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Deborah Howell (Host): Hello, and welcome to the show. You are listening to the Weekly Dose of Wellness. It's brought to you by our friends at MemorialCare Healthsystem. I'm Deborah Howell. Today's guests are Dr. Mario Brakin, a board-certified pediatric endocrinologist and the Medical Director of the Endocrine and Diabetes Center at Miller Children's Hospital Long Beach. Trudy Bly is an RN and a certified diabetes educator at the Endocrine and Diabetes Center at Miller Children's. Welcome, Dr. Brakin and Trudy.

Dr. Mario Brakin (Guest): Thank you. Glad to be here.

Trudy Bly (Guest): Good morning.

Deborah: Glad to have you. Today, we're talking about American Diabetes Month. It's the whole month of November, a time to raise awareness about the immense impact of this disease. Just a couple of things. Diabetes is one of the most common chronic diseases in children and adolescents; 215,000 Americans younger than age 20 have diabetes, and most cases of diabetes among children and adolescents are type 1. Each year, more than 13,000 young people are diagnosed with type 1 diabetes. It is a huge problem, it's heartbreaking. So let's get right into it. First of all, what is diabetes?

Dr. Brakin: Diabetes is a condition characterized by high blood sugar, resulting from the body's inability to use the blood sugar for energy.

Deborah: Are there any signs parents should be looking for in their children?

Dr. Brakin: Yes. The warning signs that the parents should be looking for include increased thirst, frequent or nighttime urination, blurry vision, unusual fatigue, unexplained weight loss in spite of increased appetite, and dark skin around the neck or armpit.

Deborah: I haven't heard that last one.

Dr. Brakin: I'll give you a little more explanation on what that is maybe a little later, or I can do it now. It is a condition called acanthosis nigricans, and these are a darkened skin patches common in people whose body is not responding correctly to the insulin that they make in their pancreas, also called insulin-resistance. It's seen mostly in people that have pre-diabetes or type 2 diabetes.

Deborah: Thank you for that. What is the difference between type 1 and type 2?

Dr. Brakin: In type 1 diabetes, the pancreas no longer makes insulin. Therefore, blood sugar cannot enter the cells to be used for energy. Type 1 diabetes is usually diagnosed in children and young adults and was previously called juvenile onset diabetes. On the other hand, in type 2 diabetes, the body is unable to use insulin correctly or does not respond to it properly. It's also called insulin-resistant. Eventually, the pancreas does not make enough insulin. In both types of diabetes, blood sugar cannot get into the cells normally. In the past, type 2 diabetes was almost exclusively seen in adults. That is why it was called adult onset diabetes. But now, more children and teens are being diagnosed with type 2 diabetes, which is directly related to the rapidly increasing number of overweight children.

Deborah: That's just heartbreaking. What causes type 1 diabetes?

Dr. Brakin: Type 1 diabetes is an autoimmune disease. The immune system attacks the pancreas and destroys the cells that make insulin.

Deborah: How are we treating type 1 diabetes these days?

Dr. Brakin: The treatment and management of type 1 diabetes is composed of a sample of elements including insulin, nutrition, exercise, blood sugar monitoring, and emotional support/education. It is up to the child and the family to monitor blood sugar levels at least four times a day or more and appropriately administer multiple daily injections of insulin with either insulin pins or syringes or an insulin pump. The parents need to work closely with the healthcare team to determine which insulin or insulins are best for their child. In regards to nutrition, eating well is one of life's greatest pleasures. Having diabetes does not prevent your child from enjoying a wide variety of foods. People with diabetes have the same nutritional needs as anyone else. It is important for growing kids to get enough calories and nutrients for normal growth and development. The parents should learn how to prepare well-balanced meals in the correct amounts, read labels, and choose the so-called diabetes superfoods or healthy foods that are going to help more with the management of the blood sugar. Finally, exercise. Regardless of the type of diabetes that your child has, regular physical activities is important for his or her overall health and wellness. With type 1 diabetes, it is very important to balance the insulin doses with the food your child eats and the activity that he or she does. Planning ahead and knowing your child's body typical blood sugar response to exercise can help keep the blood sugar from going too low or too high.

