Diabetes-related bullying in school

Daniel Sher discusses the impact that diabetes-related bullying can have and how therapy can help empower a child in this position.


Children and adolescents who have diabetes are more likely to experience diabetes-related bullying. This can lead to some serious mental health issues, as well as negatively affecting their diabetes management and overall well-being.

Meet Siya

Siya (not his real name) was diagnosed with T1DM when he was 11-years-old. His parents brought him to see me when he was 14. They were worried that he seemed sad and withdrawn and that he wasn’t willing to help them understand why.

Once Siya felt that he could trust me and the confidentiality of the space, Siya began to open-up. It turned out that once he had moved to a new high school, his peers started to mock and tease him about his diabetes.

The bullying really was relentless. Every time he scanned his CGM or adjusted his insulin dose, this would attract the attention of his peers. Their nasty comments would make him feel ashamed and angry.

He would frequently sit through class with symptoms of high blood glucose, rather than take his insulin. Apart from wreaking havoc with his HbA1c and emotional well-being, Siya’s grades started to drop rapidly, as the high blood-glucose stopped him from being able to focus properly.

More than just bullying 

Discrimination is the unjust or prejudicial treatment of different categories of people based on what makes them different. When somebody is denied a job opportunity because of their gender, for example, this is a clear example of discrimination.

If Siya is being bullied and ostracised because of his diabetes, isn’t this a case of discrimination? The answer is yes; and to support kids like Siya we, as adults, need to start calling a spade a spade.

Calling a spade a spade

When Siya came to see me, he had been ashamed to raise the issue of bullying with his parents or teachers. He didn’t want to be labelled as a tattle-tale. He also didn’t want to “make a big deal out of something that happens to other people every day.”

A part of his treatment involved helping Siya to name and identify what was happening as being both bullying and discrimination. This helped him to understand the seriousness of what was going on. Most importantly, this made Siya feel confident enough to act by raising the issue with his teachers.

Many kids like Siya think that this is “just bullying” and that they need to simply get over it. It’s important for us to recognise, however, that this sort of discrimination, when it happens to people with diabetes, can worsen their blood-glucose control and emotional well-being.

What is the impact of diabetes-related bullying?

Research tells us what we all know intuitively: bullying can lead to some serious mental health consequences. These include:

  • Depression
  • Panic attacks
  • Low self-esteem
  • Impaired concentration
  • Social anxiety
  • Poor peer relationships
  • Missing out on opportunities for social development
  • Greater chances of developing depression in adulthood.

The fact that kids who get bullied are at risk of experiencing these sorts of outcomes means that for those with diabetes, in particular, bullying needs to be addressed. This is because having these sorts of psychological difficulties, over and above having diabetes, can make it that much harder to effectively manage one’s physical health.

Other ways in which diabetes-related bullying negatively affects T1DMs

As was the case with Siya: people with diabetes might end up skipping tests or injections, to avoid attracting attention to themselves. Alternatively, they might be more likely to eat things which are not conducive to their health (and without making appropriate corrections) when they are out in public, to feel more “normal”.

Furthermore, the stress that bullying causes triggers a cascade of hormones in the bloodstream which can raise blood glucose. Kids who are chronically stressed are also more likely to eat sugary snacks which can bring them a moment of comfort and calm amidst the chaos.

How can therapy help?

It seems strange to even suggest that your child who is being bullied should see a therapist, given that the problem clearly lies with the person doing the bullying.

Nonetheless, therapy can provide a valuable space for a child or adolescent who has been bullied to build resilience and learn how to assert themselves constructively.

In my own work with Type 1s who are bullied, a space is provided in which they become self-empowered to take decisive action against bullies. Different forms of practical action are appropriate for different types of bullying. What’s vital here, however, is that we focus on helping to empower a child to take control. Why?

Quite simply, bullying makes a person feel powerless. Having uncontrolled diabetes also makes a person feel powerless. People with diabetes need the right support so that they can take responsibility for themselves. The same applies for children with diabetes who are being bullied.

As parents (or therapists, for that matter), the impulse is often to “swoop-in” and help. Often, depending on the impact of the bullying and the age of the child, this is necessary. To do so without fostering a sense of empowerment and autonomy in your child at the same time, however, is to do them a disservice.

Therapy can also help to:

  • Foster personal growth. This involves developing an understanding that bullies are not bad people: they are simply emotionally and psychologically wounded. As a result, they need to inflict pain to process their own sense of inadequacy. The implication here is that fighting back is not the answer. The best way to deal with bullies is through firm boundaries and an attitude of empathy.
  • Helping kids to understand and regulate the emotions which they experience because of bullying. For children with T1DM it is valuable to confront and take ownership of the sense of “otherness” (i.e. of being different) that gets elicited when others bully them about their diabetes. This is an important aspect of personality development for us; and when we make peace with our fears of being different, we are better able to thrive with diabetes.
  • Finally, therapy helps to bolster children’s self-esteem by showing them that they are neither alone nor powerless.

