Diabetes is a disease that doesn’t just affect one person, it affects the entire family as well. Parents are likely to dedicate a lot of their time to a child’s diabetes care, but siblings without diabetes are also impacted. Brothers or sisters may watch their sibling struggle with managing diabetes and want to help, but they may not know exactly how to do so. Debbie Butler, M.S.W., L.I.C.S.W., C.D.E. and Associate Director of the Pediatric Programs at Joslin Diabetes Center, provides some useful tips for both children and parents on how siblings can show their support for a brother or sister with diabetes.

For Brothers and Sisters

Communication and patience are two ways to encourage a sibling with diabetes. Particularly in the first year of being diagnosed with diabetes, children may struggle with adjusting to a new lifestyle. It’s important for siblings to take time to learn what diabetes is, and how their brother or sister will manage it. Fortunately, even young children can learn in very basic terms why their sibling needs to check his or her blood sugar and take insulin to keep their body healthy.

“Sometimes it may be helpful to have a doll or stuffed animal in the house too that has diabetes that the sibling can play with,” says Debbie. There is now even a diabetes kit for American Girl dolls that can be used to explain diabetes and help siblings relate.

Another way that siblings can get involved in a brother or sister’s diabetes care is by learning what high or low blood glucose symptoms are, and then alerting an adult in charge if they see any of these symptoms. Siblings can also help with other daily tasks. “Younger siblings can help a parent by grabbing the meter when it’s time to check or a juice box to treat a low blood glucose,” recommends Debbie. This way the siblings can feel like a participant and as though they achieved something. If a sibling is older, they can learn how to check a brother or sister’s blood sugar and administer insulin.

For Parents

Parents can set an example of how to assist or comfort a brother or sister with diabetes.  For activities where a child with diabetes might feel left out, such as at a birthday party or on Halloween, Debbie advocates for parents keeping the same rules and traditions for their children with and without diabetes. For example, if the parents offer to buy back Halloween candy, they should buy it back from the other siblings without diabetes as well. Or if the child with diabetes can only have one piece of candy after their dinner, then that should be the standard for all members of the family.

A parent should be aware of their other children’s feelings. “Most children get jealous when they think that their parents are giving their sibling extra attention,” comments Debbie. “This definitely happens in the first year that a child is diagnosed with diabetes and every time the child with diabetes needs to check a blood sugar, take insulin, check their CGM, etc.” Debbie suggests that parents try to acknowledge those feelings and saying something simple like “That must be so hard,” instead of telling the sibling not to feel that way.

Parents might also consider setting aside special time for siblings who feel left out. This may sound simple, but is not always easy. One idea to try may be spending 30 minutes a week together or doing one special activity alone with each parent every month. This schedule can be followed through for every child in the house, and makes all siblings feel included in their parents’ attention and care.

For children with diabetes, learning to manage the disease is both challenging and demanding. It is difficult to return to normalcy in the beginning, and a child may be confused and frustrated. But support from their family will go a long way for children with diabetes. Whether siblings assist with simple diabetes care tasks or are just emotionally supportive, their encouragement will help in both the physical and mental care of a child with diabetes.

For more information on how to help siblings understand a brother or sister’s diabetes, visit our Child Life Services page. For questions related to your child’s diabetes or to make an appointment, contact our Pediatric Clinic at 617-732-2603.

  by Stephanie M. McPherson, science writer and video producer for Joslin

I’m all about fall. When the air chills and pumpkins adorn doorsteps, my tastebuds turn to cravings for caramel apples, pumpkin seeds, and cider donuts. With such a short window to celebrate this season, I try to cram as many of these treats in while I still have time.

But since I started working at Joslin, I’ve become acutely aware of nutrition and calories. So this year I decided to find out—What exactly am I eating? How many calories do those crunchy seeds have? How many carbs am I consuming in that delectable donut?

