Having Kids with Type 1 Diabetes

Both my son's have Type 1 Diabetes and it seems more and more kids lately are developing this mystery disease. But what Is Type 1 Diabetes? According to the Junior Diabetes Research Foundation, they simply explain it this way:

 

"Type 1 diabetes (juvenile diabetes) can occur at any age, but most commonly is diagnosed from infancy to the late 30s. In this type of diabetes, a person's pancreas produces little or no insulin. Although the causes are not entirely known, scientists believe the body's own defense system (the immune system) attacks and destroys the insulin-producing cells in the pancreas. People with type 1 diabetes must inject insulin several times every day."

 

When our oldest, Russell, got sick, we had no idea what the symptoms where. Honestly, we thought he was going through a growth spurt. But is just wasn't right. He was thirsty all the time, soaked his bed every night, lethargic and eating more then normal but losing weight. I took him to the doctor and they did a simple urine test and checked his blood. At the time his brother was only 4 months old and sleeping in my arms. As soon as the tests came back, the Dr. told me I need to get him to the ER right away! I called my husband and we raced to Children's Hospital. He spent 1 night in the ICU as his blood sugar numbers where so high and out of control.

 

We felt guilty waiting so long to take him in, but honestly had no idea what was going on in his body. He spent 4 days total at the hospital (they did move him to a reg. room after the first day) so my husband and I could be educated on how to take care of him at home.

 

A few short years later, his little brother Brian was also diagnosed weeks before his 3rd birthday. He was showing the same symptoms for about a week or so and so we used his big brothers meter to check his blood sugar. Finally, while on Russell's 7th birthday, we decided to take Brian to Children's Hospital as the blood sugar meter kept saying "hi" (meaning his numbers where over 600). He spent 5 days at Children's Hospital because he also developed a viral infection.

So now we have two kids with Diabetes, two kits, two sets of insulin, meters, syringes, test strips, etc. All the tools of the trade to manage this mystery disease from home. But we do manage it. The kids have taken it on as normal as brushing their teeth.

 

Both my kids are on Lantus (long acting insulin) and Humalog (short acting). Every morning they each get a shot of Lantus, units are different for each child due to age and weight. The Humalog is given every time they eat food with carbohydrates that fall within a ratio of their target blood sugar. For example, at lunch, my youngest may eat food that ads up to 25 grams of carbs, so if his blood sugar is within its normal range before he eats, his shot will be 1 unit of Humalog. Same applies with his big brother, just a different dosage ratio.

How do we figure out their dosages for Lantus and Humalog? Every three months since the date of their diagnosis, we visit the Endocrine Clinic at Children's Hospital here in Seattle. Their Dr. takes a blood sample, much like their finger pokes and that will tell her their A1C levels (A1C is a test that measures a patient's blood glucose level over the previous three months that might also help predict serious health complications like heart attack and stroke).

 

They also download their blood glucose meters to get a readout of their average blood sugars over the last few months. With this information, she can decide where the peaks and lows are, and where the Lantus and Humalog may need adjusting. Their Dr also has a computer program on the hospital database that helps with the calculations as well as "cheat sheets" we use for each child. You see. They many times have different dosages for the Humalog for EACH meal during the day, for EACH child. A chart for Breakfast, Lunch and Dinner (if they eat a snack, for example, mid morning, I use the dosage for breakfast to treat it if necessary).

 

We've been very lucky with Children's Hospital, they've got the best Endocrine team there and have helped us weather many storms through both boys dealing with illness or simply not able to get their numbers under control.

This leads me to another thing we have to watch out for, ketones. Or as we like to tell our kids, we need to fight the "ketone monsters".

 

What are Ketones?

Ketones are due to not enough insulin being available to meet the body's needs. The 2 main causes are illness/infections (the body needs extra energy to fight off a virus or bad cold) or forgetting to take an insulin shot. There are other causes, but the primary ones we've had to deal with are the two mentioned. Another bugger, which is worse, is acidosis.

