Comprehensive Pediatric Diabetes Program
Although diabetes is primarily known as an adult disease, it is also encountered among children, starting from early ages. Type 1 diabetes among children occurs due to permanent deficiency of the insulin hormone, which regulates blood glucose levels. Therefore, once diagnosed, diabetic children are required to measure blood glucose levels at least 4-6 times a day and receive insulin hormone externally by means of injection or an insulin pump accordingly.
Diabetic training is as important as insulin intake and treatment in terms of long-term follow-up and leading a healthy life. Diabetes has recently become not so much of a burden for children and parents after the advent of “Flexible Diabetes Therapy”, which is essentially based on carbohydrate counting. Training also plays an important role in alleviating level of concern for diabetic children and their parents. While diagnosed children are provided with basic information after being admitted to a hospital, diabetic children camps also offer quite an effective means of training by enabling children to meet physicians, nurses, dietitians and other experienced diabetic peers.
All of these efforts should also be reinforced with support in the school setting, resilience building to cope with diabetes, early diagnosis of possible mental problems, a diabetic-friendly life and guidance on the route to adult life.
The Comprehensive Pediatric Diabetes Program includes the following:
- Physician consultation for 45 minutes at minimum for type 1 diabetes patients presenting for the first time, who are then given a written report on the physician’s recommendations/glycemic targets.
- Basic training updates and advanced training (consultations once with a nurse, 3 times with a dietitian and once with a psychologist - training on carbohydrate, protein and fat count as well as exercise management).
- Constant communication with the diabetes team.
- Dietitian consultation during at least one of every two visits.
- Use of Continuous Glucose Monitoring Systems (sensors) for cases where it is possible.
- Use of insulin pump for cases where it is possible.
- “First Visit Package” and “Insulin Pump Therapy Package” aimed at facilitating access to our programs and payment.
Insulin Pump Therapy and Advanced Technologies Program
Treatment of type 1 diabetes has recently use of insulin pumps as well as introduction of some significant technologic advancements. Insulin therapy with
“smart insulin pumps” renders treatment more physiological, whereas continuous blood glucose measurement systems are about to replace the conventional fingertip puncture. Not so long ago, these advancements have also enabled routine use of systems such as “artificial pancreas” and “bionic pancreas”, which allow automatic administration of insulin and blood glucose measurements. Insulin pump therapy and sensor products that are available in our country are utilized at our department. Currently, 20% of the children followed at Koç University Hospital with the diagnosis type 1 diabetes use insulin pumps, and 46% use continuous glucose monitoring systems.
As the Pediatric Diabetes team of Koç University, we do realize that insulin pump alone will not make a substantial contribution to treatment. That is why we concentrate on comprehensive diabetes training, primarily carbohydrate counting. Upon reaching a mutual agreement with diagnosed children/adolescents, parents and team members, we decide on fitting patients with pumps and make sure that they are trained in and follow training on carbohydrate counting/management. Insulin pump therapy consists of a 3-day process and consequent follow-ups.
Insulin Pump Therapy
- Consultation with dietitian and psychologist, determination of insulin/carbohydrate ratio and insulin sensitivity factor in the morning;
- Pump training, demo pump fitting with distilled water and treatment continued at home in the afternoon.
- Downloading GCMS data, if available, and glucometer;
- Training on pump functions;
- Training on hypoglycemia and hyperglycemia management;
- Team session, basal rate adjustments;
- Switch to insulin in the demo pump;
- Report compilation.
2 weeks later
- Answering questions;
- Change of set;
- Training on exercise management;
- Management of disease conditions.
1 month later
- Pump and sensor download report;
- Review of settings;
- Introduction of models;
- Detailed sensor training, introduction of alarms.
- Pump and sensor download report
- Review of settings.
Diabetic Children’s Parents Solidarity and Guidance (Mentorship) Program
The diagnosis process of type 1 diabetic children, management of the consequent process, parents’ approach and perception of their children’s condition and social support are of utmost importance. Availability of people healthcare personnel as well as other parents who can provide support and share their own experiences can positively influence the mood of parents and increase their level of resilience.
