HELP ON DIABETES

CHALLENGES AT DIFFERENT AGES

You and your child will face unique challenges as he or she ages.

Infants Less than One Year Old

In infants, your biggest challenge is recognizing hypoglycemia—your child may be sweaty or restless or pale. Therefore, it is important to monitor the glucose levels frequently, maybe even during the night. The goal is not to achieve normal glucose levels, but to avoid very high and very low glucose values.

Toddlers—Ages One to Three

With toddlers, it is best to establish a schedule with food and insulin injections. This can be challenging, especially with a child who refuses to eat or is a picky eater. Hypoglycemia is the biggest concern with this age group, and often it is best man­aged by giving insulin after a meal. Other steps that you can take include the following:

• Establish a routine for checking glucose and injections. 
• Use a glucose meter that requires the smallest blood sample and gives quick results. 
• Test glucose levels on arms, where it hurts less than at fingertips. 

Children—Ages Three to Seven

Quite often, children this age participate in their diabetes management by helping with glucose monitoring and choosing foods. This is also the age when parents will need to involve other caregivers or school staff in the diabetes management. The ADA has set out recommendations on how schools and day care centers should respond (see Resources) and how to set up a Diabetes Health Care Plan for your child.

In addition to providing all the supplies (insulin and syringes, log book, glucose meter, testing strips, glucagon injection, ketone testing strips, and glucose tablets or gel) for caring for your child’s diabetes, you should also provide the following infor­mation to the caregivers at your child’s day care or school:

• How and when your child’s blood glucose should be monitored 
• How to store the insulin and other supplies, such as testing strips, glucagon injection, and glucose tablets and gels? 
• When your child should eat (meal and snack schedule) and how much insulin should be given before these meals; if there are parties and special events at school, provide instructions on how much extra insulin should be given? 
• How your child behaves or what symptoms may indicate he or she is hypoglycemic, and how much glucose should be given when his or her blood glucose is low? 
• When and how to administer glucagon injection? 
• How your child behaves when the blood glucose is high and when and how to test for ketones? 
• Whom to contact in an emergency: parent and family phone numbers, doctor’s phone numbers, and emergency room phone numbers? 

Children—Ages Eight to Eleven

At this age, children frequently do their own blood glucose testing and insulin injec­tions. Many may use insulin pumps for the fi rst time. You will still be involved in supervising at this stage—there is evidence that children do better if parents are involved. Children who develop diabetes at this age are more likely to get depressed and anxious, especially when the honeymoon phase ends and the child realizes that the diabetes is not going to go away and may get harder to manage. With parental encouragement and support, the child should participate in school activities and sports.

Adolescence

 Adolescence, when there are physical changes of puberty as well as cognitive and emotional changes, brings some new challenges to managing diabetes.

• Early adolescence—ages twelve to fifteen: Puberty increases the insulin needs, so your child’s medical team will make adjustments of the insulin dose. At this age, the child will do his or her own blood glucose monitoring and injections. You may need to negotiate with your child as to how much supervision is appropriate. It is a good idea to talk to your child about issues such as weight and body image. Occasionally an adolescent child may limit insulin use in order to lose weight. This leads to poor diabetes control and is harmful. 
• Late adolescence—ages fifteen to nineteen: At this age your child will manage his or her diabetes fairly independently. You can help by guiding your teen to improve his or her coping skills and transition to full independence for college or work. 

Diabetes can impact the adolescent issues of smoking, alcohol, risky behaviors, and sexual activity. Smoking increases the risk for diabetes complications. Let your teenager know how alcohol causes hypoglycemia and what can be done to prevent it. Discuss driving safety with your teenager, and let him or her know how important it is to check for hypoglycemia before and during driving. She also needs to know how diabetes can impact pregnancy and the importance of preg­nancy planning. She can use oral contraception without medical risk. Both teenage sons and daughters need information about barrier contraception and prevention of sexually transmitted diseases.

With diabetes intruding into the teenager’s struggle to separate from parents and the need to be accepted by peers, depression can occur, and if your child shows any signs of depression, he or she should get professional help.