Table 6

DSME content based on life stages

Infancy (birth–18 months)
 Period of trust versus mistrust
 Providing warmth and comfort measures after invasive procedures is important
 Feeding and sleeping or nap routines
 Vigilance for hypoglycemia
Play age (3–5 years)
 Reassurance that body is intact, use of Band-Aids and kisses after procedures
 Identification of hypoglycemic signs and symptoms (temper tantrums and nightmares are common)
 Include child in choosing injection and finger-prick sites
 Positive reinforcement for cooperation
 Begin process for teaching child awareness of hypoglycemia
School age (6–12 years)
 Integrate child into educational experience
 Determine skill level
 Identify self-care skills
 Determine roles and responsibilities
 Communication with peers and school staff—who and when to tell about diabetes
Adolescence (12–18 years)
 Begin transition care planning
 Personal meaning of diabetes
 Determine roles and responsibilities in care
 Social situations and dating
 Who or when to tell about diabetes
 Driving
 Sex and preconception counseling
 Alcohol and drugs
 College and career planning
Young adults
 Personal meaning of diabetes
 Roles and responsibilities in care
 Social situations and dating
 Who or when to tell about diabetes
 Genetic risks, conception, and preconception
 Travel
 Choosing or pursuing a career
 Workplace rights
 Health or life insurance
 Involving friends and significant others in diabetes care
 Safety
 Creating a support network
 Establishing or maintaining independence
Middle-aged adults
 Personal meaning of diabetes
 Roles and responsibilities in care
 Involving spouse or significant other in care
 Sexual functioning
 Developing a support network
 Travel
 Pursuing a career
 Workplace rights
 Health or life insurance
 Talking with children or other family members about diabetes
 Balancing other responsibilities with diabetes care
 Safety
 Facing complications
Older adults
 Personal meaning of diabetes
 Roles and responsibilities in care
 Maintaining independence
 Obtaining assistance with diabetes care tasks
 Involving spouse or significant other in care
 Travel
 Talking with adult children or other family members about diabetes
 Safety
 Assessing for declines in ability to perform self-care/activities of daily living
 Caring for diabetes along with other chronic illnesses or comorbidities
 Obtaining health care when living in multiple locations
 Community resources
 Care of type 1 diabetes in long-term or other care facilities