Chapter VIII The Family and DiabetesTHE CHILD WITH DIABETES As part of the health care team, it is partially up to the caregiver to help the family and the child accept his or her diabetes with a minimum of stress. The American Diabetes Association and the Juvenile Diabetes Foundation can be of great help. Other parents who have faced the same problem and learned to cope with it are more than willing to share ideas and advice. It is important to help the family learn to protect without dominating to supervise while encouraging self-care. It is important to work with the child and the parents for the best control, but to help them understand that “ideal” control is not always possible. The Child’s self image and self-esteem are threatened by diabetes. Encourage the parents to be understanding and supportive. No child can be expected to assume complete responsibility for diabetes control at a very early age. Ultimately, responsibility for eating properly, injecting insulin, testing blood sugar and planning exercise will be the child’s responsibility. Avoiding unnecessary anxiety about “cheating” and guilt feelings is essential in order to help the child develop the maturity, independence self control, and self esteem needed as the child learns self-care. The parent’s role changes as the child grows. The role of the parent changes as the child grows. Every child is different but there are some things that remain the same. A child with diabetes is a child first, and a child with diabetes second. Accept, love, teach, discipline just as you would a child without diabetes as a factor. Remember that by overprotecting or overindulging, the child might develop feelings that reinforce feelings of inadequacy and over-anxiousness. Birth through 7 years The parent has full control of all responsibilities during early childhood. It is important for the parent to involve the child at an early age. In order to start the process of developing self-reliance, offer the child some choice in his/her care such as picking out the spot to inject or selecting which finger to get a drop of blood. Parent approval is always important, be sure to describe results as high, low or normal, and not in terms of good or bad. 7 years through 12 years During this time of the child’s life, the child can assume more responsibility for his/her own care. The child can take over blood glucose testing and insulin injections some of the time. By the age of 12, most children can manage their own injections. It is important for the parent to remind the child of his newly assumed responsibilities. Once again by encouraging the child to participate in his/hr own care the child learns to become independent and self-reliant. 12 years through 17 years By the time the child reaches adolescence, it is essential that the child be permitted to participate in treatment decisions. Even with a child that is educated about their disease process, adolescents may act as if they did not have diabetes. This includes ignoring their diet and falsifying blood sugar tests. Depression is common at this time and contacting a professional counselor might be helpful. It is important that the child understand that people with diabetes live full lives. 17 years through 20 years At this age the child will begin to mature in attitude and responsibility. By setting realistic goals, and by educating the child about their disease process all through childhood, the child by this time has progressed from dependence to independence and self-reliant. Physical Education and Sports It is essential to remember that exercise is an important factor in diabetes control. With some planning, a child with diabetes may enjoy all the benefits of physical education and sports. If the child has gym class before lunch, increase the morning snack of carbohydrate and protein. If the child has a late gym class or participates in after-school sports, increase the afternoon snack. Make sure the child understands to carry fast acting sugar at all times. It is also important for the child’s gym teacher or coach to know how to be of assistance if the child needs help in case of a reaction. Parties Diabetes is no reason for missing out or not being able to enjoy social occasions with friends as long as a few simple rules are followed. If there is a social occasion pending, plan ahead by saving some food exchanges from dinner. Bring diet soda or make sure to drink only diet soda at the party. Choose foods carefully and replace calories used for dancing. Through trial and error and with the help of blood testing, the teen will learn how many calories to replace, and always carry fast acting sugar. School School personnel should be informed that a student has diabetes. Teachers, coaches, school nurse and other school personnel need to understand what having diabetes means and how they may assist the child if a reaction occurs. By giving the school personnel a concise overview of diabetes, this will help school personnel cope with the child’s special needs. It is advisable to prepare a written plan, which should include the following information:
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