Edward Leyton, MD, CCFP
Dr Leyton:Our six-year-old daughter was just diagnosed with type I juvenile diabetes. She is adjusting well and has gained back her weight and her blood sugar levels are getting better every day.
Dr Leyton:Our six-year-old daughter was just diagnosed with type I juvenile diabetes. She is adjusting well and has gained back her weight and her blood sugar levels are getting better every day. The local diabetic team still encourages continued doses of insulin. She is currently on two needles per day at six units in the morning and three units at supper. With a controlled diet, exercise and vitamins, will we be able to prevent any long-term damage? Do you also feel that if she has good control, we need to monitor blood sugar levels four times a day, or can we go back to once or twice a week?
It is unequivocal that tight control of blood sugar is the most important aspect of your daughter's treatment program in the long run. It's the unutilized sugar outside of the cells that causes the long-term damage by combining with proteins and forming associated glycosylated end products. In fact, one of the ways of measuring good blood sugar control over the long term is by using a blood test called glycosylated hemoglobin. Performed every 120 days, this test shows whether the sugar has been adequately controlled in the previous four months. As far as how often your daughter's blood should be checked, I recommend that you follow the guidelines of her doctors until a regimen is well established. You should also get a test for homocysteine, which, at high levels, is an independent risk factor for heart disease.
Beginning now with good nutritional habits and good quality supplements will help prevent complications down the road. Most diabetics lead long productive lives. Even though your daughter must get her insulin from outside her body, you can still optimize her diet to make sure that it is as healthy as possible. You have a few short years prior to adolescence to establish good nutritional habits. The most difficult time for diabetics is often the teenage years, when adhering to specific diets and supplements is difficult, and yet it's often the time when control needs to be stepped up.
Begin by following the dietary guidelines provided by your diabetic team, and then modify it to a more natural-based vegetarian diet. The glycemic index classifies carbohydrates according to how fast they are absorbed by the body and thereby increase blood sugar. Stick with low-glycemic foods such as soy, some grains and some fruits and vegetables. This will greatly "smooth out" the blood sugar highs and lows that you want to avoid if possible.
Most studies on supplements have been done with adult type II diabetics. However, children of your daughter's age can safely take multivitamins and antioxidants, which should include mixed carotenes 15 mg per day, vitamin E (with mixed tocopherols) 200 IU per day; vitamin C 500 mg per day; selenium 25 mcg per day and evening primrose oil 500 mg three times daily. If homocysteine levels are high (greater than 10) they can be reduced easily by making sure your daughter has 400 mcg/day of folic acid, either in the form of dark green veggies or from supplements. (Most multivitamins now contain this nutrient.) Another mineral, chromium, can also enhance glucose absorption. The usual adult dose is 200 mcg per day. Adequate levels of magnesium are also critical to vessel health and can be taken at 400 mg per day.
Whatever you decide to do with regards to diet and supplements and other lifestyle measures, you should always let your doctors know which supplements your daughter is taking or planning to take, since some supplements will lower the insulin requirements.
Written requests for advice must contain your age, gender, height and weight and a good description of your present problem; any past medical problems and treatments; a list of drugs and supplements you are taking and any recent blood or other test results.
Address letters to the medical advisor, 7436 Fraser Park Drive, Burnaby, BC, V5J 5B9. Please include a cheque or postal money order for $20 made out to Canadian Health Reform Products Ltd. Expect six to eight weeks for a reply.