101 Mineola Blvd, 2nd Floor
Mineola, NY 11501
The professionals at Winthrop’s Pediatric Diabetes Center understand that a team approach is necessary to effectively deal with life events that a young person with diabetes encounters on a daily basis. Diabetes affects the entire family and the community and the Center’s team is committed to promoting awareness and support within the family, schools and the community in order to achieve the best possible lifestyle for children and teens with diabetes.
- Board Certified Pediatric Endocrinologists
- Nurses with advanced and specialized training in Diabetes
- Certified Diabetes Educators
- Registered Nutritionists with specialized education and training in diabetes nutrition
- Certified insulin pump trainers
- Exercise Physiologists and Social Workers
Board Certified Pediatric Endocrinologists
Physicians who spent three years learning about Pediatric Endocrinology and then passed the boards to specialize in Pediatric Endocrinology.
Certified Diabetes Educators
Diabetes Educators are specially trained in all aspects of diabetes care. They assist the child and family in learning about diabetes and its effective management and assist them in learning necessary skills and management. They work with the family or caregiver at every stage of life to support them in achieving optimal control of their diabetes while living the life they choose. They are the ‘problem solvers’ in our office. If the child or family is having a difficult time incorporating diabetes management into their lifestyle, the educator suggests numerous ways they can achieve that. Their motto is to educate, guide, motivate and advocate for the children in our practice.
Registered Dietitian Nutritionist
Our Registered Dietitian Nutritionist is a Certified Diabetes Educator (CDEs) who will help your family by assessing your child’s individual nutritional needs and creating a comprehensive customized plan. They use a combination of diet, exercise, glucose monitoring and medication to keep your child’s diabetes under better control. Our Registered Dietitian is a specialist in pediatric diabetes nutrition and will provide professional nutritional counseling ensuring that your family receives evidence based guidance for lifetime success.
The diagnosis of diabetes can be shocking and devastating for some. There are certainly many emotions that the child and family must work through at diagnosis and beyond. Learning to live day to day with diabetes and live an active life can be overwhelming at times and the counseling provided by our social worker can assist the child and family in coping in a healthy manner.
Our Registered Dietitian Nutritionist (RDN) is a health care professional who has a Master’s degree in Nutrition Science and clinical training. The RDN has passed a National Exam and is considered a diet and nutrition expert. The RDN is professionally licensed in the State of New York (CDN) and is a member of the professional association. Our Registered Dietitian takes complex medical and nutrition research and makes it easier for you to make daily food choices and plan healthy meals. The RDN can show you how healthy eating can be fun, enjoyable and delicious! The RDN is also a Certified Diabetes Educator (CDE).
Carbohydrate counting is one of several methods of meal planning used by people with Type 1 diabetes. Carbohydrates in the diet have a direct effect on blood glucose levels. All foods that provide calories are converted into glucose by the body. While fats and proteins in a meal are eventually converted by the body into glucose to use for energy, carbohydrates (sugars and starches) are converted to blood glucose quickly- within an hour or so after a meal. Therefore, the level of glucose in the blood after a meal will be directly related to the amount of carbohydrate just eaten.
With the help our Registered Dietitian Nutritionists, we can determine the amount of carbohydrate that your child should be eating per day and at each meal and snack. The total amount of carbohydrate needed daily is based on child’s calorie needs- carbohydrate should comprise 50 to 60 percent of the day’s calorie intake. For consistent blood glucose levels, the amount of carbohydrate eaten should be spread throughout the day; this will allow for a relatively even release of glucose into the blood from meal to meal and from day to day. Carbohydrates are measured in grams (g). Packaged foods carry a nutrition label that will tell you the number of grams of carbohydrates per serving. Be sure to read label carefully as to the difference between a single serving and the entire contents of the container. Foods that are harder to measure are whole foods, such as fruits and starchy vegetables which do not have labels. An easy way to find out the carbohydrate amount of different foods is to use a carbohydrate counting book, nutrition scale or online tool that allows you to access the nutrition information for foods.