Pumpkin seeds pack a lot into their small husks. Full of good things like anti-oxidants, vitamin E, protein, potassium and magnesium, they’re also fairly high in calories, coming in at a little more than 700 per cup. But don’t let this high number dissuade you. With everything else they’ve got going for them, a smaller serving more along the lines of 2 tablespoons (100 calories) will satisfy you.

To make this classic fall snack, I put all the pumpkin innards from Jack-o-Lanterns aside (I usually carve at least two per year, so I have plenty of supply!) in a big bowl with water. Most of the seeds will float to the top. Scoop them out, give them another good rinse, and either lay them out overnight to dry fully, or pat them dry with paper towels.

Preheat the oven to 350 degrees. Spread the seeds on a baking sheet and dress lightly with extra virgin olive oil. Sprinkle with salt. I like to add some cinnamon or cayenne pepper (or both!) for extra spice. Put in the oven for about 20 minutes, or until seeds are golden brown and crunchy. I like to put handfuls of them in plastic bags to bring to work for snacks. These also make a great topping for pumpkin chili.

Nutrition Information for 1 ounce of roasted pumpkin seeds: 163 calories, 8.5g protein, 13.9g fat, 1.8g fiber and 4.7g carb

Caramel apples are the fall treat I look forward to the most. I’m a traditional girl—I don’t need my caramel apples dressed up with candy or nuts. As delicious as they are, and as healthy as their base may be, I figured that draping an apple in sheath of caramel can’t be good for you.

And I wasn’t wrong. One medium to large apple on its own comes in around 100 calories. The caramel covering contributes about 120 to 150 to that, depending on how much caramel you use, or if you opt for those pre-rolled caramel sheets. Overall, the grand total comes to around 250 calories. Add some sprinkles or crushed nuts and you’re looking at another 40 to 100 calories, respectively.

Caramel is made by heating a sugar mixture over high heat for a long time. So the major problem with caramel apples, of course, is the carb content. Between the 20 and 30 grams of carb per serving from the coating alone and the approximately 20 grams of carb in an average apple, this treat can be tricky for people with diabetes. Instead of a full-fledged caramel apple, you can snack on a few apple slices in fat-free caramel dipping sauce. You can get this snack at Sonic for 100 calories and 25 grams of carb (when you substract the fiber).

Nutrition Information for 1 medium-large caramel apple, no toppings: approx.250 calories, 4g fat, 4g fiber and 40-50g carbohydrates.

It’s not Halloween without Dirt Cake, that visually disgusting but quite delicious mash-up of pudding, Oreos, gummy worms, cream cheese and whipped cream. I almost didn’t want to investigate the contents of this nutritional disaster for, as they say, ignorance is bliss.

But here it is. There are variations on the theme, of course, with different recipes calling for differing ingredient amounts. So depending on which recipe you go by, one serving of dirt cake will set you back between 500 and 800 calories, using full-fat ingredients.

One website managed to get it down to 318 calories by using lighter versions of each ingredient, which is still higher in calories than many of us would like. So if you truly must consume dirt cake, stick with a half serving (most recipes will tell you what fraction of the whole equals one serving).

Nutrition Information for 1 serving (1/12 of a whole) of dirt cake: 509 calories, 31g fat, 29mg cholesterol, 478mg sodium, 53g carb, 1g fiber, 5g protein.

I refuse to go through September without purchasing some orchard fresh Apple Cider. Mass.gov notes that cider differs from plain juice in that it’s unsweetened and unfiltered, making it slightly more nutritious than apple juice.

Cider contains potassium, iron, and pectin (which is linked to lower cholesterol levels). An 8-ounce glass has about 120 calories, so keep it to one serving at a time.

Nutrition Information for 1 8-oz glass of apple cider:  120 calories, 30g carb

One of the best parts about going to an apple orchard is the smell of the freshly baked Apple Cider donuts wafting from the bakery. Unfortunately, this year I arrived at my favorite orchard to a one hour wait for these treats. They’re good—but they’re not an hour’s wait good. So instead, I used some of the apples I picked that day to make my own.

