FOR PARENTS

It’s important to talk to your child about how he or she is feeling about her diagnosis, and help alleviate her fears. Learn about what diabetes is together, including how it will affect your family and how best to manage it. Your healthcare team can help you explain things to your child in a simple way.

As your child grows, he or she will also grow into the responsibility of taking care of their own diabetes. Help your child learn the things they need to know now so that they can take charge later.

Start with the basics, including what diabetes is, and how to recognize the signs and symptoms of hyperglycemia and hypoglycemia. When your child has grasped the basics, help them learn to take control of her condition and teach them the importance of measuring results.

If your child has type 1 diabetes, injecting insulin everyday or using an insulin pump will become the new normal for him or her. Make sure you take the time to help your child feel comfortable with injecting or using an insulin pump and reiterate the importance of regular self-monitoring with their CONTOUR^®NEXT meter.

If your child is using a Medtronic pump,  CONTOUR^®NEXT LINK is an excellent match. It wirelessly connects with the pump and does the insulin calculations for your child so that he or she doesn’t have to. This ensures accuracy – and gives you a peace of mind. Learn more about CONTOUR^®NEXT LINK. 

• Create a caregiving schedule: Make diabetes management a part of your child's daily routine and a special time for you and your child to be together.
• Stock up on diabetes care products and keep them in one place: Avoid extra trips to the pharmacy by keeping products handy. Just be sure to check expiry dates.
• Change recipes and collect new ones: Ask a dietitian to help adapt your family's favourite recipes, and keep meal planning interesting by trying new things.
• Prepare for school: Have your child keep a diabetes kit at school with things like snacks, glucose tabs and testing strips. You may consider sending an extra meter as well. Remind your child to check their kit occasionally, to ensure it has everything they need.

COMMUNICATE

• Talk with your child's healthcare team: Ask questions and make sure your child is involved in learning too.
• Have family meetings: Diabetes affects the whole family. If your child has diabetes, your other children may feel left out because they are not getting as much attention from you. It's a good idea to talk openly and share information and feelings.
• Talking to your child's friends: Host a diabetes party at your house for your child's friends and parents. Make delicious healthy snacks together, share a story or tell them what you've learned about diabetes. Tell your child to express their feelings about having diabetes and ask their friends what makes them feel the same way.

FIND SUPPORT

• Join a support group: Whether your diabetes educator puts you in touch with a live support group, or whether you go online for support, it's important to talk about your experiences. You're not alone — many other parents are going through a similar time.
• Find a diabetes camp for your child.

BE INFORMED

• Go online: Use our Resources and other trusted, credible websites to learn more.
• Visit your local library: You'll find books, magazines and films that will help.

Healthy eating is a vital part of diabetes management. Consult your diabetes educator or registered dietitian for advice on what your child should eat, when and how often. A registered dietitian can help you set up a personalized food plan for your child, and even adapt some of his or her favourite dishes.

NUTRITION TIPS

• Create and enforce a food routine: Eating at regular times will help keep a child's blood sugar levels under control. Meal planning should be individualized to accommodate your child’s preferences, age, needs, etc. Be consistent in carbohydrate intake, spacing and regularity of meals.
• Monitor your child's sugar intake: Sugar will spike your child's blood glucose levels. Limit sugars and sweets, including regular pop, desserts, candies, jam and honey.
• Help your child maintain a healthy weight: A healthy weight helps with blood glucose control. Limit high fat foods, such as fried foods, chips and pastries.
• Encourage your child to eat high fibre foods: These foods may help your child feel full and lower blood sugar levels. Encourage high-fibre foods including whole grain breads and cereals, lentils, dried beans and peas, brown rice, vegetables and fruits.
• Help your child make smart drink choices: Teach your child that regular pop and fruit juice will raise his or her blood sugar. Encourage your child to drink water or milk.
• Help your child get active: Add regular physical activity to your child’s routine to help keep their blood sugar under control.

WHAT'S IN A HEALTHY MEAL?

