The difference between Types I and II Diabetes
Type I diabetes is insulin dependent diabetes and type II diabetes is insulin resistant diabetes. Sometimes kids have a hard time understanding the difference between the two. For younger children, I often explain it this way: with type I diabetes, your pancreas just wakes up one day and decides “Well, I’m not going to work anymore, and that’s that.” So your body becomes dependent on this insulin and the way that we need to give you insulin is through injections. Type II is a little bit different. Type II is predominantly a lifestyle based illness. With type II diabetes, your pancreas just gets really, really tired. It doesn’t necessarily stop working, but whatever insulin is being produced is just not working right for your body. That is why you have to take either pills or you may need to have insulin injections.
Jennifer Rein, LICSW, Licensed Social Worker
Correcting misconceptions about Type I Diabetes
Younger children often believe that they did something to cause their type I diabetes. Some children believe that eating too much sugar caused their diabetes. It is essential to correct this misconception and reassure children that their diabetes is something that their body was born with and has nothing to do with what they did or how they behaved. With each developmental milestone, children will understand their diabetes, its treatment, and the role they play in taking care of themselves in a new way. As their cognitive understanding of their illness grows, it is important for children to be encouraged to ask questions.
Lauren Mednick, PhD, Clinical Psychologist
The rise of Type II Diabetes
I think this is a natural disaster of proportions so major that we now are seeing it being echoed around the world as people eat more like us, or more of our food. Who would have thought that it would be a plague in India, where historically people of a nation like India could not have had this problem because of its economic and nutritional situation? Within our own country, diabetes type II is not limited anymore to the people who were considered to be high risk, like the Native American, African American and Chicano populations. Imagine what the rates of diabetes II will be like in a few years since 72 million Americans are now obese. When I was an Endocrinology Fellow in the mid 1970s, we saw 2 3 newly diagnosed Type II Diabetes patients a year. We now see that many each week and have a special clinic for them. The thing is that this is all preventable. It’s all preventable.
Norman Spack, MD, Physician
Discussing diabetes with preschoolers
The amount of involvement in discussions and treatment is different for different age groups. Due to their immature reasoning skills, preschoolers engage in several errors in logic that need to be considered when speaking with them about their diabetes. First, preschool age children often demonstrate magical thinking and egocentrism in which they believe that they did something which caused their diabetes. In addition, preschool age children think in a very literal, concrete manner. It is therefore essential to provide them with very simple, minimally confusing explanations about diabetes and the need for treatment. It is also very important for young children with diabetes to be reassured that their diabetes and its treatment is not a punishment for poor behavior and more importantly, they did nothing to cause their diabetes. An easy way to assess for misconceptions in preschool age children, as well as school age children, is to ask the child to repeat back explanations and listen for and correct any errors.
Lauren Mednick, PhD, Clinical Psychologist
Discussing diabetes with school aged children
As children grow developmentally, their definition of diabetes and understanding of its treatment will also mature. School aged children will have many questions and concerns. It is important to provide basic, non threatening explanations about their diabetes and the consequences of not following their recommended treatment regimen. In addition, school age children will still need help with many of the daily diabetes related tasks, but this does not mean parents should do everything for them. In fact, this is a perfect age for working together and helping the child start to develop problem solving skills related to treatment. For example, when a child checks his/her blood glucose and he/she has a high or low, the parent can assist him/her to determine the steps he/she needs to take to correct for this. Joint problem solving and modeling will provide the tools necessary for more independence in adolescence.
Lauren Mednick, PhD, Clinical Psychologist
Discussing diabetes with adolescents
Adolescents need the most sophisticated information and are typically involved in most conversations with medical staff and decisions concerning treatment. Abstract thinking is a hallmark of adolescents and many teenage children will be asking many “why” questions and experience concerns about the future. Whether newly diagnosed or diagnosed with diabetes for many years, adolescence is the period of time which has been most consistently linked with adherence difficulties. Open communication between parents and teenagers about daily treatment regimen behaviors has been shown to improve adherence.
Lauren Mednick, PhD, Clinical Psychologist
Navigating the adolescent years
There is a period when kids are young enough that they do what they’re told to do. They’re easier to get along with and their diabetes is easy to control. Then during the adolescent years, parents and kids have to navigate the whole process of adolescence, which is normally a period of exploration and of challenging authority. The regimentation and restrictions of diabetes back up against the natural biological process of adolescence. Taking risks and doing crazy things can sometimes be very dangerous if you have diabetes, and parents worry terribly about that during that period. Another time that parents particularly experience a lot of stress and anxiety is when the child eventually finishing high school and moving on to college. Up to that point the teenager may have been managing the diabetes largely independently; however there is still a sense that there is a safety net. Once they go off to college, who knows what they are going get up to. If something goes wrong, who is going to recognize it? Who is going to be there for the child?
Joseph Wolfsdorf, MD, BCh, Associate Chief, Division of Endocrinology
Diabetes and alcohol experimentation
Being a teenager with diabetes is doubly challenging because there are some things that your family, school nurse or your doctors really need to be told about, that teenagers often keep to themselves. For example, experimentation with alcohol. Experimenting with alcohol is quite dangerous for a teenager with diabetes. It’s important for the medical team to educate teenagers about risk taking behaviors so that they know how to take care of their diabetes in a variety of different situations. The risk factors with alcohol are many you go “low” when you drink alcohol and many teenagers are not aware of this fact. Also, the more alcohol you drink, your inhibitions relax and the less the less responsible or cognitively aware you become. So maybe you do need a shot or you need to check your blood sugar, but you think that you don’t.
Jennifer Rein, LICSW, Licensed Social Worker