Ask the Expert

Ten Techniques for Managing Blood Sugar in Kids with Diabetes

 by, Gary Scheiner MS, CDE,
Type One Nation Keynote Speaker and Named 2014 Diabetes Educator of the year by the American Association of Diabetes Educators, Gary Scheiner has dedicated his professional life to improving the lives of people with insulin-dependent diabetes.

** To learn more from Gary Scheiner, Don’t forget to Register for TypeOneNation on February 3^rd where Gary will be Out Keynote Speaker and Breakout presentation speaker!

We used to receive a call every week asking if we held support groups for kids with diabetes. Honestly, I never thought to have one. Why would any kid want to come to a support group when there are cartoons to watch and siblings to torment? Finally, I caved and decided to start a kids’ diabetes support group. It was an epic failure and a rousing success all wrapped up on one. The kids were miserable. They varied in age from 4 to 14, which may have accounted for some of the struggles in getting them focused. As much as we tried to engage them in fun social activities, the younger ones were too hyperactive to hold still, and the older ones were too caught up in the “this is stupid – I’d rather be on Facebook” thing. About the only time they would look up would be to check the clock. The parents, on the other hand, had the time of their lives. We had coffee and snacks for them in the other room. I could hear them laughing and carrying on. There were snippets of conversation that stuck in my brain:

“… you wouldn’t believe the food stash I found under his bed…”
“…if she remembered her meter like she remembered her cell phone…”
“…anyone else have bloody test strips all over their house?…”
“…we change his pump while he’s sleeping so we don’t have to sit on him…”
“…exercise? You’ve got to be kidding…”

All things considered, it was some of the best venting I had heard since the HVAC convention was in town. It was then that we decided to give the kids a reprieve and start a Parents of Kids With Diabetes support group. For years, the group met, shared some things, learned some things, and taught me a thing or two. I already understood how complex it can be to manage diabetes in a growing child, having worked with so many over the years. (I was lucky enough to be diagnosed after age 18.) But I also learned that having diabetes is very different from parenting a child with diabetes. For example, when my sugar is high or low, I deal with it and move on. But when your child is high or low, most parents become frustrated, dwell on it, and feel a bit guilty.

One of our most productive parents’ meetings was an impromptu discussion of tips for a recently-diagnosed family. From that discussion (and with a bit of refinement on my part), we developed our own“Top 10” list of techniques for managing blood sugar in kids. (If you’re an adult with type-1, most of the same principles apply.) Anyway, it goes something like this:

• 10. Persistence Pays.
  Parenting is a never-ending challenge. And so is diabetes care. Stay involved in your child’s management even when he/she grows to the point that they can perform many of the daily self-management rituals on their own. Your involvement keeps them accountable and on their toes. That’s not to say that you can never take a break. Ask someone else to help handle your tasks/oversight for a day or two, and give your child opportunities to indulge in favorite foods or ease back on exercise, record keeping and frequent blood glucose monitoring once in a while. Just don’t ever miss the basic things that keep them out of immediate danger: taking insulin and checking blood sugar at least a few times each day.
• 9. Build structure.
  In Fiddler on the Roof, the main character Tevya poses the question during the title song (“Tradition”), ‘Why do our people keep all these traditions?’ His answer: It helps us keep our balance. Likewise, maintaining routines in our daily living helps us to keep our blood sugar in balance. Which can be a challenge, because we all know about the odd appetites, habits, and assortment of activities that pervade kids’ lives. But the fact remains that kids thrive in a structured environment. Look for ways to have meals at consistent times. Play or exercise at regular intervals. Go to sleep and wake up at about the same times each day. Check blood sugars, take insulin, change pump infusion sets, and so on… on a schedule. The more consistent their daily lives, the more consistent and predictable the blood sugars will be.
• 8. Support year-round exercise.
  This deserves special attention because of the tremendous influence physical activity has on blood sugar regulation. Too often, kids get involved in sports or “play” type activities that are intermittent. They may be very active on weekends and “slugs” all week. Or they may run like crazy in the summer and fall, and sleep their way through the winter and spring. This causes erratic activity pattern causes major changes in insulin sensitivity – how well the body’s cells utilize insulin to lower blood sugar. As mentioned in item 9 above, consistency counts. And that goes for physical activity as well. Encourage and support your child to stay physically active on a regular basis, year round. And remember, if all else fails, there is nothing more effective than leading by example!
• 7. Keep records.
  They can be annoying and time-consuming, but there is nothing like written record keeping to achieve and maintain quality blood sugar control. Sure, meters, pumps and CGM systems are downloadable. But there is a psychological advantage to writing something down. It makes us instantly accountable for our actions. And if the records are kept in a format that is easy to analyze, they let us take a step back and see how things are going. In general, I find that people who keep written records are able to achieve better control than those who do not. Records should certainly include blood sugars, but they can also include factors that affect blood sugars, such as insulin, carbohydrates and physical activities. Many people find that blood-sugar-only records work fine until a problem is detected. Then, the more detailed records allow for effective troubleshooting.
• 6. Think Like a Pancreas.
  This is purely a nuts & bolts recommendation (and the title of my first book, in case you’re wondering). Your insulin program should match your needs as closely as possible. This is how we achieve blood sugars that are as close to target as possible, minimizing both the highs a