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Home > Knowledge & support > Guide for parents and carers > Managing your child’s type 1 diabetes > Managing type 1 diabetes in children with neurodiversity > How can ADHD affect a child’s type 1 diabetes management?
Impulsivity is one of the most common aspects of ADHD, especially if someone is predominantly hyperactive. This can make managing type 1 difficult. A child with ADHD and type 1 may struggle to say no to a high carb snack, engage in behaviour that is not safe (such as not stopping in PE when hypoglycaemic) or bolusing too much out of frustration.
Hybrid closed loop technology (HCL), which sends reading from a continuous glucose monitor (CGM) to tell an insulin pump how much insulin to deliver, can be really helpful for children who are impulsive. However, HCL still needs to be closely monitored by their parents. If using HCL, make sure your child knows that they still needs to tell the pump how to operate.
Although more commonly associated with autism, recent research shows that children with ADHD report similar levels of sensory sensitivities.
Read more about using type 1 technology with neurodiverse children.
Interoception is the internal sense we have of our body. People with ADHD can find it difficult to recognise how their body is feeling. When managing type 1 it can affect how someone can tell their blood glucose is going high or low.
Type 1 technology, like CGMs, can help. CGMs use alarms to alert someone if their glucose levels are going too high or too low. However, a child with ADHD may be distracted after an alarm or hyper focused on an activity and ignore it.
Most CGMs have software which allows others involved in a child’s care to be alerted at the same time as the child, such as Dexcom Follow. At school, responding to high and low glucose levels should be part of your child’s individual healthcare plan.
Difficulty focusing can make it difficult for a child to manage type 1.
This might be forgetting to restart an insulin pump after changing it, forgetting to eat after a bolus injection, or forgetting to inject after an unplanned snack.
Children with ADHD can often lose or forget things. They may find themselves in situations without spare kit or hypo treatment. It can also be difficult for children with ADHD to keep to a routine, because they may find them frustrating, boring or simply forget to do them.
Ask your support network and the people involved in your child’s care to keep spares, whether it be in a childminder’s car or the school nurse’s office.
‘Habit chaining’ is where you group together activities so that doing one activity triggers a reminder to do another. For example, you can ‘chain’ putting supplies in your child’s school bag with dinner, so it becomes part of what they do after dinner time.
Identify where there are regular areas of forgetfulness. Use post-it notes or phone reminders where you can to address these. For example, a post-it note in the snack cupboard to remind your child to inject before eating. But be aware that you may have to change how you do this regularly.
Hyperfocus is when someone is fixated on what they are doing. Doing anything outside of the fixation can feel uncomfortable and meaningless. It can last for hours and even sleeping or using the toilet can go ignored.
This means that tasks related to type 1 management can be ignored, such as responding to CGM or insulin pump alarms, taking a regularly scheduled injection or eating. It might be that the child needs extra supervision during these periods to ensure their safety.
For most people, there are generally signs when they entering hyperfocus. Learning to recognise these and managing type 1 tasks in advance, such as changing pumps, can reduce the risk of those tasks being ignored later on.
Type 1 requires a lot of organisational skills. Planning when to eat, exercise and inject can be challenging people who have ADHD. This can become more apparent as children with both conditions mature and take more responsibility for their type 1.
Putting alarms and charts in areas that can’t be ignored are useful, such as next to the bathroom mirror or on your child’s gaming computer.
Combining action or inaction with an immediate consequence or reward can also help. Keeping different elements of diabetes management around the house can also be useful, for example keeping hypo treatments or supplies in several dedicated spaces across the house to reduce the number of steps your child needs to take to manage their type 1.
Many people with ADHD say that they swing between feeling able to do anything and being completely overwhelmed. Children and young people with type 1 can go experience this with their diabetes management. This can result in having a lower time in range. Feeling incapable can also cause a lot of shame and guilt for young people.
Technology like hybrid closed loop (HCL) can significantly reduce feelings of overwhelm or burnout.
Reducing ‘cognitive load’ can be very useful at these times. Cognitive load is the number of things we have to think about at any given time. ADHD and type 1 are both conditions that can effect our executive function (our mental skills such as memory, flexible thinking, and self-control), so reducing your child’s cognitive load can help their executive function.
Think about ‘bare minimum’ needed. What are the things that really need to be done and how can you help your child do these tasks? For example, can you help them get ready for school, prepare a carb counted lunch or help with homework? Consider cancelling any events they don’t need to attend. You can also reduce cognitive load by providing low or no carb snacks which means they don’t need to calculate boluses or inject (keeping them separate from hypo treatment), allowing them to engage in a mindless activity they enjoy, and giving them extra emotional support.
Avoiding extra pressures or demands can also help relieve overwhelm and burnout and help your child recover more quickly.
It is common for people with ADHD to struggle to manage their emotions, known as emotional regulation. This can show as emotional outbursts, inappropriate emotional responses and hypersensitivity to criticism (sometimes known as rejection sensitive dysphoria).
When managing type 1, this can lead to arguments with parents and caregivers and difficult relationships with healthcare professionals.
Having a non-judgemental space where children with ADHD can express their emotions can help. Try and be sensitive in how you talk about their type 1 management. For example, encourage your child to see glucose readings as data, rather than anything with a value judgement like ‘good’ or ‘bad’.
There is also emerging evidence that time outside in nature can significantly help with ADHD symptoms, as well as regular exercise. Read more about managing type 1 with exercise.
ADHD is a disorder in executive function, which is a set of mental skills like memory, flexible thinking and self-control. Executive dysfunction can make it difficult for someone to do things like plan, follow instructions, pay attention to details and manage their time. Hyperglycaemia also causes executive disfunction. If your child has ADHD and is struggling with high blood sugars at the same time, it can strongly impact their executive function.
This doubling up of executive dysfunction (known as global dysfunction) makes it difficult to manage type 1, a condition that requires lots of the mental skills that people with ADHD can find difficult. Children may struggle to regain control of their attention, thoughts and diabetes management.
If your child is experiencing this, they will benefit from seeing a specialist psychologist.
There is some evidence that children with type 1 who take medication for ADHD find diabetes management easier and have better HbA1c levels, time in range and reduced emergency admissions to hospital.
Technology like HCL (hybrid closed loop) can also help automate much of your child’s type 1 management, reducing the burden on their executive function.
You can discuss these options with your Diabetes Healthcare Team and other healthcare professionals involved in your child’s care.
This content was created by Dr Jacq Allan, Psychologist: Children’s Diabetes Team. It has been reviewed by ADHD UK. It does not constitute medical advice, always speak to your child’s Diabetes Healthcare Team if you need support with their T1D care.
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