Developmental Issues and Expectations by Age

Learn more about development issues and expectations for children with diabetes. 

Your toddler is learning new things every day. Diabetes is part of your toddler’s life. Now is the time to start teaching them about the importance of taking care of their diabetes.

Follow a routine.

• Have an area in your home where you always test and give shots.
• Teach your child always to tell you before eating anything.
• Always test before eating.
• A smile or a “Great job!” after testing makes the task more fun.
• Stay calm with all diabetes care — even if the numbers aren’t what you expect.

Let your toddler do some things for themself. 

• Let them choose which finger to test.
• Let them help clean up after testing.

Try new foods with your toddler.

• Many toddlers want the same food every meal. Encourage them to try new foods — it may take eight to 10 times of offering before they eat it.
• Let your toddler eat when they are hungry and stop eating when they are full.
• Some days kids eat a lot and some days they don’t. This is normal. Don’t force your toddler to eat.
• Use post-meal dosing. There is less worry that your toddler will go low if they don't eat all their food.

Mealtimes

• Allow your toddler to feed themself with a fork and spoon. This helps with motor skills.
• A toddler’s portion is about 1 tablespoon of each food for every year of age. Allow your child to eat until full.
• Mealtime should not last longer than 30 minutes.
• After the meal, count the carbs, then give the insulin.
• Never use food as a reward.

Offer your toddler a sippy cup or regular cup

• Toddlers should learn to drink from a cup at the age of 1.

Invite older toddlers to help prepare food

• They can tear lettuce or help stir and mix. Children are more likely to try foods they help prepare.

Make sure your child always wears a medic alert bracelet

Remember: You set the tone for your toddler to learn lifelong habits for diabetes care. If you need help, ask your diabetes team.

Finding childcare

Finding a daycare center or a babysitter that can take care of your child’s diabetes is important.

• You are less stressed if you know someone is properly trained to take care of your child.
• Your child feels safe when other adults know how to care for his diabetes.

General advice

• Not all daycare centers have a nurse to give insulin.
• Some parents find a daycare close to work and go to the daycare to give insulin.
• Some daycare centers are willing to be trained by the parent to give insulin, check blood sugars, and count carbs. They can call you if your child’s blood sugar is out of range.
• Some daycare centers provide snacks. You may want to bring your child’s food from home. This way you know exactly what your child is eating.
• Make sure your child is on the best insulin regimen that fits into your life. Some insulin programs do not require an injection at lunch time. This might work best for daycare centers that do not have anyone to give an injection during the day.

Diabetes Care Plan

• Meet with the daycare staff and set up a “Diabetes Care Plan.”
• This plan outlines who does what in taking care of your child’s diabetes.
• Some daycare centers require a doctor’s order to give your child insulin. Talk with your diabetes provider to get these orders.
• Make sure your child has enough diabetes supplies and snacks at his daycare.

Where should I go to find a daycare that can take care of my child with diabetes?

• Some health insurance companies will pay for a child’s medical daycare. Talk with your diabetes provider and social worker about medical daycare centers.
• If you live in Pennsylvania, call the Special Kids Network (1-800-986-4550). They can help you find ways to get training for daycare staff.
• If you live in New Jersey, call the Child Care Help Line of New Jersey (1-800-332-9227). They can help you find child care resources near you.

Your preschooler is always learning. What they learn will stay with them as they grow. The same is true for their diabetes care. Teach them the basics now to give them great habits for the future.

Help your preschooler to:

• Come when called for tests and shots.
• Help set up equipment for tests and shots.
• Choose which finger to test.
• Choose an injection site (different than the one used before).
• Check with you before eating anything.
• Recognize when blood sugars are low. Talk to them about how a low feels: “I’m hungry,” “My stomach hurts,” “My head hurts.”
• Help get the site ready for the pump.
• Always wear a medic alert bracelet.

As an adult in charge your responsibilities include:

• Do and reward all blood sugar tests.
• Find the reason for highs or lows.
• Decide, give and record all insulin doses.
• Rotate injection sites.
• Decide what your preschooler will eat.
• Offer a few different food choices.
• Notice physical symptoms (sweating or shaking) and behavior signs of low blood sugar.
• Always have something to treat a low.
• Let your child help get the pump-site ready.
• Manage the pump. Your child must be locked out of the pump.
• Make sure they always wear a medic alert bracelet.

General parenting tips

• Praise your child when they cooperate. Say “I like the way you got your meter!” This builds confidence and encourages them to keep doing it.
• Stay calm and matter-of-fact when you do tests or shots.
• Follow a routine so your child knows what to expect.
• Don’t fight with your child over food. Post-meal dosing can help.
• Teach sibling what lows look like and what they should do.
• Blood sugar numbers are high, low or normal, not “good” or “bad.” “Good” or “bad” tempts a child to make up “good” numbers to please you, or to not test because “bad” numbers upset you.

