Juvenile Diabetes & Celiac Disease

 

JUVENILE DIABETES  

Diabetes - a chronic condition in which the body is unable to produce insulin and properly break down sugar (glucose) in the blood, requiring the administration of insulin by external means.

  • Diabetes affects 25.8 million people of all ages, 8.3% of the U.S. population. 

  • About 215,000 people younger than 20 years had diabetes - Type 1 or Type 2 - in the U.S. in 2010. 

  • Diabetes is the leading cause of kidney failure, non-traumatic lower limb amputation, and new cases of blindness among adults in the United States. 

  • Diabetes is a major cause of heart disease and stroke. 

  • Diabetes if the seventh leading cause of death in the United States. 

 

TYPE 1 DIABETES:

A vast majority of children diagnosed with diabetes have Type 1 or autoimmune diabetes. Type 1 is an autoimmune disease. The body of a person who develops Type 1 diabetes "turns against itself." It is extremely important to know there is absolutely nothing a person or child did to cause Type 1 diabetes. Nothing a person can control, like diet or exercise, can start or stop the progression of Type 1 diabetes and Type 1 diabetes is not family related - not genetic. 

 

The T cells (a type of blood cell that protects the body from infection) become confused and attack the body instead of protecting it. The T cells attack the pancreas' beta cells, located within the Islets of Langerhans (a group of specialized cells within the pancreas that make and secrete hormones). The beta cells produce insulin to help convert food into fuel. 

As the body develops autoimmunity and the T cells attack and damage/destroy the Islets of Langerhans cells, the body begins to lose its ability to process food into fuel. When these cells are damaged the body can no longer produce insulin and glucose is not stored properly in the body. Insulin is what the body uses to turn food (or glucose from food) into fuel to keep the body moving. Without insulin, the body doesn't receive the message that it's time to process the food. 

The affected person's blood sugar rises and they begin to urinate more often as the glucose forces the body to produce more urine. Increased loss of urine can cause dehydration, which the body senses as increased thirst.

As Type 1 diabetes progresses the insulin shortage becomes more severe; the body goes into starvation mode. Starvation mode causes the body to break down fat for energy, which causes a by-product called ketones to build up. Now a scary metabolic crisis can occur termed diabetic ketoacidosis or DKA.

 

DKA:

Shorthand for diabetic ketoacidosis, DKA is a serious and life-threatening condition in which the body is so deprived of insulin that the patient can lapse into a coma and even die.

Diabetic ketoacidosis is a condition in which the body is so deprived of insulin that it becomes desperate for fuel and begins breaking down fatty tissue and muscle. Ketones are the by-product of this process and the liver can only process a certain amount of ketones at a time. When the body produces too many ketones, they spill over into the bloodstream and, like an acid, basically poison the person.

TYPE 1 SIGNS AND SYMPTOMS:

After the autoimmunity begins and the Islet cells slowly begin to die, the child (or person) affected begins to show signs and symptoms that can add up to a diagnosis of Type 1 diabetes.

Obvious Signs:

First to Occur:

  • high frequency of urination

  • heavy or soaked through diapers on a consistent basis

  • older children visiting the restroom more often

  • bed wetting as a child or even teenager

Second to Occur: 

  • weight loss due to the body using stored fat as fuel

Less Obvious Signs: 

  • behavior changes that often accompany high blood sugar levels

  • excessive thirst or hunger

And Lastly: 

  • vomiting

  • stomach pains

  • rapid breathing

 

TYPE 1 DIABETES: COMMON MYTHS

False: If you feed your child right you wouldn't be dealing with Type 1 diabetes.

Truth: Nothing the parent, caregiver, or child did caused this autoimmune disease and there is nothing you could have done to stop it.

False: People with diabetes need to eat less sugar.

Truth: The realization is that all carbohydrates break down into glucose in the body. This means that "a carb is a carb is a carb." In today's Type 1 care, as long as you count the carbohydrates and match them with insulin, just about any food is acceptable.

False: A prevalent misconception is that diabetes is a controllable disease and once you've figured out insulin doses and cut back on sweets, it's not a big deal.

Truth: There is no such thing as "regulation" or "remission" when it comes to Type 1 diabetes. Because the body can never again produce its own insulin and injecting insulin is a rough art at best, children with Type 1 diabetes are watched vigilantly. Insulin is a treatment that keeps children alive but does not cure diabetes. 

 

TREATMENT FOR TYPE 1 DIABETES:

Type 1 diabetes has only one basic treatment option: replacement insulin therapy.

