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Pediatrics - Diabetes, Type 2 Treatment

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Treatment of Pre-Diabetes can return blood glucose levels back to normal and prevent or delay the onset of Type 2 Diabetes.  Treatment for Pre-Diabetes includes good nutrition, weight loss, and exercise.  Even a small amount of weight loss, 5-10% of the total body weight, can help.  Moderate exercise, such as walking, should be done for 30 minutes each day, five days per week.
Because people with Pre-Diabetes have an increased risk for heart disease or stroke, they should be screened and treated for high blood pressure and high cholesterol.  They should also quit smoking.  Not only can smoking raise blood glucose levels, but it can also contribute to heart disease, stroke, high blood pressure, and high cholesterol. 
There is no cure for Type 2 Diabetes, but it can be treated and managed.  Treatment can help stop the symptoms from happening.  Treatment may also prevent or delay the development of medical complications associated with diabetes.  Your doctor and health care team will teach you how to keep your child’s blood glucose levels as near to normal as possible with medication, nutrition, and exercise.
Purchasing diabetes care supplies can be confusing.  You should select the products that you are most comfortable with and that you will use.  The American Diabetes Association has an extensive list of diabetes care supplies in their Resource Guide.  The Resource Guide provides detailed information that allows you to compare the features of various products.  You should also talk to your health care professionals for product advice, demonstration, and trial.
You need to carefully follow your doctor’s instructions for monitoring your child’s blood glucose levels.  You will need to check your child’s blood glucose levels throughout the day.  To test your child’s blood glucose level, you will prick your child’s finger with a sharp needle or lancet.  Your child may test his or her own blood sugar when he or she is at an appropriate age.  Some newer monitoring devices allow a person to prick the forearm or other sites on the body, which may be less painful.  You will place a small amount of blood on a test strip.  A glucose monitor will display your child’s results. 
Blood glucose meters have advanced over the past 20 years.  They have become easier to use and there are many types to choose from.  Some meters are easier to use than others.  Most meters provide results in less than a minute.  Some of the newer meters display results in just five seconds.  “Talking” meters are helpful for people with visual impairments.  The talking meters provide verbal instructions and results.  Some of the units are available in Spanish and other languages.
You should take your time when deciding on a glucose meter.  You should select the one that you are the most comfortable with because you will be using it regularly.  When purchasing a blood glucose meter, you should check if your insurance company covers the meter and the care supplies, such as the test strips.  You should compare prices for items not covered by insurance. 
Your doctor will help you establish a schedule for checking your child’s blood glucose.  Make sure that you write down the time that you tested your child’s blood and the result.  Bring your logbook to each of your child’s doctor appointments.  It is recommended that you keep a written log even if your child’s glucose meter can store the results. 
Data management systems are an alternative for storing the results of your child’s glucose monitoring.  Data management systems are a convenience, but not a requirement.  You may keep your own records in a written log.  Some of the newer blood glucose meters have a built in data management system that can store the results of 500 blood glucose checks.  Data management systems vary.  They can record such variables as when you checked your child’s blood glucose, the type and dose of insulin used, and your child’s meals and exercise.
There are several things to consider if purchasing a data management system.  You should talk to your doctor to see if your unit is compatible with the doctor’s computer.  You should also ask your doctor what type of records he or she would like the data management system to track.  As always, try the equipment before you purchase it.  Data management systems can be expensive.

