A Diabetes
  B Blood sugar
  C Hyperglycemia
  D Hypoglycemia
  E Urine tests
  F Insulin
A. Diabetes   
1. Why am I diabetic ?
Diabetes is a disease, which every child can get. We don’t really know why I get sick but it has nothing to do with nutrition or with sweets. It’s not my fault nor my parents’ fault. It’s not contagious.
It’s an auto-immune disease, which means that my body progressively destroys all my beta -cells of my pancreas so that I cannot produce any insulin anymore.
2. What does diabetes mellitus mean ?
If I have this disease I have too much sugar in my blood. It’s not because I have eaten too much sugar but because my pancreas does not produce any insulin anymore.
It’s an auto-immune disease, which means that my immune system destroys my beta-cells.
Type 1 diabetes is always treated by insuline.
3. What are the signs of diabetes ?
-tiredness
-thirst
-urinating often and a lot
-glucosury, which means presence of glucose in the urine
4. How long will my disease last ?
The beta cells of my pancreas are progressively destroyed without showing any signs. This time is called pre-diabetes. When there are only 15 to 20% of these cells left, I will start to feel ill.
If the doctor has diagnosed diabetes, I will be treated with insulin.
During 1 to 2 years my needs in insulin are small because my pancreas will produce some insulin again. This is the remission phase or honeymoon.
After that time my pancreas will never produce any insulin any more..
Lots of doctors in the world are searching for a cure or a better therapy for my disease.
5. What is the role of the pancreas ?
The pancreas is on organ, which is located in the middle of my belly. Within the pancreas there are small particles called Langerhans cells. These cells produce differnt hormones:
1. insulin, which helps to decrease the blood sugar
2. glucagon, which helps to rise the blood sugar
6. Why does my body need sugar ?
Sugar is the essential energy for the cells of my body. It’s like fuel for the car.
B. Blood sugar   
1.What do all these numbers on my glucometer mean ?
Blood sugar means the amount of sugar in the blood.
I can measure it with my glucometer.
The quantity is expressed in mg/dl (or in mmol/l).
My values should be situated between 80 and 180 mg/dl.
2. Why do I have to measure my blood sugar ?
As my body does not produce any insulin anymore, my blood sugar will rise,especially if I eat something with carbohydrates.
So I have to test myself to know how much insulin I need.
3. What should I pay attention to when I test my blood sugar ?
-wash my hands; because if my fingers are dirty I may have wrong results
-change the needle regularly
-check the code of the test strips
-heat up my fingers if it’s cold outside otherwise I will not have enough blood for the strip
-prick always laterally in the finger, the tips are too painful
-avoid pricking in the forefinger and the thumb because I use them too much
4. Why do I have to write down my blood sugar levels ?
It is very important to write down my glucose levels and my insulin doses every day, otherwise I will forget them quickly. It will help us to understand why my levels are sometimes too low or too high. I should also registre when I do sport and also what I eat. My parents need all this information to adjust my insulin doses with the help of my doctor.
5. When should I test my blood sugar ?

-always before I want to eat (if I need an isulin injection)
-in the morning when I get up
-in the evening when I go to bed
-before starting a physical exercise
-when I don’t feel well

Why at these moments ?
-to calculate the insulin dose before a meal, which depends on the amount of food and my glucose level at that moment
-to be sure that the night dose was right
-to correct the high or low values
-to avoid hypoglycemia during an effort
6. What makes my blood sugar go up or down ?
-food
-physical exercise
-strong emotions (happiness or pain)
-disease (caugh,fever…)
-growing hormone and puberty
7. What does HbA1c mean ?
Glucose is bound to haemoglobin which transports the oxygen in the bloodstream.
The red blood cells are produced in the bone marrow and are destroyed after 120 days in the spleen.
HbA1c is calculated by a simple blood test and reflects the average blood glucose during the last 6-8 month.
C. Hyperglycemia   
1. What is too high blood glucose ?
Blood glucose over 180mg/dl is too high and we call it hyperglycemia.
2. How do I feel if my blood sugar is too high ?

