Building Competency in Diabetes Education THE ESSENTIALS

4-12 | CHAPTER 4

Table 2. Treatment targets for BG in children and adolescents with type 1 diabetes Age (years) A1C (%) Fasting/ Considerations

Two-hour postprandial PG* (mmol/L)

preprandial PG (mmol/L)

<18

≤7.5

4.0–8.0

5.0-10.0

Caution is required to minimize severe or excessive hypoglycemia.

<18 For children or adolescents who have had severe or excessive hypoglycemia or have hypoglycemia unawareness. *In children <6 years of age particular care to minimize hypoglycemia is recommended due to potential association in this age group between severe hypoglycaemia and later cognitive impairment A1C=glycated hemoglobin; PG=plasma glucose. ∗ Postprandial monitoring is rarely done in young children except for those on pump therapy for whom targets are not available. Adapted from Diabetes Canada 2018 Clinical Practice Guidelines (8) >7.5 6.0–10.0 —

Target A1C for most children with type 2 diabetes: ≤7.0 % (2) .

One of the characteristics of the infant to preschool stage that presents a challenge is the rapid growth spurts, accompanied by fluctuations in appetite. According to Erickson, young children are developing a sense of themselves, first by developing trust as an infant and then through curiosity, initiative and imagination as toddlers and preschoolers (37). The goals of diabetes management in young children are outlined below. These goals are unique to this stage of development. For safe management and peace of mind, parents should be clear about the goals of management for each stage. Parents of very young children with diabetes will need help to strive for the following (35,38): • Normal growth and weight gain. • Accomplishment of developmental skills, such as rolling, sitting up, crawling and talking. • Freedom from signs of hyperglycemia (such as a good energy level, no overly wet diapers or abnormal thirst). • No severe hypoglycemia. No more than a few episodes of mild hypoglycemia. • No ketones in the urine or blood.