By Amy Levenson, MD
Amy Levenson, MD, is an assistant professor of pediatrics and associate program director of the Pediatric Endocrinology Fellowship at the UNC School of Medicine. She is also a board-certified pediatric endocrinologist.
Age-specific guidelines for diabetes care.
If your child has been diagnosed with diabetes, you may have dozens of questions and concerns. While a diagnosis can feel scary and overwhelming, it does get better.
“Take it one day at a time, and after a few months, it’s going to feel a lot easier and manageable,” says Amy Levenson, MD, a pediatric endocrinologist at UNC Medical Center.
When your child is first diagnosed, you will work closely with an endocrinologist, diabetes educator and dietitian to create a diabetes management plan to keep your child healthy.
“There will be a lot of education right after diagnosis, and you will learn all of the important skills for diabetes management, such as how and why to monitor blood sugar and how to administer insulin,” Dr. Levenson says. “And by planning ahead and thinking through different scenarios, you can help ensure your child can do normal childhood things.”
The major goal in treating type 1 and type 2 diabetes is to control blood sugar (glucose) levels so they are within a goal range. Patients—or their caregivers—have to continuously monitor their blood glucose levels and give themselves doses of insulin when needed.
Managing diabetes is a big job, but the disease should not prevent your child from enjoying school sports, sleepovers or family vacations. Here are some age-specific tips for managing your child’s care.
Managing Diabetes in Toddlers
The challenge with managing diabetes in toddlers is that they are unpredictable. You don’t know how much they’re going to eat and when they’re going to eat, which makes monitoring their food intake difficult. And they’re not really able to tell you they feel bad when their blood sugar is too high or too low.
“So in terms of giving insulin, we sometimes recommend you first see how much your toddler eats and then give the insulin,” Dr. Levenson says.
You also can modify a toddler’s insulin plan so he or she is on a set dosage. To do this, Dr. Levenson will often recommend an insulin pump because the device will continuously deliver insulin and does not require repeated injections, reducing the frequency of needle sticks. Additionally, smaller doses of insulin can be delivered via the insulin pump.
Because kids this age don’t like having their blood sugar checked, consider having your child wear a continuous glucose monitor (CGM), which tells you your child’s blood sugar in real time 24 hours a day. To place it, you hold it on the skin anywhere the child has a little extra tissue, such as the upper arm, the upper leg or the stomach, and press a button that inserts a sensor right under the skin.
“This device does not generally require pricking a finger, and it allows the parent to monitor the blood sugar,” Dr. Levenson says.
Some sensors can be used up to seven days, so you only have to change it once a week.
Because young children are heavily dependent on a caregiver to manage their diabetes, anyone who might care for your toddler needs to undergo diabetes education training. This includes parents, babysitters, grandparents and day care providers.
“We invite everybody who’s going to be caring for the child to attend our education training sessions when we first meet with a patient’s family, but obviously, that can’t happen all the time, so we have a full curriculum in a binder that we send home with our families,” Dr. Levenson says.
Caring for Preschoolers with Diabetes
Managing diabetes can get easier with children of preschool age because they have more of a set regimen.
“Having a child on a schedule in terms of the times that they eat and the amounts that they eat at each time is very helpful for managing diabetes,” Dr. Levenson says.
If your child is in a full-time or half-time preschool program, it’s important for you to be in very close communication with the preschool teachers. While most preschools don’t usually have a nurse on staff, often teachers can be trained on how to deliver insulin and check blood sugar.
“We provide preschools, as well as the schools, order forms that say this is how you’re going to manage this specific child’s diabetes, what their insulin types are and what their insulin dose is,” Dr. Levenson says.
With preschool, some parents feel more comfortable packing food for their child so they know exactly what the child is eating. Some who work or live close to the preschool may even go in each day to give their child insulin.
Elementary School and Diabetes Management
Just as it was in preschool, it’s important to be in communication with your child’s elementary school. Meet with your child’s nurse and teacher before your child starts the school year or goes back to school after being diagnosed. And make sure there’s a written medical plan in place.
Because not all schools have a school nurse on-site every day, Dr. Levenson says sometimes patients will have an insulin plan that does not require an insulin shot at lunchtime.