The Diabetic Children’s Parents Solidarity and Guidance (Mentorship) Program aims to facilitate access to correct knowledge, train experienced parents practicing good management as mentors, and closely support other type 1 diabetic patients and their parents. Below are the objectives of this program:
- Creating an environment where type 1 diabetic children and their parents can share their experiences, questions and knowledge alongside experts sharing their scientific data with the help of the website www.arkadasimdiyabet.com
- Training volunteering parents who can act as mentors;
- Allocating a certain number of parents to mentors (by taking into account specific features such as having diagnosed children of the same age group and residing in close proximity to each other), who will then assist these parents in matters such as management of diabetes and social support (immediately as needed);
- Visiting recently diagnosed type 1 diabetic children and their parents at the hospital and supporting them;
- Organizing activities where parents and children gather together and promoting sharing among them;
- Providing voluntary aid to those families whose may be in need of financial support.
My Friend Diabetes İznik Camp
“My Friend Diabetes” camps have been set up in İznik since 1997 and Diyarbakır since 2011 (and commonly in İznik since 2016) in order to provide a setting that can help improve training and restore health among diabetic children. While basic topics are covered in the form of class lessons, groupwork and experience sharing activities are held at the camp. Children are grouped in accordance with age groups, where they are trained and share their experiences in topics like “general approach to diabetes treatment”, “being at peace and coping with diabetes”, “type 1 diabetes and exercise”, “insulin pump therapy and new technologies”, “carbohydrate, protein and fat counting”, “adjusting insulin dosage” and “hyperglycemia and ketonemia management at home”. Various sports -primarily swimming-, entertainment and art activities are also made available outside the training hours. A team of pediatric endocrinologists, pediatric health and mental health specialists, dietitians, diabetes nurses, psychologists, activity leaders and students from departments of medicine, dietetics and nursing works on the camp grounds 24 hours a day under leadership of at least 2 faculty members. Experienced older brothers and sisters also share every moment of the day with children as “role models”.
You can find out more on the My Friend Diabetes İznik Camp
My Friend Diabetes Parents’ Camp
Parents sending their children to these camps have often mentioned that they would also like to attend such a camp, where they get to meet other parents or diabetic children and interact with them. To answer this call and complete the “value creation chain” as part of our “Comprehensive Pediatric Diabetes Program”, we have been organizing the “My Friend Diabetes” parents’ camp since 2018. This is a camp for diabetic children as well as parents and non-diabetic siblings.
You can find out more on the My Friend Diabetes Parents’ Camp
Diabetes at School Program
Diabetic children spend the majority of an ordinary day (8-10 hours a day) under supervision of school staff. The lack of glycemic control within this period of time has a negative impact on management of diabetes. Unless they receive proper training, school staff -mainly teachers- may experience difficulty in terms of responding to requirements of diabetes management and ensuring optimal blood glucose control. Furthermore, regardless of age groups and level of self-sufficiency, type 1 diabetic children are in need of support during their time at school, which means that the supervision of school staff is of utmost importance. Because there is no school nurse at many schools, monitoring blood glucose levels and administering insulin doses are a responsibility assumed by parents and school personnel. We have been practicing the Diabetes at School
program since 2010 in our country and conducting various activities within this framework.
As the Pediatric Diabetes team of Koç University, we conduct the “Emergency Diabetes Care Program at School” on the last Saturday of each month as part of the overall program. So far, 60 teachers and nurses have taken part in these courses since October 2018.
Diabetes Training Program
Our department has launched an online training program named “Diapedia” for the purpose of training the diabetic children under our supervision and their parents while also supporting training of other diabetic children and their parents around the country. All activities conducted within the framework of this program are posted on the Vehbi Koç Foundation Healthcare Institution live broadcast and video portal
, where recorded videos can be viewed at any time.
