Support Persons

carer-01

Working together to care for children with type 1 diabetes

Support persons include anyone, other than parents, who look after a child with type 1 diabetes. Such as:

  • Sports Coaches
  • Before and After School Carers
  • Babysitters
  • Grandparents
  • Aunts and Uncles
  • Friends

Children with diabetes should be able to participate in all activities along with other children, however there are important things as a carer that you need to know.

Diabetes - What you need to know

A basic understanding of diabetes and its management is important for you to feel confident in looking after the child with type 1 diabetes and for the parent to be comfortable leaving their child in your care.

 Even if you know a little bit about diabetes, always listen to the child’s parents – they know their child and their child’s diabetes best. Although the child may have had diabetes for some time, they always require adult supervision.



What is diabetes?

Type 1 diabetes occurs when the pancreas is unable to make enough insulin. Insulin is a hormone that acts as a key to let glucose from the food we eat pass from the blood stream into the cells to provide energy. Type 1 diabetes is usually diagnosed during childhood or young adulthood, but can occur at any age.

What causes type 1 diabetes?

Some people carry genes which might make them more likely to get type 1 diabetes. However, it only develops in these people when something triggers the immune system to destroy the insulin producing cells in the pancreas. These triggers are thought to be factors in the environment, but as yet are not well understood.

Type 1 diabetes is not related to lifestyle or caused by eating too many sweets. It’s not possible to catch diabetes from somebody else.

How is type 1 diabetes treated?

  • Replacing insulin by injection several times a day or by insulin pump
  • Testing blood glucose levels (BGLs) several times a day
  • Following a healthy eating plan, including regular consumption of carbohydrate containing food
  • Being physically active
  • Having regular medical check ups with the diabetes team

Giving Insulin

Insulin may be given by injection via a syringe, pen or insulin pump. Insulin is really important and should not be missed. Parents may plan for the child not to need any injections while they are in your care, or they may organise for the child to give their own insulin, if they are able.

The child must have the right insulin, in the right dose, at the right time and eat soon after their insulin injection. You may be asked to supervise the child giving their insulin, in which case simple instructions from the child’s parents are important for guidance.

Testing BGLs

Testing BGLs is an important part of diabetes care that can help parents plan the day to day management of their child’s diabetes. Even if the child with diabetes knows how to test, it is helpful for carers to also know how to perform a blood glucose test. If you are prepared to assist, the child’s parents can show you how to use the blood glucose meter and carry out the test.

If you agree to assist with blood glucose testing, make sure you wash your hands and take care with sharps. For infection control, testing should only be carried out on the child with diabetes not on anyone else.

The child with diabetes may need to carry out blood glucose tests at the following times:

  • If you or the child suspects that their BGL is too low (see hypos)
  • If the child is feeling unwell
  • Before, during and after exercise
  • Before meals

The child’s parents will advise you about their child’s BGLs, and in what situations they may need to be contacted.

Hypos

Hypoglycaemia (low BGL or hypo) occurs when the BGL drops to less than 4mmol/L or when hypo symptoms are being experienced at a level close to 4mmol/L.

What causes a hypo?

  • Being physically active (sport, excitement, play etc)
  • Delaying or missing meals or snacks
  • Not eating enough carbohydrate
  • Having too much insulin

What are the symptoms of a hypo?

  • Headache
  • Looking pale
  • Sweating
  • Being irritable
  • Trembling
  • Feeling hungry
  • Crying
  • Feeling or acting confused
  • Any behaviour out of character for the child
Young children may not say “I’m having a hypo”, they may use other words like – “I feel funny”, “I feel wobbly”, “I’m tired”. BGLs less than 4mmol/L should be treated even when there are no symptoms. If in doubt, do not waste time doing a blood glucose test.

