Although diabetes is recognized as an adult disease, it is also detected even in very young children. Childhood type 1 diabetes develops secondary to permanent deficiency of insulin hormone which regulates the blood glucose level. Therefore, diabetic children need to monitor their blood glucose levels for at least 4-6 times a day and use insulin hormone via injection or an insulin pump, after being diagnosed with diabetes.
Regarding long-term follow-up and a healthy life for diabetic children, diabetes training/education is as important as insulin treatment and relevant technologies. We can say that diabetes does not seem to be a major problem anymore for the diabetic children and their families thanks to “Flexible Diabetes Management” based on carbohydrate counting. Training is highly important to help alleviate worries of the diabetic children and their families. The diabetic children get basic information throughout the hospital stay, but diabetes camps for children, which allow them to experience this process under supervision of doctors, nurses, dietitians and experienced diabetic patients, also provide an effective training.
Besides, it is necessary to support the diabetic children at school, improve their skills to cope with diabetes (gaining resistance), recognize their mental problems early, help them be at peace with their disease (“friend”) and guide them during transition to adulthood.
We, as Pediatric Diabetes Team of Koç University, are happy to share our experience and knowledge about treatment of diabetes with the diabetic children in the light of recent developments and cutting-edge resources for 27 years. Moreover, we closely follow and implement recent technological developments in treatment of diabetes by collaborating with Assoc. Prof. Eda Cengiz, Head of Pediatric Diabetes Program in Yale University, and Assist. Prof. Halis Kaan Aktürk from Barbara Davis Center for Diabetes. We are striving to expand our services as a center where 750 children with type 1 diabetes presented within three years.
Comprehensive Pediatric Diabetes Program Includes these basic steps:
- Baseline admission (For each child with type 1 diabetes, minimum 45-minute encounter with physician and providing a report that indicates treatment recommendations / glycemic targets)
- Basic training update and further education (a program that involves discussion with a nurse for once, dietician for 3 times and psychologist for once/ Carbohydrate, protein and fat counting, training on exercise management)
- Continuous communication with the diabetes team
- Discussion with dietitian in one of every two doctor appointments.
- Use of “Continuous Glucose Monitoring Systems” (sensor) for each eligible child
- Use of insulin pump for each eligible child
To facilitate access to our programs, “Baseline Admission Training Package” and “Insulin Pump Therapy Package” are introduced and thus, families are given two alternatives to relive the financial burden.
Programs provided by our Pediatric Endocrinology Team to manage diabetes are as follows:
- Inpatient treatment and training for children, who are recently diagnosed with diabetes.
- Treatment of emergencies, such as diabetic ketoacidosis
- Insulin pump insertion and training
- Placement and monitoring of new generation blood glucose measurement systems (not requiring finger-stick glucose monitoring)
- Structured diabetes training and training resource
- Carbohydrate counting / management training
- Follow-up of mental health and resistance trainings
- Emergency support and counseling
- Social meetings / culture tours with diabetic peers and experienced diabetic patients
- Participation to "My Friend Diabetes Camp” organized in İznik every year
- Participation to "My Friend Diabetes Family Camp” organized in Uludağ every year
- Diabetes at School Program
- Social support for the diabetic children and their families / Mentor family program
Insulin Pump and Sensor Therapies
Recently, significant technological advancements have been made in treatment of Type 1 diabetes, along with new insulin therapies. Insulin therapy can be given more physiologically with “Smart insulin pump”, while continuous blood glucose monitoring systems are about to substitute finger-stick glucose monitoring Thanks to these developments, it will be possible to utilize certain systems, such as “Artificial Pancreas” and “Bionic Pancreas”, which automate blood glucose monitoring and insulin therapy, in routine treatment in the near future. At our department, all insulin pump therapies and products of sensor technology available in our country can be applied. 20% of children with Type 1 diabetes monitored at Koç University Hospital use the insulin pump, while 46% use the continuous glucose monitoring system.
As Pediatric Diabetes Team of Koç University, we are aware that the insulin pump alone has no great influence. Therefore, we adopt a comprehensive diabetes training, especially the carbohydrate counting. We make the decision regarding the insertion of the pump jointly with the child/adolescent, family and team. We desire that our patients are well trained on carbohydrate counting / management and able to perform it before the procedure.
The insulin pump therapy consists of a 3-day outpatient treatment followed by subsequent follow-up visits.