Meal planning is an essential part of managing your child with type 1 diabetes. It is important to follow a meal plan to not only give your child adequate nutrition for growth but to balance the insulin your child takes and food you eat. Remember, carbohydrates increase your glucose levels and insulin brings it down. A dietary pattern that includes carbohydrate from fruits, vegetables, whole grains, legumes, and low-fat milk is encouraged for good health. There are different methods to monitor your carbohydrates, either by carbohydrate counting, or exchanges important part of achieving glycemic control. A dietitian will review the types of food you or your child usually eats and build a meal plan with you.
Be consistent. Meals and snacks should be eaten at the same times each day. Do not skip meals and snacks. Keep the amount and types of food (carbohydrates, fats, and proteins) consistent from day to day.
The amount of each type of food you should eat depends on your diet, your weight, how often you exercise, and other existing health risks. Everyone has individual needs, which is why you should work with a registered dietitian to develop a meal plan that works for you.
Medical nutrition therapy or nutrition counseling plays a major role in the management of diabetes in children. An appointment with our registered dietitians who are specialist in pediatric nutrition will help you individualize your meal plan to accommodate food preferences, cultural influences, physical activity patterns, and family eating patterns and schedules. The meal planning approach selected will assist your family to learn the effect of food on blood glucose levels. A comprehensive plan can be implemented within your family’s lifestyle and eating patterns. Our Registered Dietitians are an important part of your healthcare team, to better manage your diabetes and help improve glycemic control.
- Consume three meals per day
- Count carbohydrates accurately
- Eat well balanced meals
- Spread out meals and snacks
- Eat a variety of food from each food group
- Bolus every bite if on pump or basal bolus regimen
- Consider whole grains
- Drink water
- Check blood sugars
- Maintain a healthy weight
Celiac disease is an autoimmune disorder that leads to damage in the small intestine and interferes with absorption of nutrients from food. It is intolerance to ‘gluten’, a protein found in wheat, rye and barley.
Some patients with Celiac Disease are asymptomatic or have mild gastrointestinal symptoms. However, some of the classic symptoms of Celiac Disease include: chronic diarrhea weight loss, short stature or edema with other symptoms being abdominal bloating and pain, vomiting, constipation, anemia, chronic fatigue, neurological symptoms, dental enamel defects and skin problems.
If you are diagnosed with Celiac Disease whether asymptomatic or symptomatic you will still need to follow a gluten free diet in order to prevent further complications.
People with diabetes may develop celiac disease because the immune system attacks the body’s healthy cells and tissues. The connection between celiac disease and this disease may be genetic. Only 10% of patients with diabetes develop celiac disease.
There can be malabsorption of nutrients during the years when nutrition is critical to a child’s normal growth and development. This can result in other problems such as irregularities in glucose control, failure to thrive in infants, delayed growth and short stature, delayed puberty, and dental enamel defects of the permanent teeth.
People with celiac disease have higher than normal levels of certain autoantibodies—proteins that react against the body’s own cells or tissues—in their blood. To diagnose celiac disease, doctors will test blood for high levels of anti-tissue transglutaminase antibodies (tTGA) or anti-endomysium antibodies (EMA). If test results are negative but celiac disease is still suspected, additional blood tests may be needed. If blood tests and symptoms suggest celiac disease, a biopsy of the small intestine is performed to confirm the diagnosis.
Before being tested, one should continue to eat a diet that includes foods with gluten, such as breads and pastas. If a person stops eating foods with gluten before being tested, the results may be negative for celiac disease even if the disease is present.
