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Type 1 diabetes mellitus in children: care and points of attention for the family

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One of the main chronic diseases that affects children and adolescents is Type 1 Diabetes Mellitus. From an immune-mediated process, influenced by genetic and environmental factors, the beta cells present in the pancreas, responsible for insulin secretion, are gradually destroyed, resulting in total loss of function and dependence on exogenous insulin.

The onset of the clinical manifestation of the disease, with symptoms such as polyuria, polydipsia, hyperglycemia, polyphagia, weight loss, can occur at any age, including the first years of life. Faced with the diagnosis of Diabetes Mellitus and despite all existing technologies for the treatment of this condition, one of the greatest challenges and concerns of the family is the maintenance of glycemic control.

From this perspective, it is important for nurses to clarify all the necessary care for the family, for better adherence to treatment and promotion of quality of life, both during breastfeeding and older children.

Read too: Reviewing type 2 diabetes in children and adolescents: epidemiology and complications

diabetes children

Breastfeeding diabetic children

Calculating carbohydrate consumption for insulin dosing in infants and young children is a major challenge. This is due to the difficulty in measuring breast milk intake directly from the breast, as well as the variability of food acceptance at this stage.

Studies show considerable increases in the variation of carbohydrate concentrations in breast milk over the days of breastfeeding, being predominantly in the form of lactose, so that they reach an average of 70g/L of carbohydrate, that is 7g in 100ml of milk.

Compared to infant formula, the carbohydrate composition of breast milk is similar. However, the major difference is the higher fat content in breast milk, which is important in modulating the absorption of serum glucose levels. Thus, although not yet proven in scientific studies, a postprandial condition seems to be more favored in breast-fed infants than in infant formulas.

For infants who require insulin doses and who are fed on expressed breast milk, calculations considering the level of carbohydrate in 100 ml of breast milk can be used. On the other hand, for breastfed infants aged between 7 and 12 months, the estimated volume of milk production of 740 ml in a 24-hour period divided by the average number of feedings can be taken into account.

Despite the enormous challenge in quantifying carbohydrate consumption by breastfed babies, families must be informed about the evidence that breast milk is the gold standard food for all babies, including diabetics, favoring the development of brain white matter, and protecting them from possible brain damage caused by hyper and hypoglycemia. In addition, breast milk reduces the risk of infections, hospitalizations, obesity in adulthood and other chronic health conditions.

Other care for diabetic children

The child diagnosed with type 1 diabetes has an adapted care routine, through a differentiated diet, the use of insulin and lifestyle changes. In this context, it is important that the health team is present in an interdisciplinary way in order to guarantee the clinical and psychological care of the child, since he/she may have feelings of fear, insecurity and revolt to accept the adaptation.

From this perspective, nursing has the possibility to guide the family and the child through playful tools, such as the therapeutic toy (TP). This tool allows the health professional to establish a dialogue with the child, teaching the necessary care with games, such as blood glucose monitoring, insulin administration, diet and exercise, as well as stimulating bonding and expressing their emotions.

In addition, family participation is essential in order to help adherence to treatment. When young children are not able to take care of themselves and need caregivers to help with insulin administration and glycemic monitoring. Faced with this reality, an improvement in food adherence can also be observed when the family is involved in the change, not being an obligation only for the child, but a family readaptation.

In view of this, it is understood that the active participation of nursing professionals, the establishment of a bond and the continuous construction of health education based on individualized care according to each family nucleus guarantee greater adherence, understanding and care for the child.

To learn more about nursing care for diabetic children, access our app Nursebook. There you will find all pathophysiology, signs and symptoms, clinical management, nursing diagnoses and prescription, and much more!

Co-author: Nathalia Schuenque Cholbi – Pediatric Nurse

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# CVT Peril. Treatise of the specialist in maternal and child care with a focus on breastfeeding. Belo Horizonte: Mame well, 2019.

# Pennafort, Viviane Peixoto dos Santos et al. Instructional therapeutic toy in the culture care of the child with diabetes type 1. Revista Brasileira de Enfermagem [online]. 2018, v. 71, suppl 3 [Acessado 23 Junho 2022] , pp. 1334-1342. Available at: . ISSN 1984-0446. https://doi.org/10.1590/0034-7167-2017-0260.

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# Miller D, et al. ABM Clinical Protocol #27: Breastfeeding an Infant or Young Child with Insulin-Dependent Diabetes. BREASTFEEDING MEDICINE Volume 12, Number 2, 2017.

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