Our team has also recently published the course books “Diary of the Diabetic Child”, “Time to Befriend Diabetes” and “Learning to Live with Diabetes”. These books and other presentations are available on the My Friend Diabetes
My Friend Diabetes Basketball Show and Run
One of the common issues encountered by diabetic children and youngsters is that the society does not really know much about type 1 diabetes. Most people meeting a type 1 diabetic child for the first time typically think that they cannot live a normal life, get married and have children like everyone else or carry on performing any sportive activity they may have taken up. What is more, some business owners and HR departments tend to be reluctant to employ type 1 diabetic youngsters. Because of all of these realities, some diabetic children cannot help but think that people will treat them differently after finding out about them being diabetic.
However, it is currently possible for diabetic children and youngsters to live a completely normal and successful life by receiving the appropriate treatment and do everything that their peers can by “Befriending Diabetes
”. Basketballer Alper Saruhan and marathon runner Gürkan Açıkgöz are some of the successful diabetic athletes, to name a few. Alper Saruhan notes that diabetic children deserve the title of ‘survivor’ the most rather than the contestants on the television. He states that his life is an example that one can succeed as a diabetic athlete, underlining that diabetes is not an obstacle that prevents one from achieving their goals and all difficulties can be overcome by befriending diabetes.
To emphasize the fact that type 1 is not an obstacle for sportive activities and that type 1 diabetes patients can make a difference in their own lives by means of sports, the Turkish Basketball Federation’s Association of Coaches has been arranging show matches between famous basketballers and type 1 diabetic basketball players since 2017. Also since 2017, the Koç Sports Collective has been organizing the My Friend Diabetes Run in the Bağlarbaşı grove.
Comprehensive Obesity Program
Obesity and related disease -particularly diabetes- have turned into the most urgent public health issue of our time. Mortality rates associated with obesity have even surpassed that of hunger in some parts of the world such as the USA. Recent research has also shown that over 30% of adults and 20% of children in our country are overweight and obese.
According to findings of the “Childhood Obesity Research” among second-grade children, which was conducted on the basis of the methodology proposed by WHO, prevalence of obesity is 8.4 and prevalence of overweight, which signals risk of obesity, is 14.3 in this age group. It has also been found out that prevalence of overweight is three times higher in urban areas than in rural regions. A similar difference exists between İstanbul/West and East/Southeast. This set of data clearly displays the extent to which lifestyle and dietary habits determine the increased risk of obesity for children. Children living in cities and in western regions overall encounter food items that instigate a sense of enjoyment upon consumption and create a lifelong habit more often, which results in them gaining weight early on. We all know how junk food is “readily available” everywhere, particularly supermarkets. It is also known that these products are usually described as cheap and “safe” -which is not entirely true; they may be safe, but also they are unhealthy-, and marketed as favorable items often by means of cartoon characters. Those children who are exposed to such advertisements consume 40 percent more stick crackers than those wo are not. This is all closely related to the high and rapidly absorbed sugar content found in “junk food” and processed products, which in turn causes “food addiction”.
Obesity is a complex problem that respectively leads to an increase in the overweight population in a society, prevalence of obesity and obesity-associated diseases like type 2 diabetes, shortened life expectancy due to these diseases and eventually epigenetic accumulation carried over from one generation to the other. From this point of view, it seems that protecting children from the risk of obesity and treating obese individuals constitute the most notable strategy for maintaining children’s and adults’ health, i.e. public health as a whole.
We are glad to serve obese children with 27 years of experience and the latest technology at our disposal as the Pediatric Endocrinology team of Koç University Hospital. Below are the services our team offers:
- A comprehensive evaluation at the time of first visit and determination of tailored approaches for each individual;
- Analysis and treatment of insulin resistance;
- Analysis of dietary habits and body mass components (fat, muscle and bone tissue ratios);
- Structured healthy dietary training;
- Dietary planning in accordance with level of obesity and personal features, and close review of progress;
- Tailored exercise planning;
- Psychosocial assessment and support;
- Support at school and prevention of “stigmatization”;
- Treatment with the latest obesity medication available;
- “Metabolic Surgery” planning in collaboration with the Metabolic Surgery unit of Koç University Hospital, as may be necessary for adolescent obese individuals.