The correct approach to diabetes from childhood is of great importance, since it will influence adult life.Complications in children are rarely chronic.When they occur, they are acute, such as ketoacidosis and hyperglycemia.Other complications related to diabetes such as psychological or social nature may also appear, which affect both the child and their family.
The presence or absence of complications in the type 1 diabetic adult show the degree of metabolic control that this patient had in his pediatric age.
The secondary complications to chronic hyperglycemia must be taken into account.The persistent increase in blood sugar causes blood vessels to be caught, so that it is increasingly difficult for blood to circulate to a given organ (eyes, kidney, etc.).This makes these organs stop working well.It is clear that those blood vessels that are narrow and small will be obstruct before and that is why the most precocious complications are microvascular, with eye or kidney involvement, for example.
They are called chronic complications because they are due to the presence of the disease for many years.Quantify after how many years the complications arise is difficult, it depends on each person and their metabolic control.Many studies have shown that the risk of suffering these problems increases with bad glycemic control, the long duration of the disease, an older age and a family history of diabetes complications.
Importance of control
Therefore, it is very important to try to maintain good glycemic control and avoid other added problems that will increase the possibility of future problems.But we must bear in mind that the person with diabetes will not be bad because they have high glycemia, but their blood vessels will be beginning to suffer.You have to prevent and avoid complication so as not to have symptoms later.
Among these complications, the diabetic retinopathy, which is ocular affectation and can lead to blindness.Current recommendations include evaluating the Fund annually in the adolescent after two years of evolution and after five years in prepubertal children.
Regarding nephropathy, we must know that renal failure can end up producing.The first sign is the presence of microalbuminuria, in other words, loss of protein by urine.It must be evaluated following the same frequency as diabetic retinopathy and is done by analyzing a urine sample.
For its part, diabetic neuropathy is nerve involvement and over time can cause leg pain, tingling sensation, muscle problems, etc.
When talking about macrovascular complications, you have to focus on the bad irrigation of blood on the legs mainly, myocardial and cerebral infarction.And it is that cardiovascular disease is the biggest cause of adult mortality with type 1 diabetes, although it is rare that it appears in young people.
Nutrition
When establishing control, it is very important to look at nutrition and food as an essential part of diabetes treatment.Diabetes food has always had a very restrictive approach in relation to carbohydrates, excluding foods containing sugars from the diet.Currently, it has not been found that the inclusion of sugars moderately in meals worsen metabolic control.The most important thing, therefore, is to maintain regular food habits and make a balanced diet.
A proper diet allows to maintain a better glycemic control, for this, it is necessary to have basic knowledge ofNutrition, so that the diet of people with diabetes is balanced and contains all the essential nutrients for life.It is very important to keep in mind that children's diabetes is insulin -dependent.
The diet must meet the needs of macro and micronutrients of the child, taking into account that it is in growth period and participate in its metabolic control.It must be very well coordinated with the pharmacological (insulin) treatment and physical exercise.Therefore, they must balance their consumption of carbohydrates with their insulin and activity levels to maintain their blood sugar levels under control.In addition, children with diabetes should consume food that can help them to keep blood lipid levels in a healthy range.
physical exercise
With respect to physical exercise, we must remember that caloric expenditure increases and helps maintain the right weight and cholesterol levels and triglycerides in normal range.Other figures that improve are those of blood pressure.The vasculature is also benefited by physical exercise.Therefore, international recommendations are to last at least 30 minutes of physical exercise.
Thus, it decreases insulin requirements as it improves sensitivity to it.The effect that occurs during exercise is that the body tends to use more glucose, the result being a decrease in sugar levels during physical activity.There is also a prolonged period that can last up to 24 hours.This is because during the year the liver glycogen reserve has been used.This reserve tends to fill after exercise, hence glycemia decreases.
The most advisable are aerobic exercises (cycling, footing, football ...) because they favor blood circulation and nutrition of all cells.For the exercise to be more effective, it is important that it be daily, of intensity and similar duration, and fun.It must be avoided if there is acetone in blood or urine, since ketone bodies would increase more.
avoid risks
There are two possibilities of having hypoglycemia associated with physical exercise.The first is to have a decrease during the physical exercise.The second possibility is to have a delayed hypoglycemia, which can occur from 4 to 24 hours after the physical activity has finished.
Recommendations to avoid hypoglycemia associated with exercise are planning in advance so that the fast action insulin can be eaten and administered from 1 to 2 hours before exercising.In this way, the dose of prior insulin can be reduced and inject it in a place that will not be very active during the exercise.Become glycemia controls before, during and after exercise.The appropriate values to start physical exercise are between 130 and 250 mg/dl.If blood glucose is below 130 mg/dl, something should be eaten before starting.If the blood glucose is greater than 250 mg/dl, a determination of ketone bodies should be made since if these are positive, exercise should not be performed.
If the exercise is prolonged between 30 and 45 minutes, something must be eaten during its realization.For every 30 minutes of intense exercise, 10 to 15 extra carbohydrates will be needed.The insulin dose must also be reduced after the exercise.In some cases the decrease can be up to 50% of the total dose.
To avoid hyperglycemia associated with exercise, it must be taken into account that it is due to the release of catecholamines, stress hormones, which in turn increase blood glucose.The effect ofThese hormones are short, between 60 and 90 minutes.Therefore, immediate posttejercio hyperglycemia should not be corrected.Another different situation is that glycemia increases during exercise due to lack of insulin.The glucose level will increase if exercise and insulin levels in the body are low.Muscle cells need more energy, which get burning glucose, but having enough insulin, glucose cannot enter cells and, therefore, the body acts as if there were not enough blood sugar and stimulates the liver forLet more sugar out of your reserve.This makes blood glucose levels increase more.The way to correct this problem would be injected insulin.
In the management of the child with diabetes, the role of nursing is basic for the necessary learning and to achieve the best metabolic control.Insulinotherapy, dietary regime, physical exercise, psychological support and diabetological education are the main aspects that these professionals provide.
An active and informed patient is the one who understands the disease process, knows what his daily responsibility in his self -care is, has the support of his environment.Nursing is a source of information, training and support.
For the elaboration of this article, the collaboration of the doctors specialized in primary care Angela Rodríguez Arrondo, Luis Carlos Sánchez de Ocaña Insausti, José Luis Gutiérrez Esteban, Gema González Carmona and Ainhoa Ugarte Goñi, of the Intxaurrondo Health Center;Sebastián Vallespir Bisquerra, Beatriz Laviada Pardo, Marga Rodríguez Valdespino, Teresa Adanez Elorza and Begoña Baranda Gómez, of the Health Center of Gros, both of San Sebastián;Specialists in General Medicine Rosario Martínez Fuerte, Mariano Egidado Martín, María Esther González Garrido, Enrique Sanz Monedero, Luis Manuel López Ballesteros and Elena Gutiérrez Martín, from Valladolid, and José Pablo Miramontes González, María Teresa Polo Rodríguez, Manuel Ramos Rodríguez, ManuelJosé Vicente and José Luis Pérez-Moneo García.