Summing up

Research has shown that children and adolescents with Type 1 diabetes are victimised by their classmates more often than people who don’t have diabetes. As if people with diabetes didn’t already have enough to worry about!

Unfortunately, bullying can cause an emotional response in children with diabetes that makes it harder for them to thrive with their self-management. Therefore diabetes-related bullying needs to be addressed as a priority.

Not sure how best to manage? Reach out to your doctor and request a referral to a counsellor or psychologist who can provide the right support.


References

Ando, M., Asakura, T., & Simons-Morton, B. (2005). Psychosocial influences on physical, verbal, and indirect bullying among Japanese early adolescents. The Journal of Early Adolescence, 25(3), 268-297.

Nascimento Andrade, C. J., & Alves, C. D. A. D. (2019). Relationship between bullying and type 1 diabetes mellitus in children and adolescents: a systematic review. Jornal de Pediatria, 95(5), 509-518.

MEET THE EXPERT


Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit www.danielshertherapy.com


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Tips to get your kids eating healthy

The Heart and Stroke Foundation suggests five ways to get your kids eating healthy to support their growth and development, all while building healthy eating habits.


The COVID-19 outbreak is upending life for families around the world. To make things even harder, panic buying and disruptions to food supply systems mean some foods can now be difficult to find. And for many people, unemployment and lost income are making food shopping an additional financial challenge.

While many parents are understandably looking to ready meals and processed foods as a quick and low-cost way to feed the family, there are convenient, affordable and healthy alternatives to get your kids eating healthy.

Five healthy eating tips

  1. Keep up fruit and vegetable intake

Purchasing, storing and cooking fresh vegetables can be challenging. But it’s important to ensure children are getting plenty of fruit and vegetables in their diet. Whenever it’s possible to get hold of fresh produce, do so.

As well as being eaten fresh, vegetables can be frozen where possible and will retain most of their nutrients and flavour.

Using fresh vegetables to cook large batches of soups, stews or other dishes will make them last longer and provide meal options for a few days. These can also be frozen where possible and then quickly reheated.

  1. Use healthy dried or canned alternatives when fresh produce isn’t available

Fresh produce is almost always the best option, but when it’s not available there are plenty of healthy alternatives that are easy to store and prepare.

Canned beans and chickpeas, which are high in protein and fibre, can be stored for months and can be included in meals in many ways. Canned oily fish, such as sardines, pilchards and tuna, are rich in essential omega 3 fatty acids and a range of vitamins and minerals. These can be used cold in sandwiches, salads or pasta dishes, or cooked as part of a warm meal.

Dried goods like dried beans, pulses and grains, such as lentils, split peas, rice, couscous or quinoa, are nutritious, long-lasting options that are tasty, affordable and filling. Rolled oats cooked with milk or water can serve as an excellent breakfast option.

  1. Build up a stock of healthy snacks

Children often need to eat a snack or two during the day to keep them going. Rather than giving kids sweets or salty snacks, opt for healthier options like unsalted nuts, low-fat plain yoghurt, chopped fruit and boiled eggs. These foods are nutritious, more filling, and help build healthy eating habits that last a lifetime.

  1. Limit highly processed foods 

While using fresh produce may not always be possible, try to limit the amount of highly processed foods in your shopping basket. Ready-to-eat meals, packaged snacks and desserts are often high in saturated fat, sugars and salt.

Remember when shopping, always look out for the Heart Mark and DSA logos to help you choose healthier food options for you and your family.

  1. Make cooking and eating a fun and meaningful part of your family routine

Cooking and eating together is a great way to create healthy routines, strengthen family bonds and have fun. Wherever you can, involve your children in food preparation.


Five lunchbox menus to get you started

1. Quick and easy

  • Cheddar cheese cubes
  • Mini whole-wheat rice crackers
  • Apple slices

2. Sandwich option

  • Hard boiled eggs
  • Whole-wheat bread
  • Baby carrots

3. Salad option

  • Tuna pasta salad
  • Sliced orange

4. Vegetarian option

  • Hummus
  • Whole-wheat pita
  • Tomatoes
  • Cucumbers
  •  

5. Funky Friday option

  • Peanut butter (no added sugar)
  • ½ banana
  • Sliced apple
  • Low-fat plain white yoghurt

For more healthy, tasty recipes, download our Cooking from the Heart recipe books onetwo, and three from our website.

 

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Shiara Pillay – Diabetes community helps keep you accountable

Shiara Pillay tells us how her diabetes community, formed at DSA youth camps, has helped her be accountable for managing her diabetes.


Shiara Pillay (25) lives in Muizenberg, Cape Town. She has Type 1 diabetes.

About Shiara

Shiara has attended the Diabetes South Africa youth camps for many years. First as a child and then as a teenager and young adult. She progressed from being a camp attendee to becoming a camp leader.  Presently, she is a dedicated member of the YT1 team that helps to organise and manage the Diabetes SA YT1 Children’s and Youth Outreach.

