Health

Back to School Tips

By Leah Berthold, RN, CDE
MassGeneral Hospital for Children Pediatric Endocrine Unit

Blank Chalk Board

Have you begun getting ready to send your child back to school?  As the beginning of the  school year comes closer, here are some important things to remember:

  • Make sure you have a current Diabetes Medical Management plan (school orders) in place before the first day of school.
  • Make an appointment with the school nurse to review the plan and bring all supplies needed to school before school starts. Meeting the nurse before school starts will help build a relationship and confidence for you, your child and the nurse.  Refer to the box below for a list of supplies to keep at school.
  • Be sure your child has a 504 plan in place. Review this plan every year.
  • Give the school a hypoglycemia or “low” box with glucagon/glucose tablets/juice or whatever you prefer to treat low blood sugar
  • Be sure all school personnel, including bus drivers and coaches, are educated about Type 1 Diabetes and know what to do for low blood sugar.

 

School Supplies Box

Guest Post, My Story

My Story: Nothing Holding Me Back

By Anne-Maria

I’ve had Type 1 Diabetes for 49 years – next April will be my 50th diaversary.  When I was diagnosed in the 60’s/70’s, there wasn’t as much information about diabetes out there as there is now.  But still, having diabetes never held me back from anything I wanted to do.  I still travel, and I stayed out late in my 20’s and 30’s like any other young person would.  I strongly believe that diabetes is just a part of life.  The key is to accept it and make it part of your routine.

There are professional hockey players who have diabetes.  Gary Hall, Jr. has Type 1 Diabetes and he swam the 50-meter freestyle at the Olympics.  They didn’t let diabetes stop them; they made it work.  Put your sight on what you want to do and figure out how to do it (I just don’t know if they can send you into space yet).  People are happy to work with you if you talk to them about your needs.  When I was still in school, we went on ski trip to the Alps.  At the time, they didn’t have refrigerators in the hotel rooms so I stored my insulin in the one in the kitchen.  I got to know the kitchen staff pretty well and they were happy to accommodate me.  Nobody has ever said “no” when asked to help.

The only time my health factored into any of my life choices was when I decided not to become a physician.  Sleep is very important for me and I knew I wouldn’t be able to function with the little bit of sleep med students get.  But again, it was my choice based on what I needed to take care of my own health.  I know my body inside and out, so I know when something isn’t right and how to adapt.  When I have late meetings, I’ve learned to check my blood sugar and drink some juice before it starts so I don’t go low.

My biggest piece of advice for parents or anyone who has been diagnosed with Type 1 diabetes is:  take a deep breath and relax.  If you were diagnosed as an adult, know there’s nothing abnormal about what you have.  You can maintain your regular routine without much extra effort.  The only time I need to pay more attention to my blood sugar is when I’m sick.  I might have to take some extra time off from work to recover these days, but that could be because I’m getting older.

If you’re a parent, let your kids be kids.  Let them have fun at parties and eat a small piece of cake like the other kids (maybe take of some of the frosting first).  Don’t stress too much about what they eat.  You don’t have to make big formal meals.  Sometimes when I get home late I’ll have cereal and fruit for dinner.  Just use common sense and think about what you need to do to cover it with insulin.

 

 

 

 

 

 

Health

The Science of Celiac

By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

It seems like many people these days are being diagnosed with celiac disease. While this phenomenon may be the result of increased screening, celiac disease has been recognized in the medical community in both children and adults since the 19th century.

Celiac is an autoimmune illness sparked by a reaction to gluten, a protein found in wheat, affecting  approximately 1 in 105 people in the United States.  Because there is a genetic basis to celiac, it’s thought to have a possible association with other illnesses such as Type 1 Diabetes. In people with celiac disease, exposure to gluten triggers a reaction, causing their own immune system to target and attack an enzyme located in the lining of the intestine. Part and parcel of this attack is inflammation and damage to the intestinal lining.  Since this is where food is absorbed into the bloodstream, people with celiac disease are unable to effectively absorb digested food. Thus, they may develop deficiencies in minerals and nutrients such as calcium, iron and Vitamins A, D, E and K. Without a healthy lining, people with celiac are also unable to absorb carbohydrates and fats; in sum, these deficiencies can cause weight loss, fatigue and slowed growth (particularly in children).

In addition, unabsorbed food in the intestine stimulates diarrhea and gas, both of which may lead to abdominal bloating, cramping, and pain. In some people celiac disease may be a silent or subtle illness showing up only as a borderline anemia due to poor absorption of iron.  In others, celiac may present full force with the entire spectrum of symptoms.

Gastrointestinal symptoms such as recurrent diarrhea and bloating or weight loss should prompt a discussion with a healthcare provider. Because other conditions such as lactose intolerance and irritable bowel disease can present in a similar fashion, it is important to talk to a healthcare provider first rather than making diet modifications or other lifestyle changes based on ‘self diagnosis’. Healthcare providers may themselves suggest testing for celiac disease for someone with unexplained nutritional deficiencies or, given the genetic basis of celiac disease, with Type 1 Diabetes or other autoimmune illnesses. Testing for celiac disease is a multi-step process that often begins with a blood test and may include a biopsy of the small intestine.

Unlike many other diseases, we know the underlying cause of celiac disease: gluten. Treatment then rests in avoidance of this trigger – a task that may be easier said than done. Though ‘gluten-free’ is a quickly growing food category in restaurants and grocery stores alike, adherence to this diet requires care and attention.  If you have been diagnosed with celiac, a nutritionist can help develop an eating plan that works best for you.

Nutrition

What’s the Deal with Gluten-Free Foods?

Question Mark Photo Credit: Steven Goodwin

Perhaps you’ve noticed many items in the grocery store now have the words “gluten-free” on their labels, or “gluten-free” menu options appearing at your favorite restaurant.  Gluten-free foods seem to be everywhere lately, and gluten-free diets have developed a reputation for being an all-around healthier way to eat (helped along by numerous celebrity endorsements).  But what is gluten, and is there really a reason to avoid it?

Gluten is a protein found naturally in wheat, barley and rye.  It helps give breads and other baked goods their chewy texture, and can sometimes be used to thicken sauces and soups.  Most of us can eat products containing gluten with no problems.  For some people, though, eating foods containing gluten can lead to serious health concerns.  People with celiac, an autoimmune disease affecting a small portion of the population, are gluten intolerant.  Eating even a small amount of gluten causes a reaction in the body that damages the small intestine so that it is unable to absorb nutrients in food.  According to the American Diabetes Association, about 10% of people with Type 1 Diabetes also have celiac.

There are also some people who have gluten sensitivity, meaning they experience unpleasant reactions to eating gluten (gas, bloating, diarrhea, etc.) but do not have the damage to the small intestine associated with celiac.  Only a medical professional can diagnose celiac (it requires a blood test and a biopsy of the intestine).  If you have any questions or concerns, it’s best to talk with your health care provider.

So should you start eating gluten-free?  Well if you have celiac, a gluten-free diet is mandatory and a nutritionist can help create an eating plan that works for you.  If you don’t have any type of gluten sensitivity, then there’s really no reason to spend the extra money on gluten-free foods.  Just because an item is gluten-free, it doesn’t mean it’s necessarily healthier – in fact some products can be higher in calories and fat (and lower in some nutrients like fiber) than similar products containing gluten.   A diet emphasizing fresh fruits and veggies, whole grains, lean protein and low-fat dairy while limiting packaged and processed foods will serve you well.  Just make sure you’re watching your portion size!

(Content reviewed by MGH Nutrition Department. Photo credit: Steven Goodwin)