Managing your Child's Diabetes

Supporting your child and teenager with managing their Diabetes

As your child’s primary caregiver, the role of managing their Diabetes will fall mainly to you in the early stages of their childhood. This can be very daunting at first but there are a lot of supports and resources available to you. Your child’s GP, Pharmacist and Diabetes team are also here to help you. There may be a parent support group in your area or on social media that you can join for additional support.

Whilst you are their primary carer today, as they grow up, they will need to manage their condition themselves. Therefore, it is important to involve your child in the learning process of daily diabetes management and make decisions with them. Whilst it will be challenging at first, overtime you will realise that your child can live a happy and healthy life with their diabetes.

There are a number of ways to make Diabetes management and care a bit more manageable.

Embrace technology - More and more children with Diabetes are using technologies such as Apps, Flash System Sensors and continuous glucose monitors (to monitor blood glucose levels with minimal need for finger pricks) and insulin pumps. These technological advances have the power to dramatically improve the lives of those living with Diabetes by reducing the care burden.

Stay involved - Children as young as 4 years old in some cases have the ability to check their own blood glucose level, and children who are 5 and can give their own injection, but that does not mean that they understand what to do with the information they are getting. Similarly, teenagers may be able to mentally understand what diabetes is and monitor it, but that does not mean they will give it top priority. It is important to make sure Parents stay involved during all steps of care.

Teach children to manage their Diabetes in front of others without fear – Children should be encouraged to check blood glucoselevels or administer Insulin discreetly in public, as a child with Asthma would use their Inhaler.

Realize that setbacks will occur - There are times when your child’s blood glucose may be higher or lower than it should be. This could be due to normal growth in children, weight gain, puberty or an imbalance between insulin doses and carbohydrate intake. Use these setbacks to learn from them and discuss with your child how to have a different outcome next time. It is also recommended that parents/care givers avoid calling blood glucose levels ‘good’ or ‘bad’ Instead, they should stick with more matter-of-fact terms for blood glucose levels, such as ‘high,’ ‘normal’ or ‘low’. Talking about blood glucose ‘tests’ implies it is either a pass or a fail, so instead call them blood glucose ‘checks’.

Be aware of Exercise-associated lows. Children can sometimes have a delayed response to exercise, and that can lead to lower blood glucose levels at night in some. In some instances, physical activity can make your body more sensitive to Insulin for up to 24 hours. Although everyone is different, find out the post-exercise norm for your child so you are prepared to manage it. Discuss this with your childs diabetes nurse and dietitian so they can advise you.

Keep their social circle informed. For young children, make sure their babysitter, other family members know the basics of Type 1 diabetes management to ensure your childs diabetes is cared for at all times. In school your childs teacher and SNA and the wider school staff will need to be informed about the management of Type 1 diabetes during school. Your childs diabetes team will help you with this. If your child participates in sports, his or her Coach should be informed and aware of interventions required in the case of a hypo for example. Your child should wear ID stating they have Type 1 diabetes and always carry some fast acting carbohydrate in the event of a hypo. It is helpful to let your child’s good friends know as well. If they notice their friend acting more irritable than usual, they can tell a Teacher or other Adult in charge to check what’s going on.

Track blood glucose trends on paper or electronically and share this information with your childs diabetes team so they can help adjust insulin doses accordingly.

Ask for professional help when you need it - This can includes the Diabetes team, GP, Pharmacists and others. There are lots of supports available.

If you have a teen with diabetes, find a time once a week to review and discuss blood glucose patterns or trends. Teens with Type 1 diabeteshave been shown to have trouble following their Diabetes treatment regimens. Of course, they’re also at an age when it’s important to learn self-care. This is why it is so important for parents to find the right balance between handing over the reins and not letting go. A weekly check-in for parents to make sure the teen is on the right track is very helpful.

Teach your child about appropriate food choices. By addressing healthy eating while they are young, it will make it easier for them to choose wisely when they are more Independent. Your childs diabetes dietitian should support you with learning carbohydrate counting.

Special Considerations

Menstruation/Puberty

During a girl’s menstrual period, the need for insulin often increases because of higher hormone levels in the body. Some girls notice a change in their blood glucose pattern and may have to adjust insulin doses during this time. If Diabetes is poorly controlled, menstrual cycles may cease.

Illness

Older teenagers should know how to manage their diabetes in the event of other illness. They should understand the principles behind never stopping their insulin, that they may require extra insulin during illness, when and how to check for ketones and what to do if they are present and know what to do when they have nausea and vomiting. Older teenagers should understand that they may need to get help from the Diabetes care team during illness. Encourage teenagers to discuss sick day management at their diabetes appointments so they know what to do in the event of any illness.

Eating or sleeping away from home

Older teenagers should be able to travel independently, taking all necessary precautions. They should know that it is important to have blood glucose under good control before starting out on a trip.

Once your child is old enough, educate on the safer consumption of alcohol

Older teenagers should be taught practical information about how to handle alcohol safely.
They should know how alcohol affects blood glucose. They should know what precautions people should take when drinking, especially the need to eat extra food to decrease the risk of low blood glucose. Encourage them to discuss alcohol at their diabetes appointments.

Sex

Older teenagers should know the importance of practicing safe sex and avoiding pregnancy. It is essential that pregnancies are planned when a woman has Type 1 diabetes and that they receive pre-pregnancy care from their diabetes team.

Long term complications

Teenagers should know their diabetes check ups should include :

Routine blood tests to include a HbA1c blood test
Blood pressure monitoring
Testing urine for microalbuminuria (protein)
Foot assessment to check sensation and circulation in the feet
Annual eye screening for those age 12 and over (National screening service: Diabetic Retina Screen).

These checks are necessary to support the individual in managing their diabetes daily, modifying therapy when needed. They health checks are also to detect if there are any early signs of complications of diabetes. Teenagers should be reassured that these complications of diabetes are preventable.

HSE Paediatric Diabetes Resource Pack

This family resource pack gives clear, concise advice on common scenarios as you begin learning to manage your child’s diabetes. Your child’s diabetes team will advise you based on your individual needs. Click here to download the informative booklet from the Diabetes Ireland website.

How your Pharmacist can help?

Your Pharmacist is ideally placed to help you to:

Understand your Childs Diabetes Treatment,
Answer questions about Diabetes and related health conditions.
Offer guidance on the proper use of medications and other supplies used to treat Diabetes.
Overcome challenges in managing your Childs condition,
Provide and where appropriate, refer to relevant Services for support.

Ask your local CarePlus Pharmacist for help and advice in managing your Childs Diabetes.

There are lots of supports available from Diabetes Ireland, see www.diabetes.ie or telephone 01-842 8118

Information from Diabetes Ireland