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PEP Talk

Infants and Toddlers with Diabetes

In a recent Facebook group conversation, we discussed the topic of children with diabetes under the age of 2.  We received an overwhelming response by members who shared the special challenges of dealing with infants and toddlers with diabetes.  Here’s what the PEP Squad had to say…

My son is 2 years old and diagnosed Sept 27th of this year so it's only been a couple months for us. My main challenge is food and getting him to eat the right amounts. It's hard because I measure out the food on his plate then he only eats a certain amount, and then we have to calculate and subtract what he doesn't eat.

Since we have to do this, we can't dose him until after he eats which makes his insulin intake later than his food intake so he usually runs high after meals. It's a bad cycle. I believe the older he gets, the better this will get because he will be able to tell me how much he will eat, but for now it's very difficult.
December 21, 2011 at 6:40am

Our T1 son, Alden, was dx'd at 10mo. of age. He is now 3yrs. What we did with Alden, when he was younger, was multiple boluses throughout the meal. We would start with pre-bolusing for a small amount of carbs we KNEW we could get him to eat .  If you normally give him 1/4 cup of Mac & Chs, put 1/8 cup on his plate and save the other 1/8 for if he eats the first portion. Then as our son continues to eat we'd give a mid-bolus, and then a final one at the end when he'd eaten it all. This won't 100% prevent a dinner spike, but it will make it not quite as pronounced since you are at least getting some of the insulin in before all of the carbs are sitting there in his stomach.

As you get more comfortable (and trust me, you will!), you will learn that you can indeed 100% pre-bolus even a toddler... because you can always make up the uneaten carbs left on the plate with something else. Kids will rarely refuse some juice or a treat.
December 21, 2011 at 12:32pm

Our son was dx at 16 months old and we had the same issue. We started calculating how much we think he'll eat plus offering a special treat if he finished and including that in the calculation. We'd give him a Popsicle or something like that. That has worked wonders for us.

One of the biggest challenges we've had is attending parties/play groups because food is often the focus. While he can have anything (as long as I cover it with insulin) it's hard when the food is out the entire time.
December 21, 2011 at 12:45pm

My daughter was diagnoised at 2 1/2 and two years later her two brothers were also diagnosed. One of the biggest problems we came across was her going low on us because she couldn’t tell us that she was going low. We had to do lots of testing and preschool was a real issue.
December 21, 2011 at 1:23pm

Hello, our daughter was diagnosed two years ago at 16 months old. Unfortunately, food is the biggest challenge. First because they are so small and their eating habits are not yet established, it is very difficult to calculate carbs/insulin intake. Because they need their regular amounts of fats, protein, and carbs so they can grow strong and healthy, and their bodies are going through some rapid and unpredictable changes, it is going to take a while to adjust. So it’s either a high or a low in the beginning. We kept fighting the highs and ended up getting lows all the time.

Our Endo suggested accepting that it’s ok for a child this young to run in the 200s, but it was hard for us, because we feared that running high was going to bring complications later on. It is exhausting. It takes time to find the right formula, and every diabetic has their variations, because anything, from exercising to excitement, to stress or a different brand of food can affect your numbers, especially at this young age. Patience and time, lots of reading and education on this helps to be informed.
December 21, 2011 at 1:40pm

Our daughter was diagnosed at age 2 and is now 5. I 'ditto' everything Cherie stated and suggested. We've been pumping with the Ping since a couple months after diagnosis, and we've been using the Dexcom CGMS for almost two years.... LOVE LOVE LOVE having the CGMS. It made a huge difference for us, and I’m happy to share our experience for how to get the best performance out of such a device. Message me privately if you'd like more information.
December 21, 2011 at 2:34pm

Our daughter was dxd at 23 months. An adult T1 gave us some excellent advice by recommending that every time she had a low, to say to her, "This is what a low feels like and when you start feeling this way, it is REALLY important that you tell Mommy or Daddy or some other grown-up right away, so we can help you." She didn't start recognizing and alerting us to her lows until she was about 4 yrs old, but I am sure that this coaching helped her to recognize the "shaky" feeling and know that she needed to ask for help quickly. Now she is 5 and is amazingly 'in-tune' with her body. These kids never cease to amaze me. They are all my heroes. :)
December 21, 2011 at 9:24pm

We are coming up to a year of living with T1D for our 3 year old daughter. We have been pumping for 6 months. I can't even imagine not pumping made a world of difference. We are also going to begin training for a CGM in January. The biggest challenge... (oh, there have been so many!) First, when using injections, I thought it was totally bizarre to try and stuff food in my toddler to meet her insulin intake. We had it backwards. Every day I thought in my heart, "This is so not right." Just before the pump, we began playing with delaying the bolus until after she ate, but the spikes would happen still. With the pump there is such freedom...eating when hungry not when the insulin is spiking, sleeping in (!), less needle pokes...Also, our daughter can sometimes feel highs or lows, but often confuses them. That's ok, but it is very unreliable. We are very keen on a diabetic alert dog (DAD) and know it will happen in the next few years. We have been told by so many people that every toddler should have a DAD dog. Thanks for all the tips...this is wonderful!
December 22, 2011 at 12:57am

What good is measuring and weighing the food if half of it ends up all over the floor and the baby?  Our PEP Squad parents offer some helpful tips!


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