Time to develop a self-care plan

November is National Diabetes Month, a time when communities across the country team up to bring attention to diabetes treatment and prevention. According to the CDC, more than 34 million people in the United States have diabetes, and one in five don’t know they have it. Included in that number is the rising diagnosis of Type 2 diabetes in younger people. After collecting sugary sweets from Halloween festivities and looking forward to the high-calorie holiday feasts of Thanksgiving and Christmas, now is an especially opportune time to focus on diabetes in children and teens.

Diabetes is one of the most common chronic conditions in school-age youth in the United States, affecting about 193,000 youth under 20 years old.

Juvenile diabetes, also called Type 1 diabetes, is the common form of diabetes seen in children and teens. In Type 1 diabetes, the pancreas does not make insulin, a hormone responsible for regulating glucose levels within the body. Carbohydrates found in both healthy and unhealthy foods break down into glucose, a sugar that our cells use as a primary source of energy. Without insulin, too much sugar stays in the bloodstream and can lead to a multitude of health problems such as heart disease, stroke, kidney disease, vision problems and nerve damage.

Type 2 diabetes is now on the rise in younger people due to an increase in childhood obesity and a sedentary lifestyle. Enterprising food producers and restaurant chains actively market delicious and sugar-heavy foods to children and youth. In Type 2 diabetes, the cells do not respond to the insulin produced by the pancreas (insulin resistance). The pancreas tries to make more insulin but eventually can’t keep up enough production, and the blood sugar continues to rise. Unlike Type 1, Type 2 diabetes can be prevented and controlled with diet and exercise. Regardless of age, sometimes youth who have diabetes need support with their diabetes care. That’s why it’s essential to help your child or teen develop a plan to manage diabetes and work with their health-care team to adjust the diabetes self-care plan as needed.

Here are some tips to consider for your youth’s diabetes self-care plan:

• Manage blood glucose levels. Make sure your child or teen takes their medicines as prescribed, at the right time, and in the correct dose – even when they feel good or have reached their blood glucose, blood pressure and cholesterol goals. Regular testing of blood sugar levels as instructed is also important.

• Get active. Include regular physical activity in your child’s schedule. Aim for one hour of physical activity a day, in short sessions or all at once. Mixing up the type of activities can keep kids engaged. A brisk walk in the park, meditative yoga or a team sport like soccer are great ways to stay active as a family while establishing healthy habits. Youth with Type 1 diabetes should also check their blood glucose levels before, during or after physical activity.

• Follow a healthy eating plan. Because being overweight increases the risk factors for Type 2 diabetes, a balanced diet is especially important if your youth takes insulin. Eat more fruits and vegetables, drink more water and cut down on sugary drinks. If possible, increase natural foods and decrease processed foods; choosing more whole fruit instead of fruit juice, carrots instead of candy, home-prepared lunches and snacks instead of fast food or packaged treats. Taking time to eat instead of rushing through meals, rewarding kids with praise instead of food and not forcing a child to clean their plate can be effective ways to strengthen mealtime routines. In addition to eating healthy, parents may want to limit screen time to increase focus and ensure children get enough sleep. A recent study showed that when the amount of TV time was limited, kids snacked less, which led to an increase in weight loss and more physically active habits.

Stay prepared for emergencies. A basic “gokit” could include:

• At least one week’s worth of medical supplies and equipment.

• Emergency and health-care professional contact lists, a medication list, including doses and dosing schedules and an allergy list.

• Face coverings, hand sanitizer and disinfecting wipes may also be added to your “go-kit” during a pandemic.

• Monitor for diabetes complications. Early diagnosis and treatment can help reduce the risk of heart disease, vision loss, nerve damage and other related health problems.

• Seek mental health support. Please encourage them to connect with other youth who have diabetes. Youth may not be used to talking about feeling anxious, depressed or alone about their diabetes. Speak with your health-care team for help.

• Look for visible symptoms. While insulin resistance usually doesn’t have any symptoms, some children develop patches of thickened, dark, velvety skin – usually in the body creases and folds. This condition, called acanthosis nigricans, often occurs on the back of the neck or in the armpits. Other conditions, such as high blood pressure, high cholesterol or polycystic ovary syndrome, can be indicators of insulin resistance. Excessive thirst, dry mouth and frequent urination are the most common symptoms of high blood sugars.

New medications, better technology for monitoring blood sugar, and better insulins are already here. These welcome changes are becoming more convenient and available. So, let’s keep our diabetic children and youth healthy now, for an even better future tomorrow.

David Scarborough, MD, associate clinical professor and division chief of endocrinology. Arshpreet Kaur, MD, FACE, assistant professor of endocrinology, director of diabetes initiatives.