How to Handle Diabetes in Your Baby or Preschooler

By Alan L. Rubin

If your infant or preschooler is diagnosed with diabetes, you may feel overwhelmed. The following information can help you understand that this diagnosis isn’t the end of the world — it’s the beginning of many years of special care for your child.

Nurturing a diabetic infant

Although type 1 diabetes doesn’t usually show up in babies, it can, and you should know what to expect when it does. Obviously, your baby is not verbal and cannot tell you what is bothering him or her. And you may miss the fact that the baby is urinating excessively in his or her diaper. The baby will lose weight and have vomiting and diarrhea, but these symptoms may be ascribed to a stomach disorder rather than diabetes. When the diagnosis is finally made, the baby may be very sick and require a stay in a pediatric intensive care unit. Do not blame yourself for not realizing that your baby was sick with diabetes.

Type 2 diabetes is almost never seen in babies. The current epidemic of type 2 diabetes in children is the result of excessive weight gain, which is rare in babies and toddlers. The treatments described below are for type 1 diabetes.

After the diagnosis of type 1 diabetes is made, the hard work begins. You must learn to give insulin injections and to test the blood glucose in a child who will be reluctant to have either one done. You have to learn when and what to feed the baby, both to encourage growth and development and to prevent low blood glucose.

At this stage, you don’t need to be as worried about tight glucose control as you will be later on. There are several reasons why not. First, the baby’s developing neurological system can be damaged by frequent, severe low blood glucose, so the glucose is permitted to be higher now than later on. Second, studies show that changes associated with high blood glucose leading to diabetic complications do not begin to add up until the prepubertal years, so you have a grace period during which you can allow less tight control.

According to a study in Diabetes Care in June 2011, vitamin D deficiency is associated with increased prevalence of diabetic eye disease in children and adolescents. Make sure your child has sufficient vitamin D. It’s available as drops that you can add to your baby’s food.

On the other hand, a small baby is very fragile. He or she has less of everything, so small losses of water, sodium, potassium, and other substances lead more rapidly to a very sick baby. If you keep the baby’s blood glucose around 150 to 200 mg/dl (8.3 to 11.1 mmol/L), you are doing very well.

Taking care of a toddler with diabetes

Diagnosing diabetes in your preschooler may be just as difficult as it is in the baby. The child may still be preverbal and running around in diapers.

A preschooler is beginning the process of separating from his parents and starting to learn to control the environment (by becoming toilet-trained, for example). This separation process makes it more difficult for you, the parent, to give insulin injections and test the glucose. You must be firm in insisting that these things be done. You’ll need to do them yourself because a small child neither knows how to do them nor understands what to do with the information generated by the glucose meter.

Because a toddler’s eating habits may not be very regular, the use of very short-acting insulin like lispro is especially helpful. Very soon, people with diabetes should have a way of measuring the blood glucose in a painless fashion, which will be of great assistance in monitoring children.

Becoming an educated caregiver

For a time of variable duration in the child with type 1 diabetes — a so-called “honeymoon period” — your child will have seemingly regained the ability to control his or her blood glucose with little or no insulin. This period always ends, and it isn’t your fault that it does. When it ends, you have to work with your child’s doctor, dietitian, and diabetes educator to find out how to control diabetes with insulin.

To give your child appropriate care, you need to know how to do the following things:

  • Identify the signs and symptoms of hyperglycemia, hypoglycemia, and diabetic ketoacidosis. Each child has a particular way of expressing low or high blood glucose, for example, by becoming quiet or loud. Learn the signs for your child, and let anyone else who cares for the child know them.

  • Administer insulin. Thanks to rapid-acting insulin, you can wait to see how much the baby is eating before you decide on the amount of insulin.

  • Measure the blood glucose and urine ketones. Very frequent blood glucose measurements are essential. The more information you have, the better the control and the less frequent the hypoglycemia. Most children need between four and seven blood glucose measurements a day to achieve excellent control.

    Toddlers who are toilet-trained may have accidents when their glucose is high, because high glucose causes a large quantity of urine.

  • Treat hypoglycemia with food or glucagon. Young children require half the adult dose of glucagon. Glucagon may cause a toddler to vomit, but it still raises the blood glucose.

  • Feed your diabetic child.

  • Set an example for lifelong exercise for your child by exercising with her.

  • Know what to do when your child is sick with another childhood illness. If your child must go to the hospital, approach it as a positive experience — a chance to get a tune-up.

Your responsibilities as the parent of a diabetic baby or preschooler are extensive and time-consuming. Training your usual helpers to take over, even for a short time, is especially difficult. Unless you hire a professional to take over for a while, you may not get very much time away from your diabetic infant.

Placing your child in preschool is a difficult decision. You can do so only if you are sure that the adult supervisors are fully aware of your child’s needs and willing to provide for them.

Your other children may resent the attention that you pay to this one child. If your other children start to misbehave, this may be the reason.