The American Diabetes Association recently shared an updated position statement on the management of type 1 diabetes in children and Adolescents. This statement is an update to their previous position statement issued in 2005. Their statement highlights the common sense idea that children are not just mini-adults. Treatment plans for children with Type 1 diabetes need to be tailored to both their current situation and their future growth and development.
The following areas were highlighted in the updated statement of recommendations for children and adolescents with Type 1 Diabetes (T1D):
- Diagnosis of Diabetes
- Blood Glucose Level Management
- Lifestyle Considerations
- Self-Management of Diabetes
- Complications and Comorbidities
- The Transition from Childhood to Adolescence and Adulthood
New Recommendations for Blood Glucose (BG) Management in Children and Adolescents
Most children’s T1D should be treated with insulin regimens with either multiple daily injections or via insulin pump therapy. Healthcare professionals should measure A1C levels of their non-adult patients at 3 month intervals. The target level of A1C should be 7.5 %. Patients or their caregivers should monitor BG levels multiple times a day, typically 6 to 10 times.
Medical devices such as insulin pumps and continuous glucose monitors (CGM) can be very helpful in the management of T1D. The ADA recommends that the CGM be considered in all children and adolescents, even though not using insulin pump therapy. Studies have found that compliant use such devices correlates with better BG control, lower A1C levels and reduction in hypoglycemic events.
Adjunctive Therapies for Children with T1D
One highlight in their recommendations between the management of type 1 diabetes in children versus adults is in regard to adjunctive therapies. They do not recommend the use of adjunctive therapies, such as the medication metformin in children. Clinical trials showed that despite the advantages of such therapies to help with weight loss or other diabetes comorbidities, there are more risks than benefits for children.
Check back next month for our follow-up blog talking about the unique behavioral aspects of managing diabetes in children and adolescents. We’ll focus on the challenges of self-management of their disease and other related health and wellness concerns.
411 on CGM
Exercise for Children with Diabetes
ADA Position Statement
Type 1 Diabetes requires continuous monitoring, regardless of the patient’s environment. In previous blogs, we’ve discussed carrying an emergency bag and other methods for managing your diabetes when away from home. However, one area we did not discuss is what to do at school.
Monitoring Diabetes at School - Communication is Key
First and foremost, you cannot communicate enough with school staff including teachers, bus drivers, and health personnel about your child’s condition. Provide as much information as possible so they will know how to assist your child when the need arises.
A Diabetes Medical Management Plan (DMMP) should be completed and gone over with school administrators so everyone is on the same page. An example of this can be downloaded here.
This comprehensive and critical document should contain the following information:
- Blood sugar target and testing times
- Insulin schedule
- List of supplies
- Meal and snack plan
- What aspects your child can handle on their own vs. what they might need help with
- How to handle a low blood sugar or high blood sugar episode
ADA and IDEA
There are many laws that protect your diabetic child including the Americans with Disabilities Act (ADA) and the Individuals with Disabilities Education Act (IDEA). IDEA is a law that provides services to diabetic students. For more information about IDEA, click here. In addition, in a public school setting (or a private one that receives funding from the federal government), you are entitled to set up a Section 504 plan for your child.
This would require that the school make special accommodations for him or her including the following:
- Allowing him or her to use the restroom and use the water fountain when they need to
- Eating wherever and whenever necessary
- Allowing extra absences
- Scheduling exams at a time that will not cause your child to suffer from the hypo or hyperglycemia
- Ensuring that a trained diabetes care personnel member be present during sports, extracurricular activities, and field trips
If your child is not currently using a Continuous Glucose Monitor (CGM) (more on this in our previous blog “The 411 on CGM”) or an insulin pump, the beginning of school is a great time to look into these options, as these devices provide peace of mind for the parent, school staff member, and child alike.