My three-year-old daughter was just diagnosed with diabetes. I know this may be in the future, but at what age should I begin to teach my daughter gradually how to become self-sufficient managing her insulin and diabetes? I am still in the process of learning about diabetes. My primary family doctor said I should teach her when she turns 15, but I don’t want to just throw everything onto her and I feel that 15 is too late. Should it be a gradual process?

At this time, learn to take care of your child and get the support that you and your family need. If you are able to see a diabetes specialist and diabetes educator, please take that opportunity for you and your child. Please talk to a social worker or someone who can help you obtain health insurance for your child.

It wouldn’t be unusual if your three-year-old temporarily puts up a fight about injections and blood sugar checking when you get home. It is normal at this stage to have to learn to cooperate. Be consistent and loving, get everything ready before you approach your child, get the tasks over quickly, and they will adapt sooner than you think. (Sticker reward systems are great). Children are resilient.

When parents ask me the question about a child taking on responsibility for diabetes care, my overall answer is to think about children in general, and how they grow and mature and take responsibility for themselves in other ways. It happens in stages with forward and backward progress as kids mature. Follow their lead and let them participate along the way. There is no magic age, and taking complete ownership of tasks earlier may not necessarily be the best, however participating along the way is wonderful. Give them simplest tasks at first (maybe asking “help me get everything ready”) and slowly move on to the more complex aspects of diabetes care. Expect that they will not be consistent, as they are children/teenagers, but help them learn the priorities.”Did you brush your teeth?” may have the same level of importance to them as “did you take your insulin?” Knowing how to do a task, such as injecting/infusing insulin, is not the same as having the maturity to be responsible for it.

Please see the excellent chapter on Responsibility of Children of Different Ages in Understanding Diabetes. In fact, this is an excellent overall book about diabetes.

My advice is easy to say and hard to do: Be supportive; be there for them to keep them safe; transition slowly and flexibly; and let them be the kid/teen they need to be at each step along the way. And, take care of yourself too.

LM