The recipe I used produced excellent donuts—sweet, cakey, and a little tangy from the cider glaze. It claims to make 12 donuts, but I made each donut smaller than recommended, winding me up with closer to 20. And after I figured out the calorie count, I’m glad I did. (**Instead of using buttermilk, I used a milk/lemon juice mixture, and the top of a drinking glass to punch out the shape.)

If I had stuck to the original 12 count, each donut would have been 401 calories. The smaller sizes come in at 240. Compare to the Dunkin’ Donuts Apple n Spice (270) and the Apple Crumb (490), it’s a pretty good deal.

Nutrition Information for 1 homemade apple cider donut: 240 calories, 44.8g carb, 4.9g fat

Candy Corn’s great, because it never seems to go bad. That’s probably because it’s nothing more than sugar, water and corn syrup. First developed in the late 1800s, this candy, with its orange, yellow and white stripes meant to look like a kernel of corn, is now a Halloween staple.

Candy corn is not as caloric as you might think—19 pieces come to 140 fat-free calories. But the carbs can be problematic, at 36g.

Nutrition Information for 1 serving candy corn (19 pieces): 140 calories, 36g carb

So this autumn, celebrate with these once-a-year treats in moderation. There’s no need to completely avoid any of these foods as long as you take into account their nutrition information and plan the rest of your meals accordingly.

It’s also a great time to check in with diabetes self-management, so make sure everything is on track before the craziness of the holidays. Is your A1C where you want it to be? How are your blood pressure and cholesterol levels? Have summer parties and barbecues taken their toil on your waistline? If everything is A-OK, than congratulations are in order. Pat your self on the back for a job well done and keep on trucking.

If you notice you may need a little fine-tuning, don’t worry! A little back sliding is nothing to be ashamed of. That’s exactly why it’s good to take stock every once in a while, to prevent your diabetes control from completely getting away from you.

If you haven’t been in to see your health care team for a while, perhaps a visit is in order. They can help you set priorities and give you suggestions on how to meet them.

In the meantime, try to tune-up your nutrition and physical activity plan.

Make a commitment to eat better now. Sweep out the cookies and chips and replace them with colorful fruits and vegetables. Use the plate method as a guide for portions and nutrition distribution. To do this, divide your plate in half and then divide one of the half’s in half again as in the animation below. Put all the fabulous greens of fall in half the plate and your favorite lean proteins and whole grain starches in the quarter divisions. Add a piece of fruit or a glass of milk or yogurt and you are good to go.

Start moving more. Aim for at least 30 minutes of physical activity each day. Use the cool evenings to talk a brisk walk after work or jump on your bike for an early Sunday ride. This one addition to your daily routine is down payment on a triple header— lowering your blood pressure, your cholesterol and your A1C.

And since you have started doing this, what better way to see the fruits of your labors than to check your blood glucose on a regular basis. Humans crave nothing more than positive reinforcement. Watching those numbers go down on your meter will catapult your enthusiasm for eating right and moving more right through the roof.

But can someone with diabetes get one?

Of course! And if you’re thinking about getting a medical alert tattoo, you’re taking a great step to ensure proper care in case of emergency.

What are the Risks?

Suzanne Ghiloni, BSN, RN, CDE, a nurse educator at Joslin Diabetes Center, says tattoo precautions for patients with diabetes aren’t all that different from anyone else getting a tattoo. “Make sure the parlor you choose is licensed, state inspected, and clean,” she says.

When choosing a tattoo parlor, ask about how they manage their equipment. The shop you choose should:

1. Have a licensed/accredited tattoo artist (preferably someone with artistic talent)
2. Use a brand new needle just for you
3. Autoclave their tattoo machines between customers
4. Use disposable ink pots

“The only time I’d be hesitant is if the person has uncontrolled diabetes,” says Ghiloni. Her advice to anyone with diabetes, “get your HBA1C in a good range before you go to the tattoo parlor.” The reason:  if your levels are out of control, you put yourself at risk for slower healing, nasty infections and, in severe cases, amputation.

