Being diabetic is bad enough, being diabetic when you’re a young child, that’s even worse. Most children have type 1 diabetes or what doctors used to call ‘Juvenile Diabetes’, which makes up 5-10% of all diabetics. “There is no diagnosis as sudden or life-changing as type 1 diabetes,” says Dr David Segal, a paediatric endocrinologist and diabetic specialist at Mediclinic’s Wits Donald Gordon Medical Centre.
Although type 1 diabetes can occur at any age, most type 1 diabetics are diagnosed as young children. This means for the first few years after diagnosis, much of the treatment steps and protocols must be facilitated and managed by the patient’s parents, said Dr Segal.
For parents of a child with type 1 diabetes, treatment and care is an ongoing, everyday process. Whereas type 2 diabetics will need to undergo various lifestyle changes, from eating a healthier diet to adopting a new exercise regimen, type 1 diabetes has an all-encompassing effect on everyday life.
A child with type 1 diabetes will need to have their blood sugar tested up to ten times a day – before meals, at school, and even during the night. They will also require frequent, painful insulin injections to guard against hypoglycaemia, or low blood sugar, which could, if missed and left untreated, leave them in a life-threatening diabetic coma.
“Type 1 diabetes is not a condition that can be managed in a hospital, or by a team of nurses. All that falls on the parents,” Dr Segal explained. “They’re the ones who need to learn how to take blood tests, administer insulin, prepare healthy meals. And they must learn all of this incredibly quickly.”
Parents play a vital role in helping newly diagnosed children come to terms with their ‘new normal’. But for these parents, acclimatising can be a challenge. “That first consultation is key. We have an hour or two to revolutionise how they see their world – and to really help them understand, this is serious, but we can help.”
Dr Segal said type 1 diabetes is a life-long disease, and the whole family of the person affected needs to recognise and help to manage the effects of that. “If you don’t manage type 1 diabetes, it will kill you. So, your mindset needs to shift quite dramatically right up front: you need to say, I am willing to manage it. Parents, grandparents, siblings, everybody – the whole family needs to adopt a positive attitude of, we will do what it takes.”
One of the biggest frustrations for young type 1 diabetics (apart from the regular pin-pricks and the obsession with numbers) comes at children’s parties. While their friends are digging into the party packs, they know that sweets are off the menu for them. So, what’s a kid to do? And what advice can you give the parent of a type 1 diabetic about what their child is allowed to eat?
Ilsabé Spoelstra, a dietitian at Mediclinic Bloemfontein, doesn’t believe in treating diabetic children differently. “Every child should eat healthily,’ she said. “So, if anything, a diabetic child’s parents should influence their friends to change their children’s diets.” Ilsabé said that type 1 children should avoid trans-fatty acids and hydrogenated fatty acids, describing them as “the really bad stuff”. “Trans fats are found in processed foods, like biscuits, rusks, pies and pastries, so you have to read the labels when you buy your groceries.”
Sugar, of course, is the big baddy. But, as Ilsabé pointed out, “sugar is not good for diabetics, but too much sugar is not really good for anyone.” She advised parents of type 1 diabetics to try low-GI options. “There are loads of nice low-GI recipes – including birthday cakes. With these you don’t have to avoid the sugar, because it’s there in moderation and in combination with the other ingredients, like flour, eggs, and milk.”
Some type 1 children are advised to eat biltong instead of sweets – but even here, Ilsabé recommended moderation. “Biltong has a lot of salt, so make sure that it’s just a snack and not a meal on its own,’ she warned. ‘And while lean biltong is better for a diabetic than sweets, you need to eat a proper meal so that you’re not so hungry.’
Whether your patient or their child are diabetic or not, it all comes down to eating properly. “Children need a proper meal, with protein and low-GI carbs, and a lot of veggies,” Ilsabé said. ‘If you eat a combination of those foods, then usually you’ll feel satisfied, and won’t want to snack.”