By Asleita Hussain, Diabetes Nurse Educator, Diabetic Society Singapore

Parents of children with diabetes know it is essential to maintain good blood glucose control. They need to be actively involved for almost all of their children's childhood. Giving our children some responsibility for their daily diabetes management is also important as it builds self-confidence, self-reliance, and self-control.

Children of different ages are able to take on different parts of these tasks and accept responsibility for them. Take care not to demand more from our children than they are emotionally and physically ready to handle. Expecting too much may produce a sense of failure and this could lead to problems including poor daily diabetes management and self-care.

Encourage them to gradually assume more of their own care, as they are able, to become independent in their daily lives as well as their diabetes care.

All children develop at different rates so age alone is not a good measure, but here's a guide to help you decide if your child is ready for those responsibilities:

Infant - 3 years
Handle with tender, loving care. Check blood sugars more often because babies can't tell you when they feel low. Because of this the acceptable blood sugar range for children in this age group is a little higher than for older children, 80 - 200mg/dl. Children this young have no idea what is happening to them. All they know is pain - that blood tests and shots hurt. You have to get past the guilt of causing pain and develop an acceptance of daily diabetes management as a normal part of life.

3 - 7 years
You will still need to handle all daily diabetes management. Coordination at this stage is not developed enough for tasks such as injecting with a syringe. Your child can choose which finger for a blood test or wipe the injection site. By 5 to 7 years of age, children can recognise the symptoms of low blood sugar. They may not articulate it exactly but watch out when they say "I don't feel good" or "I have a tummy ache". They begin to have some concept of the foods they can eat but are not ready to make proper choices. They still don't have a concept of time so ensure that they keep to their meal and snack schedule.

8 - 12 years
They can start doing their own blood testing. Many children want to start administering their own insulin as well. If your child has developed the fine motor skills, go ahead. It is critical to supervise every aspect of the injection. They have an acute sense of fairness - having diabetes seems very unfair. Listen and be aware of those feelings. Allow them to speak openly. They are able to make proper food choices but often don't. Stay involved in their daily care as their acceptance of responsibility may vary from week to week, even day to day.

13 - 18 years
While teenagers can gradually take over more and more of their daily diabetes management, you still need to be there for assistance from time to time. Your teen will do better if your help isn't always so obvious. Diabetes "burn-out", which is a real factor, may last a few days or longer. Just be there to help and support. Peer acceptance is the most important aspect of their existence. If their peers are caring and encouraging, then your teen will be more likely to take proper care and make healthy decisions. Your role is that of a catcher. Be ready when they either move forward or slip backward. Continue to support, set limits, share responsibility, and love them, to give them the best possible chance at good diabetes control during this tumultuous period of their lives.

Small Talk: Most children with type 2 diabetes are overweight or obese (up to 85%), and sometimes this can be masked by significant weight loss just prior to presentation.