Khalifa’s doctor, Consultant Paediatric Diabetologist Dr Amani Osman from Mubadala Healthcare’s Imperial College London Diabetes Centre (ICLDC), explains that children with poorly managed type-1 diabetes should avoid exercise until their blood sugar levels are under control.
She says medical recommendations are that if a person’s blood sugar is more than 250 milligrams per decilitre, he or she needs to be extremely cautious about exercising due to the threat of diabetic ketoacidosis.
“Diabetic ketoacidosis is a serious complication that occurs when your blood sugar is very high and acidic substances called ‘ketones’ build up to dangerous levels in your body. If this occurs, it can cause symptoms such as vomiting, abdominal pain and in serious cases, even coma or death. It was therefore vital that Khalifa stabilized his blood sugar and had it under control before starting his horse-riding lessons.”
The turning point
Khalifa gave up his habit of eating erratically - often skipping lunch and secretly buying sweets from a local shop - and, instead, began to follow his doctor’s dietary advice to the letter. With the help of his family, he stuck to regular mealtimes, avoided processed and sugary foods, and counted the carbohydrates he was eating so that he could match his dose of insulin accordingly.
His next diabetes test confirmed that his efforts were paying off. Dr Amani says, “We regularly give patients a hemoglobin A1c (HbA1C) test, which measures blood sugar over the previous three months. The target for children should be a score of around 7.5 per cent, but Khalifa’s had always been between 10 and 13 per cent. However, this time, it had already dropped to under 9 per cent, and we expect Khalifa to achieve his target very soon.”
Khalifa’s mother, Farhat Nasim, says she was impressed by his determination. “When Khalifa decided that horse riding was what he wanted to do, everyone was saying, ‘He is sick, he cannot do it,’ but he always said his diabetes was not going to prevent him, and he could accomplish anything he wanted to do.”
Dr Amani stresses that a supportive family can play a vital role in improving outcomes in children diagnosed with diabetes. “His whole family has made a huge difference and even modified their own lifestyle. His mother and his siblings, Asia and Ahmed, all helped in checking his blood sugar, giving insulin injections and talking to him about the importance of eating healthily.”
Ahmed, 16, adds: “Khalifa had not taken his condition seriously before but has completely changed his habits now. Horse riding has been an important turning point, not just as an inspiration to eat well, but also because it has taught Khalifa patience in dealing with his condition.”
Dr Amani says, “It was important that Khalifa tackled his disease now as there are many complications associated with type-1 diabetes, including retinopathy, kidney disease and nerve damage. In addition to the regular HbA1C tests, we also give children a full check-up every year, including their eyes, kidneys, and thyroid. He has recently got the all-clear, so our aim is to bring Khalifa’s HbA1C score down to seven per cent, and keep it there to avoid any future complications.”
Dr Amani says the results demonstrate that a healthy lifestyle, including exercise and a balanced diet, is the cornerstone of a diabetes treatment plan. “While insulin is important, it is not sufficient in itself. At ICLDC we treat patients holistically, and they have an entire team working together on their case from all angles, including offering diet and lifestyle advice.”
Khalifa is sure he will not go back to his old habits. “I used to feel tired all the time, but now I have much more energy, I have noticed the difference in school sports too; in the past, I couldn’t run far before stopping,” he says. “My dream is to become a professional rider, like my older brother Sultan, who has won many awards. I want to have my own horses and I want to be a part of the Royal Stable.”
Dr Amani Osman’s top 5 tips for families of children with diabetes
- Parents should try to accompany children to doctor’s appointments, and make sure they know they are not alone in dealing with the condition.
- Parents or older children can support the child in the management of the condition, especially in the beginning stages, when it can feel overwhelming. Remember to encourage and reward the child for his/her efforts in diabetes monitoring.
- Families can help persuade the child to lead a healthy lifestyle by setting a good example. Healthy eating should be encouraged for the whole family so that the child does not feel excluded.
- A child’s perception of diabetes also plays a crucial role in how they cope with the condition. Parents need to explain that diabetes is not a “bad disease”, but rather a health condition that requires specific lifestyle and dietary changes, and constant monitoring.
- Encourage children to discuss their feelings, frustrations and experiences freely. Support groups can be a great help too.