieve, even with the best advice and the best intention on everyone’s part. Some children are more unstable than others through no fault of their own. Some children find it almost impossible to keep to all the restrictions of a regimen for diabetes. Emotional and social upsets will upset diabetic control, and for some children these upsets may make stable control quite unattainable for a long while.

Most people however can keep good control. For others it may take time but will happen eventually. It is always worth trying, and you shouldn’t become discouraged and give up. Situations change and a new adjustment to the diabetic regimen may be all that is needed.

Your doctor will evaluate the quality of control

We can tell whether diabetic control is satisfactory in a number of ways, all of which contribute to an assessment. This is one of the objects of a consultation with a physician.

Perhaps the first consideration is how your child feels and whether she has any symptoms of diabetes. The next is how growth in height and weight is progressing. Then there are a number of observations the doctor can make on examination.

Your record of blood tests at home will be helpful in evaluating overall control, but you will realize that blood tests can only tell you what is happening at certain times of the day and not at others.

There are a number of laboratory tests that may be helpful, such as the levels of fats in the blood. The most useful test of all however is a test called the glycosylated hemoglobin test.

As a result of all these observations and tests the physician will probably be able to reassure you that control is satisfactory. If not he will be able to let you know and discuss ways to improve control.

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At times the body may make chemical substances called ketones. These are derived from fat, which is an important source of energy for the body but which also requires insulin. If the fats are not burnt up properly they produce ketones which are a kind of toxic by-product from the inefficient burning up of fat.

Ketones may be made in large amounts when diabetes is untreated or if there is insufficient insulin. They may also occur during illness and vomiting when the insulin may not work properly. Occasionally ketones may develop when not enough carbohydrate is eaten and the body is forced to burn up fat.

When ketones are formed in large amounts they circulate in the blood and spill out in the urine. There they can be detected. They may also be smelt on the breath.

Ketones should be tested during illness

It is important to test urine for ketones when your child’s blood glucose levels are very high during illness. It is particularly important to test during a vomiting illness. Ketones may themselves make the child feel ill and vomit.

There are two common tests for ketones in urine: Ketostix and Ketur-Test. Both work on the same principle as the urine glucose tests, using a plastic strip with a reagent block at one end. When the strip is dipped in urine, a purple colour develops if ketones are present.

Some tests have glucose and ketones on the same stick

It is often helpful to be able to test glucose and ketones at the same time. These tests are Ketodiastix which is a combination of Ketostix and Diastix, and the Keto-Diabur-Test 5000 which is a combination of Ketur-test and Diabur test-500.

The tests on each of these are just the same as the two tests that are present on the strip and are read in the same way.

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