“A person with diabetes need to be hyper-vigilant about preventing infection,” says Ghiloni. “Follow all the aftercare precautions.”

Stephan Lanphear, an award winning tattoo artist who helped legalize tattoo parlors in Massachusetts, is also a Joslin patient living with type 1 diabetes. During the legalization process, Lanphear helped the board of health write guidelines and regulations for the tattoo industry. “Health releases in tattoo studios have a question to see if you have diabetes,” he says.  “The tattoo industry recognizes it’s a risk.”

Lanphear finds his biggest concern as a person with diabetes is healing time. Usually, tattoos take around two weeks to heal. “But for me,” says Lanphear, “It’s usually a week to a week and a half more time where can I say okay, this is what a healed tattoo would be for someone with normal health.”

He notes, however, that healing time will differ person to person. “If you’re somebody who has diabetes you need to know your body,” he says.

You should also be aware that there are some spots for your tattoo that are better than others. Ankles, feet, shins, and buttocks are all problem areas if you suffer from poor blood circulation since they take longer to heal and are more susceptible to infections.

Another tip for those with diabetes: tattoos can take a long time, sometimes much longer than you expect. Sitting in a chair for hours puts you at risk for hypoglycemia so be sure to bring some glucose tabs or whatever else you use to treat your lows.

Tattoos for Your Health

Not everyone is vigilant about wearing a medical alert bracelet. But if you have diabetes, especially if you’re insulin dependent, you put your life at risk heading out of the house empty-wristed. If you find yourself often forgetting to wear medical identification, consider a medical alert tattoo.

These permanent ID’s have seen a surge in popularity over the past few years.  “It’s a really great idea,” says Lanphear. “I’m surprised I haven’t seen more people doing it.”

So, where should an alert tattoo go? Although there are no standards for medical alert tattoos, the general consensus is the right wrist. Another option is on your neck above the carotid artery (where EMT’s check your pulse), but that can be harder to cover in professional settings. Over the heart is another popular choice, although that may not be the first place the medics look.

When choosing the design, try to keep it simple and fairly obvious it is health related. The caduceus and the Rod of Asclepius are both the most commonly used symbols on medical alert jewelry. The light blue circle, a universal diabetes symbol started by the International Diabetes Federation in 2006, is another popular motif.

If you’re adding words—which you should, the point of this is to inform healthcare workers—make sure you choose a legible font. Medical tattoos for diabetes often read “Type 1/Type 2,” “Diabetic,” or “Insulin Dependent.” If you don’t add this information, the tattoo will only confuse people in an emergency. Is this for a penicillin allergy? Does this person have epilepsy? What does this mean?! If you’re going to invest in a medical alert tattoo you want it to do its job.

Lastly, whether it’s a medical alert tattoo or an artistic design, bear in mind that this is going to be on your skin the rest of your life. Although laser technology for tattoo removal has come a long way in the past decade, the treatment can take much longer to heal for those with diabetes (you are, after all, burning off your skin). On top of that, laser treatment is not cheap—anywhere from $49 to $300 per square inch depending on your skin type and the ink used.

If you’re considering a tattoo, whether it’s medical or not, don’t stop by the parlor on a whim and don’t be afraid to voice any concerns that you have.

“If the people in the shop don’t want to spend the time to walk you through the process and explain everything that’s going on and answer all your questions then turn around and walk out,” says Lanphear. “That would be my best advice.”

If you want a less permanent fix that doesn’t involve a bracelet, try temporary medical tattoos. These are a great alternative for teenagers (and even younger children) who have a hard time remembering their medical identification.

Most people are familiar with white fat, which stores energy, and can be a problem: Having too much white fat can lead to metabolic problems, including an increase in insulin resistance, which can cause type 2 diabetes.

