Real Healthcare Debates from the Kitchen Table
Introduction
Kids are not just small adults — we know this firsthand as parents of three young kids! But that “you can’t just treat them like little adults” idea goes far beyond morning routines, bedtimes, and how they interact with grown-ups. It’s especially true when it comes to diabetes.
While neither of us personally manages pediatric patients, our years in healthcare — paired with the daily reality of raising children — give us a unique lens. We can combine our clinical knowledge, current research, and real-world parenting experience to explore what makes diabetes care for kids different. Growth spurts, changing hormones, sports, sleepovers, and school lunches all make things… interesting.
From the pharmacy side, I focus on precision, dosing safety, and avoiding med errors. Cassie’s NP lens centers on the child’s development, mental health, and how the family functions as a diabetes care team. Together, we explore ways to keep kids healthy without taking away the joy of being a kid.
Pharmacist Perspective (Cory)
For me, safety and accuracy come first:
- Precise dosing: Insulin for kids often means tiny adjustments — a unit too much or too little can make a big difference.
- Growth and puberty: Hormonal changes during growth spurts and puberty can throw insulin needs into chaos. Kids might suddenly become more insulin resistant during a growth phase, only to swing back toward higher sensitivity once things stabilize. That means the “perfect” basal rate or carb ratio from a few months ago can suddenly be way off. Regular dose reviews — sometimes every few weeks — are key to avoiding a constant roller coaster of highs and lows.
- Technology literacy: Pumps and continuous glucose monitors (CGMs) are amazing, but only if the family knows how to use and troubleshoot them. And just because a 3-year-old can order a toy from Amazon doesn’t mean they can program their bolus insulin dose on a pump.
- School coordination: Teachers, school nurses, and coaches all need to know how to respond to lows and highs. This can be especially tricky with very young kids, who may not notice or express symptoms clearly.
- Medication safety: Small-volume insulin doses are easier to mess up — double-checking technique is critical.
Nurse Practitioner Perspective (Cassie)
I’m thinking beyond numbers — I’m looking at how diabetes fits into their whole life.
- Family-centered education: Parents need to understand management, but so do siblings, babysitters, and grandparents. Beyond management, understanding whether it’s Type 1 (no endogenous insulin) or Type 2 (excess insulin + insulin resistance) matters for medication, lifestyle, and complication prevention.
- Mental health: Kids can feel “different” or isolated. It is important to watch for signs of burnout or bullying.
- Normal activity: Sports, playdates, and school trips are all possible with the right planning — diabetes shouldn’t hold them back.
- Gradual independence: Teens should start taking on more self-management skills — but with safety nets in place.
Kitchen Table Consensus
We both agree: managing diabetes in children is a team sport. The child, the family, the school, and the healthcare team all need to work together. The goal is keeping kids safe while giving them the freedom to live their lives.
Practical Takeaways
- Kids’ insulin needs change rapidly — keep regular communication with the care team.
- Use tech tools like pumps and CGMs — but teach backup plans for tech failures.
- Encourage participation in sports and social activities.
- Involve school staff in the care plan.
- Support mental health at every stage.
References
American Diabetes Association. Children and Adolescents: Standards of Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S180–S194. doi:10.2337/dc24-S012