Day 1
- In the morning, dietitian and psychologist visit, analyzing insulin-to-carbohydrate ratio and insulin sensitivity factor
- In the afternoon, technical training on the pump, insertion of a demo pump with distilled water and maintaining treatment with injection at home
Day 2
- Loading CGMS data, if any, and glucometer
- Instructing the pump functions
- Training on management of hypoglycemia and hyperglycemia
- Team session, basal rate adjustments
- Switching to insulin in the demo pump
- Reporting
Day 3
- Answering questions
- Review
- Set replacement
- Training on exercise management
- Management in case of diseases
2 weeks later
- Pump and sensor loading report
- Reviewing the settings
- Opening models
- Detailed training on the sensor, activating the alarms
1 month later
- Pump and sensor loading report
- Reviewing the settings
Solidarity and Counseling (Mentorship) Program for Families of Diabetic Children
Pre-and post-diagnostic assessments, parents’ attitude, the child’s perception about the condition and social support are very critical for children with Type 1 diabetes. When the families communicate properly with healthcare personnel and other people that they can share their experiences and get support from, their mental status is influenced positively and their resistance improves.
Solidarity and Counseling (Mentorship) Program for Families of Diabetic Children trains experienced families competent in the management as mentor to make access to correct information easier and support other patients with Type 1 diabetes and their families. This programs aims to:
- Create a virtual environment where the children with Type 1 diabetes and their families can exchange their experiences, ask questions and give information and specialists provide scientific data and to use www.arkadasimdiyabet.com for this purpose,
- Train volunteer family members who can perform mentorship,
- Refer a certain number of families to counselors (Mentors) (provided the children are at same age or have similar diagnoses and the children reside close to each other) and help them manage diabetes and get social support (immediately in case of need),
- Visit the children, who are recently diagnosed with Type 1 diabetes, and their families in the hospital and to support them,
- Organize social activities where the families and children participate to share their experiences,
- Help families with poor financial resources.
My Friend Diabetes Camp in İznik
To train the diabetic children on diabetes and improve their health, “My Friend Diabetes Camps” have been organized in İznik since 1997 and in Diyarbakır since 2011 (Joint camps have been held in İznik since 2016). The camp involves group studies and experience exchange as well as training and instructing the basic issues. Groups are formed according to age and it is aimed to train these groups on “General approach to diabetes treatment”, “Being at peace with diabetes and coping with diabetes”, “type 1 diabetes and exercise, “insulin pump therapy and new technologies”, “carbohydrate, protein and fat counting”, “insulin dose adjustment” and “Management of hyperglycemia and ketonemia at home”. The groups share their experiences with each other.
Various sports, particularly swimming, entertainment and art activities are planned out of the training hours. In the camp, a team of pediatric endocrinologists, pediatricians, pediatric psychiatrists, dietitians, diabetes nurses, psychologists, medical students, dietetics students, nursing students and activity leaders works 24/7 under supervision of two academicians. Also, experienced people stand by the children as group leaders and “role models” round the clock.
Philosophy of the camp: To encourage the children to be at peace with diabetes and create multidimensional means for this purpose. Being at peace with diabetes is the first step of living with diabetes. The children are instructed to act gently regarding the diabetes, as is the case with their friends. It is necessary to improve their coping skills to enable them overcome diabetes-related problems and concerns. We encourage the children to leave the past behind, look to future and be at peace with diabetes.
Aims of the camp
- To encourage the children to be at peace with diabetes and create multidimensional means for this purpose,
- To provide the diabetic children with information about diabetes care and treatment and enable them to struggle with diabetes care-related problems,
- To raise awareness on diabetes care,
- To enable participants to share their experiences with each other and alleviate their feeling of loneliness,
- To boost self-confidence of the participants through social and physical activities,
- To help them have an optimistic and safe look for the future,
- To boost their knowledge about diabetes,
- To further train pediatric diabetes teams and create a health team that would understand the diabetic children better
You can access to information regarding My Friend Diabetes Camp in İznik at http://www.arkadasimdiyabet.com/kamp-zamani/kamp-zamani
My Friend Diabetes Family Camp
Allowing participation of their children to “My Friend Diabetes Camps”, many families were requesting that such camps are also held for themselves and stating that they want to get such a comprehensive training like their children and they also need to share experiences and interact with other families with diabetic children. We have organized “My Friend Diabetes Family Camp” since 2018 to cater to this request that has long been emphasized, make contribution to treatment process of the diabetic children, meet educational needs and complete “value creation chain” within the scope of “Comprehensive Pediatric Diabetes Program”. Besides the diabetic children, parents and their non-diabetic siblings can also participate to this camp. You can get information about our camp at://www.geleceginyildizlari.com/programlar-57/arkadasim-diyabet-aile-kampi-81.html.
Philosophy/mission of the camp: The philosophy / mission of the camp is to provide the families with multidimensional means that they can find a new “normal”, avoid feeling desperate and be at peace with diabetes. Being at peace with diabetes is the first step of living with diabetes; we aim to support the families to overcome diabetes-related problems and prevent worries of the children and families. We encourage the children and their families to leave the past behind, look to future and be at peace with diabetes.
