How will
my diabetes
affect me?
Growing up
with diabetes
www.withyoualltheway.info
At Novo Nordisk, we are changing diabetes.
In our approach to developing treatments,
in our commitment to operate profitably and
ethically and in our search for a cure.
With you all the way is a patient
support programme created by
Novo Nordisk, providing practical
information on diabetes and its
management for children and
young adults with diabetes.
This material has been reviewed by
a panel of experts:
Lead Diabetes Specialist Nurse –
Nicola Lewis, UK
Paediatric Endocrinologists –
Prof Thomas Danne, Germany and
Dr Nandu Thalange, UK
Morganne Shone,
UK
Morganne has type 1 diabetes
This information is not designed to
replace the advice of a healthcare
professional. Please consult your doctor
or nurse if you have any questions or
concerns about managing your diabetes.
1
Growing
up with
diabetes
Being a teenager is complicated enough
without having diabetes. Having to think
about what you eat, when to test and
when to take your insulin can sometimes
feel like a hassle. But it is important that
you learn how to manage your diabetes
and fit it into your daily routine.
This leaflet provides practical information
on some issues you may face growing up
with diabetes. If you have any questions
or concerns about your diabetes speak to
your doctor or nurse.
2
About
diabetes
Finding out you have diabetes can be
difficult, whatever age you are diagnosed.
What is diabetes?
Type 1 diabetes
Type 2 diabetes
Diabetes is a condition where the body
is unable to make enough insulin.
In people with type 1 diabetes, the
pancreas is no longer able to make the
insulin needed to transport glucose to
the cells that need it. This means you will
need to take insulin every day to help
manage your blood glucose levels.1
Type 2 diabetes occurs when the
pancreas does not make enough insulin
or the body is unable to use insulin
properly (insulin resistance). Type 2
diabetes is linked to being overweight
and is usually diagnosed later in life.
However, there has been an increase
in type 2 diabetes seen in teenagers
and young adults.
Insulin is a hormone that is made by cells
in the pancreas.1 Insulin is needed by the
body to help remove glucose (a sugar)
from the bloodstream and turn it into
fuel for other cells that need it.1 When
there is not enough insulin, this leads to
high levels of glucose in the blood.
3
Type 1 diabetes is currently more
common in children and teenagers
than type 2 diabetes.2
Low blood glucose
(hypoglycaemia)
Keeping in
control of
diabetes
Low blood glucose, also known as
hypoglycaemia, may occur when your
food intake is outweighed by your
insulin dose or physical activity.
The key to managing diabetes is getting
the right balance between your food intake,
insulin dose and physical activity.3 This will
help to avoid low or high blood glucose.
This may happen when:
You have taken your normal insulin
dose but have not eaten enough
(or have been sick)
You have been more active than
usual without decreasing your
insulin dose or eating more
You have had too much insulin
Signs of
hypoglycaemia
When you have hypoglycaemia you
may notice the following signs:1,4
Hunger
Dizziness
Nervousness
Confusion
Shakiness
Tiredness
Sweating
Grumpiness
Tingly lips
You will soon learn how you feel
when you have low blood glucose
and get to know the early signs.
4
High blood glucose
(hyperglycaemia)
Signs of
hyperglycaemia
High blood sugar
can be dangerous
High blood glucose, also known
as hyperglycaemia, may occur when
your food intake outweighs your
insulin dose or physical activity.
The following may be signs that
your blood sugar is too high:1
Severe high blood sugar or lack of insulin
can sometimes lead to a serious condition
called diabetic ketoacidosis (DKA).
This may happen when:
You forget to take your insulin
or do not take enough
Feeling tired or weak
Feeling sleepy or drowsy
Feeling very thirsty
Needing the toilet more often
In DKA, the body breaks down fats
for energy leading to the production
of chemicals called ketones.
You are less active than usual
If you notice any of these signs and
have high ketone levels, you should
tell one of your parents or another
adult immediately as you will need
to see a doctor or go to hospital:
You are ill
Dry mouth or tongue
You eat more than usual
(without adjusting your insulin)
Blurry vision
Feeling sick or being sick
Stomach pain
Rapid breathing
Fruity smell on breath
Your doctor or nurse will explain
how to manage low or high blood
glucose and test for ketones.
5
Coping
with
diabetes
Living with diabetes can be overwhelming
at times. Dealing with diabetes every day
on top of everything else can be hard.