She is currently working in the social development and capacity building industry, and studying towards completing her Honours in Development Studies.

Consistent focus and attention

Life with Type 1 diabetes seems like the most normal thing in my life right now. Especially during the COVID-19 pandemic! It hasn’t always been that way though. It has required consistent focus and attention since I was diagnosed 15 years ago.

The last decade and a half has seen me experience things not a lot of other people I know have. I have advocated for diabetes awareness in school and social environments. Experienced an unexpected DKA admission to hospital. Held the space for countless conversations with friends and family about diabetes management support. All the while I am studying and pursuing a career path.

Community holds you accountable

One of my favourite triumphs of this journey is being a part of the gathering of young diabetic children at the DSA educational camps. Experiencing the connection between the diabetes community (young, old, family and friends) through shared and individual struggles and triumphs is so rewarding.

Being able to accept, grow and take control of the role that diabetes plays in my life is an ongoing commitment that this community has helped me stick to.

I work constantly to maintain my glucose levels through diet, exercise and regular testing. Supplemented by as much information as possible and a healthy balance of finding pleasure in all these things.

Shiara in Amsterdam, the Netherlands.
Shiara in Visakhapatnam, India.
Shiara Pillay
Shiara with her group of campers dressed for their Saturday camp concert evening at Diabetes SA April 2017 Diabetes Childrens Camp in Kommetjie, Cape Town.

Play therapy in diabetes management

Daniel Sher educates us on the basics of play therapy and how it can help a child to manage their diabetes.


Diabetes is, quite literally, a matter of life and death. The implications for a child diagnosed with this condition are huge! That’s a lot of seriousness for a little human to be taking on board, right? This is where play therapy can help.

Play provides kids with a wonderful medium through which to counteract and cope with all this tiresome seriousness. This sort of work is vital when it comes to helping your little one develop healthy beliefs, emotions and behaviours in relation to their diabetes.

What is play therapy?

Play therapy is an evidence-based counselling intervention. It is based upon scientific knowledge about how child development happens, with particular reference to the importance of play in the context of emotional and mental growth.

More specifically, it seeks to empower a child to express themselves non-verbally and in abstract, rather than concrete ways. In doing so, this type of therapy equips children with a new language with which to express their emotions and experiences.

What happens during a session?

There are many different models and approaches. The most common format for this sort of intervention involves the child meeting regularly with a trained psychotherapist and playing together during session times to build a therapeutic relationship and promote emotional healing.

The child will be encouraged to “play out” conflicts, feelings and experiences which they may not otherwise be ready to verbalise.

Some therapists bring specific games, such as a doll or snakes-and-ladders, that is directly focused on promoting healthy diabetes behaviour. Other therapists might use painting, word games or any number of toys and activities that they have at their disposal.

What does the research say?

Play therapy is a widely-used intervention that psychologists all over the world have used to help children cope with a range of psychological and emotional difficulties. For example, research has found that it can be effective in managing:

  • Depression
  • Anxiety
  • Post-traumatic stress disorder
  • Communication difficulties
  • Anger outbursts
  • Grief and bereavement
  • Conduct disorder

Studies1,2 which systematically analyse the results from existing research (i.e. meta analyses) have consistently found that play therapy has a lot of potential in successfully treating these psychiatric symptoms.

How does play therapy help with diabetes?

To date, the research directly exploring play therapy applied to children with diabetes is sparse. Nonetheless, one study3 published in The International Journal of Play Therapy found that this approach can help young children with Type 1 diabetes to reduce emotional difficulties (including depression and anxiety) related to diabetes.

The researchers also advised that children with diabetes receive preventative play therapy to foster longer-term medical and psychological health.

Furthermore, given the positive impact that this approach can have on children’s cognition, emotional development, problem solving and communication skills generally, there are good reasons to believe that play therapy can significantly help kids with diabetes to cope.

Therapy goals

In my own practice, I use play therapy as a way of helping children with diabetes to:

  • Cope with difficult emotions related to a new diagnosis.
  • Process the “unfairness” of having this condition.
  • Develop healthy communication skills and thus better manage relationships with their family and treating team.
  • Increase responsibility and self-respect.
  • Regulate and express difficult emotions, such as frustration, grief and anxiety.
  • Feel heard and supported.
  • Recognise and address diabetes burnout.
  • Develop healthier dietary habits to prevent later eating disorders.

Improved self-efficacy

Another benefit is that play therapy can help a child develop their self-efficacy. This refers to a child’s belief in their own ability to successfully manage their condition. Self-efficacy is absolutely vital when it comes to diabetes self-management.

Research4 has consistently shown that diabetes patients who have high self-efficacy are more likely to have better glycaemic control. In this way, it can help children with diabetes to feel more in control of their behaviours, habits and overall blood glucose management.

