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Intensive Management of Diabetes
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Intensive Management of Diabetes


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We understand how challenging it can be for children living with a chronic condition like diabetes. Our specialists work with patients and families to make disease management a little easier. Intensive insulin therapy is one option that enables many diabetics to effectively control their blood sugar and reduce the risk of diabetes related complications.

Intensive therapy requires a significant commitment from the patient, however, and a physician referral or order is required. Your child’s diabetes physician can help determine if intensive management is a safe and appropriate therapy for your child.
 
Assistance and education for intensive insulin regimens, including Basal/Bolus with injected insulin and insulin pump therapy, is coordinated through the Diabetes Program at Children’s National Medical Center — the largest pediatric diabetes program in the mid-Atlantic region.  

Facts to Consider Before Making the Change
Intensive management requires a great deal of discipline, which is important for patients and families to consider before making the change. Carbohydrate counting is essential for successful intensive management.

The patient must demonstrate to parents and the healthcare provider the ability to count carbohydrates, not only for foods with nutrition labels, but also for also common foods without food labels, such as fresh produce. This includes identifying the portion size, carbohydrate amounts, and measuring the food. Keeping a food diary may also be necessary.

Basal/Bolus and Insulin Pump Therapy
 
In addition to a physician referral, children also must see a dietitian before attending a Basal/Bolus Class. You may schedule an appointment with a Children’s dietician at Children’s main hospital or at one of Children’s Regional Outpatient Centers. Children’s National hosts Basal/Bolus classes, which last about four hours, every two to four weeks.

Injected Basal/Bolus regimen requires one injection of basal insulin (Lantus) and an injection of rapid-acting insulin for all carbohydrate intake. During a typical day, this means four or more injections per day, including one at lunchtime. The lunchtime injection may require assistance at school if your child cannot calculate the proper dosage or administer their own insulin injection.

Before a child can use insulin pump therapy, he or she must have demonstrated successful Basal/Bolus management (with Lantus and rapid-acting insulin) for a minimum of four to six months. This is necessary to learn the skills to safely and successfully use insulin pump therapy. Patients go Children’s main hospital facility for insulin pump starts.
For More Information
Your child’s diabetes physician can provide more information or you may contact Children's Division of Endocrinology at 202-476-2121.


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