PRACTICAL ASPECTS OF MANAGING PRESCHOOL-CHILDREN WITH TYPE-1 DIABETES

Day-to-day variations in diet and physical exercise, large variations in the glucose response to small changes in insulin doses, and high in sulin sensitivity are characteristic of preschool children with diabet es. Hence, difficulties in achieving adequate metabolic control and st able glycaemia in preschool children are common. In addition, hypoglyc aemic episodes tend to be frequent and severe in this age group. Probl ems identifying and treating hypoglycaemia present an additional chall enge for the diabetes team and for the family caring for the young chi ld with diabetes. Specific glucose targets are provided for this age g roup: premeal levels of 6-12 mmol l(-1) (110-220 mg dl(-1)) with bedti me levels above 8 mmol l(-1) (140 mg dl(-1)). It is important to note that children who suffer severe hypoglycaemic events at a young age sh ow evidence of subtle cognitive deficits when tested during adolescenc e. The question of whether or not the years before pubertal onset cont ribute less towards the development of diabetes-related microvascular complications than do the years starting with the onset of puberty rem ains controversial. Twice-daily or multiple insulin injections, dietar y adjustments and considerations, home blood-glucose monitoring, famil y education, support groups and 24-h hotline information facilities ca n help to achieve good metabolic control without severe hypoglycaemia in the preschool child. In general, good metabolic control without sev ere hypoglycaemia can be achieved using frequent counselling and a car ing team approach.