Deborah: Right. That's type 1. Now, what causes type 2 diabetes?

Dr. Brakin: Type 2 diabetes is directly related to excessive weight gain and the obesity epidemic that affects not only adults but also children and adolescents. There are other risk factors that make you more prone to develop type 2 diabetes, like a positive family history of diabetes. If you belong to the following ethnic groups: African-Americans, Latinos, Asian-Americans, Pacific Islanders, and Native Americans. Also, physical inactivity. And, like I mentioned in the beginning, if your child has acanthosis nigricans or the darkened patches around the skin of the neck or armpit, they also are predisposed to develop type 2 diabetes.

Deborah: Can type 2 diabetes be prevented?

Dr. Brakin: Yes. There are things you can do to help prevent type 2 diabetes. Specifically, encourage a healthy lifestyle—active play, physical activity, as simply as walking the dog or mowing the lawn, eating healthy meals, low fat, nutrient-rich foods, like whole grain foods and breads, fruits, vegetables, dairy products, and lean protein. Try to limit a time for TV and video games to less than four hours a day. Drink less regular soda for drinks, juices, and drink more water instead. Finally, limit the fast foods and/or eat smaller portion sizes, what we call portion control.

Deborah: Okay. Doctor, I have one more question for you, and then we'll bring in Nurse Bly. My child has diabetes. What do I need to do to ensure their diabetes is managed correctly?

Dr. Brakin:   I want to mention that diabetes is a disease that affects the whole family, especially when a child is diagnosed with diabetes. Whether you're a parent, a sibling or a family member, your support and understanding can make all the difference in the management of this disease. And we all work as a team. You're not alone. We're all united in this, and maintaining close contact with the healthcare team is going to make the difference on how the child is going to do.

Deborah: Okay. Nurse Bly, as a parent, how can I help my child cope with diabetes?

Nurse Bly:   Well, I think one of the most important things that we do is we try to let them know that this is a lifestyle change. They're not sick. We're just changing their lifestyle. One of the biggest predictor, though, on how well children are going to do is if both parents are involved. Because if you have a dad who's not involved and a mom is, then they're giving the child conflicting information. The child gets confused. And then typically, they'll just stop managing their disease because they don't know which way to go, or they'll use one parent against the other. The other thing is not to make them just a diabetic. They're still the same child they were before they were diagnosed, but now they happen to have diabetes, which is just a little part of them.

Deborah: It doesn't define them.

Nurse Bly:   Yes. So when they come in from school, the first question on your mouth shouldn't be, "What was your blood sugar while you were at school?" It should be, "How was school?" Don't forget around to the diabetes part, but it's not their whole being.

Deborah: I have one last question. I'm sad that we are running out of time. We could talk for hours. Diabetes is a disease that affects the whole family, especially when a child is diagnosed. How can parents find support for themselves and for their child?

Nurse Bly:   Well, here at Miller Children's, we have two different programs. We have a program called SKWDS, Supporting Kids with Diabetes. It's a parent-driven group, and they put on events for kids because we know it's important to bring these families together so that they can meet each other and not feel like they're the only one. We also have a support group for children where they can come and get education and go through some of the emotional components of this disease. But by going on the web page, you can find different support groups. Try to stay on reputable websites such as American Diabetes Association, Children with Diabetes, juvenile. CDRS is another good website that they can go to. There's a lot of false information out there, so they just have to be careful of what information they're getting.

Deborah:   Thank you both so much, Dr. Brakin and Nurse Bly. It's been really wonderful to have both of you on the program today.

Dr. Brakin:   Sure. It was a pleasure.

Nurse Bly:   Thank you.

Deborah:   To listen to the podcast or for more information, please visit memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness, brought to you by MemorialCare Healthsystem. Have a fantastic and healthy day from all of us here. Normal 0 false false false EN-US X-NONE X-NONE

Deborah: To listen to the podcast or for more information, please visit memorialcare.org. I’m Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness, brought to you by MemorialCare Healthsystem. Have a fantastic and healthy day from all of us here.

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