Toddlers with diabetes --- caring for the youngest patients

by Bob Fleming

Toddlers with diabetes are suffering from Type 1 diabetes, also known as juvenile diabetes or diabetes juvenile. The number of children under the age of five being diagnosed with diabetes juvenile has almost doubled in the past five years. Caring for toddlers is a challenge under the best of circumstances, and toddlers with diabetes need even more special care and attention.

Symptoms

First, if you are wondering whether your toddler has diabetes in the first place, here are some signs to look for:

	often complains of thirst
	hungry more often
	suddenly lost weight
	urinates more than usual
	sometimes breath smells fruity or winelike

If you notice any of these symptoms in your child, discuss with your doctor the possibility you have a toddler with diabetes.

Special challenges

You or your caregiver will have to closely monitor your child's blood sugar throughout the day to be sure it stays within a safe range. Ideally this means 6-12 mmol just before meals.

Toddlers with diabetes also require daily insulin shots, which can be traumatic for you as well as your child! When administering both finger pricks for the blood sugar tests and the insulin shots, you should be as quick and calm as possible about the procedure. If your child is playing, go where he or she is rather than having them come to you. That helps establish the procedure as just a normal part of their day.

Of course, your child will resist these procedures, and it can be hard for parents and caregivers to remember they are doing this for the child's health. It must be done, however, and you may have to learn to restrain the child gently. It also helps to give them a big hug and a kiss after it's finished to make sure they understand you still love them even though this hurt a bit.

Another problem is that toddlers with diabetes can't tell you when they are feeling the effects of low blood sugar, which is another reason for careful monitoring.

Toddlers in general can be picky eaters, and toddlers with diabetes are no different. The challenge here is in making sure that all your alternatives fit within a healthy and appropriate diabetic diet. Have as wide a selection of those foods available as possible so that when they do refuse certain foods, you can tempt them with an appropriate alternative.

Young children go through the same stages of growth and development whether or not they have diabetes. So one way to be sure your child is otherwise healthy is to watch out for:

	normal weight gain and growth
	ability to roll over, sit up, crawl, stand, walk and talk at about the time you'd normally expect
	normal level of energy
	blood sugar levels that don't go above 12 mmol/L, at least not for long periods of time
	no wetter than usual diapers
	no unusual thirst
	happy and secure attitude

The Royal Children's Hospital in Melbourne, Australia has produced a helpful video called "Here We Go Round the Mulberry Bush --- Positive Parenting of Toddlers with Diabetes". You can order this online from the hospital at http://www.rch.org.au/erc/video/order_mulberry.cfm