Congratulations! Your child has graduated from kindergarten and is about to enter elementary school. You may breathe a sigh of relief. These children are so much fun to be around! Rules are incredibly important to them and must be followed (think when you cheated at Monopoly and your 8-year old reprimanded you). School, of course, adds another layer of complexity requiring other personnel to act as caregivers in lieu of you. It is often very difficult to let your child go to school...alone...let enough leave their diabetes care to school officials. (A word about school staff: generally people are afraid of what they do not know. You will reap major benefits if you plan ahead and talk to the appropriate school officials and even teach them diabetes skills so they are not frightened. It is my belief that a health professional need not necessarily perform these diabetes related tasks. Most parents are not health professionals!)
This is the time to take advantage of your child's developmental stage. These children like rules, routine, and most importantly to know what to expect. They generally can understand what is going on when you take the time to explain everything. They revere authority figures: parents, schoolteachers, coaches, religious icons, and even their diabetes healthcare teams. Because most of these children are willing to take on their diabetes care responsibilities in earnest, it is important to delegate these skills when they become developmentally ready. Some children are quite capable of blood glucose monitoring in the 3rd grade and others are not! This is ok. Everyone is different. 4th and 5th graders are often able to administer their own insulin injections....with supervision!
I love seeing elementary school children in my office. They are very proud of testing 6-8 times/day and are very quick to show me their written blood sugars and downloaded meter printouts. They worry why their hb A1c went up to 7.8 from 7.0. They ask "what did I do wrong? It must have been that ice cream last week" and look to the parents with guilty faces and often dissolve into tears. I emphasize to both the kids and parents that they are managing the diabetes as best as possible and that life happens. Growth always occurs over the summer, thus increasing insulin requirements. It is often my job, as I relate to the child and parents, to adjust insulin to meet growth needs. I actually often have to reassure the child (more than the parent) that it is ok to have a slightly higher hb A1c if they are performing all self-care skills appropriately. The hb A1c at this visit is only one in a "sea of thousands."
The latency-aged children often want to increase the complexity of their insulin regimen (just like they may want to do more math division problems or read more books). Many request basal bolus insulin regimens and insulin pump therapy. If the child has performed all the necessary self-care skills required for insulin pump therapy and really wants it, we certainly will move forward and be very enthusiastic with the decision.