• At least 2 kinds of vegetables for nutrients
• Grains and starches (whole grain breads and cereals, rice, noodles or potatoes) for energy
• Meat and alternatives (fish, lean meat, chicken, beans, lentils, low-fat cheeses, eggs or vegetarian protein sources) for protein
• A glass of milk for calcium
• A piece of fruit for nutrients (it's also dessert!)

MONITORING CARBOHYDRATES

By eating regular amounts of carbohydrate over three meals daily, your child can better manage his or her diabetes.

ACTIVITY

For a child with diabetes, being active uses up energy and can help them manage their blood sugar. Help your child find an activity they love, such as swimming, playing soccer or riding a bike.

TIPS FOR PLAYING SAFE

• Let coaches and teachers know that your child has diabetes, and to watch for the signs of low blood sugar.
• Give your child and their coaches fast-acting sugar just in case your child's blood sugar gets low. Good options include:
• 15 g of glucose (glucose tablets)
• 15 mL (3 tsp) or 3 packets of table sugar dissolved in water
• 175 mL (3/4 cup) of juice or regular soft drink
• 6 Life Savers^® (1=2.5 g of carbohydrates)
• 15 mL (1 tbsp) of honey

PLANNING FOR SICK DAYS

To help fight illness, the body releases hormones that cause the liver to release sugar. This can make your child's blood sugar rise, even if they're not eating the way they normally do. It is important to talk with your healthcare team to learn how to manage your child's diabetes when they are sick. You will also find some helpful tips in Taking care of you.

Having diabetes doesn't mean your child needs to feel left out of birthday parties, school activities or other celebrations. If you plan ahead you can make sure they can fully participate, keep their blood sugar under control and still have fun!

The secret is to balance treats with activity and medication or insulin and emphasize the fun, non-food aspects of the event. Ask your diabetes healthcare team for specific instructions for handling special occasions.

SPECIAL OCCASIONS TIPS AND TRICKS

Birthday party tips

• Find out in advance what food will be served and when so you can plan your child's meals around the party that day.
• Organize your child's meals or snacks the day of the party so they can eat with the other children.
• Send along a treat your child likes and that they can eat as an alternative to cake and ice cream. Send enough so they can share with friends.

Family holiday celebration tips

• Include fun physical activities as part of your holiday plans.
• Offer treats such as chocolate or candy canes one at a time, and make sure there are always nutritious snacks available.
• Stuff stockings or Easter baskets with toys, games, colouring books or other fun, non-food items.

Halloween tips

• Emphasize costumes, pumpkin carving and decorations more than candy.
• Sort Halloween loot with your child. Encourage your child to choose his or her favourites then offer those treats one at a time instead of all at once.
• Encourage your child to trade candy to you or siblings for fun, non-food items like toys or games.

One of the best ways to cope and help your child stay as healthy as possible is to stay organized. Our "Tools for parents" are designed to help you keep track of important information and make diabetes more manageable. Use these resources to keep organized and informed:

• Read the latest Diabetes Guidelines from the Canadian Diabetes Association
• Know exactly what to do if your child becomes hypoglycemic or hyperglycemic

CANADIAN DIABETES ASSOCIATION (CDA) GUIDELINES

The Canadian Diabetes Association  publishes clinical guidelines for the monitoring and management of diabetes. Use these guidelines for reference when learning more about managing your child's diabetes.

CDA GLYCEMIC TARGETS

• Glycemic targets should be graduated with age.
• Children under 6 should aim for an A1C of <8.0%. extra caution should be used to minimize hypoglycemia because of the potential association in this age group between severe hypoglycemia and later cognitive impairment.
• Children 6-12 years of age should aim for an A1C target of ≤7.5%.
• Adolescents 13-18 years of age should aim for an A1C target of ≤7.0%.

CDA RECOMMENDATIONS FOR ROUTINE FOLLOW-UPS AND DIABETES COMPLICATION SCREENING

Below are recommendations for routine follow-up and complication screening for children as put forth by the CDA. Your child may be tested more frequently if he or she is considered to be at particularly high risk for any complication.