Diabetes MUST be diagnosed by a physician so the child receives the proper care and so that parents/caregivers can receive proper training.

 

TYPE 2 DIABETES:

Until recently Type 2 diabetes, formally know as adult onset diabetes, was thought to only affect adults. But in some cases children are also being diagnosed with Type 2 diabetes as well. 

Type 2 diabetes is highly familial or genetic. This type of diabetes begins with a genetic precursor.

In Type 2 diabetes the body can still produce insulin; however, the body has a hard time properly using that insulin. As Type 2 develops, the body begins to be unable to make the connection with the insulin available. The pancreas struggles putting out more and more insulin.  

Children experiencing the onset of Type 2 diabetes usually have a weight problem, even obesity. Although children experiencing constant high blood sugar, can lose weight it would follow a period of obesity. There are more occurrences of Type 2 diabetes in children, particularly obese and sedentary children.

Pediatricians are not on the lookout for Type 2 diabetes in children. Markers would include: 

  • family history

  • a child with body mass index over the 85th percentile

  • a child who is over the 120th percentile in weight for age

 

Children in these categories are being watched carefully and being counseled on how to avoid the disease.

A height/weight chart for male children can be found here .

A height/weight chart for female children can be found here .

 

While some studies show the number of children with Type 2 diabetes increasing they are still the minority when it comes to the total number of children with diabetes.

Children with Type 2 diabetes need to make lifestyle changes such as restrictions to their diet and a need for increased exercise. These changes can be hard for a child particularly if a parent or caregiver is not pushing or pushing too hard for it to happen.

Since Type 2 is tied to lifestyle, weight and activity levels, a child and their parents/caregivers can feel as if they had control in the onset. This can come with shame due to its connections - avoid lashing out against the child or parent.

 

TYPE 2 DIABETES: TREATMENT

There is good news for Type 2 diabetes sufferers. Type 2 diabetics are in a position to improve their situation. Step by step, Type 2 can be controlled.

Step 1: Diet

A good dietitian can help guide a child to a lifetime of healthful eating. A new eating plan can be difficult for children; adapting slowly is the best practice. A "cold turkey" type of diet rarely works for anyone.

Step 2: Exercise

Incorporate more exercise into the child's lifestyle, making exercise fun for the whole group so the child will want to participate instead of feeling singled out like it's "work." Limit TV, video, and sedentary activities. Parents should consult a physician on appropriate amounts of exercise and how to gradually increase the amount and intensity.

Step 3: Medication

Pharmaceutical companies are extremely motivated to find Type 2 medications that work. Type 2 medications are modernizing more quickly than Type 1 medications. This may be an option for the child but that is a decision for the physician, parent and child (if appropriate) to make together.

 

TYPE 1 VS. TYPE 2  

  • 90% of patients in all age ranges have Type 2 diabetes. 

  • Type 2 is a metabolic disease; Type 1 is an autoimmune disease. 

  • Type 2 produces insulin, but the body has a hard time using it properly and sometimes does not produce enough; Type 1 produces no insulin and never will. 

  • Type 2 can somewhat improve, Type 1 cannot improve. 

  • There is no connection between Type 1 and Type 2 diabetes running together in a family. 

  • In the world of diabetes, Type 2 sufferers are the vast majority, but in the world of children and diabetes, Type 1 is the most prominent. 

 

Since diabetes is a serious illness and needs to be monitored by physicians, Mid Michigan Child Care Food Program suggests that any sort of diet for diabetes sufferers be prescribed by physicians or dietitians. Please take the health and safety of the children in your care seriously and follow the physician's instructions.

 

Resources: The Everything Parent's Guide to Children with Juvenile Diabetes by Moira McCarthy with Technical Review by Jake Kushner, M.D. 

Celiac Disease

Celiac disease is a condition in which consuming gluten (a protein found in wheat, rye, barley, and some other grains) leads, in susceptible people, to damage of the lining of the small intestine, resulting in the inability to properly absorb nutrients into the body. 

As many as 3.3 million people in the United States and Canada have celiac disease. 

Knowing What Causes Celiac Disease

In order to develop celiac disease, several factors must be present. Some of these factors are present from the time of conception and several play a role later on in the process. Here are those key factors: 

  • Genes that put you at risk: In order for you to develop celiac disease, you must have something in your genes that puts you at risk of celiac disease. Without these "at risk" genes, your risk of getting celiac disease is almost nonexistent. 