Aims of the Camp
- To provide the diabetic families (and their children) with information about diabetes care and treatment and enable them to struggle with diabetes care-related problems,
- To raise awareness on diabetes care,
- To give further education on novel treatments and technologies,
- To enable participants to share their experiences with each other and alleviate their feeling of loneliness,
- To help them have an optimistic and safe look for the future,
- To impress democratic attitudes, instead of negligent, authoritative and permissive attitudes of parents,
- To make the diabetic children and their families better understand and manage the puberty issues/changes,
- To further train pediatric diabetes teams and other people participating to the camp, create an environment where they can get feedback from the families and evaluate their works/attitudes and create health teams that better understand the diabetic children lifelong,
- To promote new participations to “My Friend Diabetes Family Program” that is maintained for supporting and guiding the families of the diabetic children, and to popularize the program across the country.
Diabetes at School Program
The diabetic patients spend most of their time (8-10 hours a day) under supervision of school personnel. Inability to perform glycemic monitoring at school may affect diabetes management negatively. When school personnel, particularly teachers, do not know diabetes management well, it may be potentially difficult to maintain optimal blood glucose monitoring. Also, no matter what age and how efficient they are, all students with type 1 diabetes should be assisted under supervision of school personnel at school. In many countries, there are no legal provisions about the necessity of assistance at school for the children with Type 1 diabetes, and the responsibility of blood glucose monitoring and insulin therapy is left to parents and school personnel, because school nurses are not available. In our country, Diabetes at School Program has been maintained since 2019 and many activities are performed within the scope of this program.
We, as Pediatric Diabetes team of Koç University, organize “Emergency Diabetes Care at School” training on the last Saturday of every month pursuant to this program. 60 teachers and nurses have attended these training programs since October 2018.
Characteristics of the program are as follows:
- First Training: Basically, it involves noticing the signs and symptoms of hypoglycemia and its urgent treatment (including Glucagon). Applied training on the administration of Glucagon, insulin injection and blood glucose monitoring is given.
- Second Training: The training is given by pediatric diabetes nurse before noon on Saturday at Koç University Hospital for 1.5 hours.
- Third Training: It is given free-of charge on the last Saturday of every month. 10-15 teachers are accepted to each program.
- Volunteer teachers and school nurses attend the trainings. The families notify the teachers, who have close relationship with their diabetic children, about this training program and the volunteer teachers can apply over the below specified e-mail address and phone number.
- The participant teachers are given a certificate of participation.
- The certificate of participation does not indicate that the teachers are competent on the administration of Glucagon or insulin. This training only makes the teachers gain the skill to administer Glucagon and insulin, if required, subject to permission of parents.
Diabetes Training Program
An online training program, called “Diyapedia”, was initiated to help both our diabetic children, who are followed up by our clinic, and their families as well as other diabetic children and their families residing in our country. All training activities performed within the scope of this program are published on Live Broadcast and Video Portal of Vehbi Koç Foundation’s Healthcare Facilities. Video recording of these activities can be accessed over the portal. (https://live.vkvhealth.org/login).
Recently, the training books authored by our team are published, including “The Diary of the Diabetic Kid”, “It’s Time to be Friend with Diabetes” and “It’s Time to Learn How to Live with Diabetes”. You can access these books and presentations at http://www.arkadasimdiyabet.com/ogreniyoruz/okuyarak-ogrenelim/e-kitaplar
My Friend Diabetes Basketball Exhibition Match and My Friend Diabetes Run
One of the problems faced by diabetic children and adolescents is about failure of the population know and be aware of type 1 diabetes. Those who meet a child with type 1 diabetes for the first time think that the diabetic children cannot maintain a normal life; for instance, they cannot get married and have children like everybody else or cannot engage in sports activities. Some employers and human resources professionals are reluctant to hire young people with type 1 diabetes. Accordingly, some children cannot banish the thought that they would be treated differently, if their diabetes is known by others.
In fact, today, the diabetic children and youth can maintain a normal and successful life with an appropriate treatment and do everything like everybody else by “Being at Peace with Diabetes”. For example, among diabetic people, many successful athletes exist, such as Gürkan Açıkgöz, who is a basketball player, and Alper Saruhan,who is a marathoner. Alper Saruhan states that the diabetic children deserve the title of “Survivor” rather than those who are involved in TV shows, and adds that his life, as a diabetic, proves that even diabetic people can be successful athletes, diabetes is not a handicap to reach targets and all difficulties can be figured out by being friend or at peace with diabetes. He serves as a model for the diabetic children.
To draw attention that type 1 diabetes is not a handicap for doing sports activities and the people with type 1 diabetes can make a difference in their lives, exhibition matches between basketball players with type 1 diabetes and famous basketball players have been held jointly with Turkish Association of Basketball Coaches every year and My Friend Diabetes Run has been organized in Bağlarbaşı Wood in cooperation with Koç Sports Community since 2017.