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Column originally published Aug 11, 1999
Column last revised/updated on Nov 4, 2018

Insulin Injection, Meal Plan, And Exercise Are all Important In Managing Diabetes

Question: Our teenage son was just diagnosed with diabetes mellitus. This is totally new to us. The nurses and doctors at the hospital were great in helping us to learn about this medical condition, how we can help with his diet, checking blood sugar, and giving insulin. We had overcome the fear of needles together. However, we are still terrified. We worry whenever he is not feeling well. We are also concerned about his future health. Can you give us some advice?


Diabetes is a lifelong medical condition that requires daily care. For the sake of other readers, I will briefly explain about the condition before discussing how your family can adjust to your son’s diabetes.

Most diabetic children have type 1 diabetes. This is generally an inherited condition where “beta cells” in the pancreas cannot produce enough insulin for the body. Insulin controls the amount of sugar in the blood. When insulin decreases, blood sugar will rise. Excess sugar escapes into urine, bringing with it water. That is why early symptoms of diabetes include excessive drinking and voiding.

Other symptoms of diabetes include weight loss and lack of energy. Without insulin, sugar cannot get into cells for metabolism. Body fat is broken down to produce more sugar, leading to a vicious circle.

Once the diagnosis of diabetes is made, the child and the family need to spend time to accept the condition and start dealing with it. Successful management of diabetes depends on three components: using insulin, meal planning, and exercise. I will explain each of these here.

Because “beta cells” cannot produce insulin on demand, insulin has to be given from outside to keep blood sugar within safe range. Unfortunately, insulin cannot be given by mouth, but has to be injected under the skin.

The most common way to give insulin nowadays is by injection with a small needle two to four times a day. The amount and type of insulin given are usually guided by the physician, with blood sugar information provided by the patient and family.

Most physicians advise patients to check their blood sugar 2 to 4 times a day, before meals and at bedtime. Testing blood sugar has become much more convenient in recent years. Spring-loaded needles make it easier to get a drop of blood with very little pain. There are reliable machines which can determine blood sugar within seconds, and can even store results for days. If cost is a concern, colour coded strips are less expensive, although it is sometimes hard to judge the exact blood sugar.

It is almost inevitable that blood sugar can get too low or too high even with the best of care. Children and parents have to learn about the symptoms and how to respond. Early symptoms of low blood sugar include dizziness, tremor, sweating, and feeling sick in the stomach. If blood sugar gets dangerously low, a person can lose consciousness and develop convulsions. When this happens, injection of a medicine called Glucagon directly into the muscle can become a life-saving measure.

If blood sugar is low and giving a reaction, drinking some juice or eating starch can raise the sugar. If blood sugar is high, an extra dose of insulin may be necessary. Make sure this is discussed with your doctor beforehand.

Because the body cannot produce the proper amount of insulin on demand, meal planning is essential in order to co-ordinate with insulin injections. Eating too little food will result in low blood sugar. However, the problem with most teenagers is eating too much.

Teenage years are accompanied by rapid body growth, and most teenagers are hungry much of the time. As a result, they are always looking for food around the house. For diabetic patients, this can result in major difficulty in controlling blood sugar. Therefore, good understanding by your son about meal planning is most important.

Another great difficulty is peer pressure. Most teenagers are used to eating anything and at anytime. Many are more inclined to consume “junk foods” than meals prepared by their parents. Changing eating habit is more difficult than one expects.

The place to start is to meet with a dietitian for some good advice on the amount and type of food that is appropriate for your son, taking into account that he is going through puberty. It is important to make sure that the kind of food recommended is acceptable to your son, otherwise he will have a hard time sticking to the diet. You will have to become more inventive in cooking and baking to make sure that the food does not become monotonous.

Some of my patients’ families have decided to change the eating habit of the whole family, so that the child with diabetes does not feel being singled out or punished for the medical condition. You may also consider inviting your son’s good friends (with his permission) to help him with the dietary adjustment. It is most difficult to resist food when everyone is eating!

Last, but not least, regular exercise is very important for anyone with diabetes. Exercise allows muscles to use sugar effectively, lowers blood sugar and reduces the need for insulin. Obviously, it is important to monitor carefully to ensure that he doesn’t develop low blood sugar, and he carries extra starch to be taken before exercise or whenever he feels his sugar is low.

If one works on all the areas that I have discussed, blood sugar can be controlled quite well most of the time. Regular follow up with your doctor to review the blood sugar is very important. Your doctor will also arrange for regular blood and urine tests.

When diabetes is well managed, your son can lead a very healthy and productive life. Almost all the complications of diabetes are preventable. On the horizon is transplantation of insulin-producing cells, although this will take some years before it can become routine treatment.

You can obtain further information by contacting the Diabetic Education Centre in your area, or the local branch of Canadian Diabetes Association. If you have access to Internet, you can also visit their web site at Good luck to your son and your family.

[Note to Readers: After almost 20 years, this column’s content is still valid. There are newer insulins available, testing blood sugar is more easy. However, most children with type 1 diabetes still need to inject insulin 2-4 times a day, combining short-acting and long-acting insulin. Unfortunately, type 2 diabetes that used to happen to adults are now seen more and more frequently in children, most of the time associated with childhood obesity. Our society has not improved in some ways!]