More than just fun and games

Ultimately, play therapy is a safe, enjoyable, empowering and affirming experience. Younger children struggle to express abstract concepts verbally, in the way that adults do. Play therapy is effective because it meets children on their level, drawing on the language of play to help them express their inner world. By providing children with a safe space in which to play therapeutically, we can help them develop healthier relationships toward themselves and their diabetes.


References:

1. Bratton, S., Ray, D., & Rhine, T. (2005). The efficacy of play therapy with children: A meta-analytic review of treatment outcomes. Journal of Professional Psychology Research and Practice, 36(4), 376-390.
2. Ray, D. C., Armstrong, S. A., Balkin, R. S., & Jayne, K. M. (2015). Child-centered play therapy in the schools: Review and meta-analysis. Psychology in the Schools, 52(2), 107-123.
3. Jones, E. M., & Landreth, G. (2002). The efficacy of intensive individual play therapy for chronically ill children. International Journal of Play Therapy, 11(1), 117.
4. Beckerle, C. M., & Lavin, M. A. (2013). Association of self-efficacy and self-care with glycemic control in diabetes. Diabetes Spectrum 26(3), 172-178.

MEET THE EXPERT


Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit danielshertherapy.com


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Shelly Schutte – Diabetes is my superpower, not my disability

DSA YT1 Youth Warrior Children’s and Youth Outreach volunteer, Shelly Schutte, shares how she came to see diabetes as her superpower and not her disability.


Shelly Schutte (29) lives in Fish Hoek, Cape Town. She has Type 1 diabetes.

I grew up in an outdoorsy family. My childhood was filled with running, hiking and playing sport. Even if I wasn’t the most gifted at it! I was a healthy, active child with a healthy, active family, and I still got diabetes.

Despite what well meaning textbooks or radio shows often describe, diabetes (especially Type 1) doesn’t only affect people who struggle with weight or health issues. It can affect anyone, and more importantly, you don’t sacrifice everything you were before when you became a ‘diabetic.’

Diagnosis

In early February 2001, I started feeling…off. My thoughts began wandering more often in school and weight started dropping off me. Fast forward a week or two and an intense thirst began to burn in me all day. No matter how much I drank, I could not seem to fill up the desert inside. What goes in must come out. So, I visited the bathroom multiple times an hour.

This period is foggy in my mind. But one of the most vivid memories I have is the night I slept over at my best friend’s house. I was thirsty. So, thirsty in fact, that I went to her fridge, grabbed a 2L bottle of apple juice, and just chugged it. I was exhausted and feeling ill but also not sleepy. So, I stayed up chatting to her dad (who was sitting trying to work) long after my friend went to bed. She still teases me about this to this day.

The next day my parents and I began to realise that the gradually increasing tiredness, nausea, thirst and weight loss couldn’t just be chalked up to a nagging flu anymore. There must be something more.

My mother took me to my GP, who took one look at me and did a blood glucose test. He later told me he smelled the fruity odour of ketoacidosis the minute I walked through the door.

My blood glucose level was 22,9. No doubt about that: T1 diabetes. He booked me into hospital and by the time I arrived that evening, my blood glucose level was 44. I was doubled over with pain and nausea. When ketoacidosis hits, it hits hard.

The start of acceptance

The next few days were a bit of a whirlwind of pulling me out of ketoacidosis, getting my glucose stabilised, working out insulin doses and meeting the amazing Sister Stark. She made me realise that there was a road of learning ahead, and she would be with me on that road.

I was so grateful to not feel sick at first that I was not actually upset about the diagnosis. However, I was determined to learn to inject myself . I overheard the nurse telling my mom that it was one of the conditions of my discharge from hospital. I really wanted to be out by the weekend so I could still go to church camp!

About three days into my hospital stay, I remember asking my mom how long I would have to inject myself for. She very kindly and gently gave it to me straight, until a cure was found. And that’s when it hit me. This was going to be something that would be a part of me for the rest of my life. I have cried many times about having diabetes over the years and that day was the first time I felt that pain. But it was also the start of acceptance.

I did go to the church camp that weekend, carrying a humorously enormous box of syringes, insulin, glucogel, glucagon injections and information packets. It was not the same as it had always been as people didn’t know how to treat me at first. But, gradually they began to see I was the same person. Just with a lot more needles in tow and a tendency to not be phased by blood anymore.

The many hates

Diabetes is not an easy condition to have as a child, teenager or adult. For a long time, I hated diabetes. It was blamed for me feeling tired and lethargic when my friends would have energy for days. I hated having inappropriately-timed lows that disrupted or delayed plans. I hated having to eat a certain way, or sometimes, having people question why I didn’t eat a certain way! But most of all, I hated the planning. 

Even today, if I ever jump into spontaneous plans, I realise at some point that I need to leave early because I don’t have my overnight insulin on me. This is just one example of the many ways that Type 1 diabetic patients need to plan their daily lives.

A force for positiveness

It was only when I started realising that diabetes could be a force for positiveness in my life that I truly began to see it as a gift. And really, in many ways it has been.

