Issues in the care of infants and toddlers with insulin-dependent diabetes mellitus.

Infants and children in the preschool age group who have insulin-dependent diabetes mellitus present a unique set of problems to the health care provider and to their families. These management issues include difficulty in achieving maximal metabolic control; the limited ability of the child to communicate feelings and needs; a significant financial burden to many young families; and the increased family stress and altered psychodynamics seen in families with very young children with chronic illnesses. The lability of diet, exercise, emotions, and overall life-style seen in this age group exacerbates each of these problems markedly. This paper addresses the challenges that these children present; discusses the issues and controversies; and describes how the Diabetes Clinic at Michigan State University uses a combination of methodologies and disciplines to deal with these problem areas.