Diabetes Work Book for Children - K. Lange - ebook

Diabetes Work Book for Children ebook

K. Lange



Diabetes in children: a treatment and training program Diagnosis diabetes! You just heard about it. But what does that mean for you and for your parents? Ian (10 years old) has diabetes since a few years. He is talking about his everyday life, his favorite sports, his friends, and his experiences with the disease. In five chapters Ian explains: • What is diabetes actually? • Food and drinks for children with diabetes • How to treat myself well with insulin? • What do I need to do to keep my blood glucose from going too high or too low? • How do I notice that my blood glucose is too high or too low? Ian is telling you, what is important to know about diabetes and to have a good life like any other child: go to school, having parties, sports, and do everything, what else you love to do. He also has many practical tips for you, and you can train with him, how to get along well with diabetes. In the sixth chapter Ian introduces his twelve-year old friend Laura. Together with her parents she is just learning how she can calculate her insulin dose by herself. Each chapter ends with a small knowledge check – so you can see how much you've learned about diabetes. An extra brochure for your parents includes suggestions and assistance for a relaxed family life with diabetes.

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Diabetes Work Book for Children

Children with diabetes: a treatment and training program

Bibliografische Information der Deutschen Bibliothek

Die Deutsche Bibliothek verzeichnet diese Publikation in der Deutschen Nationalbibliografie; detaillierte bibliografische Daten sind im Internet über <http://dnb.ddb.de> abrufbar.

ISBN 978-3-87409-664-5 (EPUB)ISBN 978-3-87409-665-2 (MOBI)

Founded by:P. Hürter, H.-U. Jastram, B. Regling, M. Toeller, K. Lange, B. Weber, W. Burger, R. Haller (1985)

Responsible for the 5th edition:Prof. Dr. rer. nat. Karin Lange (Psychologist, specialized in Diabetes): Medizinische Psychologie OE 5430, Medizinische Hochschule Hannover, Carl-Neuberg-Straße 1, 30625 Hannover.

Martina Lösch-Binder (Diabeteseducator DDG), Prof. Dr. med. Andreas Neu (Diabetologist DDG): Universität Tübingen, Klinik für Kinder- und Jugendmedizin, Hoppe-Seyler-Straße 1, 72076 Tübingen.

Sarah Biester (Diabeteseducator DDG), Kerstin Remus (Diabeteseducator DDG),

Dr. med. Wolfgang von Schütz (Diabetologist DDG): Kinder- und Jugendkrankenhaus auf der Bult Hannover, Diabeteszentrum, Janusz-Korczak-Allee 12, 30173 Hannover.

Editor: Arbeitsgemeinschaft für Pädiatrische Diabetologie e. V. (AGPD)

Illustrations:Steffi Krohmann, Köln

Cultural adaptation and English translation 1st English edition 2017:Katarzyna Zinken, Sheonagh Clark, Karin Lange + Leeds Beckett University, Headingley Campus, LS6 3QQ Leeds, UK

Acknowledgements: The authors thank Liz Webster, the course leader, and all the participants of the first Advanced Diabetes Educator Course at the Leeds Beckett University, UK for their comments on an earlier draft of the Ian-book.

Funding: The English translation and publication have been kindly supported by Roche Diabetes Care Deutschland GmbH.

1st English edition 2017, based on 5th German edition 2017© Verlag Kirchheim + Co GmbHKaiserstr. 41, 55116 Mainzwww.kirchheim-shop.de


Chapter 1

What is diabetes actually?

Chapter 2

Food and drinks for children with diabetes

Chapter 3

How do I treat myself well with insulin?

Chapter 4

What do I need to do to keep my blood glucose from going too high or too low?

Chapter 5

How do I notice that my blood glucose is too high or too low?

Chapter 6

For children who already know about diabetes


Ian and then also Laura have helped German children with diabetes to become familiar with the situation for more than twenty years. An accompanying booklet for parents gives advice how to handle this new task for the adult family members and explains in easy terms the concept of age-appropriate diabetes education.

Age-appropriate education and training has become standard over the last three decades in treating children with diabetes. It is included in both national and international guidelines like the 2014 Consensus Guidelines of the International Society for Pediatric and Adolescent Diabetes (www.ISPAD.org).

Despite guidelines and consensus statements, there remains huge variation in diabetes outcomes across countries and even between treatment facilities within the same country. Patient education is one of the most important measures within the scope of diabetes therapy for enabling people with diabetes to conduct active self-management. „SWEET“ is an acronym derived from “Better control in Pediatric and Adolescent diabeteS : Working to CrEat CEnTers of Reference” and is based on a partnership of established national and European diabetes organizations (www.sweet-project.eu) led by ISPAD. With a vision of equal, high quality care for all children with diabetes, SWEET has the mission to harmonize care to optimize outcomes in children and adolescents. In light of the advances of modern diabetes therapy becoming more widely available it created a platform for exchanging best practices among leading pediatric diabetes units.