It led me towards teaching and advocating for others as a career. It has allowed me to meet some of the most awesome people imaginable. And now, I belong to a global community of fascinating, intelligent, strong, powerful individuals who are doing great things to change the world’s perception of chronic conditions and invisible disability.

I belong in this community. I am one of these people because of the journey I am on and the 20-year path with diabetes I have walked.

Slightly out of tune but better for it

People with diabetes are not sick. We are not diseased. We are just slightly…out of tune. My brain, pancreas and immune system do not do what they should, in terms of opening my cells and letting the glucose flood in automatically when I eat. So, I must help.

I calculate the carbs and inject the insulin and along the way, become highly attuned to how my body feels in every variation of high, low, rising, falling, normal tired, low tired, high tired, low moody, high moody, high thirsty, low shaky and so on.

I make a hundred decisions every day to keep myself alive and to keep myself healthy. And because of that, I am stronger, calmer under pressure, more empathetic and more analytical than I ever would have been without diabetes.

I have travelled the world for work and play with diabetes and continue to look forward to the many opportunities my future holds. Diabetes is difficult but it can be your superpower, instead of your disability. I have been involved in diabetes advocacy for many years and so excited to now be a part of Diabetes South Africa: YT1, which aims to bring T1 diabetes youth together to learn from and support one another.

PEAD-SA – Should children with diabetes go back to school?

The Paediatric & Adolescent Endocrinology & Diabetes Society – South Africa (PEAD-SA) share their position statement on children with Type 1 diabetes mellitus returning to school.


All children should return to school in accordance with government guidelines. Type 1 diabetes mellitus (T1DM) does not seem to increase the risk of acquiring infection or of having COVID-19 severe disease in children and adolescents. Our position as PEAD-SA is that children and adolescents with T1DM should not be prevented from returning to school.

Background

The pandemic of infection with coronavirus (SARS-Cov-2), which has caused corona virus disease since 2019 (COVID-19) has affected all aspects of life throughout the world.

South Africa has not been spared and we are now in the early stages of this epidemic. The carefully considered and courageous decision by government to call for a lockdown was timely and necessary as is the easing to the different levels.

As part of this change, it has been recommended that children and adolescents begin returning to school. Considering concerns raised by numerous people, PAEDS-SA is presenting our position on this aspect of the epidemic.

What does PEAD-SA know about children and infection with SARS-Cov-2?

What we do know comes from very limited information from other countries and from limited local experience.

  1. Children (under 20 years) do get infection with SARS-Cov-2. In most countries, children make up a small fraction of all the people with infection. Thus, it seems that children and young people don’t contract COVID-19 at the same rate as adults. In China and Italy, children less than 10 years were only 1% of all cases, and those between 10 and 19 years were 1,2% of all cases. In the USA, children and adolescents (under 18 years of age) were 1,7% of all cases reported1,2,3.
  2. Children do not seem to get severe infection very commonly. This may be the reason why children make up such a small fraction of people with infection, because in most countries, people are only tested when they are ill. It is thought that most children get infected but do not have symptoms. Children rarely require hospitalisation or have severe disease4. (1,1% of cases are critical, 2,2% of cases are severe)5(5,7% of children hospitalised US)3
  3. Very few children have been seriously ill or have died from this condition. To date, it is thought that 30 children have died from COVID-19.
  4. Children do not seem to be responsible for the major spread of infection to others. Most children are infected by adults rather than from each other.
  5. It is not clear that children have the same risk factors as adults for serious illness e.g. hypertension, lung disease, Type 2 diabetes, etc. Reports from colleagues suggest that children with T1DM do not contract Corona virus infection more frequently than other children2 and do not have more severe forms of COVID-19 disease than other children. In China and Italy, no-one under 25 with T1DM landed up in hospital or with severe disease (needing ICU).2
  6. In South Africa, we are starting to see a few children with COVID-19 disease and the pattern does not seem to have changed from the rest of the world.
  7. We are seeing increasing numbers of children with stress, anxiety and other psychological, social and emotional issues because of the lockdown.

Conclusion

PEAD-SA, therefore, have taken the position that children and adolescents with T1DM should not be treated any differently from other children in terms of going back to school.

All usual advice for the care of children and young people with T1DM remains valid:

  • Better control means better health, particularly in winter when everyone gets sick.
  • Children with T1DM should have a flu vaccine.
  • Any illness will affect glucose control, which then needs extra attention.
  • If children are ill, they or their caregivers should not delay in contacting their healthcare provider because they are afraid of COVID; unmanaged DKA is far more dangerous.
  • Hypoglycaemia remains the most urgent problem that must be treated immediately, including at school.

PEAD-SA will continue to monitor reports from international organizations (WHO, ISPAD, ADA), colleagues and from across the world and update this statement promptly as new information becomes available.

Click on the video below to hear The International Society for Paediatric and Adolescent Diabetes (ISPAD)  statement on COVID-19 and children with diabetes.

