Caring for a 
child with type 1 diabetes is challenging, and perhaps even more so when the child is a toddler. Indeed, living with a toddler is no easy task on the best of days!
Mindful of this and considering the unique needs of families caring for very young children with type 1 diabetes, a team in the Perth Children’s Hospital’s (PCH) Diabetes Clinic is currently working to improve services and resources for families with toddlers (see story below for more information on the toddler group).
PCH consultant endocrinologist and Children’s Diabetes Centre researcher Dr Uma Ganti said challenges associated with diabetes in toddlers included achieving adequate glucose control, avoiding severe hypoglycaemia, and dealing with toddler behaviours and communication.
“Managing the normal spectrum of toddler behaviours and development, and the difficulty implicit in the developing but limited communication of needs and emotions all takes its toll,” she said.
“All of this might make daily diabetes care for parents hard work and frustrating.”
Dr Ganti said diet was another challenge as toddlers often had erratic eating patterns, evolving food preferences, or relied on frequent breast or bottle feeds rather than solid meals.
Food refusal, especially after a mealtime insulin dose, could lead to anxiety and fear around risks of hypoglycaemia, she said.
“Multiple finger pricks, interpreting continuous glucose sensor data, daily injections or pump cannula insertions, reaction to the adhesives leading to skin irritation and breakdown all make insulin administration and glucose monitoring even more challenging in little bodies,” Dr Ganti said.
Dr Ganti said a supportive family environment, along with an experienced multidisciplinary diabetes team, was key to the child and the family managing diabetes well, no matter the child’s age.
“The main aim of treatment of toddlers is to achieve good metabolic outcomes and to reduce blood glucose fluctuations,” she said. “This protects children from diabetes complications.
“To achieve this, insulin can be administered by either injections or through insulin pumps — there are advantages and disadvantages to both methods. The choice and success of multiple daily injections or insulin pump therapy depends to a large extent on the understanding of the parent or carer, and the support they receive from their treating diabetes team.”
Dr Ganti said PCH’s diabetes clinics were multidisciplinary in nature and run by highly experienced and dedicated health professionals including doctors, nurse educators, dietitians, social workers, and school liaison teachers.
“The team is constantly striving to provide better care and to improve the self-management skills and wellbeing of parents and carers,” she said.
Currently, the Diabetes Clinic is:
- Identifying gaps in current toddler care by administering a parent survey and collating responses.
- Updating current clinical resources and guidelines for toddlers and young children, especially around insulin pumps.
- Working on diet and nutrition resources specific for very young patients, particularly for breastfed infants and toddlers, and those transitioning to solids. These will focus not only on nutritional content (eg. how many carbs does breast milk have?) but also on how to facilitate a healthy relationship with food in young children with type 1 diabetes.
- Facilitating small parent group interactions to exchange ideas.
- Working on identifying peer support persons.
- Working on a toddler-specific webpage – a one-stop-shop for all things related to toddler type 1 diabetes.
Diabetes resources can be found here and here.
First published Wednesday 10 June 2020.
Harper keeps mum on toes
Cassandra Cooper knows all too well the challenges of caring for a toddler with type 1 diabetes.
Her daughter Harper Spark, now aged three-and-a-half, was diagnosed with diabetes when she 16 months old – an extremely difficult age behaviour and communications wise, without even throwing diabetes into the mix.
“The hardest part is carb counting and controlling what Harper is eating,” Cassandra said.
“Harper is very fussy with foods and there will be torrential screaming if she wants to eat something right then and there. There’s just no way of communicating to her that her blood sugars will go up if she eats that now – she just doesn’t understand.”
Harper is on multiple daily injections and continuous glucose monitoring.
Cassandra said insulin administration was fine in the early days of Harper’s diagnosis but then she built up a strong hatred for injections that lasted about a year.
“Every time it came time for an injection she would run away, scream or hide under the table,” she said.
“She was always screaming ‘no insulin’ and that was heartbreaking. Thankfully, she’s better now.”
Cassandra said she carried most of the load when it came to Harper’s diabetes management.
“It really does feel like I’ve had a baby for the past three years,” she said.
Cassandra’s biggest tips to parents of a toddler with diabetes was to take it one day at a time.
“I kept looking ahead to Harper’s future in the early days of her diagnosis and it really burnt me out,” she said. “Now I take every day as it comes. This has made a huge difference.”
She also recommended parents take some time out of every day to focus on themselves.
Be involved: Toddler group
PCH's Diabetes Clinic is currently working to improve services and resources for families with toddlers. We would like to invite parents of toddlers to be part of this group to ensure we are meeting the needs of our type 1 families.
How you can be involved?
1. The first aim of the group is to survey parents of all toddlers in the clinic to enable us to understand their needs and identify any gaps in the current care they are receiving in regards to resources, education materials, interactions with their clinical team etc. We would like a couple of parents to review this survey and provide feedback which can be done via email.
2. We would like to partner with parents to develop resources for nutrition, managing pumps, sick day management etc. This can be done at home by email, phone or virtual video meetings.
3. The final aim is to coordinate parent sessions, mentors and get-togethers. This will be done in consultation with parents.
No special skills are required and you can choose to be involved in some or all of the aims.
To register your interest, please email diabetes.research@health.wa.gov.au