Special Concerns for Kids

Dealing with diabetes is difficult for all who have this chronic disease, but there are special concerns for the child with diabetes. Simple activities such as going to birthday parties, spending the night with friends, or playing sports must be carefully planned. It is important for children with diabetes to take their medications as prescribed and check their blood sugars several times a day. Young children may have difficulty understanding the sudden changes, glucose monitoring, insulin injections, food restrictions-that Type 1 diabetes brings to their lives. Some common reactions among children are as follows:

• A feeling they are being punished for disobedience
• Feelings of shame or guilt
• Fear of death because diabetes starts with the sound “die.”
• Show signs of depression or eating disorders

These reactions may prompt your child to act hostile towards you, feeling that somehow you have failed him or her. Because children think their parents are all powerful, your child may believe you can make the diabetes go away. Dealing with diabetes may also cause a child to experience emotional and behavioral challenges. Often times talking with a diabetes educator, psychologist, and/or social worker will help the child and his/her family learn how to adjust to the lifestyle changes required to stay healthy and happy.

The Key to Treatment

The key to successful treatment of childhood diabetes is teaching the child to become self-sufficient and to show the child that he or she must take an active roll in treating the disease. This point cannot be overstated: parents must get the child involved in self-care as soon as he or she is able to master self-management tasks and is emotionally ready. At the same time, supervision by caregivers must continue. In order to control diabetes and prevent further complications, blood glucose levels must be as close to the “normal” range as possible. Parents / caregivers should work closely with health care providers to ensure that a personal diabetes plan for the child is in place to keep the child’s diabetes under control.

Tools to help children / parents control their diabetes:

• Take all diabetes medication as prescribed by the healthcare provider. For children with type 1 diabetes insulin shots should be taken at regular times each day. Some children prefer to use an insulin pump to deliver their insulin. Children with type 2 diabetes may take oral medications, insulin shots, or both. In either situation, all medications should be balanced with food and activity daily.
  
• Get Regular Physical Activity. Children with diabetes need regular physical activity. Exercise helps to lower blood glucose levels. Exercise is also a good way to help children manage their weight. A child’s blood glucose should be checked before beginning a physical activity, and a child should never exercise if blood glucose levels are too low!
  
• Check blood glucose levels regularly. Children should have their blood glucose checked regularly. The child or his/her parents should keep a journal or other records of blood glucose results to discuss with his / her health care provider. This information helps the provider make any needed changes to the child's personal diabetes plan.
  
• Follow a Healthy Meal Plan. A child needs to follow a meal plan developed by a physician, diabetes educator, or a registered dietitian. A meal plan outlines proper nutrition for growth. A meal plan also helps keep blood glucose levels in the target range. Children or adolescents and their families can learn how different types of food - especially carbohydrates such as breads, pasta, and rice - can affect blood glucose levels. Portion size, the right amount of calories for the child's age, and ideas for healthy food choices at meal and snack time also should be discussed. Family support for following the meal plan and setting up regular meal times is a key to success, especially if the child or teen is taking insulin.

Hypoglycemia and Hyperglycemia

The goal of diabetes control is to keep blood glucose levels within the target range. However, extremes in blood glucose levels can occur for several different reasons. The parent or caregiver should talk with their health care provider about how to deal with these potential problems related to a child's diabetes.

Low Blood Sugar (< 70mg/dl)

Blood glucose levels can sometimes drop too low - a condition called hypoglycemia (low blood sugar). A child or teen can become nervous, shaky, and confused. When blood glucose levels fall low, the child may become nervous, shaky, confused, irritable and / or drowsy. In extreme cases of low blood sugar the child may lose consciousness or develop seizures. Talk to the child's or teen's health care provider about how to deal with this serious but manageable condition. Listed below are some causes of hypoglycemia in children and teens.

1. Taking too much diabetes medicine
2. Missing a meal or snack
3. Exercising too much

High Blood Sugar (>240mg/dl)

Blood glucose levels can sometimes become too high - a condition known as hyperglycemia (high blood sugar). Over time, hyperglycemia can lead to serious health problems and cause damage to the eyes, kidneys, nerves, blood vessels, gums, and teeth. Listed below are some causes of hyperglycemia in children and teens.

1. Forgetting to take medicines on time
2. Eating too much
3. Getting to little exercise
4. Being ill
5. Stress (due to social environments, exams, sickness, etc…)