REFERENCES: 

  1. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in ChinaSummary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention Zunyou Wu, MD, PhD; Jennifer M. McGoogan, PhD JAMA. 2020;323(13):1239-1242. doi:10.1001/jama.2020.2648
  2. Summary of recommendations regarding COVID‐19 in children with diabetes: Keep Calm and Mind your Diabetes Care and Public Health Advice | International Society of Pediatric and Adolescent Diabetes (ISPAD) | Ped diab 2020;21(3):413-414 doi.org/10.1111/pedi.13013
  3. Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020. 422 MMWR / April 10, 2020 / Vol. 69 / No. 14. CDC COVID-19 Response Team 
  4. SARS-CoV-2 Infection in Children Xiaoxia LuLiqiong ZhangHui Duet alNEJM 18 Mar 2020
  5. Clinical Manifestations of Children with COVID-19: a Systematic Review Tiago H. de Souzaa, MD, PhD; José A. Nadala, MD, MSc; Roberto J. N. Nogueiraa et al
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Lunch ideas for home or school during lockdown

Mommy, what are we eating for lunch? A question that most mommies have heard a lot during the lockdown period. Donna Van Zyl, a dietitian, shares a few lunch ideas for the family


School-going children generally have a routine and other activities that makes diabetes management a bit easier than children at home during lockdown. They may be sleeping late at night, waking late morning, and eating at irregular times. The lack of routine may contribute to irregular blood glucose levels.

In addition, we find ourselves walking far more to the cupboard or refrigerator due to boredom and we catch ourselves snacking slightly more. Boredom eating is one of the bigger challenges in lockdown and therefore routine should also be established like the school day at home with breakfast; school work; snack and lunch time. However, eating at home or school; a diabetic lunch is no different to a healthy lunch that every child should eat.

A healthy balanced lunch will ensure that your child gets the right amount of nutrients and energy they need to concentrate or perform optimally. A balanced lunch consists of a wholegrain/unrefined low-GI carbs, protein, fats, fruit, salads and vegetables.

 Tips for lunch or lunch boxes

  • For those who are carb-counting, a good tip is to write down the total amount of carbohydrates on a sticky note, paste inside the lunch box so that it is easier for your child, or the school nurse, to count carbs at school. Preparing portioned foods can also aid your child at school, or at home, when carb counting.
  • Prepare or pack a healthy lunch you know your child will eat. Otherwise your child may enjoy swopping his or her food with friends or end up not eating. It is important to switch up the foods regularly. Let your children try new foods over the weekend or at night, so that you know whether you can prepare or pack the food in for them.
  • Allow your child to help you prepare the lunch or pack the lunch box. At the same time, you can teach your child how to do the carb counting or even some culinary skills. Often children who take responsibility for preparing the meal establish healthy and good eating habits.
  • Always provide a low-carb option, such as a protein or fat snack. See options listed below.
  • Always have a snack available to pick up a low blood glucose level; longer life options, such as a packet of raisins, can be kept close by just in case.
  • Prepare food in advance and freeze or prepare more portions the evening before so that leftovers can be used for lunch the next day

Use leftovers

How to use leftovers the next day; and if there are no leftovers what can you serve for lunch tomorrow?

When leftovers are available:

Chicken Chicken mayonnaise whole-wheat wraps, whole-wheat rolls with added salad preserves

Pesto quinoa/durum wheat pasta chicken salad with added rosa tomatoes and feta

Pineapple and pineapple mixed salad

Chicken, feta and bean salad including salad preserves

For the lower carb: Chicken salad with a honey mustard dressing

Steak Steak Prego whole-wheat roll with added salad preserves

Stir-fry and steak vegetable wrap

Steak strips served with baby potato salad and salad/veg on the side

For the lower carb: Steak salad with a balsamic & olive oil or Blue Cheese dressing

Mince Mince and cheese toasted whole-wheat or rye sandwich (can even be topped with a fried egg)

Cheese, mince and corn whole-wheat wrap (Toasted)

Mince, guacamole, corn and diced tomato tacos

Prepared Soup Chicken and noodle soup

Hearty beef and barley soup

Vegetable and lentil soup

When no leftovers are available:

Eggs Lean bacon, cheese and egg toasted whole-wheat sandwich

Scrambled egg muffins/omelette (bacon, mushroom and cheese or spinach and feta) served with a whole-wheat or rye toast

Tuna Apple and tuna salad mixed with salad preserves and mayonnaise

Tuna pasta salad

Salmon and tuna fishcakes (prepared) served with roasted vegetables or mixed assorted salad

For the lower carb: Tuna, cucumber, tomato and chickpea salad dressed with mayonnaise

 

Snack items

For those children heading off to school, a lunch box can include a few more snacky items; especially when lunch is generally served at home. You can include the following:

  • Proteins

Scrambled egg muffins; or lean meat, such as beef strips, chicken breasts strips, sosaties (mini), biltong, salami slices/sticks, meatballs (chicken or beef), cheese: wedges, blocks of cheddar cheese, cottage cheese or cream cheese, yoghurt, smoothies.

