Managing your child’s diabetes

As your child’s primary caregiver the role of managing their diabetes will fall mainly to you in the early stages of their childhood. This can be very daunting at first but there is a lot of resources available to you. Your child’s healthcare team and Diabetes Ireland are also here to help you. Check out our Pete the Pancreas booklets below. They are designed to help parent and child learn about diabetes in a child friendly way.

Pete the pancreas – Children

Pete The Pancreas for Parents 

Whilst you are their primary carer today, as they grow up they will need to manage their condition themselves. Therefore, it is important to involve your child in the learning process and make decisions with them. Whilst it will be challenging at first, overtime you will realise that your child can live a happy and healthy life with their diabetes.

Parental leave – The Parental Leave Act 1998, as amended by the Parental Leave (Amendment) Act 2006, allows parents to take parental leave from employment in respect of certain children. On 8 March 2013 the European Union (Parental Leave) Regulations 2013 increased the amount of parental leave available to each parent per child from 14 weeks to 18 weeks. (Those who have taken or are taking 14 weeks’ parental leave are also entitled to this extra 4 weeks.) The Regulations extended the age limit for a child with a long-term illness to 16 years. For more information visit Citizens Information – – http://www.citizensinformation.ie/en/employment/employment_rights_and_conditions/leave_and_holidays/parental_leave.html

Self-management 

Self-management is the best way to manage diabetes. Your child may be too young to do this at the moment, it is up to you the parent to manage their diabetes and teach them along the way. This means that you keep track of  their blood glucose and take an active part in the treatment of their diabetes.

What and when to teach your child

0 – 5 years old

  • From 0-4 months, most children have limited memory. They will not remember testing or receiving injections once completed.
  • By around 8 months your baby will be beginning to make the connection between their discomfort and your reaction to it. They will pick up on parent’s emotions and levels of stress.
  • By one year, your child will be able to say a few words and will begin to make the connection between and action and its effect on them. They will realize that the meter or syringe means discomfort for them.
  • By two years, your child will be able to communicate with you. They should be able to point at the piece of diabetes equipment you mention.
  • By three years, your child will relate present activities with past experiences. They will begin to associate that needles mean discomfort and will have a learned behavioral reaction to it.
  • By four years, your child will be able to count up to 20 but may not fully understand the numbers.
  • They will be able to make the association between do’s and do not’s but will not be able to understand why.
  • By five years, your child will be able to draw pictures that reflect their feelings and thoughts. They will be able to draw pictures that reflect their views of diabetes.

The parent is always responsible for diabetes care, but should allow the child to help as appropriate.

There are no rules of the game for this age group. It is important that parents communicate a relaxed approach to diabetes management as children learn quickly and will reflect their parent’s distress. Use simple language to explain about diabetes and use correct terms. Check out our child friendly booklet, Pete the Pancreas

6 – 8 years old

Children will know their numbers and alphabet and may be able to read a little. Many do not understand the concept of time, and do not know how to tell time accurately.
Children are curious, active and ask a lot of questions. Some are ready to learn. Others would rather play. Imagination is very important. Children take things very literally. Girls are often more mature than boys. The parent is always responsible for diabetes care, but the child may be allowed to help.

Children should be able to state that:

  • They have diabetes
  • Their body needs insulin
  • When they receive insulin and eat regularly their blood glucose is fine, they feel well, and they can live just like other children.

Children should know that

  • They will always have diabetes
  • It is not their own nor anybody else’s fault that they have diabetes
  • No one knows why some people get diabetes
  • Diabetes is not contagious.

Food

  • The child should know when to eat while at school and after-school care
  • Eating times may occur, for example, during a certain break or when a pre-set alarm on the child’s watch beeps.
  • If sweets are offered, the child should be able to explain that he or she has diabetes. The child may eat a small amount and take the rest home.

Insulin
Insulin injections are the parent’s responsibility. Children may help by finding the syringe, pump supplies or monitoring device and help prepare it for use. Children of this age may inject themselves, but only if the child wants to and always with supervision!

Exercise
If the child participates in sports, it is the parent’s responsibility to supply extra food and/or to adjust the insulin dose. It is good, however, if the child is able to explain in simple words the relationships among food, insulin and exercise.

Blood glucose testing
The child may help in blood glucose testing, but only under the supervision of an adult. Children should know that the blood glucose test shows how much glucose is in their blood.

Hypo = low blood glucose:
Children should know that if they are shaking or sweating, or if they feel “funny” in their head, stomach or legs, they must tell an adult right away.
A child who has had low blood glucose should be able to describe his or her own symptoms.
Children should know that they should eat 3 or 4 glucose sweets or drink 100ml of a regular (not diet) fizzy drink if they have a low blood glucose and to have a snack

8-9 years old

Children now know the numbers up to 100. They understand the concept of time and can tell time. Toward the end of this period children are learning units of measure such as litres/decilitres, kg/gram, km/metre/cm.
Children are motivated to learn new things. They concentrate on having things ‘look right,’ and with making sure that assignments are done correctly. Children are very ambitious. It is important that adults do not demand more than the child of this age can handle.
Children begin to take over more of the practical responsibility for diabetes care, but the parent is still mainly responsible.