 

Now acidosis is the result of letting ketones get out of hand. Perhaps insulin isn't available due to an emergency situation, or the person is simply not taking care of their diabetic needs properly. See, it is not high blood sugar that causes ketones or acidosis; eating sugar does not cause acidosis. Ketones come from the breakdown of body fat. The role of insulin is to shut off fat breakdown. Now if the stress hormones are high or there simply isn't enough insulin, fat will begin to break down. And the side product of fat breakdown is ketones production. In the early stages, it can be tested with urine. But if left undetected, ketones can also build up in the blood and eventually in the body tissues. When it gets this far, it will result in acidosis (DKA).

 

For example, my youngest spent a week at Children's Hospital when he got the stomach flu last February. He was so sick; we couldn't get him to keep any food or liquid down. Because he wasn't eating, his blood sugar dropped low, and we couldn't give him insulin to deal with the heavy ketones because he wasn't eating. So in turn, he was on an IV drip to help rehydrate his little system as well as supply glucose for his body to work with. Even the smallest amount of long acting insulin dropped him low to the point the Glucagon wouldn't work (that is an emergency glucose administered through as a shot to help the body draw stores of sugar from the liver). But because we where able to get him in and on an IV drip, he never got as far as DKA.

 

Our oldest son has also developed ketones because of the flu and or a head cold. His body will have really high blood sugars (only a couple of times has he had heavy ketones and low blood sugars, luckily never needing to be admitted, but did have an ER visit). So we follow a sick day management regimen and different calculations according to how heavy his ketones are so we know how much extra insulin he needs to get his blood sugar under control. As with any illness, lots of fluids, especially water are a necessity but even more so with diabetics.

 

So anytime my kids come down with even just a sniffel, we're on them to check for ketones and watching their blood sugars closely. We have test strips that can be dipped in urine that show a color code to how light or heavy their ketones are. Staying on top of their sick day management has prevented many trips to the ER.

 

What can my kids eat?

Anything! What is so nice about the insulin they're on; they're not restricted to how much food or type of food they can eat. We do, however watch how much fat (limited "fast food" and "junk food") and salt intake because it raises blood pressure as well as threatens the circulatory system. The reason fat restriction is very important because high cholesterol and diabetes are two of the four risk factors for developing heart disease. (The other two for developing heart disease is smoking and family history).

 

So I make a lot of my own foods for home. I've posted many of our favorite recipes at The Poor Chef website. I also input the nutrition information on a program I use at home that gives me the carb amount on home recipes per serving (FitDay.com). Another great resource for food items, especially if you're eating out (most restaurants now supply nutrition info) is a pocket book from Calorie King. I keep a copy in the car just in case, trust me, having extra resources to go to in a snap is so handy.

 

What about school?

Again, we are very lucky to have a great school district who supplies a full time nurse. Nurse Alice is the best. We have a system down for my oldest son Russell. I make his lunch and provide all the carb info for what is packed. She just has to add up what he's eaten and is able to use the "cheat sheets" I've provided so she knows how much insulin to give him at lunch time. We talk almost every day about his numbers so I have a complete log for when it's time to go to the doctor. It's a team effort and I can use all the help I can get. Brian isn't quite ready for school yet, but I know he'll be well taken care of when it's time.

 

I can't say it's been an easy road and wouldn't wish it on anyone. But if you're reading this and have a loved one with Type 1 Diabetes, I hope the information has been of some help. It's an ongoing education and we're so grateful to live in a time where medical breakthroughs are happening all the time. Who knows, maybe by the time my kids are in high school, there may be a cure for Diabetes. Until then, we'll keep managing their care, not let it get us down or hold us back from living a happy and normal life.

 

For more information regarding Type 1 Diabetes, please visit:

http://www.jdrf.org

 

"Understanding Diabetes, A Handbook for People Who Are Living with Diabetes", by H. Peter Chase, MD (aka: The Pink Panther Book)

 

This Article is Written by Kathleen Schmidt (c) 2009

Kathleen Schmidt:

Domestic Goddess and Work At Home Mom

877-762-1450

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Kids Diabetes Alert - Are Your Kids At Risk?