STAYING ON TRACK

There is a lot to remember when your child has diabetes. Being prepared and staying organized can help you feel more secure and in control. Below are some tips to help you stay on track:

• Know exactly what to do if your child becomes hypoglycemic or hyperglycemic. It might be a good idea to create a checklist of symptoms to watch for and steps to resolve so that you always have it handy in case of emergencies.
• Keep the contact information for your child's healthcare team in one place.
• Know whom to call to arrange the care your child needs.
• Remember the steps for testing your child's blood glucose and when, why and how often to do it.
• Keep track of the diabetes supplies and prescriptions you'll need to buy.
• Help your child keep track of their blood glucose readings using their CONTOUR^® meter.

Coordinating diabetes care for your teenager is a lot different than it is for a younger child. While you still need to be involved, it's time to start shifting responsibilities to them and finding a balance between supervision and independence.

You can help your teen during this transition by equipping them with the tools and resources they need to make informed and responsible decisions.

HORMONES AND TRICKY DECISIONS

Hormonal changes in adolescents can affect blood glucose levels and make it harder to keep them under control. Teenagers with diabetes should keep careful track of their blood glucose readings and discuss the results with their healthcare team. Together they can come up with a plan to keep their diabetes well controlled.

Regular self-monitoring of blood glucose will be even more important now as hormonal changes are unpredictable. Remind your child that he or she should be testing at least as often as he or she is injecting. If your child is using a Medtronic pump , CONTOUR^®NEXT LINK makes monitoring and insulin management easy as pump and meter wirelessly communicate with each other to calculate accurate insulin doses.

All teens face tricky decisions, but there are issues specific to teens with diabetes you should be aware of. Topics like weight control, peer pressure to smoke, drink or use drugs, learning to drive, dating, and sex are all important to address. Talk to your physician for information to help talk to teens about how these things affect their diabetes management.

EATING DISORDERS

Adolescent females and young women with type 1 diabetes have about twice the risk of developing eating disorders as their peers without diabetes. The extra focus on weight, food, physical activity are likely all contributing factors, as is simply being an adolescent coping with normal body changes and challenges fitting in with peers.

In people with diabetes, eating disorders can lead to poor metabolic control and repeated hospitalizations for dangerously high or low blood sugar. Chronic, poor blood sugar control leads to long-term complications, such as eye, kidney and nerve damage. It is important to recognize the signs of an eating disorder and get help for your teen as soon as possible. If you think your teen might be at risk, talk to their healthcare team right away.

As a parent of a child with diabetes, you probably have a lot of questions. The following are answers to some of the more common questions parents have:

MY CHIILD WAS RECENTLY DIAGNOSED WITH DIABETES AND I’M FEELING OVERWHELMED. WHAT CAN I DO?

It is perfectly normal to feel this way. When a child is diagnosed with diabetes there is a huge adjustment period for all members of the family. There is a lot to learn and it might take awhile to learn it all. Take it one day at a time and work together with your family and healthcare team to share the responsibility of helping your child live well with diabetes. Remember, a diagnosis of diabetes isn't anyone's fault.

WILL MY CHILD’S DIABETES EVER GO AWAY?

Diabetes is a chronic illness, which means that it cannot be cured, but it can be controlled. It is important to talk to your child’s healthcare team to learn how you and your family can help your child control his or her illness. Medication, including insulin (if your child has type 1 diabetes), regular blood glucose monitoring, a healthy diet, and regular physical activity are all important components of a good diabetes management program.

HOW OFTEN DO WE NEED TO SEE OUR PHYSICIAN?

You should be in regular contact with your child’s healthcare team. This includes your family physician or pediatrician, dietitian, pharmacist, endocrinologist, and diabetes educator. Your child’s diabetes will change as he or she grows. It is important to stay in close contact with your child’s healthcare team and notify them immediately if you notice difficulty with blood glucose control or if there is an emergency.

WHAT SHOULD I TELL MY CHILD’S TEACHER?