Children should be able to state that:

  • They have diabetes
  • Their body needs insulin
  • When they receive insulin and eat regularly their blood glucose is fine, they feel well, and they can live just like other children.

Children should know that:

  • They will always have diabetes
  • It is not their own nor anybody else’s fault that they have diabetes
  • No one knows why some people get diabetes
  • Diabetes is not contagious.

Food
Children should know the number of meals they need at school and at the after school care centre, and when the food should be eaten.
They should know which foods may be eaten in unlimited amounts and which may not.

Insulin
Children should know what types of insulin they take and when each is taken. The child should participate in giving the injection. When children are motivated to learn, they should be taught self-injection. The insulin dose and when to inject insulin are still the parent’s responsibility.

Exercise
Children should understand that exercise or sports require more food and maybe less insulin. Parents still have the main responsibility for diabetes care, but with the child’s help.

Blood glucose testing
Children should know that the blood glucose test measures the level of glucose in the blood. They should know why the test is needed.
Children should be able to test their blood glucose by themselves, but a parent must evaluate the result.

Hypo = low blood glucose:
Children should know their own symptoms of low blood glucose and how to correct it with the right amount of glucose sweets, juice or sugar.

Hyper = high blood glucose:
The child should know when the blood glucose reading is too high and inform an adult.

Special precautions
Eating or sleeping away from home:
Although children can now inject insulin by themselves, insulin doses and when to inject are still the adult’s responsibility. When the child is away from home, properly instructed adults must be there to supervise.

10-11 years old

Children can read. They are now learning about decimals, fractions, percent and angles (such as 45º).
Friends are becoming very important. Children try out their abilities among their peers and question parent’s wisdom, opinions and decisions.
Children should be able to handle the practical aspects of their diabetes, but still not adjust insulin doses by themselves. At this point the child needs only limited background information about diabetes.

Knowledge about diabetes
The child should now know how insulin works: e.g. lowers blood glucose after a meal.

Food
Children should know how many meals and snacks they need, and when each should be eaten. They should be able to create a meal.
Children should be able to give examples of foods which make the blood glucose rise quickly or slowly.
Children should know how many sweets/treats they are allowed to eat
They should be able to explain how much fruit, for example, can be exchanged for sweets.

Insulin
Children should know when to inject insulin and be able to do it independently.
They should know their insulin doses, but should not change them independently. Children should know whether their insulin is slow/longer- or rapid/short-acting.
Children should know how to store insulin.

Exercise
Children should understand how insulin, food and exercise are related.
They should be able to take precautions when exercising or playing sports.

Blood glucose testing
Children should know why the blood glucose is tested. They should know when to test, and be able to use the blood glucose meter by themselves.
Children should know their blood glucose range, for example 5 – 15 mmol/l.
Children should be able to explain how the blood glucose level relates to insulin, food and exercise.

Hypo = low blood glucose
Children should know at what level blood glucose is too low.
They should recognise their own symptoms of low blood glucose, and be able to handle the situation by eating glucose tablets/juice and bread.
Children should be able to explain the causes of low blood glucose.

Hyper = high blood glucose
Children should recognise the symptoms of high blood glucose and know that they must test their blood glucose when symptoms occur.
They should know that they must inform an adult when their blood glucose is too high.
Children should be able to explain the causes of high blood glucose.

Special precautions

Illness
Children should know that they must inform an adult when they are ill. They should know that special rules for diabetes care apply during illness.

Eating or sleeping away from home
Children should be able to handle a few days away from home as long as an adult is present to supervise diabetes care.

Long term complications
Children should have some knowledge of the long term complications of diabetes. The focus should be on prevention and control, stressing the importance of routines such as foot care. Children should be prepared to cope with the ‘horror stories’ they may hear about long term complications.

12 – 13 years old

Children can read well and they know how to compute averages.
The physical changes of puberty affect children’s perception of their body and its functions. Most children like to “look like” their peers. Relationships with parents are characterised by changing needs for dependence and care taking from parents.
Children should be able to handle the practical aspects of diabetes care. During this period they begin to learn background information about diabetes.

Knowledge about diabetes
Children should be familiar with major internal body organs. They should know about the digestive system and the function of the pancreas

Food
Children should know which foods are best to eat.
Children should be able to read and understand relevant parts of the information provided on food labels.
Children should know about different forms of food sweetener.
Children should know how to live as close to normal as possible among their friends and classmates.

Insulin
Children should take their daily insulin independently.
Children should gradually take over responsibility for changing insulin doses based on blood glucose readings (and blood glucose profiles) and their growing knowledge of the relationship between nutrition, insulin and exercise.
Children should know how much extra short-acting insulin (or rapid-acting insulin analogue) to take during special events such as a birthday party, or when their blood glucosesugar is too high.

