For Parents: Diabetes Care (3 to 5 years)

Diabetes care in young 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, a diabetes educator, dietitian, or others to develop a diabetes management plan.  

You should have a diabetes management plan that instructs you on the overall treatment plan for your child's diabetes. It should include: 

• A detailed list of medicines, instructions, and when to use each

• How to check blood sugars

• Symptoms of and treating low blood sugar levels

• Symptoms of and treating 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 the flu

• What to do in an emergency

Also make sure you discuss day care and school with your child's healthcare provider. 

Checking your child’s blood sugar

You will check your child's blood sugar using the sides of the fingertips. At first, young children 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 or site 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. At this age, children often need checks in the middle of the night. You can do blood sugar checks while your child is sleeping.

Checking for ketones

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). To check for ketones in very young children, place a cotton ball inside your child's diaper to absorb urine. Then press the cotton ball to the ketone test strip. If your child is no longer in diapers, 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 diabetes educator for more information.

Managing low blood sugar

It’s very important for young 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. Very young children can’t 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:

• Pale

• Fussy or irritable

• Sweaty

• Lethargic (sleepy or drowsy)

• Staring into space or glassy-eyed

• Shaky

• Confused or having trouble concentrating

• Complaining of visual problems, headaches, or nightmares

• Uncoordinated

• Dizzy

If you think 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 has 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 will raise your child’s blood sugar very quickly. Always have an emergency kit with a shot of glucagon with you. (Your child’s healthcare team will teach you how to give a glucagon shot.)

Managing shots

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. Your child’s healthcare provider, nurse, or diabetes educator will teach you when and how to give your child shots. In young children, the best places to give shots are the fatty areas of the:

• Buttocks

• Belly (avoid the area within 2 inches of the belly button)  

• Sides of thighs

• Back of upper arms

Coping with shots

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.

Helping your child deal with shots

It’s not unusual for children to cry and be upset when they get shots. But most children adjust very quickly to diabetes care. Shots and blood sugar checks may not be easy for your child to deal with at first. Your child should never feel that blood sugar checks and insulin shots are “punishment.” Here are some tips to help make getting shots easier for your child:

• Always give your child love and attention before and after shots.

• Use toys or other types of play to focus your child on something fun.

• Help your child adjust by demonstrating shots on stuffed animals. Your child may even be able to practice giving shots to stuffed animals using a needle-less syringe.

• Talk to your child’s healthcare team about other ways to help your child deal with insulin shots.

Food and young children

Even young children can start learning about foods that affect blood sugar the most. Keep these things in mind:

• Your child’s healthcare provider, nurse, or 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.

• 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. And some children are very picky eaters. 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. Talk to your dietitian if you are having difficulty maintaining a meal plan for your child.

Physical activity and young children

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.

School and young children

If your child attends preschool or kindergarten, you will need to meet with teachers or other staff. You will need to work out a diabetes care plan for your child. This is sometimes called a “504 plan.” You may even wish to find a preschool or day-care provider with diabetes care experience. Keep in mind that the school needs to be able to reach you in case of an emergency.

Diabetes affects the whole family

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 tips 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.

Resources

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