With the help of the Leonardo da Vinci Lifelong Learning Program of the European Union an EU wide diabetes educator course was developed and these German educational materials were identified as fulfilling the educational needs. The authors of this English translation and cultural adaptation have taken great care to make these materials appropriate for use outside Germany.

I am convinced that this edition of the “Diabetes in Children” education program will have a similar success like in Germany were it was certified by the German Federal Insurance Office for use in long-term treatment and is a part of the German Disease Management Program (DMP) for type 1 diabetes in pediatrics. Disease management is a system of coordinated health care interventions and communications for people with conditions in which patient self-care efforts are of significant importance.

I wish to thank all contributors, physicians, nurses, psychologists, educators, dietitians, social workers and other members of diabetes teams that have contributed to this program. I trust that those that are facilitating the understanding of this complex disease for families worldwide with a command of the English language may find it useful. The SWEET initiative is committed to support and continuously review and improve educational tools for pediatric diabetes, so please give us feedback for potential areas of improvement. With all my best personal wishes for the child with diabetes, its family, and all those concerned with their well-being, I remain on behalf of the SWEET project, yours sincerely

Prof. Thomas Danne

Pediatric Diabetologist,Chairman SWEET project,Former President ISPAD

Hannover, Germany, December 2017

Chapter 1 What is diabetes actually?

Hi there, my name is Ian!

I am 10 years old and in year 5. After school I like going out on my bike and meeting up with my friends.

Also, I like playing on my Wii, going swimming and playing football. My favourite subject at school is PE and I hate doing homework.

Oh yes and four years ago I got diabetes. I’ve learned plenty about it since then.

If you like I will tell you a bit about what’s important so you know what is happening and learn about your diabetes. I guess, I have a few tips for you.

Would you like to listen?

Then here we go!

What did I notice right at the beginning?

I was almost seven. I can remember very clearly how thirsty I was. Even during the night, I got up to go to the kitchen to have a drink. I could have drunk a whole bottle of water at once.

The next thing I noticed was that I had to go to the toilet a lot. A few times I nearly left it too late! Once, I almost wet the bed.

My teacher at school was wondering what made me need to go to the toilet so often. I too was confused but could not help it.

At the very beginning the huge thirst and constant urge to go to the toilet helped me to recognise my diabetes.

What else happened at that time?

Shortly before my diabetes was diagnosed I felt very tired and sluggish even when I went to bed early. Playing with my friends wasn’t fun anymore. In PE I couldn’t keep up and had to rest a lot.

Did you have similar experience?

Even though that I ate and drank plenty I kept losing weight.

Eventually my dad asked me to check my weight on a scale. My parents were horrified. I had lost lots of weight and was only 2.5 stone. My mum was very worried. She wanted us to go to the GP the next morning.

At the beginning I was not only very thirsty and tired but also got very thin.

What did your doctor say the next morning?

The next morning, we went to see the doctor. She checked my urine and a nurse took my blood.

She looked very serious. She said something about diabetes, but I did not understand it then. However, I knew that something was not right as my mum went pale and her hands started to shake.

Although I did not want to, I cried a bit when the doctor called the paediatric unit at the hospital to get us in.

What was wrong?

The doctor found too much sugar in my blood. I also had sugar and ketones in my urine. I had type 1 diabetes.

Mum called my dad and we went directly to the hospital. On the way there we collected some belongings from home for me.

The doctor found out that I have diabetes. That’s why she sent me to the hospital.

How was it for you when you got diabetes?

Take a piece of paper to write or draw a picture of how it was for you when you got diabetes. Afterwards you can share it with your parents or your brother or sister.

Why did I get diabetes?

At some point your body stopped producing insulin.

What is insulin?

The body produces insulin just as it produces blood. You do not notice it. You notice it first when insulin is missing. Then you feel unwell as I did when I was first diagnosed and went to the hospital.

This is at least how the nurse Anna explained it to me. Insulin is very important. Nobody can live without insulin.

Insulin is readily available, and you can inject it whenever you need it.

Once you inject your insulin, you feel better. You can play, eat; you do not have to drink that much and go to the toilet that often. You regain the weight you lost and grow as other children do.

You have diabetes because your insulin is missing. As you need insulin to survive, you inject it instead.

Why is insulin so important?

Food is needed not only when you are hungry, it helps you grow and get stronger. However, food by itself does not make you thrive. Insulin plays an important part in making this happen.

Insulin and food together provide energy, so that you can play, go on a bike, swim, do anything you enjoy doing.

Without insulin your food won’t give you energy. You will be tired and sluggish again.

You need insulin, so your food can give you energy.

How long does diabetes last?

After one week in hospital I asked Nurse Anna, how long will I have to take insulin. She looked at me as if she did not know what to say. Then, she said that I will have to inject insulin for the rest of my life, so that I can feel well and thrive. It made me scared. I was angry, sad and wanted to run away.

However, after a while, I convinced myself that I can do a good job of injecting insulin and it did not hurt that much. My mum told me then that there are illnesses which go away such as cold, measles or flu but there are other illnesses such as diabetes which stay forever. You cannot heal them but you can treat them effectively so that I can live a normal life as other children do. Also with diabetes I can play with my friends, go crazy, go to school and be cheeky.

