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2. Nutrition & Type I Diabetes Goals of therapy Type I diabetes: Promote normal growth & development Encourage good nutrition Prevent (minimize) complications Maintain near-normal blood glucose levels Preprandial BG goals – Infants and toddlers: 100-180 mg/dL – Children: 90-180 mg/dL 2

3. Delegation of Responsibilities Functionally able to do things long before cognitive understanding. Length of teaching sessions based on developmental age Learning theory 3

4. Developmental Issues: Infancy High caregiver responsibility Growing brain is greedy: wants glucose!! 4

5. Toddler Inconsistent dietary intake Give choices when possible Rituals and routines 5

6. Developmental Issues: preschooler Understands simple explanations Play therapy More predictable appetite Learn to identify CMs hypoglycemia – Avoid calling results “bad” High energy activities 6

7. Developmental Issues: School-age Dislike being “different” School personnel – fingersticks Less parental control Field trips, parties, athletic events Eating habits more predictable; more independent Present oriented 7

8. Developmental Issues: Adolescent Challenge: growth spurt & blood sugar Body image, peer group acceptance Risk-taking behaviors Control shifting to adolescent Not motivated by future complications 8

9. Type 2 Diabetes Increased incidence in children Metabolic syndrome (insulin-resistance syndrome) = high risk factor Sedentary lifestyle Overeat Family hx of diabetes Metformin: only oral agent approved for children 9

10. Exercise Exercise  decreased insulin need r/t insulin more efficient Avoid active exercise when insulin peaking Maintain proper hydration Watch for hypoglycemia after exercise Avoid exercise if insulin level is too low 10

11. Exercise McKinney: 15-30 Gm carb for each 45-60 min of exercise Check BG before, during & after Be prepared w/additional carbs –  BG up to 2 hours after exercise Coaches & teammates 11

12. “Honeymoon Period” After new dx, 10-20% beta cells function for a time ( ucsfhealth.org) Less insulin required Potential denial of disease 12