LIVING WITH YOUR DIABETES
Doctors and other health care professionals talk about you as ‘a diabetic’ or ‘a person with diabetes’ and you may also talk about being a diabetic or having diabetes. But this is a very poor description of you. You are a unique individual with your own lifestyle, work, hobbies, family background, home, friends, ideas and dreams. No one else in the world is capable of offering your special gifts to society. The fact that you have, at some stage in your life, been diagnosed as having diabetes is a very small part of your whole person.Your diabetes is also unique to you – no one else responds in precisely your way to changes in food, exercise, treatment and the passage of time. This is why it is very important that you learn all you can about your own diabetes. Armed with this knowledge and with the experience built up by health care professionals, scientists and others (including those with diabetes) you can take command of your diabetes and ensure that it remains well controlled and does not get in your way. Your diabetes is an inescapable part of you, but there is no need for it to intrude on your enjoyment of life.This all sounds great in theory, but when you wake up in the middle of the night and start worrying and wish that it wasn’t you, that it was all a terrible mistake and you are going to wake up in the morning non-diabetic, then it is not so simple. Being diabetic is not easy all the time. The first, and maybe the hardest, step is to accept that you have diabetes and that for the foreseeable future you will remain so. This acceptance does not come overnight and some people with diabetes never fully accept it.Jo has been diabetic for ten of her eighteen years. Nowadays she is in and out of hospital with ketoacidosis and mistakes in her insulin dose. I asked her how she felt about being diabetic and the answer was simple: ‘I don’t want to know.’Being an ostrich is all very well, but if you try to bury your diabetes in the sand you find that the rest of you gets covered in grit too!There is a tendency to see diabetes in terms of blood glucose levels and the mechanics of insulin injection or pill dose. When you go to your clinic you will be asked all about this and about symptoms of tissue damage. Sadly, in many clinics, there is too little time and too clinical an atmosphere to discuss how you feel emotionally. Many people with diabetes feel that the doctor’. . . doesn’t want to know about my private worries. He is much too busy thinking about my sugar levels.’ If you are worried, then we do want to know. It will help us to help you, and you may feel better sharing your anxieties. If something is worrying you, even if it seems to be nothing to do with your diabetes, the anxiety may upset your glucose balance.Nellie is seventy-five years old and has been diabetic for twenty years. When she came to the clinic recently she looked tired and had lost weight. I asked her how she was sleeping.’I can hardly sleep at all. I’m so worried,’ she said and she started crying quietly.She told me that because her husband had worked past the official retirement age his pension had been reduced. They were finding it very hard to pay the bills and she could not afford her proper diet.’But I’m keeping you from your work, doctor,’ she said. I pointed out that she was my work at the moment. Later, I arranged for her to discuss things with our welfare expert, who found that she was entitled to an additional allowance.Feel free to discuss how you view your diabetes with your diabetes advisers, your family doctor, your relatives and with your close friends. It will help them to understand. You will be helping your doctor too. I am not diabetic and I do not know what it feels like to have diabetes. I need my patients to tell me how they feel. I learn more from my patients than I ever have from textbooks, and that helps me to look after future patients.
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Carbohydrate is a part of food. Starch is a carbohydrate, so too are sugars and certain types of fibre. Starches are nature’s reserves created by energy from the sun, carbon dioxide and water. The building block of starch is glucose, a single sugar.

The simplest form of carbohydrate is a single sugar molecule. Chemically, this sugar molecule is known as a monosaccharide (mono meaning one, saccharide meaning sweet). Glucose is a single sugar molecule which occurs in foods and is the most common source of fuel for the cells of the human body.

Eating a high carbohydrate diet means:

? eating carbohydrate-rich foods at every meal and making sure that carbohydrates form a large proportion of the meal,

? eating carbohydrate-rich foods for snacks,

? including at least the minimum quantity of carbohydrate foods suggested for small eat.

Eating a high carbohydrate diet also means:

? not eating too much protein or fat. High fat foods are concentrated source of kilojoules. It takes only a small extra amount of them to throw your diet out of balance. Monounsaturated and polyunsaturated fats may have desirable effects on blood lipid levels but all fats have the same energy value and same propensity for ‘overconsumption.

Remember, if you are eating a high carbohydrate diet then you’ll automatically be eating less fat.

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My six year old has been asked to a children’s birthday party. Should he go, and if so, how will he cope with the party food?

Of course he must go. It is important that he should lead as full and normal a life as possible and it would be very wrong for him to miss parties because of his diabetes. He will need some guidance so that he can help himself to the party foods. It is well worth while discussing this with your dietitian who will be able to suggest the sort of things that he can have. See page 204.

