Challenges in the Management of Pediatric Patients with Diabetes


Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDCES provide insight into the challenges inherent to the management of pediatric patients with diabetes, highlighting school related considerations.

Amy Hess-Fischl, MS, RD, LDN, BC-ADM, CDCES: Some challenges that are inherent to managing a child or teenager with diabetes include a multitude of factors. One, we’re talking about growth, and we’re talking about unpredictability in the child’s life and their lifestyle, and their activity, and their eating. All of those things are going to impact glucose levels and how they’re actually going to be dealing with their lives. Their behaviors can be affected by their glucose levels during the day.

Now, if we look at type 1 vs type 2, it does depend on the different types of treatment modalities being used. For the most part, we are seeing more children with type 2 diabetes taking insulin. In type 1 diabetes, they’re typically only using insulin. So we’re going to be seeing the same types of treatments and how they are going to be affected by those. But if someone with type 2 is on a medication that doesn’t cause hypoglycemia, and there are some oral medications that don’t do that, it might be business as usual. However, depending on how those children with type 2 diabetes are managing things and their glucose levels, that is what’s going to dictate their behavior during school.

When we talk about age and what they might be able to be doing during the school days, it depends. We know that we have age-related responsibilities and things we know that children at different ages should be able to accomplish, but age does not equate to maturity. Another thing that we have to keep in mind is that the prefrontal cortex does not fully form until age 25. So we have to take all of these things into consideration, that a child is still a child, regardless of what they can do with their self-management. We have to be very sensitive to the individualization of that child. Perhaps an 8-year-old may be able to do something that another 12- or 13-year-old cannot. We do need to look at those individualizations with what types of self-management they can do during the school day.

We know that every moment in the day is affected for a child with diabetes. From the moment they get up, they have to think about what their blood glucose level is, they need to see what they’re going to be eating at breakfast or lunch, or whether they need snacks throughout the day. What does recess look like, what does PE [physical education] look like? All of these things have to go into the life of a child with diabetes, regardless of whether they’re type 1 or type 2.

Transcript edited for clarity

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