Brown fat, on the other hand, burns excess energy. Brown fat was shown to be present in adult humans in 2009. Since then, Joslin has led a number of studies showing the benefits of activated brown fat.

This new study showed that brown fat releases a specific hormone during exercise that helps to control fat metabolism by boosting your body’s ability to use fatty acids as fuel during exercise.

What are Fatty Acids?

Fatty acids are the byproduct of fat breakdown. Your body produces some fatty acids on its own, and you can get others from your diet. When you eat fat, it gets broken down by your digestive system into fatty acids. Those fatty acids make their way into your bloodstream, where healthy fatty acids (like omega-3s for example) help with things like growth and development, skin and hair health, and more.

But while some fatty acid is important to health, too much can be detrimental. Excessive amounts fatty acids (both healthy and unhealthy – think trans fats), can lead to inflammation and a host of other metabolic problems.

What did Joslin researchers see?

The new Joslin research showed that a hormone (a lipokine with the ungainly name of 12,13-diHOME) is released by brown fat during exercise and helps clear fatty acid from the bloodstream.

In a set of two different experiments, Joslin scientists tested the lipokine levels of 39 people before, immediately after, and a few hours after exercise. They saw that levels of 12,13-diHOME were highest right after exercise, indicating they spiked during the workout. They also saw that fitter individuals had higher resting levels of 12,13-diHOME, but that levels increased during exercise regardless of baseline fitness.

What does this mean?

“This is a whole new area in research on exercise metabolism, and we seem to have found another mechanism by which exercise can have beneficial effects,” says Dr. Goodyear, who is the senior author on the paper about this study recently published in Cell Metabolism. “The more knowledge we have about exercise and how it works, the better we can understand how to combat metabolic disease.”

You are not alone.  In fact, having someone in your family who has type 1 diabetes when you are diagnosed is the exception, rather than the rule.  As Dr. Jason Gaglia , M.D., M.M.Sc. , researcher at Joslin Diabetes Center explains, “At most only 10 to 15 percent of persons with type 1 diabetes have an affected first degree relative (the majority of people diagnosed do not have a known family history of type 1 diabetes). Given that the genes are very common, why some people develop type 1 diabetes and others do not is not clear. It is hypothesized that there may be environmental factors that may play a role (viruses, certain food items, etc.) but this has not been fully answered as of yet and may be different for different individuals.”

Unfortunately at present we don’t have a way to identify those at risk when they don’t have a family history.  As more research is done on type 1 diabetes we may find out more about environmental triggers as well as genetics and be better able to predict who will come down with the disease.

PROTEIN POWER-UP PANCAKES
½ c Rolled Oats (old-fashioned or instant)
½ c Cottage cheese (low-fat)
1 teaspoon Vanilla
2 Eggs
2 Tablespoons Cinnamon applesauce or natural applesauce

Combine ingredients 1-5 using a stick or stand blender. Pre-heat skillet to medium-high.
Coat skillet with cooking spray. Pour pancakes onto skillet into 2-inch rounds. Cook until
bubbles form, then flip pancakes and cook 2-3 minutes longer.

Nutrition info: 440 calories per batch, 39g carb, 15g fat, 33g protein, 604mg sodium, 1g sugar

The condition is called lipohypertrophy, which is an abnormal accumulation of fat beneath the skin. It literally means enlargement (hypertrophy) of fat cells (lipo). Lipohypertrophy is most common in people who receive frequent, multiple daily injections of insulin or use an insulin pump.

The hard bumps, usually found at injection sites, are an accumulation of fat and may also contain some scar tissue. Lipohypertrophy occurs when a patient uses the same injection site too often. Insulin acts on fat cells and encourages fat accumulation.

However, there may be other contributing factors as well. Lipohypertrophy is more common in people with type 1 diabetes than those with type 2, though researchers are still unsure exactly why. A patient’s unique skin sensitivity may also play a role.

