Caring for mental health at every age and stage

When you have type 1 diabetes, you deal with highs and lows on a daily basis. With so many things to keep track of, it’s easy to forget that highs and lows aren’t just physical. Diabetes also takes a toll on mental health. People with diabetes can experience guilt, shame or burnout. Some issues, such as depression, anxiety, and dia-bulimia, can be more serious. When things get too difficult to manage on your own, it’s wise to seek professional help.

Mental health providers can help individuals with T1D (as well as their parents and families) no matter what their age. At Carb DM’s 2017 Asian Outreach Day, Dr. Tandy Aye, pediatric endocrinologist at Lucile Packard Children’s Hospital, shared ways children — and parents — can be involved in their diabetes management through the years. She also gave an overview of the ways mental health professionals can help at every stage of a child’s development.



Toddlers (age 1.5-2) are just starting to be independent. They are increasingly mobile, and boy, is that personality developing!

What you can expect from a toddler

This is the age of the “Terrible Twos”! Toddlers are mostly concerned about their own needs and wants, but they may be able to stay still enough for a blood sugar check or injection if mom or dad manages to distract them with a toy or a silly face.

How parents can get involved

Parents are key! They are responsible for all aspects of diabetes management. It’s important for a parent to be a parent. Consistency with rules and schedules is super important: for example, if your toddler rips off his or her sensor, just put it back on.

How mental health professionals can help

Mental health support at this age is mainly for parents. When parents see a mental health professional, they don’t have to hold it together. It’s an opportunity for them to let their guard down and admit, “Yes, I’m tired. Yes, it’s tough”. Whether they get it from a mental health professional or their local parents’ group or their family, it’s important for new parents to have support.



NO is a preschooler’s (age 3-5) favorite word. Preschoolers have attitude!  Now that they are starting preschool, they are beginning to learn how to regulate emotions and how to get along with others. Preschoolers are always watching their parents, trying to test their limits. Structure and stability are important.

What you can expect from a preschooler

Preschoolers can be expected to keep their pumps and sensors on their bodies (having a pump bag belted to their waist helps!). They can start using the terms “low” and “high” and recognizing their low and high symptoms.

How parents can get involved

At this stage, parents are still responsible for all aspects of diabetes care. However, they can start helping their preschooler vocalize symptoms of their lows and highs (i.e., “How are you feeling, Dylan?”; “Is your tummy rumbly?”; “What you are feeling right now is because you are low”). Always be consistent, for developmental reasons as well as for diabetes care. If they try to tear that pump off, put it right back on. Your child is watching your reaction to everything they do. If other family members or friends are regularly involved in their care, keep the lines of communication open. Make sure rules are consistent across homes. If grandma says they can have ice cream whenever they are with her, have a talk with grandma to make sure she understands when ice cream is and/or isn’t appropriate.

How mental health professionals can help

Just like at the the toddler stage, the emphasis for mental health is still more for the parents. However, at this age, if there are more challenging issues, a child may benefit from play therapy with a mental health professional.


Elementary School

Elementary school children (age 5-11) are away from their parents during the school day. They are learning and trying everything. They begin to be actively aware of having type 1 diabetes but still want to do everything. Kids are now old enough to tell you what happened during the day and tell you whether they are happy, sad, hurt, or upset.

What you can expect from a school-aged child

Elementary schoolers can begin to actively participate in their diabetes care. The extent of care depends on the child. Involvement can range from cleaning their fingers to checking their own blood sugars. Pre meal injections and boluses should also start.

How parents can get involved

Parents can begin asking their kids to perform small tasks in diabetes self-care. Even if parents still perform the bulk of diabetes care, they can give their child some degree of control. Let them choose which finger to prick or which injection/insertion site to use. However, choices need to be within guidelines that parents set. For example, if your child only chooses his or her thigh as an insertion site, you need to be the parent and reintroduce other sites.

Parents should begin emphasizing explanations for their actions. For example, if you are checking your child for ketones, explain to them why you are doing it. You are starting them on the road to becoming a more active participant in their care.

At this age, kids begin to learn about expectations or right and wrong. Parents should establish rules, but try not to make rules that single out the child with T1D. Instead, make rules that apply to the whole family.

