DIABETES IN KIDS AND TEENS Leading an active, healthy and long life
When children are diagnosed with diabetes, parents often get emotionally disturbed, may feel angry, sad, upset, guilty, helpless or anxious, and worry whether they will be able to cope with the level of care that the child will need every day. Genuinely, parents need to be very involved in learning about the condition, participating in the routines and sharing management decisions. As children get older, they will learn how to care for themselves, but parents still play an important role in a child's health care team.
Living with the condition
Here are some suggestions to help children and their families adjust to a diagnosis of diabetes:
- Accept your child’s diagnosis without guilt. While no one really knows what causes type 1 diabetes, we do know it is not caused by eating too much sugar and there is nothing you could have done to prevent the disease, even if you had taken your child to see the doctor sooner.
- Learn as much as you can about diabetes. The more you learn, the less fear you will have and the more comfortable you will be in caring for your child. Your knowledge and confidence will help your child feel more secure.
- Take your child to see his or her diabetes health-care professional on a regular basis to discuss the growth, development and diabetes management of your child.
- If you have not been introduced to the pediatric diabetes team, ask for a referral. You and your child will benefit tremendously from the wisdom and experience of a nurse, dietitian, social worker and physician with expertise in pediatric diabetes.
- Make family communication a priority. The diagnosis of your child affects everyone in the family, but not everyone will respond in the same way. Talking to each other about these feelings - whether fear, sadness, anger, even jealousy - will help your family come to terms with your new life with diabetes. Do not forget to share your own emotions with someone who understands, such as another parent of a child with diabetes or your health-care professional.
- Be prepared to answer questions that people about your child’s diabetes. You might want to research some stock answers to common questions such as ‘What is diabetes?’ ‘How did he get it?’, or ‘Will she grow out of it?’ If people try to give you advice, you could answer, ‘Thank you, I’ll think about that,’ or ‘I’ve been told diabetes is very individual.’ You may sometimes receive conflicting advice from other people. Talk this through with your diabetes health professional to see how it relates specifically to your child.
- Take time for family fun. While diabetes is now part of your life, it is not your - or your child’s - entire life.
Children with type 1 diabetes
For children to live a healthy and fulfilling life with type 1 diabetes, you need to take care of the following:
Care for the child
Testing blood glucose (sugar) and giving insulin may seem overwhelming in the beginning. As you work with your diabetes team you will learn about diabetes and become more confident. It is important that you become comfortable with caring for your child’s diabetes so that you can help your child become comfortable too.
As the caregiver of a child with type 1 diabetes, you will help them with:
- Monitoring blood glucose
- Administering insulin
- Having regular meals and healthy snacks
- Balancing food, medication and physical activity
- Recognizing the signs of low and high blood glucose
Talk to the child about diabetes
The way you talk to your child about diabetes will have a big impact on how they perceive their diabetes and themself. Being positive and supportive will help boost your child’s self-esteem.
- Talk to your child about how foods fit into a healthy lifestyle. For example, no single food should be described as “bad” or “junk.”
- Describe blood glucose levels as “in target,” “high,” or “low.” Try to avoid describing blood glucose levels as “good” or “bad.”
- Remember that diabetes is only one part of a child’s life and not the total life. Talk to your child about other important things that are happening in their life such as school, sports and social events.
Involve other caregivers
It is important that other caregivers understand your child’s diabetes and know how to care for them. Members of your child’s diabetes care team can provide education to others. Consider providing other caregivers with:
- A schedule of blood glucose monitoring times and insulin requirements
- A meal and snack plan
- A treatment plan for low blood glucose
- A treatment plan for high blood glucose
- Contact information for emergency situations
Involve the child in diabetes care
Encourage your child to be involved in their diabetes care right from the beginning. Identify reasonable tasks that your child can do for themselves. Even young children can pick which finger is to be tested and read the numbers on the meter. As they become more independent, children can take on more of a role in their diabetes care, with parental support.
Children with type 2 diabetes
Most of the children who are type 2 diabetic are from ethnic groups at high risk for type 2 diabetes (African, Hispanic, Asian, South Asian and Aboriginal). Over the past 20 years, type 2 diabetes in children has increased around the world. Many children with type 2 diabetes do not have any symptoms and are diagnosed only when screened for other health risks related to being overweight. Therefore, children who are at a high risk of developing type 2 diabetes should be checked by their doctor every two years using a fasting blood sugar test.