Additionally, some people with Type 2 Diabetes need to take medications to stimulate insulin production and to increase their body’s sensitivity to insulin.  There are many oral medications that are available and your doctor will discuss which may be best suited for your child.
Depending on the results of your child’s blood glucose test, or your child’s response to oral medications, you may need to inject your child with insulin.  The insulin will help lower your child’s blood glucose level.  Your doctor will let you know how much insulin to use.  It will depend on your child’s weight, what your child eats, and how active your child is.
There are different types of insulin that differ in onset, peak time, and duration.  Onset refers to how long it takes the insulin to reach the bloodstream and begin lowering the blood glucose level.  The peak time indicates when the insulin is at its maximum strength.  Insulin duration describes the length of time that the insulin works to lower blood glucose levels.  Some types of insulin may be used alone or with another type of insulin to be as effective as possible.  Additionally, there are new types of medications that enhance the way that insulin works.  Medications may require mixing or they may be purchased in a convenient premixed pen.  Ask your doctor about which medications are right for your child.
Before meal rapid-acting insulins should be injected 15 minutes before a meal.  These types of insulins work about 15 minutes after they are injected, peak in an hour, and continue to work for 2 to 4 hours.  Before meal rapid-acting insulins leave the bloodstream quickly and reduce the chance of hypoglycemia after meals.  After meal rapid-acting insulins are well-suited for children because it can be difficult to predict how many calories a child will eat prior to a meal.  After meal rapid-acting insulins are also useful for people with delayed stomach emptying.
Short or regular-acting insulins reach the bloodstream within 30 minutes after they are injected, peak in 2 to 3 hours, and continue to work for 3 to 6 hours.  Short acting insulin is often used with another type of insulin, intermediate-acting insulin.  Intermediate-acting insulins reach the bloodstream 2 to 4 hours after they are injected, peak 4 to 12 hours later, and continue to work for about 12 to 18 hours. 
Insulin can be administered in a variety of ways that are easy and relatively painless.  Insulin delivery methods include small needles, a pen, or a pump.  Needles are smaller than ever before and have special coatings that make injecting easy and nearly pain-free. 
An alternative to a syringe and needle is an insulin pen.  Insulin pens are convenient for active people or those with visual or coordination problems.  The pens contain accurate pre-measured doses of insulin.  The insulin is easy to deliver.  With the push of a button, a spring-loaded device quickly inserts the needle into your child’s skin and delivers the correct does of insulin.
An insulin pump is another type of insulin delivery method.  An insulin pump delivers insulin in a continuous steady dose and as a surge dose, at your direction, such as at mealtime.  The insulin is delivered in doses similar to the body’s normal release of insulin.  Some people find that this method helps to control their diabetes better.
An infuser may be used to reduce the number of daily injections.  An infuser or a portal is a catheter device that is placed into the skin.  Insulin injections are given into the infuser instead of the skin.  An infuser can remain in place for 48 to 72 hours.
Jet injectors deliver insulin without using needles.  Jet injectors force insulin through the skin with pressure.  In some cases, this method may cause bruising. 
The insulin pump is a small device that your child can wear on a belt or carry in a pocket.  Insulin travels through soft plastic tubes to a catheter that is placed in the skin.  Some insulin pumps allow the catheter to remain in place while only needles are removed.  The insulin pumps are computerized to deliver steady doses of insulin and surge doses, per your instructions.  You will need to check your child’s blood glucose levels more frequently than with other delivery methods.  However, many people prefer the pump because it allows them to have a more flexible lifestyle.  A new method of insulin delivery has recently been approved that allows people to spray insulin into their nostrils.  Ask your doctor if this is an appropriate treatment option for your child.
Every few months, you will need to have your doctor check your child’s blood glucose average with the A1C test.  The A1C test measures your child’s blood glucose level average for the course of about three months.  Your doctor will use this information to alter your child’s course of treatment, if necessary.
You will also need to test your child’s urine per the guidelines set by your doctor.  People with Type 2 Diabetes should test their urine for ketones when their blood glucose level is high.  Urine testing involves placing test strips in your urine sample and reading the results after a short period of time. 
Managing Type 2 Diabetes also includes a nutritional component.  Your doctor or a registered nutritionist can help you plan what your child should eat to help regulate his or her blood glucose levels, cholesterol, and blood pressure.  A balanced meal plan includes a wide variety of foods, particularly vegetables, whole grains, non-fat dairy products, beans, lean meats, poultry, and fish.  Your health care professional can help you learn to read nutrition labels, measure portion sizes, and plan balanced meals.
Exercise is another important element for managing Type 2 Diabetes.  Exercise may help to lower your child’s blood glucose level, blood pressure, and cholesterol.  It also may help your child’s body use insulin better.  Your child should strive for a combination of aerobic activity, strength training, and stretching.  Ideally your child should exercise aerobically for 30 minutes a day, five days per week.  Your child can break the time period into three ten minute segments throughout the day or exercise for the entire 30 minutes.  Aerobic exercise includes physical activities that work your heart, lungs, and vascular system, such as quick walking, riding a stationary bike, or running.
In addition to managing his or her blood sugar, eating smart, and exercising, your child should also maintain appropriate cholesterol and blood pressure levels.  It is also important for your child to not smoke.  Smoking increases blood sugar and can contribute to the development of medical complications.  It is important that your child take care of him or herself daily and keep all of his or her doctor appointments.  Type 2 Diabetes is a lifelong condition; however, people with Type 2 diabetes can live healthy, happy, and long lives with good care.

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