  • A problem with your immune system: To get celiac disease, a specific problem within the immune system has to develop in which after you ingest certain types of grain proteins (gluten), your body's immune system behaves abnormally, including making antibodies against some of your own tissues. For this reason, celiac disease is classified as an autoimmune disease, meaning that the immune system attacks one's own body. 

  • Ingestion of gluten: Only the glutens found in some types of grains (including wheat, rye, and barley), when ingested, trigger the abormal immune response present in celiac disease. If a person has never eaten gluten, they could never get celiac disease. This connection between gluten and celiac disease is why celiac disease is treated with a diet that does not contain gluten, the so-called gluten-free diet. 

  • Increased uptake of gluten by the small intestine: If you have celiac disease, a larger amount than normal of gluten gets taken up by the small intestine and absorbed into the body. The extra amount of gluten increases the abnormal immune response to gluten that is mentioned previously in the list. 

  • A damaged small intestine: This results from the abnormal immune response to gluten and is the characteristic underlying feature of celiac disease. 

 

Diagnosing Celiac Disease:

Celiac disease affects about one percent of the North American population, although only a small fraction of this group has actualy been diagnosed with celiac disease. A key reason that so many people with celiac disease are undiagnosed is that symptoms of celiac disease frequently occur with other more common ailments. 

Classical celiac disease is associated with gastrointestinal symptoms such as abdominal bloating and discomfort, diarrhea and weight loss, flatulence, reflux, abdominal cramping, and indigestion. 

Atypical celiac disease has few, if any, gastrointestional symptoms. Diagnosis is usually determined due to symptoms present due to complications from celiac disease. Examples include: rashes; mood, thinking and neurological disorders; feeling fatigued; anemia; hormonal problems; musculoskeletal problems; and canker sores. 

Silent celiac disease and latent celiac disease do not have symptoms or cause any symptoms.

 

In the past, most children diagnosed with celiac disease had the classical form with the main symptoms being gastrointestinal in nature. Today, increasing numbers of children are diagnosed with atypical celiac disease with few or no gastrointestinal symptoms, the main or only features instead being impaired development or growth.  

Classical celiac disease can occur in adults, but more typically begins in early childhood. It is characterized by symptoms that arise directly from damage to the small intestine. The affected person has abdominal bloating, discomfort, and diarrhea. Also, because the damaged bowel becomes unable to properly absorb nutrients into the body (a condition called malabsorption), the individual with classical celiac disease starts to break down some of his or her own tissues to provide nutrients to supply energy for the body's normal functioning. This leads to loss of muscle mass and weight loss. 

In children, the malabsorption that is present means there are insufficient nutrients present to allow for proper weight gain, growth and physical maturation (a condition called failure to thrive). In particularly severe cases, a child's bones may not develop properly, leading to bowing of their legs.

A child who is failing to thrive will have stopped growing and developing at the rate of his or her siblings or peers. The child may also be less energetic, less able to concentrate and less socially engaged. These symptoms improve when the child is on track with a gluten-free diet.

 

Gluten:

Almost everything humans eat is made from various types of proteins, carbohydrates, and fats. When considering celiac disease, the most important of these nutrients to know about is a protein called gluten. Gluten is the general name for the various storage proteins found in grains. Ingesting gluten triggers celiac disease and thus, gluten needs to be avoided if you have this condition. 

Gluten is found in many different types of foods and is also found in many commercial products (even including some medicines). Until not too long ago, it was very difficult to know if something did or did not contain gluten, but today food and food product labels typically reveal this information. Food labels don't always indicate whether a food or product contains gluten, however. 

These foods typically contain gluten: 

  • breads and other baked products

  • cereals

  • pasta

  • prepared meats (hot dogs, hamburgers, deli meats)

  • preapred soups

  • salad dressings

  • snack foods and chocolate bars

  • bulgur

  • couscous

  • durum

  • einkorn

  • emmer

  • farina

  • farro

  • kamut

  • semolina

  • spelt (dinkel)

  • triticale 

 

A Gluten-Free Diet 

The key to successfully treating celiac disease is changing the diet. Because consuming gluten is what triggers celiac disease in predisposed individuals, the treatment relies on eliminating - not just reducing - gluten from the diet.

The first rule of thumb in going gluten-free is giving up foods that come in cans, boxes, jars and other packages. Eating naturally gluten-free foods such as fruits, vegetables, legumes, nuts, meat, poultry, fish, seafood, dairy products and certain grains such as rice and (pure) oats will ensure you are not inadvertently consuming gluten. 