Unfortunately, individuals may seek out these lipohypertrophic sites for injections since they tend to be less painful than at other sites. Not only does this make the lumps bigger, it can interfere with insulin therapy. The absorption of insulin can be erratic from these sites. Often, insulin absorption is delayed, leading to initial high blood sugars but later unexpected hypoglycemia. Lipohypertrophy itself is not life threatening, but it can make diabetes disease management more difficult.

The best way to avoid abnormal tissue accumulation is to rotate your injection sites and use as much of the skin surface as you can, over the course of weeks or a month.

It is also important to rotate insulin pump infusion sites as much as possible. That can be a challenge, but since infusion sets are in place for up to three days at a time, PWD on pump therapy are much more likely to develop lipohypertrophy.

If you are using your abdomen to inject, be sure to inject about an inch or two away from your last site. Mixing up your injections into a memorable pattern can also help you consistently rotate your site. You should also use a fresh needle each time. You can use a logbook, phone apps, or even tiny temporary tattoos to help you keep track.

If you have Lipohypertrophy

If you find yourself developing lumps and bumps beneath your skin, try to avoid injecting in the same place for two weeks to three months (depending on the size of the lumps).

“If you catch the small lumps early they can eventually regress,” says Dr. Sethu Reddy. “But if the lump develops over the course of years you could end up with something the size of a grapefruit.”

Dr. Reddy explains that even though large lumps aren’t usually painful, many patients find them unsightly. Severe lipohypertrophy can be treated with liposuction or minor cosmetic surgery.

If you’re switching up your injection spots, keep in mind that different places on your body absorb insulin differently. In general, your abdomen absorbs injected insulin the fastest. After that, your arm absorbs it most quickly. The thigh is third fastest area for absorption, and the buttocks absorb insulin at the slowest rate. If you’re concerned about a fluctuation in your insulin uptake, talk to your doctor about temporarily adjusting your insulin dosing.

If you regularly rotate your injection site but still find the hard lumps associated with lipohypertrophy, consult with your doctor or dermatologist. There may be something else going on.

Make it a habit to routinely inspect your injection sites for signs of lipohypertrophy. Early on, you may not see the bumps, but you’ll be able to feel the firmness under your skin. You may also notice that the area is less sensitive and you feel less pain when you inject. The fastest way to get rid of the lumps is to catch them when they’re small, so do a quick check once a week to make sure your skin feels normal.

“Lipohypertrophy is not an allergic reaction,” says Dr. Reddy. “Insulin promotes fat and the development of fatty lumps is expected. It’s just something to watch out for and it can definitely play havoc with your sugar control.”

That’s why in 2015 the Dietary Guidelines Advisory Committee announced that healthy people no longer need to worry about an upper limit when it comes to their daily cholesterol intake. The recommendation of no more than 300 mg per day of dietary cholesterol was gone.

After reviewing existing research, the committee concluded that “available evidence shows no appreciable relationship between consumption of dietary cholesterol and serum cholesterol.”

But the authors of the Dietary Guidelines for Americans made the point that people with diabetes should still steer clear of cholesterol-rich foods.

“It is true that in people without diabetes, cholesterol may not matter much in changing the actual blood cholesterol level, but for people with diabetes consuming too much dietary cholesterol puts them at significantly greater risk of cardiovascular complications,” says Om Ganda, MD, Medical Director of the Lipid Clinic at Joslin Diabetes Center and chair of the Clinical Oversight Committee.

The main source of dietary cholesterol in the US is egg yolk.  And one large egg yolk contains about 186 mg of cholesterol. Other sources include lobster and shrimp, meat, butter and dairy products.

