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Diabetes in a 3 year old

C

Cassie1

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Hi :D
I'm a college student currently studying Childcare and Education level 3. For a piece of research that I'm doing I am writing a care plan for a 3 year old in a nursery with diabetes. I have done the basics but am not sure how accurate I have got it and was wondering if any of you could help at all, as you'll understand a lot more about children with diabetes than I do.
Here is what I have done so far..


8.30 – arrive at setting
8.30-9.00 – free play
9.00 – nappy change if needed
9.15-9.45 – register and circle time
9.45 –check blood-sugar levels and have snack/rest if needed (The checking should be overseen at all times by a practitioner)
9.45-10.30 – activities/play
10.30-10.50 – washing hands and insulin injection (Carried out by practitioner)
10.55 – snack time (The child’s snacks need to be regulated and checked by a practitioner)
10.50-11.15 – circle time/group activity
11.15 – nappy change if needed
11.20 – check blood-sugar levels and have snack/rest if needed
11.25-12.00 – garden time
12.00-12.15 – Tidying garden and washing hands for lunch
12.20 – insulin injection
12.25-1.00 – lunch time
1.00-1.45 – sleep/nap time
1.45-2.15 – circle time
2.15 – check blood-sugar levels and have snack/rest if needed
2.20 – nappy change if needed
2.30-3.30 – free play
3.30-3.45 – tidy up and wash hands for afternoon snack
3.45 – insulin injection
3.50-4.00 – afternoon snack time
4.00-4.45 – garden time
4.45 – nappy change if needed
4.50 – check blood-sugar levels and have snack/rest if needed
5.00-5.30 – group activity/story time
5.30-6.00 – free play/getting ready for home time
6.00 – home time


What else do I need to add/alter etc?

Thank you! Cassie
 
Hi there!!

I'm just bumping this post up so hopefully someone will see it,as there's quite a few members who are here as parents of a type 1 child who have been diagnosed below the age of 5 and they should have lots of different opinions according to their child and experiences.It may also be worth posting your post in the Type 1 forum too as well.

Good luck with the assignment

Paul
 
No problem!! :D My wife is level 3 qualified in 'early years' and I remember all the assignments she had to do at the time but it was worth it in the end as she LOVES her job! :thumbup:
 
Three year olds are different so I hope a parent will reply.

Hang around a bit longer, if you don't get a better reply try googling childrenwithdiabetes forums (it's a US forum with a UK section)

edit, they have!
 
I'll try to offer some thoughts that might help. My daughter was 4 when she was diagnosed so a little older and maybe a little different as to routine. I think it's also important to know that every child is different and there are different types of insulin regimes so although you can generalise a care plan, in real life it may be different for each child and would need to be adjusted to cater for the individual child according to their parent and health team's guidelines. If you had two children in your care with diabetes then the timing of testing and injecting might be different for each child and would need to be accommodated.

Some diabetic children will have injections during the day, other children may use an insulin pump (you'd deliver insulin but via a pump rather than by injection) and other children may not have an injection whilst at nursery (they may be on a mixed insulin needing only two injections per day rather than several injections per day). All diabetic children would need to have their blood glucose tested during the day at some point but again the timing of this varies depending on the child and the care plan they are following.

Looking at your plan I'm assuming all children will have breakfast at home. With their breakfast they would have had an insulin injection to cover that meal. Usually blood glucose testing is done 2 to 3 hours after the previous meal so depending on what time their breakfast and injection was will determine roughly what time to test the child's blood glucose. Some children may not need to be tested after the previous meal but at 3 years old I think many parents would want testing done to make sure their child's blood glucose is not falling too low (incase of an error in the insulin dose at breakfast time). Testing too soon after a meal, lest say around 1 hour after, unless the child is showing symptoms of a low blood glucose level, is not really very helpful because it would be too early to be meaningful. I mention this because you have in your plan an insulin injection at 3.45pm and then a blood glucose test at 4.50pm which is near enough an hour later, too early in my opinion.