When most people think of diabetes, they usually either think of young kids with Type I diabetes who need daily insulin shots or older, overweight adults with Type II diabetes.

 

Now though, with the childhood obesity epidemic, there has also been a big increase in the number of children with Type II diabetes, which used to be thought of as adult onset diabetes.

Diabetes Risk Factors

Obesity or being overweight is one of the biggest risk factors for diabetes, both in kids and adults. You can use our BMI Calculator to see if your children are overweight. If they are, it would be a good idea to discuss it with their Peditrician, help them to eat a more healthy diet, and increase their physical activity.

 

Your child's ethnic background can also be a risk factor for diabetes, which is more common in American Indian, African-American, Hispanic American, and Asians/South Pacific Islander children.

 

A family history of diabetes, especially in first- and second-degree relatives, can also be a risk factor for children developing type 2 diabetes. Unlike kids with type I diabetes, who usually only have a 5% chance of having a family member with diabetes, type 2 diabetics have a 74-100% chance of having a family member with diabetes.

Symptoms of Diabetes

In children with Type I diabetes, the typical symptoms are well known, including increased urination (polyuria), increased drinking (polydipsia) and weight loss.

Type II diabetes is more subtle in children, who are usually overweight and either have mild or no polyuria or polydipsia. Another sign or symptom of Type II diabetes is acanthosis nigricans, a black, velvety discoloration to a child's neck and skin folds.

Testing Children for Diabetes

All children who are at risk for diabetes should be tested or screened, beginning when they start puberty or by age 10, since most kids are diagnosed during middle-to-late puberty.

 

The American Diabetic Association considers kids at risk and requiring testing if they are overweight and has any two other risk factors, including:

• a family history of type 2 diabetes in first- and second-degree relatives,
• belonging to a certain race/ethnic group (American Indians, African-Americans, Hispanic Americans, Asians/South Pacific Islanders),
• having signs of insulin resistance or conditions associated with insulin resistance (acanthosis nigricans, hypertension, dyslipidemia, PCOS)

Some children who don't meet these criteria may also be tested based on a your Pediatrician's clinical judgement.

 

Testing for Type II diabetes should usually include a fasting plasma glucose level, which will be high (hyperglycemia) if your child has diabetes. Other tests might include a urine glucose test, which will likely show sugar in the child's urine (glycosuria), a random glucose, and/or a HbA1c (a more long term test of glucose levels).

 

Since your child is likely overweight if he is being tested for Type II diabetes, he should usually also have his cholesterol tested at this time.

 

If testing is normal, you should still help your child be more active and have a more healthy diet. While your child is at risk, testing is usually repeated every two years.

 

Source: By Vincent Iannelli, M.D., About.com Guide

 

Diabetes requires adjustments for all members of the family

When a child is diagnosed with diabetes it undoubtedly will affect the entire family. Much attention is usually given to the child with type 1 to ensure proper diabetes management. But less attention is often given to the siblings of the diagnosed child. It is not uncommon for there to be feelings of neglect, anger and favoritism that arise in siblings.



Siblings can adjust to diabetes in their home if parents create a supportive environment that addresses the needs of all the children, not just the one with diabetes.

 

Here are some tips for parents on how to manage the responses of siblings to the changing family dynamic of living with diabetes.

Explain diabetes in terms they can understand

It is important that you clearly explain what diabetes is and how it works to each of the children in age-appropriate language. This will help calm fears and enable them to normalize the diabetes management process much faster.

 

For example, one of the big misconceptions that siblings often have after a brother or sister is diagnosed with diabetes is that they will “catch it.” They need to clearly understand that diabetes is not contagious and that close contact with their sibling is not dangerous. In fact, you can even emphasize that when the diabetes tasks are completed, it might be easy to forget that their sibling even has diabetes.

