Children with diabetes

Managing a child’s diabetes

Historically, type 1 diabetes most commonly comes on between the ages of 11 and 13. It is, however, becoming more common in toddlers and infants, and there are increasing numbers of cases of babies developing it within a few months of birth.
You can’t stop children racing around and burning up energy, which can make it difficult to keep their eating and insulin in the right balance. The usual
answer is to give two or three injections a day each containing some short-acting and some medium-acting insulin.
It’s only to be expected that you’ll worry about your child having hypoglycaemic reactions and find it hard to let him or her out of your sight. As they get older and you both get more used to dealing with diabetes, you’ll probably find it easier to allow them more independence.
Children can learn to inject themselves from any age, although you will probably want to check the insulin doses. Injector pens have been a big help in getting around this problem, because of their convenience and ease of dialling the insulin dose.

Home monitoring

Blood tests can be hard for young children, and quite difficult because their fingers are so small, so urine tests are sometimes recommended instead, either on their own or combined with occasional blood tests. Once your child is a bit older, you will have to encourage him or her to be disciplined about monitoring blood glucose levels on a regular basis.
However, don’t be surprised if he or she is awkward about it. Rebellion is of course a natural part of growing up, and many teenagers go through a period
of refusing to cooperate over this aspect of their diabetes care. This is a difficult situation to deal with, but it’s best to steer clear of direct confrontation as much as you can. Remember that it’s very important for your child to keep taking his or her insulin regularly.

Hypoglycaemia

Children’s blood glucose can fall quite quickly, especially if they are active, so it may be difficult to spot the warning signs in time. Very young children may not recognise them at all. When the blood glucose drops so low that the child becomes drowsy or even unconscious, the best treatment is glucagon. It’s always worth keeping a supply handy if you are looking after a young child with diabetes.
Once this treatment has worked, the child needs to have some carbohydrate in the form of food or a sweet drink. As the problem is most likely to arise when the child is exercising, it’s essential that a playgroup leader, teacher or whoever is in charge (or a friend if the children are unsupervised) knows exactly what to do if he or she does have a hypoglycaemic reaction.

In any case, once your child starts school, it’s important that the staff be aware that he or she has diabetes and know what to do in the case of a hypoglycaemic reaction. You will also need to make sure that the kitchen staff are aware of the situation if your child has lunch there, so that he or she makes the appropriate food choices.

Problems with food

The amount that a child eats can vary enormously from one day to the next. If you’ve ever looked after young children, you’ll know how difficult it is to persuade them to eat anything some days, and at other times you can’t stop them eating constantly. This obviously makes life rather difficult for you if you have a child with diabetes.
As a rule, your main priority is to give your child something to eat whenever he or she is hungry, even if this means having more than their diet says they should. As children get older, they need bigger doses of insulin, and positive urine tests or high blood glucose values mean that they need more insulin rather than less food.
Low blood glucose, on the other hand, can mean a child needs either less insulin or more food, and this will need to be discussed with his or her diabetes care team.
Many children break the rules and eat sweets or chocolate on the quiet. You shouldn’t cut down on their normal food intake to try to compensate for these extra illicit carbohydrates, however. If your child is old enough to understand, try to explain calmly why cheating in this way will result in a high blood glucose, and why this, in turn, may lead to complications (see page 107). Talking the situation over together in a calm and measured way with plenty of time is probably the best approach, although not easy.
Children with diabetes will need to take the same kind of precautions as adults when their normal routine is disrupted, say by travel or illness (see pages 90 and 93). They will also have to learn how to take care of themselves when exercising, and follow the commonsense rules outlined on page 86.
If you are in any doubt about how to handle any of these situations, the team at your child’s diabetes clinic will be happy to advise you. The Diabetes UK helpline will also be able to offer advice (see page 147).

Family reactions

When a child with diabetes has brothers or sisters, they may become jealous of the amount of extra attention that he or she gets because of the condition. Equally, children may resent the fact that they have to cope with diabetes when the others don’t have to bother.
It’s important that all these feelings are brought out into the open and discussed by the whole family. Talking things over – at regular intervals if necessary – can help to clear the air, and may encourage your other children to become involved in watching for signs of hypoglycaemia. If they’re old enough and willing, you should teach them how to treat a hypoglycaemic reaction (see page 79).
One area of possible family contention is mealtimes – with complaints from those who don’t have diabetes about having to eat healthy foods! The fact is, of course, that the kind of diet recommended for people with diabetes is the same one that we should all be following. It’s not much fun for the child who has diabetes if the others constantly eat forbidden treats like sweets and chocolate in front of him or her, so do what you can to discourage this.
Again, talking the situation over and explaining the problem is the approach that’s most likely to work and, if you can persuade other children to restrict their sweets intake, it will be good for their health too.

Playing up

Many children quickly discover that being awkward about food is a great way to wind their parents up, and those who have diabetes are no exception. They may well realise that refusing to eat at mealtimes or having a hypoglycaemic reaction is a sure-fire way to get masses of attention. They may also refuse to do urine or blood glucose tests or even make up the results.
This is obviously worrying and frustrating for you as parents, and can cause great disruption to family life. It’s not at all unusual, however, and you shouldn’t feel guilty because you feel that you can’t cope. Your diabetes care team will have seen this kind of problem many times before, and be able to offer help and advice.
Sometimes it can be a good idea to bring in an outsider – a family friend or even a specially trained counsellor – who can help the child concerned to understand the effect that their behaviour is having. It’s important to understand that this may sometimes be children’s ways of expressing their own deep-seated worries about their diabetes.

KEY POINTS

Diabetes most commonly comes on between the ages of 11 and 13, although the average age of onset is falling
Very young children may need to rely on urine tests but older children should be encouraged to use blood tests if possible
Food battles are even more common and problematic with children with diabetes because of parental anxiety over hypoglycaemia
Try to avoid confrontation, however, and if battles are causing family upset discuss the issues with your diabetes care team