Diabetes care in children is not always easy. It might seem like there is a lot for you to remember. But you don’t have to do it alone! You’ll work with your child’s healthcare provider, nurse, diabetes educator, and others to develop a diabetes management plan. Use the tips on this sheet to help you adjust to managing your child’s diabetes. You should have a diabetes management plan that tells you what to do overall for your child's diabetes. It should include:
A detailed list of medicines and instructions, and when to use each
How to check blood sugars
Symptoms of and how to treat low blood sugar levels
Symptoms of and how to treat high blood sugar levels
Carbohydrate (carb) counting
Instructions on physical activity and sports
What to do if your child is sick with a cold or flu, for example
What to do in an emergency
Also make sure you discuss dealing with day care and school with your healthcare provider.
You will check your child's blood sugar using the sides of his or her fingertips. At first, your child may be frightened of finger sticks for blood sugar checks. You can help your child feel more in control. Let him or her pick the finger to be used for the check. If needed, offer nonfood rewards, such as stickers or time playing favorite games. This can help your child feel better about checking blood sugar. With your help, your child can learn to do his or her own blood sugar checks (with supervision). And many children at this age can learn to recognize signs of low blood sugar. But you will still need to make sure your child’s blood sugar is checked regularly.
You may sometimes need to check your child's urine for ketones. Ketones are chemicals that are produced when fat, instead of glucose, is burned for energy (ketosis). Follow instructions that come with the strips and from his or her healthcare provider, nurse, or diabetes educator. If ketones are present, always call your child's healthcare provider right away. Some people also use home glucose monitors to check the blood for ketosis. Ask your child's healthcare provider, nurse, or a diabetes educator for more information.
It’s very important for children’s blood sugar not get too low. Very low blood sugar (hypoglycemia) can affect a child’s developing brain. So, manage your child’s blood sugar as much as possible without letting it get too low. Children can’t always tell you when they have low blood sugar. Over time, you will learn what is normal for your child. This will help you recognize symptoms of low blood sugar. Pay close attention to how your child is acting. Your child may have low blood sugar if he or she is:
Grumpy or irritable
Sleepy or drowsy (lethargic)
Staring into space or glassy-eyed
Confused or having difficulty concentrating
Complaining of visual problems, headaches, or nightmares
If you suspect your child has low blood sugar, check it right away. If the result is less than 70 mg/dL, or another number your child's healthcare provider, as advised, take action. Treat your child right away with a fast-acting sugar as you were told by the healthcare provider. If your child is confused, unresponsive, unconscious, or having convulsions (seizures), he or she may have severely low blood sugar. Treat your child right away with injectable glucagon. This is a substance that raises your child’s blood sugar very quickly. Always have an emergency kit with a shot of glucagon with you. (Your child’s healthcare provider will teach you how to give a glucagon shot.)
Call your child’s healthcare provider right away or call 911 or go to the hospital emergency department if your child has any of the following symptoms. Your child:
Is hard to wake or unresponsive
Passes out (faints)
Has blood sugar under the “danger number” given to you by the healthcare provider
Has a seizure
The amount of insulin your child needs, and how often it’s needed, may vary. This includes both slow-acting and fast-acting insulin. Basal or background insulin is always needed whether your child is eating or not. Meal-based insulin is adjusted based on how much your child eats. There are things you can do to help your child learn about giving shots. Your child may choose to:
Pick the shot site. At this age, the best places for insulin shots are the fatty parts of the:
Backs sides of the upper arms
Sides of the thighs
Belly (avoid the area within 2 inches of the belly button)
Push the plunger of the syringe into the insulin bottle.
Draw insulin into the syringe.
Inject the insulin.
It's not unusual for children to cry and be upset when they get shots. But, most children adjust very quickly to diabetes care and eventually show an interest in doing their own shots. Don't force your child to do shots if he or she isn't ready.
At first, you may have some concerns about giving shots. If you are nervous, you may want to practice on yourself first. Ask your child’s healthcare provider about giving yourself an injection of sterile saline to learn how a shot feels. (If you are afraid of needles, using an injection device may help ease your fear.) How quickly your child adjusts may depend on how comfortable you are giving shots. Treat shots as a normal routine.
Help your child learn about foods that affect blood sugar the most. Keep these things in mind:
Your child’s healthcare provider, nurse, or a diabetes educator will teach you about carbohydrates. Carbohydrates are foods that give your child the energy he or she needs to grow. But they also raise blood sugar higher and faster than other kinds of foods. You will learn about “carb counting.” This is a technique to help you figure out how many carbohydrates your child eats each day. Carb counting helps you decide how much insulin your child needs.
When your child goes to school, write the carb count of each food on a piece of paper. Then put the paper into your child’s lunch bag. This helps both your child and the teachers know how many carbohydrates are being eaten. It will also help your child learn to connect carbohydrates with his or her insulin dose.
Remember that kids will be kids! While it may be necessary to limit eating at times to control glucose levels, no foods should be "off limits." Children will sneak treats, especially those they love. So work the foods your child likes to eat into his or her meal plan. Adjust insulin dosages as needed. You will learn to adjust your child's insulin based on what your child eats.
Like food and insulin, physical activity plays a big role in managing your child’s blood sugar. Being active helps reduce the amount of glucose in your child’s blood. But too much activity can cause your child’s blood sugar to get too low. That’s why it’s important to check your child’s blood sugar often when he or she is active. Talk to your child’s healthcare provider to learn how to balance your child’s activity with food and insulin.
Your child should receive proper diabetes care and support at school:
To make sure your child’s needs are met, write down his or her diabetes care plan. This is sometimes called a “504 plan.” At the beginning of the school year, meet with your child’s teachers, school staff. Explain your child’s treatment plan.
Talk with the staff about your child's need to check blood sugar levels and to have food or drinks as needed.
Your child must be free to eat or drink in class if his or her blood sugar is low.
Someone at the school will need to perform or supervise your child’s insulin shots. It may be the school nurse, if one is present.
Your child will need to carry a kit for diabetes supplies. This includes testing supplies, medicines, and fast-acting sugar for emergencies.
Inform the school that your child can still be active and participate in all school activities.
Your child’s healthcare provider can teach your child how to talk about diabetes with classmates.
Caring for a young child with diabetes is a full-time job. You may sometimes feel worn out or overwhelmed. This can lead to burnout. Feeling burned out means that you might have a harder time managing your child’s blood sugar. These things can help you:
All the adults in the household should be involved with diabetes management. Anyone else who takes care of your child, such as a babysitter, must also be prepared to manage your child’s diabetes. A diabetes class can help. So can joining a diabetes support group or talking with a social worker.
It may take some time for your family to adjust to diabetes care. At first, it might seem like your child with diabetes needs more attention than siblings without diabetes. Try to give siblings equal attention.
Despite your best efforts, your child’s blood sugar numbers will sometimes be too high or too low. But try to remember: The numbers are tools to help you make decisions about your child’s management plan. As your child grows, his or her body changes quickly. This means that perfect blood sugar control is impossible. Adjustments to your child’s management plan are not a sign of failure. They are a normal part of your growing child’s diabetes care and management. Still, within these limits, most families are able to have very good blood sugar control.
For more information about diabetes, visit these websites:
American Diabetes Association www.diabetes.org
Children with Diabetes www.childrenwithdiabetes.org
Juvenile Diabetes Research Foundation www.jdrf.org
American Association of Diabetes Educators www.aadenet.org
American Association of Clinical Endocrinologists www.aace.com
National Institute of Diabetes and Digestive and Kidney Diseases www.diabetes.niddk.nih.gov