Dr Tejal Lathia, Consultant Endocrinologist, Hiranandani Hospital, talks about how to take care of children with type 1 diabetes mellitus. Caring for children with Type 1 DM is complex and challenging; there are great demands on the caretakers’ (parents, siblings, relatives) time who look to the healthcare personnel for support. This support provided by the healthcare personnel requires a multidisciplinary team (MDT) effort for best outcomes, namely a healthy and happy child.
Who are the members of this multidisciplinary team? The MDT comprises:
An Endocrinologist(hormone doctor)– She coordinates for the care of the child with the team, adjusting the Insulin requirements, screening for other hormone diseases that may occur in these children like Thyroid or Celiac Disease
Paediatrician/Physician (Internist) – to handle the day-to-day health needs and vaccinations
Nutritionist (food expert) – to teach carbohydrate counting, assess nutritional deficiencies and prescribe a healthy diet
Psychologist (mind doctor) – Type 1 DM is a disease which makes the child dependent on Insulin. This can cause a lot of stress for the family, the child especially in adolescence and needs frequent support from a Psychologist
Registered Nurse – for the administration of any vaccines and checking the site of Insulin administration for changes in the skin
Diabetes Educator (teacher) – an essential member of the team to revise Insulin administration techniques, the timing of Insulin, address queries on what is the disease, what are its effects as there is a lot of misinformation on the disease
Ophthalmologist (eye specialist) – for regular Retina (eye) check for the complications of Diabetes
Nephrologist (kidney specialist) – For regular Kidney evaluation and treatment, if needed
Parts of care: There are four main parts of the care of a child with Type 1 Diabetes
Home management: This comprises the food consumed at home, the calculation of doses of Insulin depending on the carbohydrate content of the food, the availability of glucose and the information about what to do in the event of a Hypoglycemia
School management: The logistics of Insulin administration at school in very young children, management of low sugars at school and attention to child during playtime to anticipate low sugars
Playground/ exercise management: Checking sugars before the start of play, snacks during long playtime to avoid low sugars and adequate hydration are few of the important things to emphasise upon
Sick day management: When a child is ill with fever, vomiting or diarrhoea, they often experience frequent fluctuations of sugars. Adequate knowledge of how to adjust Insulin, look for Ketones in urine, when to bring them to the hospital is needed, etc. is needed.
At diagnosis, frequent visits with the health care team will help the child and parent to learn the skills needed to manage Type 1 Diabetes Mellitus. As time goes by and they have mastered the skills, then quarterly appointments to check for the achievement of target blood sugars and evaluation of complications is required.