8 ways to protect children with diabetes from COVID-19

We know how frightening the spread of the 2019 novel Coronavirus (COVID-19) may be for parents – especially parents of children with diabetes.

The good news is that for children with diabetes, there is no evidence this virus will be any different than most other viral respiratory illnesses. As always, an illness will require increased glucose monitoring, possible ketone testing, and increased attention to insulin and carbohydrate intake.

If any person with diabetes gets sick — from any cause— CHOC Children’s endocrinology department recommends the following:

  1. If you are using a glucose meter, check your glucose more often, every two to three hours at minimum.
  2. If you are using a continuous glucose monitoring, or CGM, device such as DexCom or Libre, review the data from your continuous glucose every one to three hours to monitor for trends and adjust your insulin/food intake.
  3. If you are on injections, always take your long-acting insulin (such as Lantus, Levemir, Tresiba or Basaglar), even if you are eating less. If you are experiencing overnight lows, you can decrease your dose by 10%. For example, if you use 20 units nightly, then decrease down to 18 units, but if you need to decrease further for continued low blood glucose values, please contact your provider.
  4. If you are using an insulin pump, continue to wear the pump for basal insulin.
  5. Continue to stay hydrated by drinking lots of fluids.
  6. Check for ketones if glucose readings are higher than 300 for more than three hours.
  7. If you have moderate or large ketones, especially if you are vomiting, contact your provider.
  8. Ensure you have your diabetes supplies, and that you are not close to running out.

For type 1 diabetes–specific topics related to COVID-19, please visit JDRF.org/coronavirus.

CHOC’s endocrinology department continues to offer on-site office visits, but if you or your child is sick, please stay home and notify us that you will not be attending the visit. Our team will work with your family on alternative arrangements if you cannot make it to your scheduled visit.

CHOC endocrinology can be reached during daytime hours at 714-509-8634. During evenings and weekends, call 714-765-7679.

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7 ways to help kids cope with coronavirus (COVID-19) anxiety

If the ongoing spread of coronavirus (COVID-19) is causing anxiety, stress and uncertainty for grownups, consider how troubling it may be for children.

Depending on their age and media exposure, children may know more about the virus than grownups think. And even if unaware, children still might sense tension and anxiety from adults around them.

Here, CHOC Children’s pediatric psychologist Dr. Sabrina Stutz offers seven things parents can do to help reduce their children’s anxiety about COVID-19.

Meet children’s concerns with validation, compassion

  • Listen carefully to their concerns and learn where they heard their information. Validate their fears by saying something like, “It can be frightening when a new illness comes around that we don’t know everything about.”
  • Gently correct any misconceptions they may have heard and encourage them to continue to ask questions.
  • Maintaining a routine can provide children a sense of security. Keeping a usual schedule – including school, activities and chores – will protect mental and physical health.

Stick to developmentally appropriate facts

  • ​Avoid having adult-level conversations about COVID-19 around children. Similarly, carefully monitor children’s exposure to media reports about the virus.
  • Answer questions with brief, developmentally appropriate explanations. For example, you might tell a young child, “coronavirus is a new type of cold/flu, and so it is important for us to wash our hands more and sneeze in our elbows to keep healthy.”
  • Remind children that doctors and other experts around the world are working hard to stop the virus. This can help kids understand that smart, capable people are taking action.

Reassure kids by empowering them

  • Telling kids how they can help provides a sense of agency and can turn anxiety into an actionable goal.
  • Reassure children that they can protect themselves and others by practicing proper hand-washing and cough etiquette and taking other healthy steps.
  • Kids can also be included in other family-wide preparations. For example, if you were preparing for the possibility of being home for a while, ask the child what they might want to snack on or what activities they might enjoy during that time.

Look for kid-friendly methods

  • Make learning about hand-washing and other preventative measures fun. Help kids learn about germs by giving them some lotion and then sprinkling glitter on their hands. Tell them the glitter is like germs, and then ask the child to try to wipe it off with a paper towel or just water. They won’t get far! Then you can explain how soap and warm water removes the glitter – and germs – best.
  • Teach kids how long to wash hands for by singing a 20- to 30-second song together. “Happy Birthday” or the “ABCs” are classics. You can also be creative and estimate 20-to-30 seconds of any song the child likes.

Emphasize kindness

  • As always, it is helpful to teach kids to continue to be kind to all people, regardless of their country of origin or their appearance. Kindness is always possible – even when they feel afraid.
  • To help children more realistically assess risk, educate children that most people who visit the doctor or wear a mask probably don’t have the virus.
  • It is important to remind children that we are all trying our best to stay healthy and it’s not anyone’s fault if they do get sick.

Remember to model positive behavior

  • Parents who show good coping skills can help reassure kids that they are safe. After all, kids learn from their parents how to react in new situations.
  • Remember that kids make mistakes. If your child accidentally does not wash their hands or doesn’t sneeze into their elbow, gently remind them. Scaring children with the potential consequences of their mistakes is not helpful.
  • Adults should model self-care behaviors: Maintain activities and sleep schedules. Eat healthfully and practice hand hygiene and cough etiquette.
  • It’s also helpful for grownups to limit their own media consumption around coronavirus (COVID-19) and stick to a few trusted resources such as the Centers for Disease Control to prevent information overload and anxiety.

Watch for behavior changes

  • Changes in a child’s sleep, appetite, interest in being with friends or leaving the house, or levels of reassurance seeking, as well as excessive hand-washing can be signs that more help is needed.
  • If basic stress reduction techniques like deep breathing, distraction or guided imagery don’t help, reach out to your primary care provider for additional support.
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