For Parents: Diabetes Care (6 to 11 years)

Diabetes care in children is not always easy. It might seem like there is a lot for you to remember. But you don't have to do it alone! You'll work with your child's doctor, nurse, diabetes educator, dietitian, and others to develop a diabetes management plan. Use the tips on this sheet to help you adjust to managing your child's diabetes. 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, how to take them, and when to use each
• How to check blood sugars
• What the symptoms of low blood sugar (hypoglycemia) are and how to treat it
• What the symptoms of high blood sugar (hyperglycemia) are and how to treat it
• How to count carbohydrates (carbs) in each meal or snack
• What to do about physical activity and sports
• What to do if your child is sick with a cold or flu, for example
• What to do in an emergency

Also make sure you discuss dealing with day care and school with your child's doctor.

You will check your child's blood sugar using a lancing device on the sides of their fingertips. At first, your child may be scared of finger sticks for blood sugar checks. A lancing device kept at minimum settings may reduce the pain and fear associated with blood sugar testing. You can help your child feel more in control. Let them pick the finger to be used for the check. If needed, offer nonfood rewards, such as stickers or time playing favorite games. This can help your child feel better about checking blood sugar. With your help, your child can learn to do their own blood sugar checks (with supervision). Many children at this age can learn to recognize signs of low blood sugar. But you will still need to make sure your child's blood sugar is checked regularly. Check your child's blood sugar as often as advised by your doctor. You may also need to check their blood sugar levels when you suspect hypo- or hyperglycemia.

You may 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). Follow the instructions that come with the strips and from your child's doctor, nurse, or diabetes educator. If ketones are present, always call 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 your child's blood sugar to not 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. Children can't always 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:

• Too hungry
• Pale
• Grumpy or irritable
• Sweaty
• Sleepy or drowsy (lethargic)
• Staring into space or glassy-eyed
• Shaky
• Confused or having trouble concentrating
• Complaining of vision problems, headaches, or nightmares
• Uncoordinated
• Dizzy

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's no longer low. If it's 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 raises 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.) Ask your child's doctor about nasal glucagon. It is approved for children 4 years and older.

Contact your child's doctor right away, call 911, or go to the hospital emergency department if your child has any of the following symptoms. Your child:

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

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. There are things you can do to help your child learn about giving shots. Your child may choose to:

• Pick the shot site. At this age, the best places for insulin shots are the fatty parts of the:
  • Back sides of the upper arms
  • Sides of the thighs
  • Belly (don't inject within 2 inches of the belly button)
  • Buttocks
• Push the plunger of the syringe into the insulin bottle.
• Draw insulin into the syringe.
• Inject the insulin. Encourage cooperation and interest in diabetes care.

Ask your child's doctor to teach you how to correctly rotate the injection site and how to stay away from areas of lipohypertrophy. This is a bump under the skin caused by injecting insulin in the same spot multiple times. Also ask about correct insulin injection technique and how to prevent injecting insulin into the muscle. Accidentally injecting into the muscle or into an area of lipohypertrophy can affect how insulin is absorbed.

It's not unusual for children to cry and be upset when they get shots. But most children adjust very quickly to diabetes care and eventually show an interest in doing their own shots. Don't force your child to do shots if they aren't ready. Modern-day insulin pens are accurate, easy to use and practically pain-free even for children with diabetes. Your child should never feel that blood sugar checks and insulin shots are “punishment."

At first, you may have some concerns about giving shots. If you are nervous, you may want to practice on yourself first. Ask 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. The FDA has approved insulin pumps for children as young as age 2. A pump can be very helpful if it has been hard to control the blood sugar. Insulin pumps provide continuous insulin. They also provide meal time bolus doses without the need for an injection each time.

By this age, your child might enjoy going to a summer "diabetes camp." There they can be with other children who have diabetes and learn more about diabetes in a different setting.

Help your child learn about foods that affect blood sugar the most. Keep these things in mind:

• Your child's doctor, nurse, or diabetes educator will teach you 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. But not all carbs are the same. Complex carbs, such as those in vegetables and whole grains, do not raise blood sugar levels as much as processed or simple carbs, such as those in candies, cakes, and juices. You will learn about “carb counting.” This is a technique to help you figure out how many carbohydrates your child eats each day. Carb counting helps you decide how much insulin your child needs.
• When your child goes to school, write the carb count of each food on a piece of paper. Then put the paper into your child's lunch bag. This helps both your child and the teachers know how many carbohydrates are being eaten. It will also help your child learn to connect carbohydrates with their insulin dose.
• 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 their meal content.
• Remember that kids will be kids! While you may need to limit eating at times to control glucose levels, no foods should be "off limits." Children will sneak treats, especially those they love. So work the foods your child likes to eat into their meal plan. Adjust insulin dosages as needed. You will learn to adjust your child's insulin based on what your child eats.

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.

Your child should receive proper diabetes care and support at school:

• To make sure your child's needs are met, write down their diabetes care plan. This is sometimes called a 504 plan. At the start of the school year, meet with your child's teachers and school staff. Explain your child's treatment plan.
• Talk with the staff about your child's need to check blood sugar levels and to have food or drinks as needed.
• Your child must be free to eat or drink in class if their blood sugar is low.
• Someone at the school will need to perform or supervise your child's insulin shots. It may be the school nurse, if one is present.
• Your child will need to carry a kit for diabetes supplies. This includes testing supplies, medicines, and fast-acting sugar for emergencies.
• Inform the school that your child can still be active and participate in all school activities.
• Your child's doctor can teach your child how to talk about diabetes with classmates.
• Have your child wear a medical ID showing they have diabetes and whom to contact in case of an emergency.

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 things 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. So can joining a diabetes support group or talking with a social worker.
• 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. Your other children will also benefit from the healthy diet and activities that your child with diabetes follows.

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. Still, within these limits, most families are able to have very good blood sugar control.

For more information about diabetes, visit these websites:

• American Diabetes Association
• Children with Diabetes
• Juvenile Diabetes Research Foundation
• American Association of Clinical Endocrinologists
• National Institute of Diabetes and Digestive and Kidney Diseases
• Endocrine Society