At this age, rules are still important, so be consistent, and follow through with consequences. However, it’s never a good idea to focus solely on the negative. Instead, of scolding a child for eating cookies, focus on the positive (“Thank you for telling me”) and focus on solutions (“Let’s work on you telling me before you eat the cookies, so we can bolus for them”). Reward good behaviors.

Don’t let diabetes be the center of your life. Your child can participate in any kind of activity, and your medical professionals will work with you to make it happen.

How mental health professionals can help

Mental health providers start to be important at this age, because kids are old enough to engage and express themselves. Schools and playgrounds can be very mean places!  Mental health professionals can help a child talk through their feelings. They can help with your child’s learning needs and help develop your child’s individualized education plan. They can also help develop accommodations for sports and other situations. Even if your child doesn’t actively need a mental health professional, you may want to introduce your child to one so your child can start to be familiar with the person.


Middle School

Middle school (age 11-14) is a time when adolescence starts. It’s a challenging time for everyone, with or without T1D!  Kids at this age are constantly comparing themselves to one another. They just want to fit in. They want to look and act like their friends, but their bodies are changing at different rates, so fitting in becomes a moving target.

What you can expect from a middle schooler

Middle schoolers should be actively participating in their own care. They should be able to check their blood sugars, give themselves injections, and help set up pump set changes. They should know how to treat a high or low without their parent present. If your child has had diabetes for a while, it may be useful to take a diabetes refresher course.  Your child may be familiar with aspects of diabetes management, but not be aware of why it’s being done.

How parents can get involved

Give your middle schoolers some roles and responsibilities. Make them feel important and accountable. Don’t protect them just because they have diabetes. But remember that they still need their parents. Kids can stumble and fall, parents need to be there to catch them..

Sleepovers are ok. It’s okay to go camping. Send your child to diabetes camp!

How mental health professionals can help

With increased peer pressure and the need to fit in, middle schoolers may begin to experience anxiety and depression. Parents should begin to observe their children for signs of anxiety, stress, and depression. Seeing a mental health professional can help. Mental health professionals may recommend counseling or medication.


High School

Congratulations, parents! Your years of hard work to raise an independent individual are beginning to pay off. Teens age 14-18 are becoming the adults you raised them to be. Self expression and experimentation is important to them because they are figuring out who they are are. They will be making decisions about dating, driving, drinking, and drugs.

Your teens are becoming more and more independent. They feel like their parents don’t know anything. They feel invincible, like nothing bad can ever happen to them. If they have gotten away with not taking their meds for 3 days without going to the ER, chances are they’ll try to get away with 4 days!  Most importantly, they don’t want their parents — or diabetes — to slow them down.

What you can expect from a high schooler

Kid this are fully capable of taking over their diabetes care. Parents can help out with medical appointments, medical insurance and ordering supplies, but high schoolers can be completely independent in their daily care.

How parents can get involved

Understandably, the thought of leaving all aspects of diabetes care to their kids can be worrisome. The average A1C at this age is 9! But at this age, it’s okay to let kids fail sometimes, then step in to help them out.

Kids this age may experience diabetes burnout.  Tell them it’s okay to hand everything to their parents for a week. Parents can do all the checking, bolusing, carb counting etc. This gives kids a break — if not from diabetes, at least from the daily care. It’s also a great reminder for parents of how difficult diabetes care can be. Most important, it can be a great way to bond with your child. Temporarily taking over diabetes care lets your child know that he or she still has a safety net to fall back on.

Teens are not developmentally capable of thinking about long-term health consequences, so nagging them about future health complications may be futile. Instead, listen. Be there for them. If your kids know you are there to just listen and be a sounding board, they will open up to you and you will get to know more and more about them.

How mental health professionals can help

Peer pressure and body image issues are still strong at this age. In addition, high schoolers may experience the additional burden of heavy schoolwork and parental pressure for college. Mental health professionals can help teens with anxiety, depression, dia-bulimia, and other issues. They can help with transitioning to college and being fully independent.  They can help teens transition to adult endocrinologists and other medical care providers. In short, mental health professionals can help teens get into the driver’s seat, take the wheel, and take control of their lives.


If you decide that a mental health professional can help, it’s important to find the right one for your family. Your endocrinologist and pediatrician can help. Diabetes organizations like ADA or JDRF may have a list of local resources. Finally, don’t forget to ask fellow T1D parents and your local diabetes community for recommendations.


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