“We expect that there will be at least an adult who knows how to check blood sugar, but if there’s no school nurse we have ways of getting around that (getting an insulin shot),” Dr. Levenson says.
Also, for kids who ride the bus, it’s important to check their blood sugar right before they get on the bus to make sure it’s in a safe range. Many parents choose to use a CGM so that blood sugars can be monitored remotely, and the device can be programmed to alarm when blood sugars are too low or too high.
Kids with diabetes also should have their blood sugar checked before participating in physical activities such as recess, sports and physical education class. “Sports can either make kids have high blood sugar or low blood sugar, and it’s hard to predict, so have specific guidance for your child, and make sure their coaches and teachers are all aware that your child has diabetes and how it needs to be managed,” Dr. Levenson says.
If your child wants to go to a sleepover, make sure that the parent at home is comfortable being able to check blood sugar, give insulin, and treat a low level, or knows how to get in touch with you quickly.
Helping Middle and High School Children with Diabetes
While every child is different, around middle school is a good time to encourage your child to learn how to check his or her own blood sugar and to start calculating insulin doses, with your supervision.
“Some kids are really comfortable and want to start doing their own injections, and we don’t discourage that as long as there’s still supervision,” Dr. Levenson says.
It’s important to still be a part of a diabetes care plan as kids move into their teens. “The teenage years are when we can see the control of diabetes decrease. Things aren’t as well managed as they might have previously been,” Dr. Levenson says.
She says this happens for a few reasons. Patients get burned out from having to manage their diabetes every day, and they don’t want their peers to think they are different.
“Sometimes we’ll see patients change from wearing the insulin pump to going back to shots because it’s not something connected to their body,” Dr. Levenson says. Some teens who play contact sports might not want an insulin pump on their body, for fear that it could get dislodged.
It’s still very important for teens with diabetes to eat healthy foods that help them manage their blood sugar levels. This can be challenging as teens get older and want to eat junk food with their friends.
Before teens get a driver’s license, it’s vital they understand to always check that their blood sugar is under control before driving. And if they don’t feel well while driving, pull over and check again. Encourage them to carry an emergency supply of food to help when this happens.
“We also start to do some counseling around drinking alcohol, and the (negative) effects that it can have on blood sugar,” Dr. Levenson says.
Also, try to help your teen understand how managing diabetes now will help as he or she gets older. “A lot of teenagers just developmentally aren’t capable of thinking ahead and understanding if they don’t manage their diabetes now, then they might have consequences when they’re older,” Dr. Levenson says.
Dealing with Diabetes After High School Graduation
If your child goes to college after high school, encourage him or her to join a student diabetes support group at college.
Your child’s endocrinologist can provide information about what to bring to college, in terms of adequate amounts of insulin and supplies for glucose monitoring, Dr. Levenson says.
Encourage your child to be open about having diabetes if he or she has a roommate. This is important in case the roommate needs to take action if your child has an episode of low blood sugar.
Also make sure your child knows where to go if he or she doesn’t feel well while at college, whether that’s the student health center or a local emergency department.
Another challenge for college kids with diabetes? Their eating schedules can become erratic like when they were toddlers because they are up late studying and are not as scheduled in their meal times, Dr. Levenson says.
What to Keep in Mind for Children of All Ages with Diabetes
No matter what age your child is, Dr. Levenson says the key for keeping him or her healthy with diabetes is frequent blood sugar monitoring, while at the same time trying to not become obsessive about it.
“Diabetes is like riding a roller coaster; some days are going to level ground and other days you’re going to be going up on these loops and trying to keep up,” she says. “Try to be patient and mindful of that, keep good communication open with your child and with all the caregivers involved, and don’t be scared to allow your child to go and do the normal childhood things. Just plan ahead and make sure you have enough supplies with you.”
Also, remember you’re part of a team.
“You have a (health care) team helping you,” Dr. Levenson says. “Reach out to us, because we’re here. Don’t be afraid that you’re bothering us. Take advantage of the team that you have.”
Talk to your child’s doctor if you’re concerned about their risk for type 1 or type 2 diabetes. If you are the parent of a child with diabetes, learn more about UNC Children’s pediatric diabetes program.
