Insulin and toddlers?

Type 1 and LADA Parents of Children with Type 1 Diabetes
#1

Hi,

So my daughter was dx with type one. She is in the very early stages and they have started her on lantus 2 units first thing in the morning. He is hoping for now that’s all she will need. My question to all you parents/caregivers is has anyone have a way to give insulin that doesn’t result in screaming and holding her? She is only 3 and we did our first injection this morning and well it was anything but calm. Now I’m not unrealistic I don’t expect her to be all happy about it or not to cry but maybe a way she could better understand or not be so upset about it?

#2

That’s a really tough one–my heart goes out to you! For kids that age it’s pretty rare that a verbal explanation is going to do much good, but trying to minimize stress and drama around it is certainly helpful. Question: are you using a pen injector? There’s a lot less paraphernalia and process involved with a pen than with a syringe and vial, which means less of a build up to the Awful Event, plus the optics are just not so scary, and with a toddler you can use the smallest possible pen tip. When I was using pens I frequently didn’t feel it at all. Another question: where are you injecting? Everyone’s different of course but some areas are less liable to sting than others. Chubby spots (yay baby fat) are generally the best. A lot of the instructional material you see has pictures of people injecting into the belly, but I personally hated that spot when I was injecting (use a pump now). My favorite was the back of my upper arm, where most of the time I couldn’t even feel it. Front of the thigh was also a good one. There are also numbing creams available, and some people will ice the intended spot to numb it out, but those treatments may just ramp up the fear by giving her more time to focus on what’s about to happen. Anticipation–being able to see the needle and know you’re about to be punctured—is always going to make things worse, so being able to do it quickly and out of her eyesight will help.

#3

We have the pen and her doctor gave her the smallest top available. He instructed us to use her upper thigh. I tried to be as preapared before I got to her as possiable. And as quick as I could with process but she wasn’t very helpful along the way. I had to hold her leg to be sure I did it right because she kept kicking :frowning: I did try to talk to her and explain but it’s a lost art on a toddler. But I have it my best shot. I did however turn it to her favorite cartoon before trying. I thought maybe if I could get her zoned into that maybe she wouldn’t notice so bad I was very wrong

#4

I’m not too surprised to hear that. And of course distracting her with sweets is hardly an option :wink: It really seems that the pain per se is not the problem so much as the psychological anticipation. Back of the upper arm is worth a try–it’s usually a pretty chubby place and more out of the line of sight.

Hopefully some T1 parents will also weigh in–it must be a pretty common problem.

#5

I’m hoping they do. I might try back of arm tomorrow. He told us thigh, back if arm, or belly, but he didn’t recommend belly because it hurts more for kids. He said. I don’t think it’s pain from shot I think it’s like you said the mental effect of it. Lol.

#6

Lantus can sting a bit, especially if it is cold. Making sure your pen is room temperature will help. Otherwise, what about giving her the shot while she is asleep? If you are using something like the BD nano or the insupen 33g 4mm, she might not even notice it, especially if you go for the back of the arm or the upper buttocks. That won’t really help prepare her for when she will need meal time shots, but it might help relieve the stress for a bit. If that doesn’t work, you could try using a numbing cream like Emla first, at least until she is used to the experience.
You could also ask her endo to prescribe a indwelling subcutaneous cannula for you to do the injections into. It’s a bit like an insulin pump infusion site, except you inject the insulin into the cannula using a syringe instead of the pump, and the cannula would only need to be changed every three days or so (and you might be able to change it while your daughter sleeps). Something like medtronic’s i-port advance https://www.medtronicdiabetes.ca/customer-support/iport.

#7

So we don’t have to keep it cold the pharmacy said to keep it cold? As of now she doesn’t require meal time shots. And yes I am going to try while she sleeps. Maybe that will be easier she panics the minute she sees it so hoping that will help her.