  • Starchy food

Whole-wheat/rye bread, whole-grain Provitas, wraps, brown rice, quinoa, barley, baby boiled potatoes/sweet potato with the skin, and durum wheat pasta.

  • A good helping of salad, vegetables and fruit

Fresh fruit is easy to pack; or chopped fresh strawberries, pineapple fingers, apple slices, orange or naartjie wedges. Remember to count the fruit towards your carbs.

Raw veggies, such as carrot sticks, cherry/Rosa tomatoes, mini cucumber or sliced, gherkins, mini corn, corn on the cob, capsicum strips are all popular to add colour to the lunch box and can always be served with a dip: sour cream/hummus or guacamole.

Nuts and seeds or unsweetened nut butters can also be added as an additional treat.

The actual lunch box

  • Ensure it is a strong container that will protect the food from being squashed.
  • Have smaller containers available for dips, sauces or cut-up fruit.
  • When choosing a water bottle, make sure that it will be easy to clean. Some juice containers have a removable ice pack that you can use to keep the water cold. This is also great for milk or smoothies.
  • You can use a soft cooler bag for food that needs to be kept cool.
  • And remember to wash out the lunch box daily.

MEET THE EXPERT


Donna van Zyl is a private practicing dietitian for Nutritional Solutions, Bloemfontein. She is growing in the field of paediatrics and plays a key role in individualising nutritional therapy for Type 1 diabetics. Her special interests are optimising health, managing chronic lifestyle related diseases, and sports nutrition. She lectures part-time at the University of the Free State, which she enjoys thoroughly.


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Youth with Diabetes – How to decide if your child should go back to school

We hear Youth with Diabetes’ position statement on whether sending your child with diabetes back to school is a good idea.


Two large studies from England have just been released on COVID19 and diabetes. Because of this new information, Youth with Diabetes is adjusting our recommendations about going back to school. Please use this new advice to help you decide if you will be sending your child back to school.

The studies show that people with Type 1 diabetes are more at risk of dying from COVID-19 than those with Type 2 diabetes.

After taking into account age, sex, heart disease, socioeconomic status and race, people with Type 1 diabetes are almost three times more likely to die from COVID-19 than those without diabetes. (Hazard ratio of 2,86).

If your HbA1c is more than 10,0%, you are twice more likely to die than if your HbA1c was less than 7,5%. (Hazard ratio of 2,19).

It is important to note that age is the most important risk factor, even if you have diabetes. In these studies, no one with Type 1 diabetes under the age of 50 has died. Most of the COVID-19 deaths in Type 1 diabetes have been in the age group of over 70 years.

Other risk factors that contribute to increased risk of death for people with Type 1 diabetes are obesity and chronic kidney disease.

All this information means that you can reduce your risk by getting your blood glucose level under control and losing weight if you are obese.

Here are the links to read the full research articles:

https://www.england.nhs.uk/wp-content/uploads/2020/05/valabhji-COVID-19-and-Diabetes-Paper-1.pdf

https://www.england.nhs.uk/wp-content/uploads/2020/05/Valabhji-COVID-19-and-Diabetes-Paper-2-Full-Manuscript.pdf

Header image by FreePik

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Esther Rodrigues – My hero calls me Mom

Esther Rodrigues, a T1D Mom, shares the joys of seeing her son, Mikyle, celebrate his 21st birthday.


Esther Rodrigues stays in Cape Town with her husband, Antonio, and  their three children, Kelsey, Mikyle and Jayden.

I am a T1D Mom, who is exceptionally proud of my son, Mikyle Rodrigues, who turned 21 on 20 May 2020.

Mikyle is a strong T1D Warrior who never gives up. In his quiet confidence, he has the strength of a lion, a will to survive and a burning desire to overcome all obstacles in his way.

Currently, my son’s life consists of studies, exercise, eating lots of food, playing PS4 and managing his Type 1 diabetes.

Our family and friends are supportive and assist us wherever possible. Two and a half years ago, Mikyle fell in love, and that gave him reason to live, reason to fight and unconditional love.

Diagnosis

Mikyle was diagnosed at the tender age of 10 in August 2009. I did not know anything about Type 1 diabetes. I was completely dumbfounded with the diagnosis. In the blink of an eye, without any warning, our lives changed forever. Nothing can prepare you for this…Google became my best friend.

As a T1D Mom, I did not know how I was going to do this. I felt as if there was a huge hole in the centre of the earth and I was being sucked in. It was only once we came home, with all the reading and research I did, that I realised what Type 1 diabetes was all about.