You may feel self conscious or worry
about what other people might think
about you.
It doesn’t help that the hormones that
cause your body to change during
puberty can also make it harder to
stay in control of your diabetes.5
If you feel like you aren’t coping very
well, it is OK to ask for help. You may
find it helps to talk to friends or family
about how you are feeling. Most people
struggle with diabetes at some
point – it’s normal.
SUDE IĞDIR,
Turkey
Sude has type 1 diabetes
You are not the only one
Although it can seem lonely sometimes, there are
lots of other young people with diabetes who are
facing the same challenges as you.
You may feel you want to talk to someone
else with diabetes who is a similar age and
understands how you feel. Your doctor
or nurse can help put you in touch with
other young people who have diabetes via
support groups or patient organisations.
Bullying
Bullying is unacceptable.
Sometimes others may treat
you differently because of
your diabetes. If anyone is
teasing or bullying you, talk
to your parents, teachers
or a friend as they will be
able to help you.
6
Depression
Everyone has off days and can feel low from time
to time. But if you start to feel down most of the
time and no longer feel like doing the things you
used to enjoy, you may need to talk to someone.
AleKsey Evstratov,
Russia
Aleksey has type 1 diabetes
7
Signs you may
be depressed5
Dealing with
parents
Lack of interest in activities and
spending time with friends
As you get older and spend more time
away from home, it is likely that you
will learn how to manage your diabetes
with less support (or nagging!) from
your parents.
Sleep problems
Tiredness
Anxiety
Change in appetite
Poor concentration
Crying
Support is available
If you recognise any of these signs talk
to your parents or make an appointment
with your doctor or nurse. They can
refer you to a counsellor or specialist. For
some people, medication may help.
However, your mum and dad may find
it hard to let go and be less involved in
your diabetes management. Sometimes
you may feel like they are fussing or
interfering when you don’t want them to.
It is only because they care, not because
they don’t think you can manage on
your own. Whatever age you are, your
parents will still worry about you and
want to take care of you.
Talk about it
It may help to sit down and discuss with
them how you would like to manage
your diabetes. Let them know how you
feel and how involved you would like
them to be.
Reassure them that you feel confident
managing your diabetes and know what
you need to do. Try to understand how
they are feeling too, and let them know
that you appreciate their support.
You may have the opposite problem,
and feel like your parents have left you
to deal with too much on your own.
If you feel you need more help and
support, let them know!
If you find it hard to talk to your parents,
you may find it helps to write down
what you want to say.
There may also be a physical reason
for how you feel. For example, poor
control of diabetes can make you feel
tired, anxious or moody.5 So making
adjustments to your insulin regimen
may make you feel better.
8
Talking to your
friends about
diabetes
Speaking to your friends about your
diabetes can be difficult. You may
worry that it will change your friendship.
But your friends will soon see that you
are no different now than you were
before you were diagnosed.
Your diabetes is a part of who you are.
You should not feel embarrassed
or worry about what other people
might think. Talking to a friend about
your diabetes may even help.
It needn’t be a big deal. You
may be able to drop it into
conversation at lunchtime or
Keenan Hendrickse,
South Africa
Keenan has type 1 diabetes
9
when you are out together. You may
want to show them your blood glucose
monitor or insulin pen or pump. It may
also be a good idea to explain to them
how you feel when you experience
hypoglycaemia and hyperglycaemia
and also what you need to do.
Your friends may not have heard of
diabetes before, so they will probably
be interested in finding out more. With
a better understanding of diabetes they
may be able to help support you when
you are out together. Really good friends
will help you look after yourself.
Driving
Tips for driving:6
When you are old enough, you may
want to learn to drive a car. Having
diabetes shouldn’t stop you from driving,
but you will need to make sure your
blood glucose levels are OK before you
get behind the wheel.
Always test your blood glucose before
driving. You should aim for a blood
glucose over 5 mmol/L (90 mg/dL)
before you drive (‘Over five to drive!’)
When you have hypoglycaemia your
reaction times and ability to drive can
be affected.6 So it is important that
you learn to assess the early signs of
hypoglycaemia and test yourself
before you drive!