A meta-analysis (published in The American Journal of Clinical Nutrition, 2013) found that people with diabetes who regularly consumed eggs increased their risk of cardiovascular events by 69 percent, compared to those who did not, and for those without diabetes, eating an egg a day increased their risk of developing diabetes by 42 percent, says Dr. Ganda. “The analysis did not distinguish between type 1 and type 2. But we know that more than 90 percent of patients are likely to be type 2, so this really applies to them.”

Results from this analysis are based on a large summary of data from observational studies, which shows an association, not cause and effect. In other words, eating fewer eggs could be linked to other healthy lifestyle factors that prevent cardiovascular disease.

Another reason to avoid a cholesterol-rich diet, says Dr. Ganda, is that some studies have linked a diet low in cholesterol to a reduced risk of obesity.

Putting cholesterol in perspective

It’s known that having diabetes puts one at increased risk of cardiovascular disease. That’s why people with diabetes need to be careful about consuming cholesterol-laden food indiscriminately.

“For people with diabetes, additional changes in the diet are necessary to keep their cholesterol levels down. That entails avoiding cholesterol rich foods and saturated fat,” says Dr. Ganda.  “There is no question that the worst offenders are saturated and trans fats — they raise cholesterol levels and increase risk of heart disease.”

To help control cholesterol, follow these healthy eating guidelines:

• Avoid foods high in dietary cholesterol such as egg yolks and organ meats
• Limit saturated fats to less than 10 percent of total caloric intake, and avoid foods high in saturated fat such as beef and pork.
• Steer clear of fast food, baked goods and margarine, all of which are high in trans fats
• Choose cholesterol-free snacks such as fruits and nuts

“Good diabetes management means not only paying attention to your glucose control and your blood pressure control, but also to the cholesterol in your diet,” says Dr. Ganda. “That means not consuming eggs every day, and if you do eat eggs, you can certainly have egg whites, because that is a high-quality protein.”

To learn more about diabetes, contact our Certified Diabetes Educators at 617-309-2780 or make an appointment with our Adult Clinic at 617-309-2440.

Unfortunately, diabetes is increasingly common in children and adolescents, who can develop either type 1 diabetes (once called “juvenile diabetes” or “insulin-dependent diabetes”) or type 2 diabetes (once called “adult-onset diabetes”). That’s what we’re seeing here at Joslin Diabetes Center in our Programs for Children and Young Adults; and it’s happening everywhere.

Type 1 diabetes, in which the body stops generating insulin, affects about 1 in 500 children in the United States, and that rate is on the rise. Far fewer children get type 2 diabetes, in which the body doesn’t produce enough insulin and/or can’t use insulin properly. Type 2 cases also are climbing, as the disease is closely associated with obesity, which is soaring among children in this country.

A child diagnosed with type 1 diabetes typically is still churning out some insulin, but over time the cells in the pancreas that produce the hormone are gradually destroyed by the body’s own immune system. The child then needs insulin, either injected or received via an insulin pump, around the clock to survive.

Having a child diagnosed with type 1 can be real shock. According to Dr. Lori Laffel, the head of Joslin’s Pediatric Diabetes Programs, a diagnosis of diabetes affects the whole family. And families of young patients who receive this diagnosis generally are caught off guard, as only about 10% have a family history of type 1 diabetes. We encourage all parents and anyone who cares for young children to be aware of the warning signs for the disease. which include extreme thirst, frequent urination, lethargy, flu-like symptoms and dehydration.

Type 2 diabetes can develop silently in children and adolescents, as in the adults among whom it is far more common. Here at Joslin, our physicians generally prescribe lifestyle changes (careful diets and more exercise) and oral medications as needed.

Want more information?

Childhood diabetes
http://www.joslin.org/info/childhood_diabetes.html

What life is like for a kid with diabetes
http://www.joslin.org/info/what_life_is_like_for_a_kid_with_diabetes.html

Common questions about type 1 diabetes
http://www.joslin.org/info/common_questions_about_type_1_diabetes.html

Common questions about type 2 diabetes
http://www.joslin.org/info/common_questions_about_type_2_diabetes.html