June 9, 2010

Leading Diabetes Program Celebrates 25 Years

Helping children and their families with diabetes through education, support, and research

The goal was simple: provide a comprehensive, dedicated program for children with diabetes to access support and education about the disease. From this lofty goal spawned the Manitoba Diabetes Education Resource for Children and Adolescents (DER-CA) which has been working with children with diabetes, and their families, in the Winnipeg Health Region and throughout Manitoba for the past 25 years.

Dr. Heather Dean has been involved with DER-CA since its inception in June 1985 and was instrumental with colleagues in Manitoba Health and Children's Hospital in developing the program. Approximately 700 families a year benefit from DER-CA's care, education, support and research.

When a child diagnosed with Type 1 diabetes they are referred to the DER-CA;, a two-day personalized education session is provided to the child, parents, siblings and caregivers. This helps them understand the importance of checking their blood sugar, giving insulin injections and managing their diet. A 24-hour emergency line helps provide supports while families learn how to manage their child's health. A newsletter also communicates up-to-date relevant information.

With one in 800 diabetic children having Type 1 diabetes in Manitoba, the ability to connect with other families through DER-CA's events helps ease their isolation.

The DER-CA team also works with extended family members, teachers and coaches to help educate key contacts on how to work with a child who has Type 1 diabetes.

Before the program, children usually were admitted to the hospital for two weeks.

"The full time dedicated program allowed us to set up a program for outpatient management. Children didn't have to be admitted. We pushed the envelope so that children could be managed in an ambulatory setting. We see families immediately in a flexible, adaptable, patient-centred way," says Dr. Dean.

Children with Type 2 diabetes are also referred to the DER-CA team. Their needs are different for treatment, education, and counselling. That's why intensive counselling and support are provided to families and their children in the clinic and in the community.

"Adult health care providers in our system are going to be seeing graduates from our program who have type 2 diabetes," says Dr. Dean. "Complications that require management in the adult health world are much more severe in youth with Type 2 diabetes - problems like amputations, kidney failure, blindness, problems during pregnancy, and mental health concerns."

Having a team dedicated to working with children and their families allowed for the quick implementation of cutting edge developments.

"Our team was able to incorporate new innovative tools that came along - blood glucose monitoring, new insulins, new modes of getting insulins, new ways of monitoring diabetes and transitioning young adults to adult care," says Dr. Dean.

One of the most rewarding parts of the DER-CA team's work is participating in summer camps with the Canadian Diabetes Association. The DER-CA team provides medical supports to campers with Type 1 diabetes.

"I burst with pride seeing these children being children, all knowing they have this life threatening disease. It's the courage of these children that is a joy to see, with us being there as a safety net," says Dr. Dean. "I say to these kids yes this is going to change your life, but life goes on. Dreams you have, you can still do. You can do anything you want to do but you need to be smart, organized and careful. To see these kids push the limits, stands out in my mind."

What is Diabetes?

It's when a person's body doesn't process food properly. There are three primary types: Type 1 (where a person's body produces no insulin), Type 2 (where a person's body produces insulin but not enough or their body doesn't use it effectively) and gestational (when a woman develops high blood sugar during pregnancy).

The messages about diabetes differ for the types. For a person with Type 1 diabetes whose body can't make insulin, they must take insulin so telling them to exercise and manage their diet can frankly be insulting.

"Type 1 diabetes is a life-threatening disease that requires major effort and has a profound effect on a family. Every decision is profound in terms of life-threatening circumstances - they may need insulin four times a day, manage their blood sugar on a meal to meal basis - yet we don't see this because the kids look fine," says Dr. Dean.

Did You Know?

  • DER-CA was the first centralized program for children with diabetes in the country that offered a full-time team, including a nurse, dietitian, social worker, doctor and administrator dedicated solely to diabetes.

  • DER-CA works with 450 - 500 children who have Type 1 diabetes and 150 - 175 children with Type 2 diabetes.

  • When the DER-CA opened in 1985, there were no children with type 2 diabetes. Of the children with Type 2 diabetes referred to DER-CA as of late, 95% have First Nations heritage and live in remote communities.

  • Manitoba has the highest rate of Type 2 diabetes in children in Canada.

Further Reading

Juvenile Diabetes

Small changes

Type 1

Type 2

Managing Diabetes

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