Assessment
It's important that children with diabetes have good blood sugar control.
The overall goal for the child with diabetes is to grow, thrive and develop normally.
The diabetes health care team will monitor the child's growth at outpatient clinic visits. At each visit, the child will be weighed and measured, with results recorded on an individual growth chart.
Blood sugar levels should be checked regularly. The optimal schedule is four times or more a day (before every meal), and at bedtime to avoid low blood sugar during the night.
The target blood sugar range should be established for each child with diabetes. These will vary according to the age and stage of development, the understanding of the diabetes, and experience with hypoglycemia.
In general:
- For children under 5 years of age, the target range will be 6 - 12 mmol/L before meals
- For younger school-aged children, it will be 4 - 10 mmol/L
- For adolescents over 12 years old, the blood sugar goals will be the same as for adults (i.e. fasting or pre-meal blood glucose levels 4 - 7 mmol/L)
Blood sugar should be checked even more often during "abnormal" times such as illness, birthday parties, sports events, etc.
Low blood sugar (hypoglycemia)
Various everyday situations in a child's life can make diabetes control difficult to maintain without the occurrence of episodes of low blood sugar (hypoglycemia ).
Small children are especially vulnerable to severe low blood sugar (severe hypoglycemia ) and diabetic ketoacidosis (DKA). Severe hypoglycemia should be avoided as it can impact a child's developing brain. It can be useful to keep a record of blood sugar readings in a diary in order to see an overall pattern of readings and to react as needed to a given measurement.
The following situations contribute to the risk of low blood sugar in small children, and can also cause large fluctuations in blood sugar readings:
- Variable appetites and "picky" eating habits.
- Changes to physical activity levels throughout the day.
- Frequent illness with viral infections (small children are more susceptible compared to older children).
- Lengthy sleep periods, during which children are without food.
- "Insulin sensitivity" (small children are more sensitive to insulin compared to older children).
- "Bumps" developing at injection sites on the thighs can result in unpredictable insulin uptake (small children are more susceptible to bumps compared to older children).
Hemoglobin A1C or HbA1C
HbA1C (glycated hemoglobin ) is a measurement of the average blood sugar level over the past two to four months.
HbA1C measurement is essential to assess long-term diabetes control and to help avoid diabetes complications.
The HbA1C should be measured every three to four months. The HbA1C range for people without diabetes is 4 - 6% (this range may vary according to the method used in the particular laboratory). Therefore the target HbA1C levels to aim for should be below 8% in most children with diabetes and below 8.5% for very young children.
Your diabetes team will set personal goals for different individuals, especially for very small children and adolescents.
Regular Check-Ups
Diabetes education and regular check-ups are essential for good blood sugar control.
It's important to try to be "as good at it as possible" when it comes to diabetes care. Support from the people around you and the diabetes team is equally crucial.
Be honest with your diabetes team. Ask questions. Ask for help when you need it. Take advantage of opportunities to learn more about diabetes.
Keep regular appointments with the diabetes clinic so that you can monitor long-term blood sugar control through HbA1C, height and weight records and overall well-being of the child with diabetes.