Always keep a blood glucose meter and
treatment for hypoglycaemia in the car
(e.g. glucose tablets, sweets or fruit juice)
Stop the car immediately if symptoms
of hypoglycaemia occur. It is important
for you and other road users to stay
safe behind the wheel
If you are driving for a long time,
you need to stop and have a break
– 90 minutes to 2 hours is a sensible
driving time. Stretch your legs, check
your blood glucose and, if necessary
have a snack or drink to help keep
your blood glucose – and your
concentration – up
National regulations differ, but you may need
to notify your driving licence agency and
insurance company of your diabetes.
10
School
trips and
holidays
There is no reason why diabetes should stop
you from enjoying school trips or holidays.
They will just need careful planning!
11
School trips
Your parents will need to talk to your
teacher before the trip to make sure that
the teachers or other adults coming with
you know about your diabetes.
Planning your trip:
If you need help with testing your
blood or injecting insulin, your
teacher may need to be taught
what to do
If there are lots of activities
planned you may need to take extra
snacks or adjust your insulin dose –
speak to your doctor or nurse if you
are unsure
Holidays
You will need to make sure you
have all the supplies you need for
the duration of the trip (e.g. glucose
tablets, sweets or cartons of fruit
juice, extra insulin, needles, lancets,
blood and ketone test strips)
In hot climates you need to make
sure you can store your insulin in
a fridge
You should carry phone numbers
for your parents and doctor/nurse
just in case
School trips help teach you how to be
independent. Make sure in advance you
are confident performing all the diabetes
management tasks on your own so
that your parents or teacher don’t feel
it is necessary to come along on the
trip to help you.
Some things to remember:4
If you are flying to another country
you will need a letter to enable
you to fly with your insulin pen
and needles or pump. In some
countries, such as the USA, you have
to keep your insulin and any other
medications in its original packaging,
with the label identifying you
You will need to make sure you have
all the supplies you need for the
duration of your stay (e.g. enough
insulin, needles, lancets, blood and
ketone test strips, a spare blood
glucose meter and insulin pen)
You should carry snacks with
you while you are travelling
(e.g. glucose tablets, sweets
or cartons of fruit juice), in case
you have hypoglycaemia
Test your blood more regularly
than you would at home – hot
weather and different types of
foods can affect you differently.
Tell your parents straight away
if you feel unwell
In hot climates you need to make
sure you can store your insulin in
a fridge
If you are crossing time zones,
speak to your diabetes care team
about how to manage the timing
of your insulin
It may be a good idea to take
medications with you that help
to prevent diarrhoea, vomiting
or dehydration, in case you
need them
12
Studying for
exams
The run up to exams can be a stressful
time. Stress can affect blood glucose
levels, which can make it harder to stay
in control of your diabetes.7 Therefore, it
is important to look after yourself and try
and maintain your normal daily routine –
balancing meals, insulin and activity.
13
Planning for the
exam day:7
Your parents may need to speak to
your teachers prior to your exam.
You may be able to take insulin and
snacks into the examination room
with you
Make sure you have your blood
testing kit with you as you may need
to test your blood before or during
your exam
Your school may be able to arrange
for you to have extra time for your
exam if you do have hypoglycaemia
that needs treating during the exam
General tips:
Try to stick to your normal mealtime
and insulin schedule – don’t skip meals
or injections
Monitor blood glucose regularly – stress
can increase or decrease blood glucose
levels and changes in blood glucose affect
your concentration7
Stock up with plenty of healthy snacks
to boost your blood glucose levels
when needed
Take regular breaks – try to get some fresh
air or do some exercise if you can, even if
it is just a walk around the block
Try to get enough sleep – you will not
be able to concentrate as well if you
are overtired
14
Moving
out of
home
When you finish school or college, you
may decide to go to university or start
a job and move out of home.
15
Tell people you live with
Maintain a healthy lifestyle
Be prepared
If you are living with other people in
halls of residence or a shared house, it
may be a good idea to tell them about
your diabetes. You should explain to
them how to recognise and manage
hypoglycaemia and hyperglycaemia,
in case you need help. Make sure they
know who to ring in an emergency –
you may want to keep a book near the
phone with important contact numbers.
When you start university, it can be
difficult to stick to meal plans every day.
You may feel like you don’t have time to
prepare a healthy meal or are unable to
eat at the same time as usual. Try and
eat balanced healthy meals when you
can. You should make sure that you test
your blood regularly and adjust your
insulin if needed.
You will need to make sure that you
always have all the supplies you need
to manage your diabetes:
Find a new doctor/nurse
If you move far from home you may
need to arrange to see a new doctor or
nurse. Your current doctor will be able to
transfer your records to your new doctor.
