As if taking care of a toddler weren’t challenging enough for any parent, ministering to the needs of one with diabetes can be downright overwhelming. Fortunately, diabetes isn’t common among very young children, but it does occur. Only 10 percent of the cases of type 1 diabetes are diagnosed before age five—about 30,000 children (3 million Americans have type 1 diabetes). However, the worldwide rate of type 1 for children under 14 is rising rapidly.
When dealing with toddlers, safety and sanity should be your guiding principles. There is no perfection with a disease such as diabetes.
Unlike the older child or teenager, a toddler can’t often tell you exactly what is going on. If their blood glucose is low, they may know that something isn’t right, they can cry or become clingier, but they aren’t going to blithely let you know that their blood glucose is plummeting. Many times you won’t be able to easily distinguish the symptoms of low blood glucose from many of the normal issues of childhood, such as being overtired. In these cases your blood glucose meter will be your saving grace.
Caring for a toddler with diabetes can be more challenging than caring for an infant. Infants, even if they can’t tell you what is happening, are completely under your control. Toddlers have begun to develop a sense of independence. They have learned the word “No”. They know that blood glucose checking time isn’t pleasant and will sometimes throw a tantrum to avoid it. This can make both parent and child anxious and associate diabetes with negative feelings.
Having your child participate in the activity by having them choose which finger to use to check their blood glucose, as well as providing your child with a pleasant experience directly after checking, such as allowing them to play with their favorite toy, can help eliminate or reduce disagreeable associations, says Heidi Quinn, M.S., R.D., pediatric nutrition educator at Joslin.
Tight blood glucose control isn’t the goal with toddlers because often their appetites and eating schedules are so variable. Blood glucose targets for young children are between 120mg/dl to 220mg/dl. Although it is important to provide regular meals and snacks, turning meal time into a battle benefits no one. In general it is better to give insulin before meals, but with the erratic appetites of toddlers it is sometimes beneficial to inject insulin after the meal. If you have given insulin and your child won’t eat what you have prepared, substitute fruit or milk to make up the difference in carbohydrate. In between meals, low carb snacks such as hard boiled eggs, rolled deli meats, or cheese and peanut butter on a few crackers can help reduce hunger and provide needed calories without spiking blood glucose.
Toddlers usually require very small amounts of insulin. With current insulin pen technology, doses under .5 units aren’t available and you may find that you are under dosing sometimes to avoid low blood glucose reactions. An option for more precise insulin amounts is to consider an insulin pump. Pumps can infuse very small insulin doses on the order of .025 units to allow for precision dosing. This obviates the need for four or more injections per day. For parents who aren’t ready for the extra work of using a pump, Humalog® and Novolog® insulins can be diluted to tenths of a unit.
The toddler years are often rife with colds, earaches and stomach bugs. Sick days are more of a when and how rather than an if. Depending on the type of illness and your child’s appetite, blood glucose levels can spike or plummet. Talk with your health care team to make sure you have a plan in place and know how to reach your physician in case of problems.
Diabetes in a toddler requires vigilance twenty-four-seven, but you can’t be there every minute of every day and not go completely crazy. That is why it is so important to have backup. Although it may seem impossible to entrust the responsibilities of diabetes management to anyone else, having a plan to gradually teach a family member, friend or paid professional some aspects of diabetes care for your child can actually make your life and your child’s easier and happier.
- normal growth and weight gain
- developmental milestones, such as rolling over, sitting up, crawling, standing, walking, and talking at about the expected age
- no signs of high blood sugar levels, no overly wet diapers, no unusual thirst
- good energy
- few mild low blood sugar reactions, and no severe reactions
- no ketones in the urine
- blood sugar readings that are not often less than 120 mg/dL)
- blood sugar readings that are not over 220 mg/dL for long periods of time
- a happy and secure attitude in the child
Parents might also want to check out www.parentingdiabetickids.com