Look for opportunities to probe the feelings of your children

Initially, siblings adjust to diabetes with some intrigue, wanting to understand what it is about. But within a few weeks most siblings would like life to go back to “normal” before the diabetes came to live in the home. This causes a wide range of feelings in kids. The goal is to listen for these emotions and coax them out when appropriate.

 

For example, suppose your non-diabetic child says he also wants to have diabetes so he can spend more time with Mom and Dad. This type of comment is full of emotion. Rather than correcting your child and instructing them about the difficulties of having diabetes, focus in on helping them talk about their feelings. You might say, “Does it seem that your brother gets more attention from Mom and Dad because of his diabetes?” An inquisitive response that attends to the emotion your child is feeling sends the message that you want them to tell you more; you want them to express their feelings and you are willing to listen.

Make a point to talk about a wide variety of topics with children

Immediately after the diagnosis it is easy for diabetes-related conversation to dominate the household interaction. While this is understandable, make an effort to broaden out the topics to include areas of interest that pertain to all members of the family. This will not only help siblings to feel their lives are important but will also help the child with diabetes to see that there is more to life than diabetes.

Limit the amount of responsibility you give regarding diabetes tasks

While it is fine to ask for sibling help now and then with diabetes-related tasks, limit the responsibilities. For example, it is okay to ask an older sibling to periodically check the younger sibling’s blood sugar, but be cautious about making this type of responsibility a routine task. Diabetes is a difficult condition to manage and can be stressful, even for teens.

Be deliberate about nurturing each child’s needs

In reality, you may end up spending more time and energy addressing the needs of your child with diabetes than the others. But this doesn’t mean you can’t make adequate time for the other children as well. Show interest in their activities and challenges. Affirm their skills, abilities and efforts. Each child will have their own unique relationship with you. Nurture it by giving them one-on-one time where there is lots of conversation and fun. This is one sure way to avoid the problem of favoritism for the child with diabetes.

 

_{Source: American Diabetes Association. "Diabetes Affects Siblings Too.”}

Pregnancy and Type 1 Diabetes

It’s very important that pregnancy in females with type 1 diabetes is planned and closely monitored from preconception until delivery by a diabetes team (endocrinologist, diabetes educator and dietitian) and an experienced obstetrician. Contraception should be used by females with diabetes unless there is active planning for a pregnancy. In the case of planning a pregnancy it’s important to have very good diabetes control, as well as any diabetes complications being stable, and folate supplementation having been commenced.

 

To ensure the best pregnancy outcomes it’s important that blood glucose levels (BGLs) are well managed both before and during pregnancy. Pregnancy should not be planned until HbA1c (3 monthly average of BGLs) is within or close to the range for people without diabetes. It’s important to aim for tight blood glucose control throughout the pregnancy while still avoiding hypos.

 

The risks of unplanned pregnancy or poorly managed diabetes during pregnancy include the risk of miscarriage, having a baby that is too large or too small and the baby having congenital malformations (especially heart or kidney problems).

Pregnancy may also increase the risk of progression of diabetes complications, especially eye damage. There is also a higher risk of developing raised blood pressure during pregnancy and problems related to it. Studies have shown that a well-managed pregnancy with good blood glucose control and regular monitoring can reduce these risks significantly.

 

During labour the medical team will monitor both mother and baby carefully. Insulin is usually required during labour and may be given by regular injections, pump or via a drip (intravenous infusion). It is possible to have a natural birth, however sometimes a caesarean section will be required to deliver the baby. Both mother and baby will be closely monitored after the birth. After the baby has been born, the mother will experience a significant fall in insulin requirements especially in the first few weeks – and this may be more marked with breastfeeding. The insulin doses will be lower than before the pregnancy.

 

More information on diabetes and pregnancy can be obtained from the Australasian Diabetes in Pregnancy Society –www.adips.org

 

To hear more about women’s experiences and medical guidelines, refer to “Diabetes and Pregnancy” by Alison Nankervis & Josephine Costa, Miranova Publishers 2001. ISBN 0 9587142 31. Available for purchase from Diabetes Australia-NSW.

