Babies with Diabetes
Excerpted with permission from The Everything Diabetes Health Book (Adams Media) by Paula Ford-Martin
The Littlest Patients: Infants and Toddlers
As any parent can attest, not knowing how to help your hurting child is a horrible feeling. When your very young child has diabetes, she can't tell you if she's "feeling low" or needs to check her blood glucose. But just as parents develop a sense of a "hungry cry" versus a "wet cry," you will become attuned to the signs your child gives about how she's feeling.
A pediatric endocrinologist is a physician trained to deal with endocrine disorders, such as diabetes, in children. If your child's pediatrician or general practitioner has little experience with children with type 1 diabetes, it's a good idea to get a pediatric endocrinologist on board for her treatment.
Recognizing Signs and Symptoms
The same symptoms that occur in older kids and adults signaling the possibility of type 1 diabetes apply to infants and toddlers; the difference is that since their verbal communication skills are limited, you probably won't recognize them as quickly. In addition, symptoms like fatigue are hard to discern in a baby who sleeps a good deal of the day anyway. The positive news is that most parents, particularly new ones, will take a "rather safe than sorry" attitude and take an inconsolable infant or toddler to the doctor to figure out what's wrong quickly rather than waiting around for things to worsen. If your child is at risk for type 1 diabetes, you can be on the lookout for the following symptoms:
- Excessive wet diapers.
- Diaper rash that doesn't resolve quickly or keeps recurring.
- Constant hunger and/or thirst
- Irritability or fussiness that don't seem related to colic.
- Sleeping more than usual.
Detecting Highs and Lows
Recognizing blood sugar highs and lows may be hard when a diabetes diagnosis is new in your very young child. Fortunately you have the best tool for making sure things are in balance right at your fingertips—a glucose monitor. If your child is acting the least bit out of sorts, always check glucose levels first. It may not be her diabetes, but if it is you want to find out quickly and treat it fast. Talk to your child's doctor about an appropriate amount of carbohydrates to treat her lows. As a general rule, kids under age six require 5 to 10 grams of a fast-acting carb for each 50 mg/dl blood glucose is low.
If you have an infant or toddler with diabetes, have an oral syringe on hand to administer a fast-acting carb like syrup if a hypo occurs and your baby refuses a bottle of juice. Cake frosting in a tube and glucose gel can also work for more cooperative eaters. Never feed a child who has lost consciousness because of the risk of choking or aspiration, and never give an infant a glucose tablet or hard candy. Glucagon may be your best option in this instance.
Glucose checks are a tough job for parents, especially in very young children who don't have the capacity to understand why they must get poked and prodded. You can make the job a little easier by buying an alternate site meter, which allows you to test on less-sensitive areas like the forearm. You may also be able to stick the heel instead of the fingers. Talk to your child's doctor for her or his specific recommendations, and try out different meters until you find one that works well for you. Both you and your child will eventually get used to checks.
On Eating and Insulin
Small children have notoriously unpredictable appetites. They can go for days eating very little, and then suddenly down a whole plate of mac and cheese in the blink of an eye. Of course, if you don't know what your child is going to wolf down, or push away, at the next meal, it makes giving insulin a tad difficult. For this reason, your doctor may recommend short-acting insulin to be administered immediately following a meal to correctly cover the carbs and avoid highs or lows.
Insulin injections can be traumatic for young children, but there are several injection aids available to make the job easier on both of you. Your doctor can prescribe a topical anesthetic cream to numb the injection site, and a device called an Inject-Ease can be used with a standard syringe to both hide the needle and minimize pain by facilitating a rapid injection. You can also try simple home methods such as numbing the area with a cold spoon or soda can.
Reviewed by Francine Kaufman, MD. 01/09
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Many people say that depression is a side effect or complication of diabetes. Without discounting the association of the psychological condition with the physical one, I'm not convinced that our high and/or unstable glucose levels are directly responsible for that change in our mental state. My belief is that the unrelenting need for self-care, for following the sort of care schedules that can drive licensed, professional caregivers crazy, is what overwhelms us...