Optimal disposition of the parents at the high proportion of insulin and the low level of sugar in the blood when the child

SIGNS OF DIABETES

Normally

Our body needs energy to live like a car needs gasoline. This energy comes in part from glucose. Glucose is a sugar that circulates in the blood to be distributed throughout our body. Its quantity in the blood can be measured: it is the glycemia.

Blood sugar is under the control of insulin. Insulin is a substance made by the pancreas. It passes into the blood to regulate blood sugar.

In diabetes

In diabetes, the pancreas no longer produces enough insulin. In the absence of insulin, blood sugar rises: this is hyperglycemia. When blood sugar is too high, we have glycosuria, and sometimes ketosis (high ketonemia with ketonuria).

To lower blood sugar and ketosis, it is necessary to provide the insulin that the pancreas no longer produces.

HOW TO DISTRIBUTE THE DAILY INSULIN?

Glucose is present in many foods. The digestion of these foods releases the glucose which then crosses the wall of the intestine and passes into the blood. So after a meal, blood sugar rises.

Normally, outside of meals, blood sugar is 0.70 to 1 gram per liter (g/l). During a meal, the rise in blood sugar remains low (blood sugar does not exceed 1.50 g/l), and in 2 or 3 hours, it returns to its normal value of 0.70 to 1 g/l.

Insulin keeps blood sugar from rising too high.

Between meals, the pancreas releases a small amount of insulin into the blood. During a meal, when blood sugar rises, the pancreas delivers more insulin, which keeps blood sugar from rising too high and then brings it back down. So we need a little bit of insulin again.

In summary, at each meal, more insulin is needed to keep blood sugar levels from rising too high: in the morning at breakfast time; noon at lunch time; in the evening at dinner time. Between meals, and during the night, the need for insulin is low and regular.

To release insulin as needed, the pancreas constantly measures blood sugar.

In diabetes, the rhythm of life and insulin requirements are identical. For insulin to be effective, it must be given as needed: in small amounts between meals and at night, and in larger amounts with each meal.

To know what dose of insulin to take, you must monitor blood sugar

INSULINS

All insulins are made in the laboratory. There are two categories of insulin:

human insulin whose structure is identical to the insulin produced by the pancreas,

insulin analogues: their structure which has been slightly modified compared to human insulin, which gives them different modes of action (delay of action, duration of action, reproducibility). They are the most prescribed in children.

For treatment, insulin is available with different durations of action:

rapid-acting insulins,
long-acting insulins,
fixed insulin mixtures.
rapid-acting insulins

Rapid-acting insulin analogues

Their action begins after about 15 minutes and is absorbed just before the meal.

The peak of action occurs 30 to 90 minutes after the injection.

The duration of action is on average 3 hours, but this duration of action is variable (from 2 to 5 hours); the higher the dose, the longer the duration of action.

Long-acting insulins

Long-acting insulin analogues

These are clear solutions. Their duration of action is variable:

18 hours (long intermediate): Levemir® (Detemir). In this case, insulin is injected twice a day.

24 hours (slow): Lantus®, Toujeo® or Abasaglar® (Glargine). Most often, these long-acting insulins are injected once a day, at the same time every day.

42 hours (slow): Tresiba® (Deglutec). This long-acting insulin is injected once a day with more time flexibility than the previous ones.

NPH insulin (intermediate, rapid-acting insulin associated with a protein, Protamine)

NPH is a cloudy solution.

It is active approximately 1 hour after the injection, the peak of action occurs after 4 to 6 hours, it has a duration of action of approximately 12 hours.

It is used less and less in France.

Optimal solution in a child with diabetes who refuses to eat after insulin injection

Particularities of the first weeks

A few weeks after the onset of diabetes, blood glucose levels may be close to normal, or even below the target. This sometimes leads to a noticeable decrease in the amounts of insulin. This relatively calm and simple phase, more or less prolonged (a few days to a few weeks, sometimes a few months) is what is called the "honeymoon" period: insulin requirements have decreased to less than 0, 5 units/kg/day whereas initially they were more than double at the start of treatment, when insulin treatment was started in the hospital .

It even happens that one can temporarily stop, for a more or less short period, one of the fast or slow insulins (most often the fast insulin), but never completely the 2 insulins. However, it is preferable, even if insulin requirements are minimal, to maintain a very low dose of long-acting insulin.

Diabetes cannot be cured. It is not possible, today, to protect cells that are still functioning (for a fairly short time), before being destroyed in turn.

Types of Insulin Therapy

Treatment requires insulin throughout the day and night with greater requirements at mealtimes:

Insulins, called rapid, are absorbed at the time of meals containing carbohydrates, and submitted for 2 to 4 hours depending on the child. They make it possible to use the carbohydrates in the diet and to correct hyperglycaemia;

Insulins, called slow, are injected once or twice a day; they are said to be vital and necessary for the proper functioning of the body throughout the day and night. Slow-acting insulin should never be interrupted. They help maintain stable blood sugar levels between meals;

The medical team, in collaboration with you, can choose the most appropriate treatment according to your child's age and rhythm.

The choice is possible between:

Treatment with an external pump, especially when the child is young and of preschool age or less than 6 years old;

Or multiple insulin injections administered by means of a pen or syringes (rapid insulin associated with semi‐lente or long-acting insulins).

The honeymoon period in a child with diabetes Heney moon period

The young man tells us in his own words what "the honeymoon" is...

The honeymoon is a moment of more or less short duration when the pancreas works again. Thus, it is no longer necessary to receive insulin injections. David had the "impression of being cured" then fell back taking a "big slap".

Diabetes

Diabetes is a disease that prevents the body from properly using the energy provided by ingested food. In addition, the disease occurs when the pancreas no longer secretes insulin or when the body becomes resistant to the insulin produced.

In people with diabetes, a failure comes into play: the pancreas does not produce enough insulin to fulfill this mission. The glucose then remains in the blood and cannot pass into the cells. It therefore cannot supply energy to the muscles of the body.

Type 1 diabetes

Type 1 diabetes, or insulin-dependent diabetes, affects approximately 6% of diabetics, or 190,000 people. It is an autoimmune disease that often occurs during childhood or adolescence. It is characterized by the absence of insulin secretion by the pancreas.

The causes of the onset of the disease are still not clear. Some scientists believe that type 1 diabetes is a genetic disease that results in the attack of certain cells in the pancreas. Others believe that a virus could cause the disease and cause the immune system to attack the pancreas.

During the "honeymoon", the pancreas regains its original function which is not ensured when one suffers from diabetes.

Cilveducation

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