There is too much sugar in my blood.
-thirst
-frequent urinating
-tiredness
-weight loss (if the hyperglyceamia is lasting over a longer period of time)
-headache,pain in the belly
-difficulty on concentrating
3. Why is my blood glucose sometimes too high ?
-insufficient level of insulin
-too much food
-less physical activity as planned
-problems of injection e,g. using a new bottle of insulin, air in the needle, too cold insulin
-folded Teflon catheter when using pump therapy
-injecting in a lipodystropy
-“use-by”date of the insulin has passed
-sickness
-growing up and puberty
-stress
4. Why does my blood sugar rise while I am sleeping or not taking food ?
While you digest, the sugar is absorbed in different places with the help of insulin:
1. in the cells
2. in the liver as glycogen
3. in the muscles also as glycogen
After the digestion, the liver liberates again the glycogen as sugar in the blood to go to the muscles.
So your blood is only a transit for sugar.
D. Hypoglycemia   
1. What is too low blood sugar ?
Blood sugar under 70mg/dl is too low and we call it hypoglycemia.
2. How do I feel when my blood sugar is too low ?

There is not enough sugar in my blood (under 70mg/dl)
The symptoms can appear individually and are different from one child to another.
If I feel one of these symptoms, I should check my blood sugar immediately or tell somebody and then eat something sweet.

-dizzy spell
-trembling
-pain in the belly
-being pale
-fidgety, nervous
-tiredness
-excitement
-loss of concentration
-trouble of the vision
-perspiration
-hunger
3. What should I do if my blood sugar is too low ?
-stop immediately all effort
-test blood sugar
-take some sugar
-test again later
4. How much and what kind of sugar should I take ?

Count 5 grammes of sugar per 20 kg body weight

1 piece of sugar = 5 grammes
2 dextro energy = 10 grammes
100 ml orange juice = 10 grammes
100 ml apple juice = 10 grammes
5. When do I need a glucagon injection ?
Somebody must inject glucagon into me when I lose conscience. At this moment nobody must try to give me anymore sugar or to put some sweet liquid in my mouth because there is a danger of suffocation.
I always have a glucagon set which must be stored in the fridge. There is a syringe in the box, which contains a clear liquid and a small bottle with white powder. You inject the liquid into the bottle with the powder, you shake it and then inspear the liquid again in the syringe. Then you inject it in one of the normal insulin injection places. If the body weight is under 25kg then inject only half of the bottle.
There is always a description in the glucagon box.
6. Why is my blood sugar sometimes too low ?
-too much insulin
-not enough food
-more physical activity than planned
-vomitting, diarrhoea
-heat, sauna
E. Urine tests   
1. Why should I do urine test ?
It’s useful to search the presence of ketons in the urine when I am doing an important hyperglycemia.
So I know that my correction bolus must be higher than if I have a hyperglycemia without ketons.
2. How do a urine test ?
Therefore I need special streeps (Ketur-Test, Ketostix) which I quickly dip into the urine (collected in a cup).
After 30 seconds I can see the result as colours appearing on the stick (blue-violet).
3. Why do I have ketons in my urine ?

There are 2 possibilities:
1. lack of insulin
2. lack of glucose

The cells don’t get any glucose but the body needs energy. Therefore my body will reduce fat. One part will be used as energy and the rest will be eliminated as scraps in the urine as ketons.
4. What does keto-acidosis mean ?
If there is a lack of insulin or glucose, the body will search for energy by reducing fat.
There will be ketoacids in the blood. The blood will be acid.
It’s called keto-acidosis.
5. What are the signs of ketons ?
-either your blood sugar is too high or it has been too low for a longer period
-glucose in the urine
-nausea and vomiting
-abdominal pain
-breath with a “fruity” odour
6. What should I do if I have ketones in the urine ?