 

Expert advice from Dr Glynis Ross, Endocrinologist at The Royal Prince Alfred Hospital is gratefully acknowledged.

 

Source: http://www.diabeteskidsandteens.com.au/living_with_diabetes_15.html

Insulin Regimes For Type 1 Diabetes

While in the past there has been a tendency to try to minimise the number of injections per day, more children and teenagers are being treated with multiple daily injections or insulin pumps. This is to try to more closely match the body’s insulin needs similar to the way the pancreas works in people without diabetes. Many children now start on multiple injections or if started on 2 injections per day, soon evolve to 3 or 4 injections per day.

 

Twice daily insulin injections
This has been a commonly used combination in infants and children, who receive:
• Before breakfast: a mixture of short-acting insulin and long-acting insulin.
• Before main evening meal: a mixture of short-acting insulin and long-acting insulin.

The graph below shows how this combination is intended to work:

 

 

In many infants and young children who start on this combination, the short-acting insulin may become unnecessary after a few days or weeks and they may require only long-acting insulin, especially during the ‘honeymoon’ phase. Later on a combination will again be needed.

Three times daily injections
In this pattern of injections, children have:
• Before breakfast: A mixture of short-acting and long-acting insulin.
• Before afternoon tea or before the main evening meal: Short-acting insulin.
• Before bed: Long-acting insulin or ultra-long acting insulin.

An increasing number of children are having injections three times a day because of advantages it can offer in diabetes control, and the ability to adjust injections for eating pattens, sport and exercise.

The graph below shows how a three times daily insulin combination works:

 

 

 

 

 

 

 

Four times daily injections (basal-bolus)
In this routine, often called the basal-bolus routine, people have:
• Before breakfast: Short-acting insulin.
• Before lunch: Short-acting insulin.
• Before main evening meal: Short-acting insulin.
• Before bed: Long-acting insulin.

This offers very good flexibility for insulin adjustment, and is often helpful in diabetes control. Many children, teenagers and young adults now have four to five injections per day.

The graph below shows how a four times daily insulin combination works:

 

 

 

 

 

 

 

 

Other patterns of insulin dosage
Many other patterns of insulin dosage may be used, depending on individual needs. Those described above are in most common use.

Insulin Adjustment
Insulin requirements will vary according to your child’s activity, food intake and growth. For this reason it’s important to understand how to adjust insulin. Your educator will advise you on how to do this. 

 

Source: http://www.diabeteskidsandteens.com.au/living_with_diabetes_3.html

Giving Injections for Type 1 Diabetes

Giving an injection with a syringe

Syringes

1. Draw up insulin.
2. Take a pinch of skin at the chosen site with the index finger and thumb. The pinch needs to be at least to the depth of the needle.
3. Insert the needle straight into the pinched-up skin (ie. At 90 degrees) to its full depth and push the syringe plunger slowly all the way down to push in the insulin. In very lean individuals, injecting at a 45 degree angle to the skin may be necessary to avoid the injection going too deep.
4. Let go of the skin and leave the needle in for 5 to 10 seconds, then gradually pull out the needle.

Giving an injection with a pen

NovoPen3

1. Wash hands.
2. Check that you have the correct insulin pen (have your long-acting and short-acting pens clearly marked) and that there is enough insulin remaining in the cartridge for the current injection. It is preferable to use a new needle for each injection.
3. If giving long-acting insulin that is a “cloudy” type (eg. Protaphane® or Humulin NPH®) be sure to mix the insulin well by inverting the pen 10 to 20 times. The cartridge contains a glass ball, which mixes the insulin. Do not shake the pen as this will damage the insulin.
4. Prime the pen (get rid of any air bubbles). Dial up a 2 to 4 unit dose and, holding the pen vertically, inject into the air to expel air bubbles (air shot) and to prime the pen. The pen is primed if drops of insulin without bubbles are coming from the needle. If not, repeat this procedure.
5. Dial up the required dose.
6. Select the injection site.
7. Take a pinch of skin with the index finger and thumb at the chosen site. The pinch needs to be at least to the depth of the needle.
8. Insert the needle straight into the pinched-up skin (ie. at 90 degrees) to its full depth and push the pen button slowly all the way down to push in the insulin. In very lean individuals, injecting at a 45 degree angle to the skin may be necessary to avoid the injection going too deep.
9. Let go of the skin and leave the needle in for 5 to 10 seconds, then gradually pull out the needle.
10. Remove the needle from the pen after injection.