When you find out your child has diabetes, it is important to meet with your child’s teacher and other adults who might be caring for your child (e.g., coaches and lunchroom supervisors), to let them know about his illness. Make sure they know how your child is affected (e.g., type 1 or type 2, insulin-dependent, etc.). Your child may need extra snacks, or may need to inject insulin during the day – your teacher needs to know how to accommodate your child’s needs. Teachers, coaches and other school support staff should also know what to do in case of an emergency.

I FEEL LIKE I'M SPENDING MORE TIME WITH MY CHILD WHO HAS DIABETES THAN WITH HER SISTER. HOW CAN I PREVENT MY OTHER CHILD FROM FEELING LEFT OUT?

When a child has diabetes, it affects the whole family. To ensure everyone feels included, try scheduling family meetings so everyone in the family has a chance to learn about diabetes and talk openly about their feelings. Remind family members that things will get easier, and that your family will have the support of your health care team along the way.

HOW DO I TEACH MY CHILD ABOUT HIGH BLOOD SUGAR (HYPERGLYCEMIA)?

Hyperglycemia, or high blood sugar, is when sugar stays in the blood stream instead of being used for energy. Usually, this means a fasting blood glucose reading at or above 11 mmol/L. Tell your child that having high blood sugar can hurt the body and that's why it's so important to learn how to keep blood sugar in a healthy range.

If your child’s blood glucose values are too high, it might be because he or she is:

• Exercising less than usual
• Eating more than usual
• Taking diabetes medications and/or insulin at the wrong time
• Forgetting to take diabetes medications and/or insulin
• In need of a different dose of diabetes medication and/or insulin (never change any medication dose without consulting your child’s physician)
• In need of different diabetes medications and/or insulin
• Sick (such as a cold, flu, or infection)
• Feeling stressed

It is important that your child keep track of blood glucose (with your assistance as needed) so that you both can learn to identify trends and patterns and adjust lifestyle and medication accordingly (with your healthcare professional’s approval).

Some common signs of hyperglycemia are:

• Sugar in your child’s urine (pee)
• Needing to urinate (pee) more often than usual
• Feeling thirstier than usual

Many people have NO symptoms. The only way to actually know if you have hyperglycemia is to test your child’s blood with their blood glucose meter.

HOW DO I TEACH MY CHILD ABOUT LOW BLOOD SUGAR (HYPOGLYCEMIA)?

Low blood sugar, or hypoglycemia, can happen when there is too much insulin in your child's system, if they had skipped a meal, not eaten enough or had too much activity without enough food to meet the needs of the exercise.

WHAT ARE THE SYMPTOMS OF HYPOGLYCEMIA?

It’s not always easy to tell if your child has low blood sugar. The best way check is by testing your child’s blood glucose with their CONTOUR^®NEXT meter. Your child’s blood glucose reading will usually be below 4 mmol/L and they may experience:

• Anxiety
• Confusion
• Difficulty concentrating
• Difficulty speaking
• Dizziness
• Drowsiness
• Headache
• Hunger
• Mood changes
• Nausea
• Palpitations (rapid or irregular heart beat)
• Sweating
• Tingling
• Trembling
• Vision changes
• Weakness

Sometimes there are no symptoms.

Treatment for hypoglycemia depends on how low your child’s blood glucose is.

HYPOGLYCEMIA IS USUALLY CONSIDERED MILD TO MODERATE WHEN:

• Your child has symptoms
• Blood glucose is less than 4.0 mmol/L, and
• You or your child can treat it

Remember: The ONLY way to know your child’s blood glucose value is to test their blood with their blood glucose meter.

Treatment for mild to moderate hypoglycemia

Remember the 15:15 rule:

• Eat 15 g carbohydrates. Retest in 15 minutes.
• If after 15 minutes, your child’s blood glucose is still less than 4.0 mmol/L, retreat with another 15 g of carbohydrates.

