The goal for managing an IDDM patient is to ensure a physically and mentally healthy, and a socially productive individual. A diabetic child or youth has a right to enjoy life as much as a non-diabetic child and to be as much physically and mentally competent as others. Socially, the diabetic and his/her family need to make adjustments to each other. The family should be supportive but not overprotective. However, there should not be any rejection.
Most diabetic children / youth do not need calorie restriction and should be encouraged to have a balanced diet, supplying nutrients according to their physiological requirement. In fact, in some situations extra calories may be needed to provide for catch-up-growth or weight gain. The goals of dietary management, in IDDM, are mentioned below:
Goals of Dietary Management in IDDM
• Restore normal blood glucose and minimise hypoglycemic attacks, peaks of blood glucose and chronic complications.
• Optimal growth and development.
• Adequate nutrition for a pregnant lady, foetus and lactating mother.
• Consistency of meal pattern.
• Meal planning according to lifestyle and exercise timing.
Meal and insulin need to be adjusted according to the life pattern of the diabetic, rather than changing the life pattern, according to the insulin needs and food. In order to achieve and maintain good control, the diabetic must be independent of constant medical intervention as far as possible. He or she must learn several tasks requiring skills like handling insulin, testing blood / urine, making adjustments in insulin / food / activity. Therefore the diabetic should be motivated and educated in self-care skills.
Balancing Insulin Dose, Diet and Physical Activity
Normally, insulin secretion is proportionate to the body requirement. During fasting or low blood sugar, insulin secretion is proportionately reduced. When the sugar level further falls, stress hormones (adrenaline and glucagon) are released to raise the blood sugar level. Thus, these two hormones maintain a pull and push balance, thereby keeping the blood sugar at normal level.
In a diabetic, the normal balance of these hormones is disturbed. It is necessary to regulate the insulin requirement depending on the calorie intake, drug administered and physical activity in consultation with the attending doctor. Any indiscretion in diet, omission or delayed meals, unusual exertion and a combination of the above factors results in sudden fall in blood sugar.
Common Symptoms of Hypoglycemia
• Pangs of hunger
• Lack of mental concentration – confusion
• Uncoordinated movements
• Restlessness-emotional instability
• Headache-sinking feeling
• Fast breathing
Every recognition of hypoglycemic state is very important as it can be easily tackled. Such patients should immediately consume easily-digestible carbohydrate, such as sugar, glucose, toffees, fruit juice or biscuits followed by a substantial snack. Patients taking insulin are advised to carry sugar, toffees, glucose and candy for such emergencies.
If unrecognised early, hypoglycemia may result in unconsciousness. In such cases, the patient needs to be hospitalised and intravenous glucose has to be administered. The diabetic should always carry a diabetic card. Many a time it may so happen that symptoms of hypoglycemia may be mistaken for alcoholic intoxication.
Diabetic acidosis is due to severe insulin deficiency leading to elevated concentration of ketone bodies and sugar in the blood. Accumulation of ketone bodies, in the blood, has a toxic effect on the human body, leading to coma.
Warning Signals of Coma
Excessive thirst, excessive sweating, dry mouth, rapid deep breathing, drowsiness, vomiting, characteristic acetone breath, tremor, low blood pressure.
Unconsciousness and even death of a patient may result, unless effective measures are taken. Its treatment consists of:
• fluid and electrolyte replacement.
Diabetic coma needs to be treated in the hospital. In severe cases, fluid and electrolyte replacement is very essential to save life. As soon as the patient is fit enough to take fluid orally, fruit juices, tea, soup, gruel and broth should be started. This helps in replenishing depleted body fluid and salts (potassium and sodium). These fluids should be given very frequently for the first two days. Thereafter, a gradual intake of soft diet and finally normal diet according to individual requirement is recommended. At times, it is difficult to distinguish between signs and symptoms of hypoglycemic coma and diabetic acidosis. The physician should confirm before starting the treatment.
Whatever may be the cause of coma, prompt and effective treatment needs to be immediately initiated.