Remember: You set the tone for your child to learn lifelong habits for diabetes care. If you need help, ask your diabetes team.

Children are eager to learn and are proud of what they can do.

With your supervision, your child can:

• Set up for testing. Choose which finger to use.
• Test and record results at least once a day.
• Choose injection site.
• Learn to read food labels. Check with an adult before eating.
• Feel lows and tell an adult.
• Learn to treat lows. Carry carbs for lows.
• Wear a medic alert.
• Pick a pump site.

Even though your child wants to do more, they need your guidance and supervision. You should:

• Watch your child test at least once a day and record results. You do the other tests.
• Review blood sugars. Talk about what causes highs or lows.
• Decide, draw up and inject insulin.
• Teach your child how to read food labels.
• Recognize and treat lows. Help your child know their lows.
• Make sure your child always wears a medic alert and has carbs to treat lows.
• Talk about site rotation. Let your child pick the pump site.
• Explain what you are doing with the pump as you are doing it.
• Allow your child to press the bolus button after you have set the amount. 
• Let your child know when they are being helpful with diabetes care.

General parenting tips for diabetes care

• Your child needs a diabetes plan at school. This may be a 504 Plan or a Diabetes Plan of Care. Ask the Diabetes Center for information.
• Some children don’t want everyone to know they have diabetes. All adults who care for your child must know. Let your child decide who else to tell.
• Be calm when testing and giving shots. This helps your child be calm too.
• Blood sugar numbers are high, low or normal, not “good” or “bad.” “Good” or “bad” tempts a child to make up “good” numbers to please you, or to not test because “bad” numbers upset you.

These are general guidelines. Some children take longer to learn diabetes care. Prepare your child to take on more responsibility as they grow up. If you have questions, ask your diabetes team.

Your child needs to learn about diabetes care. This explains what most 9- and 10-year-olds can do for their diabetes, and what parents need to do. Good habits now continue into adulthood.

With your supervision, your child can:

• Test and record blood sugars at least half the time.
• Choose injection sites. Learn to draw up insulin and give shots at least once a week. Record doses.
• Pick pump site. Help fill the reservoir.
• Check with an adult before eating. Start to read food labels and count carbs.
• Learn to prevent lows. Eat a snack or lower insulin before activity.
• Feel and treat lows. Carry carbs for lows.
• Always wear a medic alert.

Your child needs your supervision. You must:

• Watch your child test and record blood sugars.
• Check the meter and logbook at the end of the day. Talk about the numbers. Look for trends.
• Decide insulin doses. Draw up and give insulin. Have your child draw up and inject once a week.
• Teach your child to count carbs.
• Know your child’s lows, and teach them to know the signs. Have them always carry carbs to treat lows.
• Make sure your child always wears a medic alert.
• Explain pump alarms, and what you do for an alarm.
• Explain bolus amounts. Supervise your child bolusing.

General parenting tips

• Your child needs a diabetes plan at school. This may be a 504 Plan or a Diabetes Plan of Care. Ask the Diabetes Center for information.
• Your child may feel different because of their diabetes. They might not want everyone to know. Adults who care for your child must know. Let your child decide who else knows.
• Be calm when testing and giving shots. This helps your child be calm too.
• Blood sugar numbers are high, low or normal, not “good” or “bad.” “Good” or “bad” tempts a child to make up “good” numbers to please you, or to not test because “bad” numbers upset you.
• Praise your child when they take on new responsibilities.
• Know when your child is frustrated so you can talk about it.

These are general guidelines. Some children take longer to learn diabetes care. Prepare your child to take on more responsibility as they grow up. If you have questions, please ask your diabetes team.

"Tweens" may want to manage their diabetes, but they can't do it all on their own. The parent's role in diabetes care doesn't end — it only changes. This explains what most 11- to 14-year olds are able to do for their diabetes, and your continuing responsibilities. 

Your tween should:

• Always wear a medic alert and carry something to treat lows.
• Do all blood sugar tests and record results.
• Review blood sugars with you. Discuss any changes.
• Rotate injection sites. Draw up and inject insulin at least half of the time (with adult supervision).
• Count carbs and cover with insulin.
• Learn to prevent lows.
• Fill pump reservoir. Learn to insert site with supervision.
• Figure out bolus amount. Check with adult.

Your tween needs supervision. You must: 

• Ensure your child always wears a medic alert and carries something to treat lows.
• Review meter and logbook with your child. Make adjustments.
• Supervise injections. Some children do all of their injections. Others want a parent to do some.
• Make sure carb-counting is accurate.
• Make sure your child fills the pump reservoir.
• Teach your child how to insert site.
• Coach your child on bolusing. Review bolus history.