Source: http://www.diabeteskidsandteens.com.au/living_with_diabetes_3.html

Injection Sites – Type 1 Diabetes

Your educator will demonstrate the best way to give insulin injections. The preferred place to give insulin is in the tummy because insulin is absorbed more evenly and the tummy is less affected by exercise than other sites. You can also give insulin into the upper thigh to obtain a slow absorption rate if given at night. It’s important not to give insulin into an area that is going to be exercising a lot eg the arm if your child is going to play tennis or the leg if your child is going to play football, as the insulin will be absorbed quicker. Insulin absorption is quickest from the tummy then arms, buttocks and thighs. Discuss with your educator what is best for your child. The following illustrates the best places to give insulin.

It’s important not to inject into the same spot all the time – it’s easy to do, as it doesn’t hurt so much! However, your child will then have unsightly fatty lumps (lipohypertrophy) if they do this, and insulin absorption will be reduced. It’s best to encourage your child to rotate their injection sites.

Insulin injections should be given into the fatty layer under the skin not into muscle, as this tends to speed up the insulin absorption. You should take a pinch of skin and give the injection at a 90 degree angle, as shown below. A short (8mm) needle is best, particularly for children with little fat. There are 5mm and 6mm pen needles also available for particularly lean children.

Source: http://www.diabeteskidsandteens.com.au/living_with_diabetes_3.html

 

Information for parents of kids aged 2-4 years

A child aged 2 - 4 years with or without diabetes

 •Wants to be in control, wants to "do", to be in charge
• Achieves tasks, repeats them, gradually becoming more competent
• Daydreams and uses magic and pretend-play in their day-to-day life
• May have an imaginary 'friend' who is very real to them and with whom they have long conversations!
• Develops language skills
• Constantly asks "why?.. why?"
• Develops a range of gestures to express themselves
• 'Reads' you like a book!
• Throws (and recovers from) tantrums more easily
• Thinks in 'black and white', right or wrong, good or bad
• Has you as parent or carer as their main attachment
• Is self-centred, happily playing with a toy alone, then gradually learning to share toys
• May have to gradually learn to share the love of their parents when a brother or sister joins the family

 

When a 2-4 year old is diagnosed with diabetes

• It is difficult for your child to understand what has happened and that a needle helps them to stay healthy. They may see the injections as a punishment. You may be able to simply explain to your child that diabetes just happened - "Johnny got asthma, it's nobody's fault, you didn't catch it"
• A will of their own is already developing so your toddler may resist finger pricks and injections. Again you may explain - "Injections are medicine, you don't have to go back to hospital"
• Painful procedures are frightening to toddlers and pre-schoolers so these should be performed quickly and treated as routine. Prolonging the agony only makes things worse for you and your child
• Your child may gradually be taught about hypo symptoms. From about 4 years old, during a hypo, you can draw their attention to the way they are feeling so that they begin to recognise their symptoms and ask for help
• You may gradually encourage your child to learn about the right foods to be eaten and give them some choices, but...
• Concept of time is not understood, so your child will not be able to connect times with insulin and food

Living with diabetes

Parent's responsibility and coping from day to day
• Play, such as allowing your child to give pretend needles to a doll or soft toy, gives the toddler a chance to act out their feelings and lays some groundwork for their future involvement in diabetes related tasks
• As your child approaches four or five and asks why?, try to make your answer concise and encourage small tasks, one at a time, to fit in with your answers. They may push the button on the meter, choose which finger to be pricked or a site for their injection. But do not give in to the same spot being used all the time!
• At times when you are tired and overwhelmed with it all, remember that your child will eventually become independent, however need you to help along the way
• Give lots of hugs and kisses after any diabetes related procedure

