From Durban, South Africa:
My son was diagnosed eight months ago, at the age of 12 months, with Type 1 diabetes. Eight months later we are still battling to get his glucose levels under any kind of control. The biggest problem seems to be that there is so little knowledge or reference material on how diabetes effects a child so young. His situation is definitely different to that of a 5, or even 4 year old -- especially now as we approach the terrible two's. Can anybody give me some tips on diet (he is not a good eater) and general daily care, and some suggestions on how to get better control, and what is considered good control at this age? I am liasing with a very caring pediatrician who has taken care of my son since birth.
The care of a toddler with diabetes is very challenging. During the "terrible twos" it may be helpful to remember how stressful kids without diabetes can be as well!
During the pre-school period, most pediatric diabetes experts would recommend avoiding hypoglycemia wherever possible. This would mean a goal for blood sugars higher than for older kids. We tell our patients to look for numbers between about 100-200 mg/dl [5.5-11 mmol/l]. Obviously many readings will be out of this range, but it is a practical "goal."
Try not to get into food battles. If your child is a picky or variable eater, talk to your doctor about giving the insulin after meals, so you can adjust the short acting insulin to what your child has eaten. Or, if Humalog is available, talk with your doctor about using this. (Humalog in the U.S. is not able to be diluted, so if 1/2 unit is too much, then we would use a diluted Regular instead.)
If your child is typical, you are already an expert on "sick day management" in diabetes. If not, then talk to your doctor or read about sick days. Look for ketones and high blood sugars to see if your child needs more insulin on a sick day. (An exception might be with diarrhea or vomiting, if you see lows, then carefully decrease the insulin with the help of your doctor, but never completely omit insulin! If your child is extra active, then increase the food, or decrease the insulin (or both).
The Joslin Diabetes Center in Boston, Massachusetts, USA, has a book about the care of the young child with diabetes.
Most of all, enjoy this lovely but so challenging stage of life!
Additional Comment from Joyce Mosiman, diabetes dietitian:I would add the reference Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace. There are many common sense suggestions in the book.
[Editor's Comment: As the parent of a child diagnosed at 24 months old, I understand your situation very well. I highly recommend the book Sweet Kids: How to Balance Diabetes Control & Good Nutrition with Family Peace by Betty Page Brackenridge, MS, RD, CDE & Richard R. Rubin, PhD, CDE. It contains a wealth of very good practical advice about raising kids with diabetes. JSH]
Original posting 28 Nov 97
Additional comment added 1 Dec 97
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