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September 12, 2008

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Question from Alexandria, Virginia, USA:

My eight year old daughter was diagnosed when she was two years old and, therefore, did not have any formal diabetes training (although her father and I did). As she gets older, we have made an effort to teach her about her diabetes care and we have explained to her that she needs to take good care of her diabetes in order to be healthy. She is interested in an insulin pump and we recently attended an insulin pump orientation offered by the local diabetes center. The Diabetes Educator leading the discussion talked at length about DKA. My daughter was frightened by the discussion, but we followed up and discussed her concerns later. I have never discussed the long term complications of diabetes with her. At what age is it appropriate to start sharing more specific information with her about the possible complications of diabetes? I don't want to scare her, but I want to make sure that I share information with her in an age appropriate way so that she understands the importance of maintaining good control of her diabetes.

Answer:

Your daughter is very young and is unable to assume responsibility for a difficult and demanding disease. When she transitions to a pump, be sure she still knows that you and your husband are fully responsible for her diabetes care and her health. Assure her that people with diabetes remain healthy as long as their diabetes is taken care of well, and that the two of you will do that for her, whether she is on injections or a pump. With respect to DKA, she should be aware that if you miss insulin (many many children/teens miss lunchtime boluses when they’re on a pump), you can feel awful because of high blood sugars, and the way to avoid that awful feeling is to not miss insulin (but that’s not her responsibility, that’s yours). As to when to tell her about complications, there is no consensus on what age is appropriate. You might want to discuss this with your diabetes team.

JWB