Building Competency in Diabetes Education THE ESSENTIALS

CHANGES ACROSS THE LIFESPAN| 4-13

• Insulin plans and BG readings that allow for unpredictable eating or food refusal. • A happy and secure child. • Knowledgeable daycare providers/alternative caregivers.

An area that creates considerable challenge in this age group is insulin injections necessary to treat type 1 diabetes. Needle anxiety is common in both the parent and the child, but it is often not reported. Research has shown that it is the parent’s attitude which is the most important factor for the child’s acceptance of the injections (39). Working with the parents and any child caregivers is essential. Several intervention strategies have been suggested, with the most successful being play therapy and distraction techniques. The use of CGM has contributed significantly to the safety of insulin use in this age group by recognizing asymptomatic hypoglycemia, especially nocturnal hypoglycemia (40,41). Although not all the studies have concluded that there is improved glycemic control with the use of CGM, many parents using CGM have commented, “I finally slept through the night” (42,43). The use of CSII in this age group has been steadily increasing, especially in conjunction with CGM. When used in combination, a significant improvement has been demonstrated in the A1C versus multiple daily injection (MDI) (8). Please refer to practical application 1 for further discussion on the strategies for interventions for this stage.