For Parents: Diabetes Care (Newborn to 2 years)

Diabetes care in young children is not always easy. It might seem like there's a lot for you to remember. But you don't have to do it alone! You'll work with your child's doctor, nurse, a diabetes educator, dietitian, and others to develop a diabetes management plan.

You should have a diabetes management plan that tells you what to do overall for your child's diabetes. It should include:

• What medicines your child takes and when to use each.
• How to check blood sugars.
• What the symptoms of low blood sugar are and how to treat them.
• What the symptoms of high blood sugar are and how to treat them.
• How to count carbohydrates (carbs).
• How much physical activity your child needs.
• What to do if your child is sick, such as 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 doctor.

Very young children need to have their blood sugar checked often. You may be checking your child's blood sugar 5 to 6 times a day. Two kinds of devices can test blood sugar or glucose levels:

• Blood glucose meter measures the amount of glucose in the blood.
• Continuous glucose monitor measures the amount of glucose just beneath the skin in the fluid around the cells. It is a wearable device that measures glucose every few minutes, all day and night.

The best places to use for blood sugar checks at this age are:

• Side of fingers tips (not the pad).
• Side of heel (for very young children who are not yet walking).

Also:

• Do not use the thumb for the test.
• Do not prick skin in a place that is not healed or is sore.
• Use a different finger and site each time. This will prevent scar tissue (a callous) from forming at a site. A callous can make it harder and more painful to get blood from that place.

You sometimes need to check your child's urine for ketones. Ketones are chemicals that are made when fat instead of glucose is burned for energy (ketosis). Having high levels of ketones is serious. It needs medical care right away.

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 ketones are present, always contact your child's doctor right away.

Some people also use home glucose and ketone monitors to check the blood for ketosis. Ask your child's doctor, nurse, or a diabetes educator for more information.

It's very important for young children's blood sugar not to 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 they are:

• Pale.
• Fussy or irritable.
• Sweaty.
• Lethargic (sleepy or drowsy).
• Staring into space or glassy-eyed.

If you suspect 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 doctor has advised, take action. Treat your child right away with a fast-acting sugar as you were told by the doctor.

Check your child's blood sugar again in 15 minutes to be sure it is no longer low. If it is still low, give your child more of the fast-acting sugar.

If your child is confused, unresponsive, unconscious, or having convulsions (seizures), they 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 doctor will teach you how to give a glucagon shot.)

Call 911 if your child has any of these symptoms:

• Is hard to wake or is unresponsive
• Passes out (faints)
• Has a blood sugar level below the “danger number” given to you by the doctor
• Needs glucagon
• Has a seizure

To control blood sugar levels, young children may need about 4 injections (shots) of insulin a day. This includes both slow-acting and fast-acting insulin. 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. This is especially true if your child is being breastfed. Your child's care team will teach you how to give your child shots. In young children, the best places to give shots are the:

• Buttocks.
• Sides of thighs.
• Backs of upper arms.

At first, you may have some concerns about giving shots. If you are nervous, you may want to practice on yourself first. Talk to your child's doctor 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.

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.
• Use play therapy to help your child adjust by demonstrating shots on stuffed animals. You can use a syringe without a needle to pretend to give the shots.
• An insulin pen is a convenient way to carry and use insulin, especially for children who take several injections a day outside the home. The pen contains a cartridge that holds enough insulin for several doses. The dose delivered on each injection is adjusted by turning the top of the pen.
• Insulin pumps may be used in children as young as age 2 along with continuous glucose monitoring systems to better track trends in blood glucose throughout the day.
• Talk to your child's care team about other ways to help your child deal with insulin shots.

What your child is eating will help determine their treatment plan. You will likely start by learning about carbohydrates. Carbohydrates are foods that give your child the energy they need to grow. But they also raise blood sugar higher and faster than other kinds of foods.

Although most dietary routines allow some flexibility in carbohydrate intake and meal times, having meals and scheduled snacks at about the same time each day with similar amounts of carbohydrates is important for the best glucose control.

You will learn about carb counting. This is a method to help you figure out how many carbohydrates your child eats each day. You may learn about carb counting even if your child is still being breastfed.

Your child's doctor, nurse, or diabetes educator will also teach you about fat and protein. Meals with more fat and protein may cause blood sugar to drop too soon after eating, or make it rise later than usual. You will learn how to adjust your child's insulin dosing to help keep a more stable blood sugar depending on meal content.

Choosing healthy foods can help control blood glucose and protect heart health. A child's food plan should focus on fruits and vegetables, whole grains, and high-fiber foods (for example, foods that have at least 3 grams of fiber or more in each serving).

Young children can often be picky eaters. So it might be harder to make a meal plan for young children with diabetes. Talk to your child's doctor and dietitian about this. They can help you, as this is very common in younger 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 they are active. Talk to your child's doctor to learn how to balance your child's activity with food and insulin.

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. Joining a diabetes support group or talking with a social worker can also help.
• Keep in mind that 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.

Despite your best efforts, your child's blood sugar numbers will sometimes be too high or too low. But try to remember: The numbers are tools to help you make decisions about your child's management plan. As your child grows, their body changes quickly. This means that perfect blood sugar control is impossible. Adjustments to your child's management plan are not a sign of failure. They are a normal part of your growing child's diabetes care and management.

For more information about diabetes, visit these websites:

• American Diabetes Association at www.diabetes.org
• Children with Diabetes at www.childrenwithdiabetes.com
• Breakthrough T1D at www.breakthrought1d.org
• Association of Diabetes Care & Education Specialists at www.diabeteseducator.org
• American Association of Clinical Endocrinologists at www.aace.com
• National Institute of Diabetes and Digestive and Kidney Disease at www.niddk.nih.gov
• Endocrine Society at www.endocrine.org