Risk factors
- Being overweight or inactive
- Being a member of an ethnic group at high risk for type 2 diabetes (African, Hispanic, Asian, South Asian and Aboriginal)
- Having a family history of type 2 diabetes
- Being born to a mother who had diabetes during pregnancy
- Having any of the following:
- Dark, velvety patches of skin on the neck and under the arms (a skin condition known as acanthosis nigricans)
- High levels of fat or cholesterol in the blood
- High blood pressure
- Polycystic ovarian syndrome (a condition in females that can include no menstrual periods, unusual hair growth and being overweight)
- High levels of fatty deposits in the liver
- Taking certain medications for mental health conditions
Tips for pevention
A healthy lifestyle that includes healthy eating and physical activity can reduce the risk of developing type 2 diabetes. Set an example for your children by eating healthy and being physically active.
Try these lifestyle changes:
- Drink water instead of sugary drinks (pop, juice, iced tea, slushies)
- Offer healthy snack choices, such as fresh fruits and cut-up veggies
- Get moving: walk or bike whenever possible. Children should get 60 minutes of exercise daily. Examples include running, playing soccer, bike riding, swimming, dance
- Switch to lower-fat dairy products, such as 1% or skim milk
- Reduce screen time (television, computers, etc.) to no more than 2 hours per day and replace it with active play time
When children are diagnosed with diabetes, parents need to be very involved in learning about the condition, participating in the routines at an appropriate level and sharing management decisions. As children grow into young adults, they need to learn the details of their condition and how to care for themselves.
For teens and young adults: learning to help yourself
Are you thinking about moving away from home to go to school or to work in a different city? Are you planning to travel, move in with friends or simply be more independent with your diabetes management? If so, congratulations, you are taking a big step and it’s normal to have questions on what that all means while living with type 1 diabetes. In the past, it was likely very easy to consult or rely on your parents to make decisions or keep track of your diabetes. Now that you’re ready to step into adulthood, many things are going to be your responsibility and it’s ok to wonder how it’s all going to work.
For parents: learning to let go
As a child matures, the challenge for many families is finding the balance
between parental monitoring and teen independence. On the one hand, careful diabetes management is
vitally important to the immediate and long-term health of your child. On the other hand, you can’t be
with your child 24/7. Even if you could take total control of your child’s diabetes (which you can’t),
teens are more likely to rebel against tight restrictions. Rather, you may want to strive
for a supporting rather than controlling role in your teen’s diabetes care. Here are some suggestions:
- Recognize how devastating diabetes can be to a teen. She wants to be carefree, and independent, just like her friends. Instead, she feels burdened with a lifelong condition and restricted by tests and injections. Help her figure out ways to fit diabetes into her schedule; share the load where you can (e.g., help her record her blood glucose results or offer to give one of her injections each day). Look for support from your diabetes team, including the social worker. Find out if your teen is interested in joining a peer support group and where this might be available.
- Recognize how devastating diabetes can be to a teen. She wants to be carefree, and independent, just like her friends. Instead, she feels burdened with a lifelong condition and restricted by tests and injections. Help her figure out ways to fit diabetes into her schedule; share the load where you can (e.g., help her record her blood glucose results or offer to give one of her injections each day). Look for support from your diabetes team, including the social worker. Find out if your teen is interested in joining a peer support group and where this might be available
- Understand, and help your teen understand, that adolescents with diabetes require more insulin as they grow and go through puberty. This is normal. It is not a sign of worsening diabetes.
- Encourage your teen to participate in sports and other activities, which are great for building self-esteem. Help her to figure out how to prevent low blood glucose (hypoglycemia), which often accompanies increased activity, by testing frequently and either reducing insulin or increasing food intake.
- Ensure that your teen understands the potentially devastating consequences that smoking, alcohol and drugs can have for people with diabetes. If you are not comfortable talking with your teen about these issues, be sure to ask your diabetes professional to raise the subject with him.
- Avoid focusing on weight and body shape in your teen. Rather, focus on promoting a healthy lifestyle for all members of the family. Some teens discover that when they are getting inadequate amounts of insulin they lose weight. Although the discovery may be accidental, some teens (particularly girls) are tempted to reduce or skip their insulin repeatedly in order to lose weight. This risky behaviour leads to poor glucose management, a risk of diabetes ketoacidosis (a life-threatening condition that arises from a serious insulin shortage) and a high risk for long-term complications. Parents who suspect this behaviour in their teen should take steps to supervise each insulin injection while they seek the advice from their diabetes team.
- Be flexible and willing to help or step back as your teen needs. Watch for signs that your teen is struggling with his diabetes management: signs of high blood glucose levels (frequent urination, extreme thirst), low blood glucose episodes (hypoglycemia), poor school attendance, depression or a significant change in behaviour. If your child shows any of these signs, re-involve yourself in your teen’s diabetes and talk to his diabetes professional for further advice.
- Keep the lines of communication open. Instead of nagging or criticizing, use open-ended questions that encourage conversation. For example, ask: “How do you feel you are coping with your diabetes?”, “What are you finding most difficult about it?”, or “What would help you now?”