Once the hypoglycemia has been reversed, prevent repeated hypoglycemia by:

• Having your child eat their usual meal or snack that is due at that time of the day
• If your child’s usual meal is more than 1 hour away, have them eat a snack (including 15 g carbohydrate and a protein)

Examples of 15 g carbohydrate

• 15 g of glucose in the form of glucose tablets
• 15 mL (3 tsp or 3 packets) table sugar dissolved in water
• 175 mL (3/4 cup) juice or regular soft drink
• 6 Life Savers^® (1 Life Saver^® = 2.5 g of carbohydrates)
• 15 mL (1 tbsp) honey

*** Always tell your child’s healthcare team about all episodes of hypoglycemia. ***

Hypoglycemia is usually considered severe if:

• Blood glucose is less than <2.8 mmol/L
• Help is needed from another person
• Your child goes unconscious

Remember: The ONLY way to know your child’s blood glucose value is to test their blood with their blood glucose meter.

Treatment for severe hypoglycemia

Severe hypoglycemia is a medical emergency.

If your child is conscious:

• Have him eat 20 g of carbohydrates, preferably as glucose gel or tablets
• Retest in 15 minutes, and if his blood glucose is still less than 4.0 mmol/L, retreat with another 15 g of glucose

If your child is unconscious:

• Call 911
• Give your child an injection of 1 mg of glucagon

Tell your child’s healthcare team as soon as possible about any episodes of severe hypoglycemia.

WHAT ARE KETONES?

In the absence of sugar, the body breaks down fat for energy. Ketones are substances left over during this process. If there is too little insulin in the bloodstream to allow sugar into the cells, the body will burn fat producing ketones. Ketones are removed from the bloodstream in the urine, but, when too many ketones build up in the bloodstream, it can lead to a condition called ketoacidosis.

SHOULD MY CHILD TEST FOR KETONES? 

Children with type 1 diabetes should know how to test for ketones, and parents should be instructed by their healthcare team when to have their child check (like during illness or times of stress.)

Finding ketones in the urine is usually a sign of trouble, so ketone testing is very important. Have your child test when they are not feeling well and when their blood sugar is too high.

WHEN SHOULD MY CHILD TEST FOR KETONES?

Your healthcare team will tell you when your child should test for ketones. It's also a good idea to test if your child:

• Has blood sugar 14 mmol/L or higher for two tests in a row
• Is sick (even with a cold) because being sick can cause ketones to build up
• Is vomiting or has diarrhea
• Is under stress or is upset

HOW DOES MY CHILD TEST FOR KETONES?

Testing urine for ketones is very easy with KETOSTIX^®. Simply dip-and-read. If the colour changes, there are ketones in the urine.

WHAT IF MY CHILD HAS KETONES?

If the test shows positive for ketones:

• Have your child drink lots of liquids, especially water
• Call your healthcare professional
• Check your child's blood sugar often
• Your child may need more insulin

WHAT'S IMPORTANT TO REMEMBER WHEN I'M PLANNING MEALS FOR MY CHILD?

Having diabetes doesn't mean your child can no longer have the foods they enjoy. Your diabetes educator and registered dietitian can help you adapt your child's favourite dishes and create a healthy meal plan. For nutrition recommendations from the Canadian Diabetes Association and to find out what constitutes a healthy meal, read the Parents’ food & nutrition guide. Parents’ food & nutrition guide.

HOW CAN I HELP MY SON FEEL INCLUDED AT A BIRTHDAY PARTY WHEN HE KNOWS HE CAN'T EAT THE CAKE OR ICE CREAM?

If you plan ahead, you can make sure your son can fully participate,

keep his glucose under control and still have fun during special occasions. The secret is to balance treats with activity and medication or insulin and to emphasize the fun, non-food parts of the event.

HOW CAN I HELP MY TEENAGER BETTER MANAGE THEIR DIABETES?

Your teenager might be growing up and gaining independence, but they still need you. As a parent of a teen with diabetes, guiding them through adolescence means keeping yourself informed and engaged in your teen’s well being. It's important to work with your teen's healthcare team and their school so that you can all help your teen stay on top of their diabetes.

Do you have a question related to parenting a child with diabetes?

Get the information you need here from the Juvenile Diabetes Research Foundation Canada the Juvenile Diabetes Research Foundation Canada.