PROBLEMS AND MANAGEMENT TIPS !!!

Issues related to parents	Management tips
Parents of children with type 1 diabetes may initially feel a sense of loss. They may question themselves and others that “why me?”, “why our child”.	Take one step at a time.
Parents may have less time together, less time for leisure activities and perhaps less freedom	It is okay to feel sad, lonely and low initially. As you will go through it, you will become more strong and positive over time.
They may blame each other for the condition of their child	Plan “couple-time”
The T1D management routine may become very taxing for them.	Seek support, go for group counseling session, join a support group
They may have difficulty in managing and balancing the siblings. Siblings might be jealous; feel rejected and may feel that all the attention is given to the child with T1D. therefore, parents need to be aware of their children’s feelings.	It’s not anyone’s fault, seek knowledge about T1D and clear all your misconceptions
It may have an impact on their personal relationship as well, leading to interpersonal conflicts and strained relationship.	Take help from others who are willing to help, be assertive and tell them exactly what you want
Parents of adolescents may find it difficult to strike the right balance of involvement in their child’s care. Some may become overbearing/ restrictive, others so lax that they don’t know the insulin doses/ BG values of their child.	Help your child express his feelings, talk to your child and to other siblings and try to meet not only their physical needs but also emotional needs.
	Involve other children in the diabetes education sessions to educate your whole family about T1D
	Listen to others but do what your child’s treating team advises
	Set some basic rules, like the child needs to take insulin in front of either parent, BG values need to be verified from the meter. Allow partial autonomy, but let children know that you (parents) have the overall responsibility of T1D management till at least 18-20 years of age.

Issues related to Infants/toddlers	Management tips
They may have to be forced to eat or drink when not hungry.	Develop a routine and follow that regularly to make the baby habitual.
They may be irritable and uncooperative for frequent injections and finger pricks.	Anything uncomfortable to be done to the baby like pricking or insulin injection should be given at a special place/area at home, which is definitely not near the bed area.
They may regress for a particular time, meaning that toilet trained babies may have accidents due to high blood glucose. However, they usually overcome with time.	Don’t keep sweets/ cold drinks at home. Treat hypos consistently with glucose only, not with sweets. Have healthier alternative snacks ready in situations when child likely to crave for unhealthy foods, like at outings etc.
They may refuse to have food and ask for sweets after being given insulin injection.

Issues related to Preschoolers	Management tips
Afraid of needles and therefore difficult to prick them or give insulin injection.	Tell them, assert it that you love them, say positive remarks and loved words to him.
They may see such procedures as punishment.	Tell them that they are brave and strong and praise their efforts.
Increased risk for hypoglycemia due to increased activity.	Gradually teach the child the importance of these procedures and allow him to participate.
Attending birthday parties.	Hold the child closely and warmly, hug him to hold him still, and try to make the procedure quick and efficient.
	You may try to understand his fears about the procedures by engaging him in interactive play.
	 Parties are special occasions and it’s okay to let them have outside food occasionally and enjoy with others. However, there are things to keep in mind like eat before going, choose food wisely, extra insulin dose.

Issues related to school going children	Management tips
Increased risk for hypoglycemia due to increased activity	Make sure the child always eats something before leaving for outdoor play. Also, there should not be any unplanned physical activity; s/he should be given something to eat after every 60-70 minutes of outdoor play.
Attending birthday parties	Parties are special occasions and its okay to let them have outside food occasionally and enjoy with others. However, there are things to keep in mind like eat before going, choose food wisely when eating outside like bread part of the cake instead of the cream part or tandoori roti instead of naan, extra insulin dose.
Informing teachers	Teachers/class teacher should be informed about child’s T1D, so as to ensure its management in school, especially at the time of hypoglycemia. It could be managed by informing the teacher about the signs and symptoms of hypoglycemia, keeping a glucose packet in child’s bag/ class cupboard, and allowing him to eat/drink in between class if required.
Hypoglycemia in school	It should be monitored that the child doesn’t share his tiffin with his peers and also doesn’t eat from others’ tiffin box as it wouldn’t obviously be according to your child’s needs and might increase his/her blood sugar levels.
Sharing tiffin box

Issues related to Adolescents	Management tips
Adolescent’s health care and emotional needs are different from other age groups	Support of parents and diabetes management team is the most crucial aspect.
Psychological issues like body image, rebelliousness, aggression & irritability, self-esteem, feelings of inferiority, depression, anxiety and stress	Motivation and acknowledgment of their efforts.
Comorbid psychological disorders like depression, anxiety and behavioral and eating disorders	Supportive parental relationship.
School related stress like difficulties with friends, examination stress or competitive activities or sports.	Seek help for psychological symptoms, including depression, aggression, irritability as well as substance abuse.
Substance abuse (risk of delayed hypoglycemia from alcohol) as well as addiction to cyberspace	Gradually shift to complete independence of diabetes management.
Peer pressure – need to fit in.	Education about diabetes as well as about psychological symptoms and disorders
They may experience and report fewer relationships, friendships and decreased level of intimacy
Higher stress – worst metabolic control.
Increased independence, in relation to diabetes management, adolescent start self-monitoring and injecting.
Issues of overdose 1. Attention seeking behavior 2. To consume sweets and more carbs. 3. To “fit-in” amongst peers and deny the need for insulin in front of them 4. Recent stressor, for e.g. birth of a sibling