General parenting tips

• Stay positive and calm. Praise your child for working hard on diabetes care, even when the results aren't what you expect. Stress, puberty, exercise and growth affect blood sugars.
• Many "tweens" are concerned about body shape. Speak to your diabetes team if your teen is struggling with body image.
• Give your child time to speak alone with the diabetes team. 
• Talk to your child about drugs and alcohol. Both affect blood sugars. Discuss sex and unplanned pregnancy. If you need help, ask your diabetes team.

Depression and diabetes

Being a teenager with diabetes can be stressful. Between school, friends, family, and all the day-to-day diabetes care tasks, teens have a lot to manage. Being stressed and nervous can lead to depression.

What is depression?

Depression is a common problem that can be caused by stress or other factors. Teens may experience the following symptoms:

• Feeling sad
• Feeling lonely
• Feeling hopeless
• Loss of appetite
• Having trouble sleeping

Depression is nothing to be ashamed about. It is a medical problem that can be treated.

How does depression affect diabetes management?

When teens are depressed, it can be hard to take care of themselves. You might find it difficult to exercise, sleep or eat well. If this happens, diabetes can get out of control. Having high blood sugars can make teens feel more stressed and overwhelmed.

Ways teens can manage diabetes and increase their mood

• Therapy. Talking to a therapist can help with managing depression. Speak with a member of the diabetes team for options here at Children’s Hospital of Philadelphia or in the community. Medication may be an option as well.
• Exercise. Walking 10 minutes a few times a day can improve your mood and help control your diabetes.
• Nutrition. Eating a healthy diet can make you feel better and improve your mood.
• Activities. Getting involved in sports, music or a community event will improve your mood and make you feel good about yourself.
• Connections. Talk to friends, family members or teammates to get support.
• Diabetes Team. Connecting with the diabetes team for additional support and guidance will help you stay on track.

Driving with diabetes

When a teenager has diabetes, it is important to plan ahead for safe driving. High or low blood sugars affect driving skills. It is important to make sure blood sugars are controlled.

Guidelines for teenagers and young adults

Be aware of possible dangers on the road. Because of high or low blood sugars you can:

• Feel sleepy or dizzy
• Feel confused
• Have blurred vision
• Lose consciousness or have a seizure
• Have a hard time concentrating
• Any of these can be very dangerous if you are driving.

Plan ahead. You are responsible for making sure that you and others on the road are safe. Here’s how:

• Test every time you get behind the wheel of the car.
• Carry your blood glucose meter and plenty of fast-acting snacks in the front seat.
• Watch out for high blood sugar levels (hyperglycemia). The symptoms may affect driving.
• If you are low, DON’T DRIVE. Treat and only drive when your blood sugar is back within normal limits.
• Wear your medic alert bracelet/necklace. If you are in an accident, you may not be able to speak for yourself.
• Check your blood sugar every one to two hours when you are driving a long distance.
• Don’t leave your insulin, meter or test strips in the car. Changes in temperature in the car can damage them.
• Use a cell phone to call for help if needed. Don’t talk on the phone when you are driving. Pull off the road or have a passenger make the call.
• Follow all basic state safety rules for new drivers. (For example, wear your seat belt, limit the number of passengers and don’t drive later than you are allowed.)

Guidelines for parents

• Help your teen stay safe.
  • Talk to your teen. Review these guidelines and make sure your teen understands them.
  • Don’t be afraid to take away the privilege of driving for a time if your teen doesn’t follow the rules for driving and managing diabetes.
  • Teens who ignore driving rules and/or whose blood sugars are out of control should not drive. Your teen could be hurt, or could hurt someone else, if you do not set limits.
• Enforce rules.
  • Check that your teen tests every time she gets behind the wheel of the car.
    • Review the blood glucose meter.
    • If your teen is not testing, take away driving privileges for a time.
  • Make sure your teen is not driving with low blood sugars.
    • Review the blood sugars after a trip. This shows your teen how serious you are.
  • Make sure your teen has a meter and fast-acting snacks in the front seat at all times.
  • Make sure your teen always wears a medic alert.
  • Make sure your teen is testing their blood sugar every hour or two when they are driving a long distance.
  • Make sure your teen doesn’t leave their insulin, meter, or strips in the car. Temperature changes can damage them.
  • Make sure your teen carries a cell phone to use if they need help.
    • Remind them not to use the phone while driving.
  • Make sure your teen follows all of the basic state safety rules. (For example, wears seat belt, drives during the times permitted, and limits number of passengers.)

The Diabetes Center has a website dedicated for teenagers and young adults with information on key topics including: 

• Managing diabetes at college
• Managing diabetes at work
• Managing prescriptions
• Understanding insurance