Mild – Moderate Hypo Treatment

If the child is conscious and has a BGL less than 4mmol/L, take the following steps: Give any one of the following (you may need to coax the child to eat or drink):
  • ½ can of soft drink (not diet or low joule)
  • ½ small glass of juice or small tetra pack
  • 2-3 teaspoons honey or sugar
  • 5-7 jelly beans
  • Glucose tablets equivalent to 10-15 grams

Symptoms usually disappear after 10-15 minutes, however if the BGL remains low and symptoms are still present, repeat the treatment and stay with the child.

A child having a hypo should never be left alone.

Follow up with extra carbohydrate food, such as fruit, a sandwich or biscuits. If a hypo occurs just before a scheduled meal or snack, follow with that meal or snack.

Following a hypo, you may find that the child is not able to rejoin the activity immediately. It can sometimes take longer than 15 minutes to completely recover from the hypo.

Severe Hypo Treatment

If the child has a fit, is unconscious or unable to take anything by mouth, get emergency help fast!
  • Do not attempt to give anything by mouth
  • Lie the child on their side, in the recovery/coma position
  • Call the ambulance (dial 000) OR
  • Stay with the child until help arrives
  • Contact the child’s parents immediately

A Hypo Kit

It’s important that parents provide a hypo kit (eg. juice and biscuits) and that the child carries it with them at all times. Parents should make sure that the hypo kit is well stocked and replenished regularly.

High BGLs

Sometimes BGLs can go too high. This can be when the child is:

  • Sick or unwell
  • Stressed, worried or excited
  • Less active than usual
  • Eating more than usual
  • Doesn't have enough insulin in their body (e.g. they forgot their insulin injection or didn't get the right dose)

Sometimes high BGLs happen for no reason at all.

If the child’s BGL is above 15mmol/L and they’re feeling OK, they can join in all activities, but really active sports are not recommended. They should drink plenty of water and do another test if they're not feeling well.

If the child’s BGL is above 15mmol/L and they're feeling sick, they might have ketones, which means that their diabetes is out of balance. High BGLs and ketones can make them really unwell, give them stomach pains, make them thirsty and want to go to the toilet a lot. In this situation, it’s important to contact the child’s parents for advice.

If the child starts vomiting, seek advice immediately.

Food

There is no special “diabetic diet” for children with diabetes, despite what many people think.

A child with diabetes in your care should be encouraged to have the same healthy food choices as recommended for all children.

Regular meals and snacks containing carbohydrate (eg. fruit and fruit juice, breads and cereals, milk and yoghurt, pasta, rice, potatoes, biscuits) may need to be included every 2-3 hours depending on the child’s insulin plan.

Children with diabetes should also be included in parties and special occasions when in care. Parents should be alerted to any activities outside the normal routine that may affect food intake, meal times etc. It’s a good idea to discuss the child’s individual needs with the parents.

Physical Activity

All children, including those with diabetes should be encouraged to be active. In children with diabetes, physical activity can have varying affects on BGLs.

Physical activity usually lowers BGLs by helping insulin to work better. Sometimes physical activity can cause BGLs to be high, usually from stress or excitement.

It can affect children differently, so it’s a good idea to discuss any planned activity or changes to regular activities with the parents, as this may require them to make adjustments to the insulin dose.

During physical activity, the child with diabetes may have to:

  • Test BGLs before, during and after physical activity
  • Eat extra carbohydrate containing foods before, during and after physical activity (one additional serve of carbohydrate may be needed for every 30 minutes of exercise)
  • Stop to treat a hypo or low BGL
  • Take time out to recover from a hypo (this may take longer than 15 minutes)
  • Watch for signs and symptoms of delayed hypos - hypos can still occur up to 16 hours after physical activity

It’s important for children with diabetes to join in all activities with other children, however, it’s vital that their additional needs are taken into consideration.

When To Seek Advice

  • If the child has a severe hypo
  • If the child’s BGL is above 15mmol/L and they are sick
  • If the child starts vomiting
  • If you are at all worried about the child with diabetes

Diabetes Education

Parents should provide sufficient information on their child’s diabetes management. Should you feel that you require further information, contact Diabetes NSW or Diabetes Australia in your state or territory.

Further information about diabetes can be found here.