Depending on the injections a child is having they may not need an injection at snack times even although they're eating a snack. With mixed insulins (when a child is having usually 2 injections a day) it is important that they snack at regular intervals to avoid a low blood glucose, they usually will not need an injection to cover these snacks. Some children on multiple injections per day may not need an injection to cover snacks either, or they may have a low carbohydrate snack which has little effect on their blood glucose levels meaning no injection is needed. A child using an insulin pump may or may not need insulin to cover snacks. It all depends on the child and how their insulin regime is tailored to them. If snack time in the morning is at 10.55am and the child needs an injection to cover the snack, then injecting at 10.30am and waiting until 10.55am may be too long between injecting and eating. Usually it will be rapid acting insulin that is used to cover snacks and meals and the injection usually needs to be done around the same time as the snack is eaten i.e. inject and eat straight away. For young children who have unpredictable eating habits it is not uncommon to allow the child to eat first and then inject afterwards. If the child doesn't eat all the meal or snack then it is easier to adjust the insulin dose afterwards. If the injection is done and then the child doesn't eat it can be a problem. I also think a snack time of 10.55am is too late and would prefer to see it between 10am and 10.30am with a blood glucose test done before eating the snack. This would allow you to check that blood glucose is not falling too low after breakfast injection and if a very high reading is recorded it can serve as a warning, perhaps the child is becoming unwell or the breakfast injection was incorrectly calculated or even missed (parents make mistakes and sometimes, although rare, we are known to forget an injection :oops: )

At 11.20am you have a blood glucose test, I think this is too early after the snack at 10.55am and I would say unless the child is showing symptoms of low blood glucose it may be an unnecessary test. If your snack time earlier was timed for 10am then a test again at around 12 noon to 12.30pm would be a better time to test. Lunchtime between 12 and 12.30pm is great. Testing before lunch and injecting immediately before or after eating is good. Some children may not require an injection with lunch if they're on a mixed insulin. They may also need to eat earlier at around 12 noon. When my daughter was on mixed insulin she couldn't go until 12.30pm otherwise she's get a low blood glucose so she either needed to eat lunch at 12 or have a small snack at 12 to carry her through until 12.30pm.

The blood glucose test you have at 2.15pm I would delay a little longer to around 3pm and include an afternoon snack shortly after that. Like the morning snack time some children may not require insulin with it.

Testing again after the afternoon snack should be around 2-3 hours later so I would do it just before home time if your snack time stays at the time of 3.50pm or move the testing time to around 5pm to 5.30pm if you move the afternoon snack time to 3pm.

I'm not sure how much detail your care plan needs to go into but other things mentioned on my daughter's care plan include what to do in the even of a low or high blood glucose, what signs and symptoms the child displays and what defines a high blood glucose level i.e. what blood glucose reading is the cut off where you contact the parents to report a high blood glucose. Other information included in the care plan is what to do if the child becomes ill e.g. temperature, vomiting, refusing to eat etc. How to accommodate sport or activities that might be organised which could cause a drop in blood glucose readings. What to do in an emergency if the child has a severe low blood glucose or becomes unconscious. It also details where all the diabetes equipment, snacks, hypo treatments etc are kept and includes emergency contact details for parents, gp, diabetes team etc.
 
Hi! My 2 year old was diagnosed last June and is now 3. I have also studied childcare and wish you luck! I think the only problem with the plan is that I have always tested blood before eating and injected after, as a 3 year old is pretty unpredictable with their eating habits. When Jac my son was in hospital at diagnosis they would inject him before eating, then I would spend the next hour trying to get him to eat enough :roll: . However, when his nurse made the suggestion to him having the injection after it made all the difference! Jac is now on a pump and it's great, but he is still unpredictable in his eating and we still bolus after he has eaten so we can carb count accurately.
Hope this helps!
Emma
 
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