Keeping things simple and concrete
I try to help families by keeping things very simple and very concrete. Maybe writing a daily schedule on a white board, that just lists the time you wake up, when you have a blood sugar check, when you eat breakfast, when you have a shot. There are no rewards attached to it, but everybody is informed about what is going to happen today in terms of insulin and food. Sometimes families find this a helpful tool to help them develop a structure around diabetes. Other times, even this small task feels overwhelming so it becomes important to focus on what will not feel overwhelming and what might work. Diabetes care is very individual to the family.
Jennifer Rein, LICSW, Licensed Social Worker
The most important thing we do is to try to simplify it as much as possible, and we say that we are going to be giving them a lot of information, but that there are a few basic things that we need them to know how to do before we can send them home. When we do send them home, we are going be in daily contact with them to help and continue to teach them so that they don’t feel that they have to understand everything before they go home. As long as they know the skills, we can help them on the other end of the phone line. Another big thing we always to tell them is that diabetes will not interfere with the activities of the child since parents are often concerned with this. Their child can continue doing any sports, any type of activities he or she was doing before. We just have to add some blood sugar checks around it and know how to give snacks.
Christina Luedke, MD, PhD, Physician
Continuous growth and education
I think of the whole diabetes care enterprise as being a training program a continuous and educational experience for the patient. We have to take individuals who may have never heard of insulin, carbohydrates, or any of these things and over a period of time train them to the point where parents of young children and the older children really understand diabetes and can become in a sense their own doctors so that they can take care of themselves in real time. They can make real time decisions about how much insulin to take, what food to eat, how to plan for sport events they want to participate in.
So the physicians, dieticians, and diabetes nurse educators are all educators. Even the mental health professionals are educators because they talk about how to cope with living with diabetes and how to deal with various problems that can arise. The education process begins literally on the day that the child is diagnosed with diabetes. At one time, I held a view that when a patient comes in my office to see me for a routine visit, I want them to understand their diabetes just a little bit better when they leave the office than when they came in to see me. Then I know that the encounter was successful.
Joseph Wolfsdorf, MD, Associate Chief, Division of Endocrinology
Working together as a family
The family environment has an important influence on adaptation of children diagnosed with type 1 diabetes. Managing diabetes in children and adolescents is most effective when the entire family is involved. It is helpful to involve the entire family in diabetes education and lifestyle changes. For example, since the child or adolescent diagnosed with diabetes can no longer drink regular soda, it is important to only have diet soda in the house. If siblings do not think that this is fair, they can be told that they can drink their regular soda outside of the house, but inside the home all of the family members will be eating the same diet. This will encourage a family cohesiveness, which has important implications for diabetes management. Specifically, family environments with increased cohesiveness, decreased conflict, and increased expressiveness are associated with a lower risk of experiencing poor metabolic control.
Lauren Mednick, PhD, Clinical Psychologist