Exercise
Children should be able to adjust their food and insulin dose to match their exercise level.

Blood glucose testing
Children should be able to interpret their blood glucose readings and use them to control their blood glucose level.

Hypo = low blood glucose
Children should know the causes and symptoms of low blood glucose, precautions to avoid it, and treatment in case it occurs.

Hyper = high blood glucose
Children should know the causes and symptoms of high blood glucose and precautions to avoid it.
Children should be able to treat high blood glucose successfully either by themselves or with help from parents or the diabetes care team.

Special precautions

Menstruation/puberty
During puberty, when girls begin to mature and grow rapidly, the need for insulin often increases because of higher hormone levels in the body. Some girls notice a change in their blood glucose pattern during their menstrual period and may have to adjust insulin doses during this time. If diabetes is poorly controlled, menstrual cycles may cease.

Illness
Managing diabetes during illness is still the responsibility of an adult.
Children should inform an adult when they become ill.
Children should know that they must check their temperature and blood sugar and test their blood/urine for ketones when they are ill.

Eating or sleeping away from home
Children should be able to handle diabetes care on their own. As a precaution, teachers or other adults should be aware of the child’s diabetes.

Long term complications
Children should recognise the relationship between blood glucose control and long term complications in order to understand why good blood glucose control is so important.

14 – 18 years old

For information on young adults and starting college / workplace, please click HERE.

Older teenagers are preparing for the future with plans for further education and working life. Real separation from parents occurs now as teenagers find their place within their own generation.
As teenagers prepare for adult life, diabetes becomes a matter to be handled by the individual and the diabetes care team.
Teenagers should be motivated to improve self-care skills and to increase the depth of their knowledge about diabetes.

Knowledge about diabetes
Older teenagers should have a good knowledge of how the body works in order to understand the different problems that people with diabetes face.
Older teenagers should know about all major body organs such as the heart, kidneys, liver and pancreas.
Older teenagers should be familiar with the circulatory system, the digestive system and the process through which nutrients are absorbed by the body.

Food
Older teenagers should gain a deeper understanding of nutrition and foodstuffs in general. They should apply the principles of nutrition to daily situations such as playing sports, eating fast food, and going to parties.
Older teenagers should be able to shop for their own groceries.

Insulin
Older teenagers should use blood glucose readings (and blood glucose profiles) independently to adjust doses of all types of insulin according to how much they eat and exercise.

Exercise
Older teenagers should be able to apply all relevant exercise precautions whether they compete in sports events or follow a daily exercise routine such as jogging or taking long walks.

Blood glucose testing
Older teenagers are fully responsible for blood sugar testing.

Hypo = low blood glucose
Older teenagers should understand the importance of teaching their friends and schoolmates about diabetes precautions, especially the symptoms and treatment of severe hypoglycaemia.
Older teenagers should know when and how to inject glucagon so that they can instruct potential helpers.

Hyper = high blood glucose
Older teenagers should know the causes and symptoms of high blood glucose and precautions to avoid it.
Older teenagers should be able to treat high blood sugar successfully by themselves

Special precautions

Menstruation/puberty
During a girl’s menstrual period, the need for insulin often increases because of higher hormone levels in the body. Some girls notice a change in their blood glucose pattern and may have to adjust insulin doses during this time. If diabetes is poorly controlled, menstrual cycles may cease.

Illness
Older teenagers should be able to take necessary precautions themselves when they are ill. They should understand the principles behind taking extra insulin when their temperature is high, and know what to do when they have nausea and vomiting.
Older teenagers should understand that they may need to get help from the diabetes care team during illness.
Eating or sleeping away from home:
Older teenagers should be able to travel independently, taking all necessary precautions. They should know that it is important to have blood glucose under good control before starting out on a trip.

Alcohol – Please note the legal age to consume alcohol is 18
Older teenagers should be taught practical information about how to handle alcohol safely.
They should know how alcohol affects blood glucose. They should know what precautions people should take when drinking, especially the need to eat extra food to decrease the risk of low blood glucose.

Sex
Older teenagers should know the importance of practicing safe sex. For information on contraception and diabetes please check out our frequently asked questions section here.

Social factors
Older teenagers should be informed about reimbursement rules with respect to diabetes care services, insulin, insulin devices, pens and syringes, blood glucose metres, test strips, etc.
Older teenagers should learn about job options, possible limitations, and any special considerations that apply to diabetes.
Older teenagers should know how to get and maintain a driver’s license.
Older teenagers should know that it may be difficult for a person with diabetes to get certain types of insurance.

Long term complications
Teenagers should know about the different follow-up examinations that are necessary, including:

  • HbA1c
  • Blood pressure monitoring
  • Testing for microalbuminuria
  • Checking sensation in the feet
  • Eye examinations

Teenagers should know why and how these tests are performed, how the results are evaluated, and what treatments are possible if any tests show signs of long term complications.