For Parents: Diabetes Care (Newborn to 2 years)

Very young children need to have their blood sugar checked often. You may be checking your child’s blood sugar 5 to 6 times a day. The best places to use for blood sugar checks at this age are:

• Side of fingers tips (not the pad)

• Side of heel (for very young children who are not yet walking)

You 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). Having high levels of ketones is serious. It needs medical care right away. To check for ketones in very young children, place a cotton ball inside your child’s diaper to absorb urine. Then press the cotton ball to the ketone test strip. If ketones are present, always call your child’s healthcare provider right away. Some people also use home glucose and ketone monitors to check the blood for ketosis. Ask your child's healthcare provider, nurse, or a diabetes educator for more information.

It’s very important for young children’s blood sugar not to 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. Very young children can’t 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:

• Pale

• Fussy or irritable

• Sweaty

• Lethargic (sleepy or drowsy)

• Staring into space or glassy-eyed

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 healthcare provider has advised, take action. Treat your child right away with a fast-acting sugar as you were told by the healthcare provider. Check your child's blood sugar again in 15 minutes to be sure it is no longer low. If it is 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 will raise your child’s blood sugar very quickly. Always have an emergency kit with a shot of glucagon with you. (Your child’s healthcare provider will teach you how to give a glucagon shot.)

Call 911 if your child has any of these symptoms:

• Is hard to wake or unresponsive

• Passes out (faints)

• Has a blood sugar level below the “danger number” given to you by the healthcare provider

• Needs glucagon

• Has a seizure

To control blood sugar levels, young children may need about 4 injections (shots) of insulin a day. This includes both slow-acting and fast-acting insulin. 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. This is especially true if your child is being breastfed. Your child’s healthcare team will teach you how to give your child shots. In young children, the best places to give shots are:

• Buttocks

• Sides of thighs

• Backs of upper arms

At first, you may have some concerns about giving shots. If you are nervous, you may want to practice on yourself first. Talk to your child’s healthcare provider 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.

It’s not unusual for children to cry and be upset when they get shots. But most children adjust very quickly to diabetes care. Shots and blood sugar checks may not be easy for your child to deal with at first. Your child should never feel that blood sugar checks and insulin shots are punishment. Here are some tips to help make getting shots easier for your child:

• Always give your child love and attention before and after shots.

• Use toys or other types of play to focus your child on something fun.

• Use play therapy to help your child adjust by demonstrating shots on stuffed animals. You can use a syringe without a needle to pretend to give the shots.

• Talk to your child’s healthcare team about other ways to help your child deal with insulin shots.

What your child is eating will help determine their treatment plan. You will likely start by learning 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. You will learn about carb counting. This is a method to help you figure out how many carbohydrates your child eats each day. You may learn about carb counting even if your child is still being breastfed. Young children can also often be picky eaters. So it might be harder to make a meal plan for young children with diabetes. Talk to your child's healthcare provider and dietitian about this. They can help you as this is very common in younger children. 

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 healthcare provider to learn how to balance your child’s activity with food and insulin.

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 tips 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. Joining a diabetes support group or talking with a social worker can also help.

• Keep in mind that 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.

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.

For more information about diabetes, visit these websites:

• American Diabetes Association at www.diabetes.org

• Children with Diabetes at www.childrenwithdiabetes.com

• JDRF at www.jdrf.org

• Association of Diabetes Care & Education Specialists  at www.diabeteseducator.org

• American Association of Clinical Endocrinologists at www.aace.com

• National Institute of Diabetes and Digestive and Kidney Disease at www.niddk.nih.gov

• Endocrine Society at www.endocrine.org