The first few years were fine until puberty struck and caused havoc in our lives. We pushed through as best we could but we were advised to look at an insulin pump. Pumps are very expensive and while trying to save towards one, Mikyle was gifted with his first insulin pump by another T1D Warrior, Rowena Carmyn Webb. Rowena gave it to Dr Tracy Janse Van Rensburg, Mikyle’s doctor at the time, to bless a child with it and Tracy chose Mikyle. Sadly, Rowena, an incredibly generous woman, passed away on 22 June.

Eating habits changed as a family

As a family, we love eating. We celebrate with food. Eating habits had to be altered, sugar was removed from our household and sugar-free drinks were bought. Xylitol was used for baking, because Mikyle has a sweet tooth.

I remember the highlight of his school camps were ending the day with hot chocolate topped with marshmallows. So, I searched high and low and made sure that I packed his sugar-free hot chocolate and sugar-free marshmallows when he went on school camps. I did everything in my power to convert the things he liked into sugar-free treats!

Insulin

Mikyle uses a Medtronic insulin pump and Humalog insulin. To test his glucose levels, he uses a Freestyle Optium Glucometer with Freestyle testing strips.

What Mikyle enjoys

Mikyle enjoys exercise, with his favourite being weight training and recently he started taking interest in cardio, specifically boxing.

Since he has joined the gym, he heals faster, and his immune system is much stronger. The blood glucose control is also much better.

Mikyle enjoys eating food. If you want to steal his heart then cook for him. He enjoys most foods, with emphasis on healthy foods. He is currently studying Dietetics (2ndyear) at Stellenbosch University so he knows the importance of consuming healthy foods.

Most of the time, he is playing games on his PlayStation, driving and spending time with his girlfriend, Tamia.

Lessons learnt

I was prepared to help my son grow into a strong, independent young man who could do anything he puts his mind to, but it turns out that he is stronger than I could ever have imagined. With many prayers and the grace of God, he celebrated his 21stbirthday with us as a family.

I believe that God gives his hardest battles to his strongest soldiers, and took some of the strongest women and made them T1D Moms.

My hero calls me mom.

Images by RE Photograghy.

20th Annual Al Bawasil Children’s Diabetes Camp

Sister Barbara Chinyerere and her son, Joshua (9), who has Type 1 diabetes give feedback after attending the 20th Annual Al Bawasil Children’s Diabetes Camp, in Doho, Qatar.


Invitation to 20th Annual Al Bawasil Children’s Diabetes Camp

Diabetes South Africa (DSA) was invited to attend the 20th Annual Al Bawasil Children’s Diabetes Camp, in Doho, Qatar. This took place from 21 to 26 December 2019. Sister Barbara Chinyerere and her son, Joshua (9), who has Type 1 diabetes, attended on behalf of DSA.

Sponsorship

Barbara and Joshua are active members of DSA’s T1 Youth Warriors committee, helping DSA to organise events and outreaches for youth with Type 1 diabetes.

The Qatar Diabetes Association sponsored mother and son to attend the annual camp for children aged 7 – 11 years with Type 1 diabetes.

Barbara’s feedback

Three words: it’s was awesome! We left on Sunday evening. The camp had started on Saturday but there was a delay with my visa. We arrived on Day 3, just in time to join the outing.

There were around 40 local children and another 30 or so children from other countries, like Tunisia, Iran, Sudan and South Africa. Joshua and myself were the first South Africans to attend. Most countries represented had a supervisor and two kids.

The programme started early with prayers. Medical teams were always available, in case any help was needed. These teams consisted of students, doctors, dietitians and nurses with a male volunteer leading each team.

All the children were placed in teams. The outings were all educational; we went to the beach where we spent the day playing games, riding camels and doing quizzes.

The next outing was to the museum where we learnt about Islamic history, the origins of the culture, and saw various statues and ornaments. We enjoyed lunch at the park that day.

KidZania

On the next day, we went to KidZania, a children’s amusement park. Kids can choose from more than 60 real-life fun activities, such as doctor, dentist, police officer, firefighter, actor and singer, etc., in a safe and secured kid-sized city. Designed by educators, for children aged 1-14, KidZania blends learning and reality with entertainment.

Here the group of children got to experience a range of different careers. Children must get involved, get tasks and experience. I must say this was Joshua’s favourite. We then went for a train rides around the area.

Evenings were loaded with diabetic-related board games and small workshops. Food would be delivered at the outings and the food was on point! Even back at the camp side we were stayed, which is a student res. It was impeccable!

Freestyle Libre machines

The Qatar Diabetes Association ensures that all children living with Type 1 diabetes has the best of care. The government sponsors Freestyle Libre machines for children under 12 to 15 years of age. They are very strict on carb-counting and their readings are not in mmol/L like in South Africa.

The last day all the children had to perform skits. They got certificates for attending and the winning team got medals. Families from around joined the closing ceremony. The Qatar Diabetes Association gave a gift to DSA. In their culture, visitors are presented with gifts.

Thank you to DSA for choosing Joshua and myself to experience this once in a lifetime opportunity. We learnt so much and had a blast.