It is also worth while speaking to the mother of the child giving the party and explain that your child has diabetes. Perhaps you could bring a bottle of low calorie soft drink when you take your child to the party and he can have that when the other children are having ordinary soft drinks. Ice-cream is permissible and there are often savory foods including sandwiches, nuts, potato chips and small pies which can perhaps be taken as part of the food allowance. It may be possible for him to have part of his evening meal food allowance as well as his afternoon tea allowance at the party, and this gives him a little more to eat. If he is very active and excited at the party, he will need extra food anyway. Your child should have a piece of the birthday cake so he doesn’t feel left out of it, or he might like to bring back his piece of birthday cake for some other member of the family and have a small piece or some other treat when he gets home.

I would like to give my child a birthday party but most of the favourite party foods are off the diet.

As discussed in the previous answer, you should certainly not allow your child’s diabetes to prevent him having a birthday party. You may get many helpful suggestions from your dietitian, and there are many things to substitute for the iced cakes and other sugary foods that children sometimes have at parties. The main food items at the party will probably be nuts, potato chips or crisps, low calorie soft drink, diabetic jellies of varying colours, ice-cream, party pies with diabetic tomato sauce or ketchup. With ingenuity you can certainly make a very attractive array of party foods for a small child. He may have an ice-cream cake as a birthday cake.

My teenager wants to give a party. What would you recommend?

You will probably want to encourage him to feel able to entertain, and you should help him prepare for the party and discuss details in advance. The most sensible occasion would be to have the party at a meal time and perhaps have a barbecue with steak, chops, sausages, salads, rolls. Teenagers very often do not want the sweet things that younger children seem to want at a party and low calorie soft drinks can be used. Your teenager should have no trouble at all in eating very adequately and freely and still conforming to his carbohydrate allotment. Extra activity will allow him to have extra carbohydrate during the evening as well as his usual supper allowance.

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The following information is provided for schools and youth groups when they are arranging camps which might include a child with diabetes.

Sometimes a school feels that it cannot take responsibility for a child with diabetes. The following might be helpful to them in making their decision.

Children with diabetes should attend school camps if possible

It is thought to be very desirable that children with diabetes should attend school camps and excursions. Children should not be seen to be handicapped by their condition, they should be able to cope fully with a camp programme, and they should benefit from the programme to the same extent as other children. It may be psychologically damaging for them to be excluded.

In general, children should be able to attend camp when they are reliably independent in their own care of diabetes. This includes an ability to measure an insulin dose accurately, to inject an insulin dose reliably, to carry out urine or blood glucose tests, to recognize the early signs of hypoglycemic reaction and to take sugar when they occur, to estimate their diet in exchanges and to understand the need for taking extra food before increased physical activity, and to have meals and snacks on time.

In some circumstances a parent might accompany the staff of the camp to assist with the child who is not fully independent, or the staff of a camp might take special responsibilities if a child is not reliably independent. This is to be encouraged if the child requires it, but discouraged if the child is reliable without special supervision.

The child needs to take equipment

A child will take adequate supplies of insulin, disposable syringes, blood testing equipment and glucose or suitable sugar products to prevent or treat an insulin reaction. Whether the child keeps these in his possession or hands them to the teacher should be by mutual agreement between parents, child and teacher. In many instances, it would be most appropriate for the child to keep his own insulin and syringes to save embarrassment and because of the self reliance which most children with diabetes develop. It is essential that blood testing strips and sugar should be kept by the child to be available when needed.

Others should know he has diabetes

It is desirable that a child’s friends should be aware of4 his diabetes, both to give moral support if needed, to save embarrassment at blood testing and insulin giving times, and to give appropriate help if needed, should the child have a hypo reaction. Children in the same bedroom or tent should all be aware of a child’s diabetes, but it is undesirable to inform all the camp group in most instances, as this may cause undue attention to be placed on the child with diabetes.

No special privileges but some spare time

In general, a child can undertake all camp duties and activities. He should however have some free time before breakfast and before the evening meal for blood testing and insulin injections and before bed for blood testing. It may be necessary to provide some private place for a child to give his insulin, but many children give it in the sleeping quarters without embarrassment in front of children.

Meals are important

Mealtimes should be adhered to as strictly as possible. If a meal is delayed, a child should have access to food, (e.g. fruit, biscuits, fruit juice) at the normal mealtime while they wait for the meal. A child with diabetes should be permitted to take extra food at odd times before extra physical activities to prevent insulin hypoglycemic reactions. On any excursion beyond the camp site, a child must take some food or confectionery.

A school camp might be considered unsuitable for someone with diabetes if the child was totally inaccessible to medical aid in the event of an emergency. In such cases a responsible school friend or teacher could be shown emergency procedures to ensure a child’s safety.

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