Pre-school
• You will probably be very reluctant to let your child out of your sight but for you and your child's sake it is a good time to give your child a chance to spread their wings (and you a chance to spread yours)
• To take this huge step you must feel comfortable that your child will be safe as well as happy
• Ask your educator to visit the pre-school to talk to the staff so they in turn will feel comfortable with the situation. They are usually most helpful and only too happy to assist
• It is helpful to the staff if you provide one or two hypo kits for them to store in a prominent place. Remember to restock hypo kits regularly
• A photograph of your child placed in the staff room and details of hypo symptoms is advisable. An emergency action poster next to the photo as a reminder is a good idea. 
• Your child should wear some type of diabetes identifi¬cation chain or bracelet. This habit is a good one to encourage at a young age as it may encourage them to maintain that habit as they get older
• The pre-school staff don’t usually mind you going at lunchtime to check your child's blood glucose level (BGL) especially when newly diagnosed

If you don’t have access to an educator, add some handy hints of your own for your child's teacher:
• If the teacher is unsure if it's a hypo, they will do more harm than good withholding treatment than treating unnecessarily
• The teacher should not be afraid to re-treat the hypo if your child is not feeling better. The teacher should not send the child alone to obtain treatment
• The teacher should stay with your child until fully recovered

For more information about managing diabetes at pre-school click here.

To care for your child you must care for yourself
diabetes takes a lot of time and energy so it's normal to feel frustrated and tired from the constant daily demands of management. Your emotions may change and recur (perhaps frequently) - guilt, frustration, helplessness, sadness, anger ... and elation when all goes according to plan!
• Try and talk to someone who may understand.
• Share your feelings with your partner, a friend or relative, support groups, your doctor, other health professionals such as a social worker or psychologist
• Share diabetes-related tasks with your partner or supportive family and friends
• Keep in touch with your educator as ongoing education can help you and your child at different stages
• Don't be afraid to ask your health professional team for support and guidance.
• Encourage relatives or friends to attend education sessions and/or support groups to learn more about diabetes so that they may in turn give you support
• Find some time for yourself. It's a worthwhile investment for the daily demands of parenting

What does any child do with food at this age?

Being a toddler means that they are learning to be independent and a person in their own right. It also means learning the boundaries of this independence. Eating food... how much, what, when and where is a way in which a child at this stage explores the boundaries of behaviour and rules. As a parent, try to help your child understand what is reasonable.

Refuses food
A toddler (like many adults) will choose foods because they like them, not because the foods are healthy. Toddlers also learn very quickly that refusing one food will mean they will get their favourite, so try not to fall into the trap of providing less nutritious alternatives.

Much of the stress of food refusal can be eased if you keep calm. Keep food preparation simple, so if it does end up on the floor or on the wall, you don't feel you have wasted time.

The love/hate relationship with food that often occurs with toddlers is quite normal. Likes and dislikes of food can change on a daily basis. There is no logic in their actions, so don't be tempted to bribe. Meeting demands for a favourite cup or plate is reasonable, but preparing special, separate meals is not. If the same food is eaten for three days in a row there is no reason to be concerned as you'll notice that over the next week or two, the range will broaden.

Has a fickle appetite
At this age it is very common for appetite to vary from day to day and meal to meal. Snacks are important, so try to offer healthy choices such as fresh fruit pieces, yoghurt, triangle or finger sandwiches and pikelets.

Drinking too much milk or juice can be contribute to poor appetite. To prevent this, it's very important to wean toddlers from a bottle to a cup from 18 months onwards. This helps decrease the amount of fluid taken and leaves more room for solids. As a guide, toddlers only need 600mL milk and up to 200mL of juice per day. It’s also a good idea to avoid giving drinks just before a meal or snack as this can reduce appetite. Anaemia and tooth decay can result if fluids are chosen in place of food, particularly from a bottle.

