Overcoming Diabetes Challenges with Type 1 Toddlers
Read part one of this series...
Week 2 post-diabetes camp was no different! The same circumstances faced our diabetes team in the inpatient setting as well. As I write this blog, staring out my window at Hurricane Irene, I have just returned from making rounds at Children's National Medical Center. We had several new admissions for new onset type 1 diabetes in all ages, as well as several tweens and teenagers with known diabetes who decided to take a vacation....from their diabetes.
Healthcare professionals can tell, after reviewing blood glucose meters, if blood sugars have been quite high for some time, or that blood sugars were doctored in the meter! Let's look at some solutions (or at least attempts at solutions) to these challenges.
It is my view that unpredictability of behavior involving mood, temper tantrums, and food is the biggest issue related to diabetes. The stage of "toddlerdom" is tough! This period is often a huge developmental leap for many children: a time to experiment, yet run back to the caregiver for reassurance. This also is a time to test out the child's ability to get what he/she wants or refuse to do what the caregiver asks. No is the answer to everything EVEN if the child actually wants to do or get something. (Do you want to eat your delicious carrots? NO. Do you want to eat your chocolate ice cream? NO.) The key to this age is to offer choices and not provide a blank slate of options. (Do you want the carrots or the green beans?) Your child may resist when you have to give insulin injections or perform blood glucose monitoring; thus making the caregiver feel guilty or sad for the child. However, for your child to live and thrive, it is medically necessary to perform these procedures. The best way to get through this tough period is to act in a no-nonsense manner and do what has to be done with minimum fuss and to move on to the next task. Ask what he wants to do first to allow him to choose and thus, empower the child as much as possible. Eventually, if you decide that these self-care skills must be done for the child's benefit without reservation (and this is reflected so the child understands), life will flow more smoothly. "Get up, brush your teeth, get dressed, check your blood sugar, get your insulin, eat breakfast, off to school...etc.). This routine becomes the "new normal."
As far as eating: toddlers are unpredictable! As I alluded to last week, if the caregiver is unsure about the amount of food the child will consume, it is ok to give the insulin after the meal to avoid lows. This is not ideal. However, it is the safest way to go in my opinion. If possible, divide the diabetes care with other caregivers in the family to get a break (and perhaps sleep through the night). However, as mentioned last week, fluctuating blood sugars are the norm with this group resulting in much caregiver anxiety.
Remember that maturing from birth to 6 years is a huge developmental stage during which your child also may have "magical thinking" and want to "wish his diabetes away." According to Selma Fraiburg, author of The Magic Years (one of my favorite books on childhood development), "like all magicians, the toddler believes that his wishes, his thoughts, his words are the instruments of his magic powers. And, long after reason has deprived the magician of his magic, and for all the days of his life, the belief that wishes can bring about real events will persist in a secret part of the self." So, do not be surprised when your toddler (and teenager for that matter) wants to "wish away" the diabetes.
The caregivers of a toddler with diabetes suffer greatly to act in the child's best interest and I often worry about parental burnout. Please be kind to yourselves and get as much outside support for you and your partner.
Toddlerdom will be over soon enough!
NEXT WEEK: The Elementary Aged Child