#8

You don’t have to keep the pen that you are using right no in the fridge, only unopened pens. The opened pen or cartridge will stay good at room temperature for 28 days, provided you protect it from extreme heat (so don’t store it next to your toaster or on the windowsill). If you are really uncomfortable keeping your pen at room temperature, taking it out of the fridge around an hour before th injection will also help. Lantus is acidic (which is how it lasts for 24 hours - after it is injected into the fat, the acidic solution is neutralized by the body to a neutral pH, but because lantus can’t dissolve at a neutral pH, it precipitates out into a solid form that’s not soluble in fat, and then it slowly moves back into solution over time and then to the bloodstream) and injecting a cold acid does not always feel good.

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#9

Ok so I’ll just take it out and let it warm before I give it to her maybe that will help. He said since she was only on 2 units a day that the one pen would last a while.

#10

Have you requested a JDRF Bag of Hope? Rufus the bear has patches for injection locations. It might be a good distraction & comfort. The bag also comes with books you can read to her to help ease the fear.

http://typeonenation.org/resources/newly-diagnosed/bag-of-hope/

Lantus stings. I would try the hip before the thigh for 3 reasons: 1) she can’t see the needle, 2) there’s more fat & 3) it should be easier to hold her down.

I’m sure there are parents with toddler experience here with more tips.

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#11

My Sarah always complains if the insulin is cold! So yes, keep it at room temp.

Sarah was 5 when she was diagnosed and I remember at first she would often just run away from the table at dinner time when it was time to get her injection. It took a lot of pleading and coaxing and patience, but she actually preferred the upper buttock - and the nice thing about there is that they don’t have to see it. Back of the arm is good too.

Another thing that helped Sarah was collecting ‘bravery beads’. We were introduced to it at SickKids, a big children’s hospital here in Canada when our baby was sick. There you can collect a bead for every poke, every bloodwork and every test and it would be strung on a long string. The baby had collected quite a few and one day Sarah said, "I’m brave too!’ and so the kind nurses started a string for Sarah. Then I went out and bought beads for her to use at home and then every time we gave her insulin or when she had to check her blood she got another ‘bravery’ bead for her string. You can imagine it’s super long! And thankfully our children’s hospital here also does bravery beads. So even though Sarah doesn’t collect them for her blood checks at home anymore, she still collects them at her clinic visits and she’ll always have that string to remind her how brave she was.

And you’ll probably find in a few months that injections and finger pokes become your new normal, as sad as that is.

Oh, and Sarah says now when we have to give her an injections that she can’t feel it, just like she says she can’t feel her finger pokes anymore, maybe others here can attest to that. :slight_smile:

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#12

There’s a thing that is supposed to minimize the pain called Buzzy, maybe some other parents have tried it

another one is called shot blocker - I remember some parents mentioning here how well it worked

JDRF can be a big help.

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#13

My daughter was diagnosed at 1. There’s nothing easy about a toddler with diabetes.

Those first few weeks of injections were incredibly hard, but it did become part of our normal eventually.
A couple of things that helped a little with my kid were:
A prize. You may want to start with a prize every time- a temporary tattoo, sticker, plastic ring. Eventually we made a chart- a sticker for every shot (then pump site injection) and then for every so many stickers, a prize (bubbles, sidewalk chalk, a little craft set). She’s 15 now and we have no formal system anymore but she’ll still occasionally ask for a box of tic-tacs at Target saying, "I think you owe me a prize…"
Offering choices- Being very clear that ‘We have to do this, but… where do you want to sit? Or what show do you want to watch? Or which spot on the leg for the shot.’ It doesn’t sound like much but the idea is that it gives her just a tiny bit of control over the situation.

Plenty of people do give shots while their kids are sleeping but I’ll share that our diabetes educator strongly suggested we not do that, because if she woke up while we were doing it going to bed could become scary, leading to a whole new collection of problems. Just food for thought.

Hang in there.