If you are old enough to drink alcohol,
make sure you are aware of the effects
of alcohol on your diabetes. Take a
look at the ‘How do I fit diabetes into
my life?’ leaflet in this pack for
more information.
Spare insulin – make sure you get a
new prescription before you move
out, and make sure you know how
to request a repeat prescription from
your new doctor
Spare pens and needles
Spare blood glucose meter,
test strips and lancets
Ketone testing strips
Plenty of snacks or drinks
to manage hypoglycaemia
You should also try to be physically active
every day for at least 30 minutes. If you
don’t manage to exercise or play sports,
try and walk regularly to keep active.
16
The future
You can do most things someone without
diabetes can do, but life often requires
more planning. Diabetes should not stop
you from achieving your goals or excelling
in whatever you choose to do. Lots of
famous people with diabetes have not let
their condition hold them back or stop
them from fulfilling their dreams.
Musicians 8
Athletes9
Olympic rower
Sir Steven Redgrave
Olympic swimmer Gary Hall
Pakistani cricket fast
bowler Wasim Akram.
Kick-boxing world champion
Anja Renfordt
Nick Jonas
Other
Aretha Franklin
Miss World Nicole Johnson
Bret Michaels
Elvis Presley
Actors 8
Halle Berry
katie Norton,
USA
Katie has type 1 diabetes
17
Sharon Stone
Peter O’Toole
Some jobs which involve driving or flying
or operating heavy machinery may not
be suitable for people with diabetes.
Speak to your doctor, nurse or careers
advisor if you have any concerns.
References
1. NIH Medline Plus Library. Type 1 diabetes.
Available at: www.nlm.nih.gov/
medlineplus/ency/article/000305.htm
Accessed October 2012.
2. IDF/ISPAD guideline for diabetes in
childhood and adolescence. Available at:
www.ispad.org Accessed October 2012.
3. Smart C et al. ISPAD Clinical Practice
Consensus Guidelines 2009. Compendium:
Nutritional management in children and
adolescents with diabetes. Pediatr
Diabetes 2009; 10(Suppl. 12): 100–117.
4. Diabetes UK website. My life. Available at:
www.diabetes.org.uk/Guide-to-diabetes/
My-life/Kids/ Accessed October 2012.
5. ADA. Depression. Available at:
www.diabetes.org/living-with-diabetes/
complications/mental-health/depression.html
Accessed October 2012.
6. Silverstein J et al. Care of children
and adolescents with type 1 diabetes.
Diabetes Care 2005; 28(1): 186–212.
7. Diabetes UK. Exams. Available at:http://
www.diabetes.org.uk/Information-forparents/Living-with-diabetes-new/School/
Exams/ Accessed October 2012.
8. Kidzworld. Celebrities with diabetes.
Available at: www.kidzworld.com/
article/10515-celebrities-with-diabetes#
Accessed October 2012.
9. Robertson K et al. ISPAD Clinical Practice
Consensus Guidelines 2009 Compendium:
Exercise in children and adolescents with
diabetes. Pediatr Diabetes 2009; 10(Suppl.
12): 154–168.
10.Novo Nordisk website. Available at:
www.novonordisk.com
Accessed October 2012.
18
About Novo Nordisk
This information was developed by Novo Nordisk,
a global healthcare company specialising in the
care of people with diabetes.
Since then Novo Nordisk has grown to become a
world leader in the provision of diabetes products
and support for patients of all ages.10
Novo Nordisk was started up almost 90 years ago
by a Danish couple with a passion for changing
diabetes. August Krogh was a professor at the
University of Copenhagen and Nobel Prize winner
and his wife Marie, a doctor and researcher into
metabolic diseases, suffered from type 2 diabetes.
They learned of insulin being developed in Canada
and were determined to ensure access to insulin
for everyone with diabetes, hence in 1923
Novo Nordisk was born.
We fully understand the challenges that children
with diabetes face and are working together with
parents, schools and healthcare professionals to
improve the care of children with diabetes, as they
grow up and develop.
For more information about Novo Nordisk,
please visit: www.novonordisk.com
This information is not designed to
replace the advice of a healthcare
professional. Please consult your doctor
or nurse if you have any questions or
concerns about managing your diabetes.
APROM ID#4600; approval date: December 2012.
Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S.
Novo Nordisk A/S Novo Alle 2880 Bagsværd Denmark
www.withyoualltheway.info