-If my blood sugar is too high, I should inject a bolus which must be higher than if I have a hyperglycemia without ketons. I should also drink a several glasses of water in order to better eliminate the ketons.
-If my blood sugar is too low, I must take some glucose and eat a snack.
7. Why can I have ketons in the morning urine ?

There are 2 possibilities:
-either I first had hypoglycemia in the early part of the night, followed by a rebound effect in the morning (glucose rising).
-Or my blood glucose has been high all night.
F. Insulin   
1. Insulin: what is it ?

It is a hormone, which is produced automatically by the pancreas when there is glucose in the blood.
In therapy we use insulin produced in a laboratory but which is identical to that which humans produce themselves. We call it “Humaninsulin”.
“Analoginsulin” means that it has been changed to have a quicker or or a slower effect.
Insulin cannot be taken as a pill because it would be destroyed by the stomach acids.
Therefore insulin must be injected under the skin into the fat tissues.
2. Role of insulin

When you eat some sugar or some food which is transformed during the digestion into sugar(bread, noodles, rice…), your pancreas produces some insulin immediately.
Between the meals and during the night your body still produces small amounts of insulin.
It allows the sugar to enter the cells (like a key) and give them some energy. Without insulin, the cells suffer from lack of energy.
3. How should I store my insulin ?

- insulin must be used within 4 weeks if it is stored at room temperature
- insulin reserves must be stored in the fridge
- insulin should not be exposed to the sun
- in winter, I have to make sure that insulin will not freeze; that’s why I don’t keep it in my outside pocket of my jacket
-I have to control the use-by date
-protect from the light (close the cap of the pen)
4. Where can I inject my insulin ?

I can choose between several places of my body:
-in my belly
-in the bottom
-in the thigh
Where and when is the insulin absorbed most quickly?
-in the belly
-if it’s warm weather
-after a physical effort

I must be careful not to inject in the same place repeatedly otherwise I will get small fat balls where the insulin is not well absorbed.
5. Do all kinds of insulin have the same action ?

No, there are 3 sorts of insulin

1. Analogs very quick insulin: Novorapid (NovoNordisk)
Humalog (Eli Lilly)
Operating: after 10-15 minutes
Action peak: after 1 hour
Ending action: after 2-4 hours
Clear liquid
Always use analoginsulin to correct a hyperglyceamia

2. Quick insulins: Actrapid (NovoNordisk)
Humuline Regular (Eli Lilly)
Operating: after ½ an hour
Action peak: after 2-3 hours
Ending action: after 4-6 hours
Clear liquid

3. The insulins with delay
Insulatard ( NovoNordisk)
Protaphan
Monotard
Humuline NPH (Eli Lilly)
Humuline long
Operating: after 1-2 hours
Action peak: after 4-6 hours
Ending action: after about 15 hours
Cloudy liquid

The more important the insulindose, the stronger the action and the longer it will last (except for Humalog, Lilly).
6. How can I know how much insulin I need ?

The amount of insulin I need depends on several factors :
-my blood sugar
-the amount of food, but only the carbohydrates in my food
-the moment in the day because I need more insulin for the same meal in the morning and evening than at midday
-the physical exercise I had before or after the meal
-the type of treatment, or by injections or by pump
-the kind of insulin I use
-my health
-my weight (the average of insulin is about 0,8-1,2 units insulin/kg of bodyweight and per day)
7. What kind of therapy is the best for me ?

My doctor will help me and my parents choose the best between different sorts.
-2 injections a day: one quick and one delayed insulin in the morning
“ “ evening
-3 injections a day: one quick and one delayed insulin in the morning
one quick insulin at midday
one quick and one delayed insulin in the evening
-insulinpump: basal and bolus (quick insulin for every meal)

The therapy should be adapted as muchas possible to the my previous lifestyle.