You and I will always need insulin, so we feel well.

Are you responsible for your diabetes?

While in the hospital I thought to myself: “Has diabetes happened to me because I did something wrong? I was always eating a lot of sweets and my mum would get cross with me.”

This thought worried me, so I talked to my doctor about it and he said “Ian, you have done nothing wrong, definitely not!”

Even if you had never eaten sweets, the diabetes would have come. Your body just stopped producing insulin at some point. It has nothing to do with what you have eaten or drank. It’s not your fault or your parents fault that you need insulin. This is true for all children with type 1 diabetes.

Diabetes just comes. Neither children nor parents had done anything wrong. Diabetes is also not because a child was naughty and fooled around. Nobody is to blame!

No one is to blame for having diabetes.

Are there any more children with diabetes?

In the meantime I got to know other children with diabetes. My parents and I went once to a diabetes event. I met some of my friends with diabetes there. The doctors and nurses explained diabetes to us and our parents. Afterwards we played and had a good time together.

I like the fact that I am not the only child with diabetes. At the event I met Charlotte, Laura, Jo and Rohan. They all have diabetes. We became good friends and have met up a lot since.

Next year we plan to travel for a week, just us, children with diabetes without our parents. We are looking forward to this.

In the whole world there are about 500 thousand children with diabetes and even more adults, who inject insulin every day. What do you think how many children with diabetes live in your country?

Would you like to meet other children with diabetes?

If so, then ask your diabetes nurse in your diabetes clinic about any events or charities she knows of who have events going on nearby.

Take a piece of paper to write down the following information about the children’s group:

Name of the children’s group?

Phone number?



There are many children with diabetes. If you want, you can get to know them.

Do you know about diabetes already?

If you know the answers, you can write them down on a piece of paper and discuss them later with your diabetes nurse.

What are the signs that tell you that you may have diabetes?

Are children to blame for having diabetes?

What is missing in the body of someone with diabetes?

What do children with diabetes need to feel well?

Chapter 2 Food and drinks for children with diabetes

Food and drinks for children with diabetes

Food and drink for children with diabetes

You have heard already that you will have to think a bit more about what you eat or drink because you have diabetes. Perhaps you have even heard the word “diet”. When I developed diabetes, I wasn’t sure what I could eat or drink.

The word “diet” means having enough food and drink to make you grow bigger and stronger.

Since I developed diabetes, one thing has mainly changed: I cannot eat whatever and whenever I want without having to think about it. At each mealtime I know what and how much I will eat. Apart from very few exceptions I can eat whatever I used to before I had diabetes. Every now and then I can eat my favourite ice cream and my favourite pizza which I make with my dad.

The right nutrition for children with diabetes is having food and drink which make us grow and thrive.

Why children with diabetes have to think a bit more about what they eat and drink?

People without diabetes, like my parents or my best friend Jo, have blood glucose levels that remain stable whatever they eat. That’s why, they do not need to pay careful attention, to how much food is on their plates.

Children with diabetes can have blood glucose levels that are too high or too low. This can be due to the food and drink they had. Some foods make blood glucose levels go high and some foods do not influence their blood glucose. To keep blood glucose on the right level, children with diabetes must pay attention to what they eat and drink.

Our dietitian explained a lot to me and my parents. She asked what I like to eat, how much and at what times we have meals at home. Then accordingly to my eating habits she explained which food my parents and I have to count when I am estimating the appropriate amount of insulin. I will explain this in more detail a bit later.

So far, I have enjoyed my food. I feel fine and have started growing again. I have a lot of energy and I am the second fastest runner in class. My doctor told me then that my blood glucose levels are good.

It is important for us to look at what we eat and drink to keep our blood glucose at the right level.

What does food have to do with blood glucose?

Now I have to monitor what I eat and drink, I want to know exactly why this is so. I asked Nurse Anna about it. She explained it to me in this way:

Imagine that you are having your breakfast. You bite a piece of toast, chew and swallow it down. What happens next with the food in your tummy?

The pieces of food will be turned into simple sugars which your body can use for energy. We call them carbohydrates.

You pronounce it “kahr-boh-hahy-dreyts” and we also call them carbs. Carbs are in almost every food. Often they do not taste sweet at all.

After the complex sugars are broken down into simple sugars in the tummy, they go into your blood. We call these sugars ‘blood glucose’. The blood takes the glucose to each place in the body, so you can have energy to run, climb, jump and think.

Most of the time, food and drink contain complex sugars. Once in the body, the complex sugars are then broken down and made into blood glucose.

Can you get your energy just from your blood glucose?

No, your body will not be able to make any use of blood glucose. Only with the help of insulin, will your food give you energy so you can run and play. That is why we have to inject insulin when it is missing.

Insulin and food are friends, who need each other. They only give you energy when they are balanced.

Your food and your insulin are good friends. They have to be equally strong, so your blood glucose is OK, and you feel fine.

What happens when insulin and food are not balanced?