Questions 39–41
These questions refer to help with dressing, personal care and getting around indoors. Children with diabetes do not usually have difficulties in this regard over and above the needs of others their age. Tick ‘no’.
Question 42
Encouragement, prompting and physical help to eat during the day.
Tick ‘yes’ and complete the ‘eat’ box as relevant. In the box for further details provide information about eating sufficient amounts of carbohydrate, weighing foods and calculating the carbohydrate content of meals. Explain the consequences of getting this wrong. Also include information about getting a child to eat or drink when hypo and the difficulties that can be involved with this as well as encouragement to drink enough fluids when blood glucose levels are high. If your child has coeliac disease then you can also include the encouragement needed to make the right food choices and importance of it.
Question 43
Encouragement, prompting and help to take medicine or have therapy.
Tick ‘yes’ unless your child does this independently with no prompting.
Fill in every box below. ‘Do their therapy’ includes blood glucose monitoring. When thinking about how often this is required include all routine injections and correction injections. If on a pump include all bolus doses and correction doses. Also include setting temporary basal rates or switching between basal patterns.
In the additional information box provide as much detail as possible. This should include any difficulties caused by distress or discomfort and encouragement to rotate injection/insertion sites. Include pump infusion set changes and connecting CGM. Detail any times when this may be more difficult such as when hyper or hypo or at times of illness or very active days. Remember testing for ketones when levels are high or at times of illness.
Questions 44–47
These questions are about hearing, eyesight and communication. These things do not generally apply to children with diabetes. Tick ‘no’.
Question 48
Fits, seizures or similar.
Tick ‘yes’. In the box below write hypos and explain what happens.
Complete the tick boxes as relevant to your child, where you see the word ‘fit’ think hypo.
In the box at the bottom of the page provide any further relevant information such as comforting any feelings of anxiety or distress. If your child’s hypo awareness varies, provide details of this here too. Also explain the consequences of leaving a hypo untreated.
Question 49
Do they need to be supervised during the day to keep safe?
If your child needs to be observed for hypo symptoms, due to either their age or lack of awareness, tick ‘yes’. Answer the remaining questions as relevant to your child thinking about how they behave when hypo. Explain in the space provided, how it could affect them or others if a hypo occurred without supervision and what the outcomes of not treating it could be.