Common Issues Seen in Paediatric Diabetes Clinics, Psychological Formulations, and Related Approaches to Management

Table 1

Various developmental aspects and their impact on diabetes management.

Developmental change	Results	Possible impact
Physical	(i) Small body size; (ii) Rapid growth; (iii) Progress in developmental milestone	(i) Small insulin doses, might need insulin dilution; (ii) Close follow-up for adjustment of doses
Behavior	(i) Erratic eating behavior; (ii) Altered sleep pattern	(i) Need of multiple insulin dosing; (ii) Risk of insulin stacking; (iii) Inconsistency of meal timing; (iv) Flexibility on glucose monitoring is required
Moral	(i) Judgment based on personal preference	(i) Difficulty in cooperation with treatment form of injection and monitoring
Emotional	(i) Sense of self and others	(i) Acceptance of carers providing the treatment might be difficult
Cognition & comprehension	(i) Understand dynamics and surrounding; (ii) Acquire language; (iii) Learn and expand expression	(i) Expression of symptoms; (ii) Expression of wish or refusal of treatment
Social	(i) Interactive play; (ii) Playgroup and preschool attendance	(i) Involvement of other personnel in the care of diabetes
Role & responsibility	(i) Majority of care by parents with variable involvement	(i) Gradual involvement of care
Incentive concept	(i) Immediate incentive expectation	(i) Possible expectation of regular rewards to routine management procedure
Learning	(i) Acquiring physical and mental skills	(i) Need to adapt a management change in parallel to the developed skills