If you're going to shop successfully for gluten-free foods, you need to know which foods contain gluten and which do not. Rice, corn, pure oats, soy, millett, teff, sorghum, buckwheat, quinoa, and amarath do not contain gluten. These grains can be used to make flours which are helpful when baking gluten-free.

When you have to purchase foods that come in cans, jars, packets, and boxes, learning how to read the list of ingredients on the food label is crucial in determining whether the product contains gluten.

Here is a list of certain common, gluten-containing ingredients found in prepared foods. Avoid foods with these ingredients: 

  • Barley malt, malt extract, malt syrup and malt vinegar. These malt-based products all contain gluten as they are derived from barley. 

  • Soy sauce is manufactured from wheat. 

  • Modified food starch if it is derived from wheat. Modified food starch made from corn, rice, potato or tapioca is safe to consume. If the label simply says "starch" (rather than "modified food starch"), then that food starch is cornstarch and is allowed. Other sources of starches must be identified in North America. 

  • Products that do not specify their content. Items such as packaged flavorings or seasonings may contain flour and other gluten-containing products such as malt or soy sauce and thus should be avoided. 

  • Maltodextrin - This can be derived from wheat. Safe dextrin sources include dextrose from corn and dextrans from corn or potato starch. 

 

Cooking gluten-free isn't easy, but very doable. Here are key elements and some tips to help you succeed with gluten-free cooking: 

  • Almost all meat, poultry, fish, seafood, egg, vegetables, potato and rice dishes can be made without adding any gluten-containing ingredients. 

  • Avoid flour as a thickener and instead, substitute a gluten-free item such as cornstarch, tapioca starch or when the dish calls for it, cream or butter.  

  • Substitute gluten-free pasta for classical family favorites like macaroni and cheese or lasagna. 

  • Leave out the croutons in salads and instead use nuts, sunflower seeds or gluten-free croutons to add crunchy and tasty items. 

  • Make your own salad dressings using various oils and vinegars along with salt, pepper, mustard powder and herbs. 

  • If a dish calls for breadcrumbs, omit them or substitute gluten-free crackers or breadcrumbs. 

  • A nut-butter sugar crust for a cheesecake base is a very tasty substitute for a graham cracker crust.

 

When it comes to successfully navigating restaurant foods, bear in mind the following: 

  • Avoid fast food. Fast food restaurants which are often life savers for busy families, are generally off limits for those with celiac disease. The problem is that many of their staples including hamburgers, chicken nuggets, seasoned French fries, pizza, hot dogs and the like, contain gluten.

  • Pick the right restaurant. In general, restaurants that are more expensive or are very small are more likely to be able to prepare custom meals from scratch that are free of gluten. 

  • Look for high quality cuts of meat and fish. Dishes prepared with higher quality cuts of meat or fish and that use ingredients such as cream and butter are more likely to be gluten-free. 

  • Pay special attention to the side dishes. Even if you've ordered a gluten-free food item, an accompaniment such as a bread roll may contain gluten. 

 

Here are some gluten-free foods to look for when scanning a restaurant menu for suitable foods: 

  • natural broths

  • cornstarch thickened gravies and sauces

  • vinegrette salad dressings

  • tortillas made from all corn grains

  • desserts such as creme brule, sorbet and sherbert

 

These are settings in which cross-contamination may occur: 

  • during food processing in manufacturing plants

  • stores with bulk food bins

  • re-use of frying oil that was previously used for frying gluten-containing foods such as breaded or battered foods

  • sharing knives

  • using toasters and cutting boards for both gluten-containing foods and gluten-free foods

  • grilling surfaces

 

Hidden sources of gluten:

  • prescription medications

  • over-the-counter medications

  • bakeries

  • communion wafers

  • lipstick

  • postage stamps and envelope labels

  • play dough 

 

Since celiac disease is a serious illness and needs to be monitored by physicians, Mid Michigan Child Care Food Program suggests that any sort of diet for sufferers be prescribed by physicians or dietitians. Please take the health and safety of the children in your care seriously and follow the physician's instructions. 

Resources: Celiac Disease for Dummies. Ian Blumer, MD & Sheila Crowe, MD. Copyright 2010. Published by John Wiley and Sons Canada, Ltd.  

To receive a certificate of training hours you must complete a quiz based on the material above. You are required to get all questions correct. If you do not get 100% on the quiz the first time, you may take it over again. The results of the quiz will be emailed to Mid Michigan Child Care Food Program. When we receive the results of your quiz, a certificate of training completed will pop up that you can print. A copy of the certificate will also be emailed to you. 

Juvenile Diabetes & Celiac Disease Quiz

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