A gluten-free diet means not eating foods that contain wheat, rye, and barley. The foods and products made from these grains should also be avoided. In other words, a child with celiac disease should not eat most grain, pasta, cereal, and many processed foods. Although this may seem challenging there are plenty of gluten free foods to choose from. A child with celiac can eat a well-balanced diet with a variety of foods. They include potato, rice, soy, amaranth, quinoa, buckwheat, or bean flour instead of wheat flour. Meat, fish, rice, fruits, and vegetables do not contain gluten. You can buy gluten-free bread, pasta, and other products.
- Find out the schedule of the school day- does it change at all?
- Does the preschool have the ability to perform blood glucose monitoring?
- Will they be willing to be educated to the care of a preschooler with Type 1 diabetes and learn about the essential items necessary to have the child in school safely?
- What method can be setup to notify you of low or high blood glucose readings or any issues that may occur in school?
- What is the plan if your child’s teacher is absent in regards to explaining and educating Type 1 Diabetes care to a substitute?
- Setup a box that has a sheet outlining the signs and symptoms of hypoglycemia and hyperglycemia explaining the exact way to treat- also put the treatment for hypoglycemia in the box and any other relevant items necessary for your child.
- Realize that sending your child to school after being the sole provider of your child’s diabetes care can produce some anxiety. Utilizing your team for support and setting up a safe situation in advance can calm your fears.
Adolescence is a time of enormous change in both the inner and outer self. They are not only experiencing the hormonal changes associated with puberty but they are also moving from dependence in regards to their parents to independence in regards to their life and diabetes care. For some, this is a challenging time. Some tips for teens and parents are in the enclosed attachment and have assisted our teens and parents in making these challenges easier to manage.
Major federal education laws affecting children with diabetes are the 504 Accommodation Act and IDEA Act
- The 504 accommodation act states that schools that accept federal funding are required to provide reasonable accommodations in order to allow the student with disabilities (diabetes included in this term) an education that is comparable to that provided to students without disabilities.
- The IDEA Act only applies to children with specific disabilities. A child with diabetes is covered if he or she needs special education or related services in order to benefit from an education. In other words the diabetes must make it more difficult for the child to learn.
- These plans must be evaluated and renewed yearly at your school.
Insulin pump therapy is another method of administering insulin. Insulin pumps are computerized devices that administer insulin via a cannula under the skin which is changed every two to three days. Pumps are programmed to administer ‘basal insulin’ which is the amount of insulin your body requires without eating or correcting elevated blood glucoses. As long as the pump is worn and attached this ‘basal’ insulin is administered. Then the pump is capable of being programmed by the individual to give insulin as a ‘bolus’ which is administered for food or if the blood glucose reading is elevated (correction). The pump has a reservoir that contains an insulin analog.
Pumping can provide advantages for some. It is not going to be placed on your child and glucose control will be automatically achieved. Just as with any other diabetes regimen, the pump takes work. The pump could improve glycemic control. It can provide more flexibility in lifestyle. The pump can promote less variability in readings because minute changes can be made in dosage which can impact at certain times where needed.
At our program, if you are interested in insulin pump therapy please speak to your Endocrinologist and or educator. You then have a ‘pump visit’ with your educator where they explain insulin pump therapy, the varied insulin pumps available and our insulin pump program. In our practice, after you choose the pump that best suits your family’s needs, the educator will order the pump and place you in a ‘pump class’ once the pump is delivered. Our pump class is two -three hour classes in a week and then the following week you spend at least a half day in our offices going on insulin pump therapy. For the first week after pump start, the educator who placed you on the pump will contact you to answer questions and guide you towards achieving control.
You then see that educator two weeks after pump start to ensure that all is going well and then return to your normal outpatient schedule.
If your pump breaks immediately remove it and call the 1-800 number on the back of the device to alert them to overnight you a new pump.
Make sure you take a blood glucose reading and if necessary a ketone check and contact our 24 hr MD beeper if an issue occurs.
During pump class, you have been educated to the use of basal insulin (Lantus or Levemir) and an insulin analog if the pump malfunctions. Contact our 24 hr MD beeper for exact guidance on how to manage this regimen until the new pump arrives.