Diabetes Self Care in Every Age Phase

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Because children and adolescents grow and develop, their ability to participate in self-management in dealing with diabetes varies with changes in motor development, cognitive abilities, and emotional maturity. Studies have shown parental involvement is needed during childhood and adolescence, to ensure proper self-management and metabolic control. However, there are several rules for the self-management abilities of children and adolescents, and their families must have a variety of concerns as long as the development of children and adolescents is sustainable.

Infants (<1 year)

When diabetes is diagnosed in infancy, parents must adapt to the diagnosis and learn a myriad of daily management skills. Exceptional responsibility for care and fear of hypoglycemia is very stressful for the family. Babies do not show classic catecholamine responses to hypoglycemia and cannot communicate sensations related to hypoglycemia; therefore, the risk of severe hypoglycemia, with seizures or coma, is the highest risk in this age group. In addition, because the brain is still developing in infants, the consequences of severe hypoglycemia that are harmful may be greater than that of older children. Parents struggle with a balance between the risk of long-term complications, compared to their fears of severe hypoglycemia and the risk of neuropsychological complications.

Thus, parents of babies need support from a diabetes team who understands these difficulties when dealing with babies with diabetes and is able to provide emotional support to manage their concerns.

Toddler (1-3 years)

Toddlers aged 1-3 years get a unique challenge for the treatment of type 1 diabetes. As in infants, parents carry the burden of management on infants parents report that hypoglycemia is a big fear, especially when children refuse to eat. An important issue at this age is discipline and often fussy children; it may be difficult to distinguish between normal developmental opposition and hypoglycemia, therefore, parents must be taught how to measure blood glucose. Parents may be too careful and interfere with children's ability to try new things, and they will need support from the diabetes team to promote healthy development for their children.

Preschool children and early school age children (3-7 years)

Children at the development stage need to gain confidence in their ability to complete tasks. However they often lack fine motor control, cognitive development, and impulse control needed to be active participants in many aspects of diabetes care. This is important for parents to realize, because most children in this age group can participate in their self-management by testing blood glucose, helping to keep records, and in some cases counting carbohydrates.

In general, parents provide care for preschoolers and young school-aged children, but others, such as child care providers and school nurses, can also be involved in the care. Sharing caring for children with diabetes is often a difficult thing for parents, who may fear that other people will not know what to do. Undetectable hypoglycemia remains a concern, because of variations in activity and food intake characteristics of this age group, and because of continuing concerns about the side effects of hypoglycemia in the development of brain function.

School-age children (8-11 years)

The effect of diagnosing new diabetes in children in this age group has been studied. Immediately after diagnosis, children are reported to experience mild depression and anxiety, but usually heal 6 months after diagnosis. After the first 1-2 years, symptoms of depression increase, and anxiety decreases in boys, but increases in girls during the first 6 years after diagnosis. This increase in depression may be related to the end of the physiological "honeymoon" period, when children realize that the disease will not go away and is more difficult to manage.

School-aged children with diabetes can begin to assume the task of managing diabetes more than daily management tasks, such as having to administer insulin injections and blood glucose testing with supervision and of course they are aware that the support of caring and knowledgeable adults is needed.

Treatment using pumps is increasingly being used in this age group, and children can learn to consume standard carbohydrates. However, they will still need significant assistance and supervision in making self-management decisions.

Several studies have shown that early and independent participation of children in handling diabetes is significantly associated with fewer controls. Recommendations for care, currently emphasizing the responsibility of shared care, between parents and children. Children may feel they are different from their peers because of diabetes and may be at risk of experiencing difficulties in social competence. It is important to encourage school-age children to come to school regularly and participate in school and sports activities to facilitate the development of normal educational relations.

Schools can present significant challenges or be a source of support for children with diabetes. Both children and parents who are afraid of hypoglycemia and the potential for hypoglycemia interfere with learning. The fear of hypoglycemia is a reasonable consequence of hypoglycemia in children, and the experience of severe hypoglycemia can cause patients and parents to over-treat the initial symptoms and learn behavioral changes to maintain higher blood glucose levels, which results in impaired metabolic control. Furthermore, the fear of hypoglycemia can be attributed to poor psychological status and adaptation in adult patients.

Teenagers

Adolescence is a period of rapid biological change accompanied by increased physical, cognitive, and emotional maturity. Teenagers struggle to find their own identities, separate from their families. Many of the tasks related to diabetes can interfere with youth enthusiasm and peer acceptance. Peer pressure can produce strong conflicts. In this age group, there is a struggle to be free from parents and other adults who are often seen as less compliant during the treatment of diabetes.

Because adolescents have fine motor control that is capable of doing most of their self-management activities, this condition is very tempting for parents to submit overall management of diabetes to adolescents. Although adolescents can carry out diabetes management tasks, they still need help regarding making decisions about insulin adjustment. Adolescents whose parents maintain some guidance and supervision in managing diabetes have better metabolic control.

So, always involve parents properly, with joint management, related to improving control. The challenge is to find a level of parental involvement that is comfortable for all involved, without the risk of decreasing glycemic control from over-or under involvement. Engagement as in the management of diabetes at this stage of development can affect parent-adolescent relationships.

Parent-child conflict has been associated with worse diabetes outcomes in several studies. In the future, parents and the diabetes care team need to help young people undergo the transition to more independent self-management and providers of adult diabetes care.

Diabetes Self Care in Every Age Phase

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