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#14

Thank you all for the wonderful ideas!!! I will definately be trying the prize approach. She loves stickers!!! She did do better this morning when insulin wasn’t cold. So that’s a plus. We do let her choose which finger to check I never thought about doing same with insulin I’ll give that a try. I haven’t heard of hope bags. I’m going to look into that and the buzzy

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#15

that sounds like a great suggestion! welcome to TuDiabetes Pam

Have you all heard of Jerry the Bear? we had them here for a live interview a couple years back, and it would be something I’d get for my child (if I had one) with type 1

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#16

Having been that toddler…

Couple possibilities here

  1. This is the FIRST time, it was traumatic to you, it was traumatic for her.
    The second time, the fifth, the hundredth it will not be scary/traumatic for anyone

Unfair, yes. Traumatic, not unless you let it

  1. Make 10,000% certain the insulin pen/vial is NOT cold. Injecting cold insulin hurts
    Roll the vial/pen between you hands like you would clay, and were trying to make a long thin piece of it from a larger ball…

  2. Having done shots since I was your daughters age, almost certain it upset you and slowed you down. Whole thing shouldn’t take more than 30 seconds IF, if that long beginning to end.

If it is taking longer, consider that “build-up” increases HER discomfort because she senses your anxiety.

Pull it out,
dial it up
pick an injection site
get a handful of her skin
inject

leave needle in for a couple seconds
pull it out
Done

On with the day
breakfast
school
all the normal

You could look for a smaller gauge needle whether its a syringe, or the pen tip.
I’ve always found the smaller length/thickness silly… and becomes counter productive at some point. In plain English truly does not matter how skinny the needle, how short the needle might be,

IT IS STILL A NEEDLE, period.

Never mattered to me, size, thickness, it was needle, and necessary

  1. Have you ever injected yourself, NOT WITH INSULIN… but simply putting a clean, brand new tip/needle into your own leg, for example? You do it, your partner does it… it time your daughter will do it all by herself with insulin. You’ll always watch her do it until she becomes a teen)(, but in the future she will.

  2. There are couple target spots, less ouchy usually.
    Butt,
    leg
    arm
    tummy.

Butt is easiest, and she wont see it coming, just gold her still for a second, and ALL DONE lets grab that toast.

Happy to explain, if needed

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#17

That was amazing I’m so glad I could hear from someone who went Thur it first hand. Yes this morning I did as another suggested and took pen or about hour before to get it warm. I will roll it with my hands tomorrow morning see if that helps. I’m going to try butt in morning. She still having some stomach pain so I’ll leave her belly alone. I never thought about using just needle show her it’s ok. And we have the smallest tiniest needle they have and your right it doesn’t matter needle is needle. I try to be as quick as I can. But she is a kicker. And I’m still learning. We did allow her to check our sugar the way we check hers that seemed to help her. Every once in while she say ok Mommie your turn.

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#18

I can only speak from my own experience but I have never kept the pen I’m using in the fridge, including lantus, but as your daughter is on such tiny doses you’d probably have to find a way to keep track of when you started using it so it doesn’t go over the month out of the fridge, label it or write the date on it. What you are going through sounds so tough, I was 8 when diagnosed so always did my own injecting which I’d imagine was some tiny ease to my mother. Hopefully as she’s so young she’Lloyd adapt quickly and there are great suggestions above to try. I love the bravery beads idea, so cute and kids love to show off the evidence of their achievements. There is also a dollar out now who has diabetes and all the paraphernalia that goes with it, meter, pump etc etc. I think it’s called the next generation doll or something like that.

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#19

Sorry it’s called the American doll and the diabetes kit is sold separately as an accessory pack for your doll, maybe she could practice giving the doll injections to take some of the fear out of it and could be used as a visual teaching tool as she gets older and your teaching her more about her diabetes and self care. The pack includes both insulin pump and insulin pen as well as a glucose metre and a couple of other bits. Best of luck and I hope it gets easier soon.

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#20

That’s really cool! I’m going to check that out. I didn’t know they had a doll like that. That’s really great and she loves playing doctor. All her animals have "boo boos"s and she makes them better so cute. I bet she would love a doll and would help her better understand