If you are worried that your child doesn't seem to be eating anything, try recording all the food and fluid taken over the day - you may well be surprised. Young children can nibble away at food over the day and take in quite a considerable amount. It’s therefore important that snacks are nutritious.

Sometimes the variety may be limited to two or three choices such as cheese sandwiches and bananas, but if the foods are nutritious there's no need to worry. Try introducing new foods a little at a time and often during the day. The problem may resolve itself over the next week or so. Toddlers are learning about their likes and dislikes and testing them out.

Begins to share family foods
At this stage, seating your child at the table is an important social event. Your child can enjoy many (if not all) of the meals that the rest of the family eats, such as stews, casseroles, mild curries, bolognaise sauce and pasta. Food may have to be cut into smaller pieces, but cooking two meals is not necessary. If there are siblings at the dinner table, offering praise for eating well can also encourage positive eating habits in your toddler.

Sometimes midday and evening meals may need to be served earlier than the rest of the family. Smaller children can't wait as long as older children or adults. Their attention span is shorter, they may lose interest in eating and they also may become very grumpy if a meal is delayed too long.

After the age of two, low fat dairy foods can slowly be introduced into your child's diet. Before this age, it is difficult for children to consume adequate amounts of energy for their requirements and regular or full cream dairy products are needed.

Some fats which can be limited at this stage are:
• Processed meats (such as devon and salami)
• Sausages
• Fried foods (such as battered fish and chips)
• High fat snack foods like crisps, corn chips
• Creamed and chocolate-coated biscuits
• Pastries
• Chicken skin and visible fat on meat

In addition, more fibre rich foods can also be encouraged, such as wholemeal breads and crackers and high fibre cereals.

Riding the food merry-go-round ... of diabetes

Erratic eating and avoiding hypos
Food fads, fussy eating, variable likes and dislikes and tantrums are common in toddlers – with or without diabetes! For the parent of a child with diabetes, these food behaviours are often an additional source of stress. In particular fears about hypoglycaemia are common.

Although many parents worry that their child is not eating enough, the rate of growth usually slows around this age, so a reduction in food intake is common. A grazing style eating pattern with regular carbohydrate choices is encouraged.

Children of this age are very aware of parental stress, so where possible try to remain calm about your child’s mealtime behaviours. It’s important to keep food choices simple and offer the choice between one or two foods. Resist the temptation to offer treats if your child refuses to eat. Try to offer a nutritious alternative instead. Avoid bribes, force-feeding or following your child around the house trying to coax them to eat. Sometimes a simple plate of finger food without fuss is enough to encourage your child to eat.

Keep encouraging healthy food choices. You may find that changing from a bottle to a cup also helps encourage appetite at meal times. Offering meals and snacks ahead of time or giving insulin after meals may also help reduce stress and avoid some of the problems that may arise with food

There's more to meals than food
Carbohydrate foods often become the focus for parents and children with diabetes – and for obvious reasons. Remember, for overall good nutrition and appropriate growth and development, other foods are equally as important. So don’t forget about vegetables, lean meats and other protein foods.

It may be tempting to resort to any carbohydrate food such as sweets or juice to prevent hypos but this is not a nutritious habit to encourage. Try to encourage a variety of food choices instead. Note: 200mL of juice a day is ample and remember that water is the best everyday drink.

The importance of a flexible insulin regimen
If you are having difficulties with amount and timing of your child’s food intake, discuss possible variations to the insulin regimen with your child's diabetes doctor or educator. If your child is refusing to eat and their BGLs are not low, it may be OK to wait a short time before offering the meal again. It may also be possible to give insulin after the meal or adjust the dose to prevent hypos. Talk to your diabetes team about possible changes to your child’s insulin plan - it is preferable adjust insulin dosage rather than to force-feed the toddler who refuses to eat.

Source: http://www.diabeteskidsandteens.com.au/parents_and_carers_2.html