Planning and structure
At the time a child receives the diagnosis of diabetes, everyone feels bad for the child. But there needs to be a lot of planning and structure. Rules and guidelines work easier for some families. It is best to create a systematic approach to maintaining the child’s diabetes–it needs to be built into everyone’s lives. Children need to know why they are doing what they are doing. When you are managing toddlers with diabetes, you should never say you are going to “test” their blood sugar–they aren’t receiving agrade. It is best to say you are going to “check” their blood. It is important for the kid to learn to trust mom and/or dad with decision making. It is also important for parents to call us when they have questions at any time. They should always call.
Maryanne Quinn, MD, Physician
Understanding what is possible for an individual child and family
We try to individualize therapy. I think that is terribly important because for chronic disease management, the non adherence to prescribed treatment is a big challenge. It is all about trying to understand what is possible for an individual child and family. What they are able to accomplish is very important, so I like to think that I don’t judge people. That is not my role. I don’t want to ever have that role. I tell my patients you’re not in a court of law when you’re sitting here and I’m not the judge. I want you to feel comfortable telling me what your concerns are. I recognize that patients come into the doctor’s office and they see us as authority figures and they feel as if they are being judged, so my own style is to try to be empathetic and non judgmental.
We can try to figure out alternative methods and options for managing diabetes. Sometimes there are compromises. Plan ‘X’ may be the ideal, but if you can’t do it then there is no point in you feeling bad, so let’s find out what you can do. It may not give optimal blood sugar control, but it will keep you going for a while and maybe in a year from now you will be able to do more. In the meantime, rather than not take your insulin or come into the office and fabricate the truth, I want you to feel comfortable what you are really doing so that we can figure out the best possible compromise.
Joseph Wolfsdorf, MD, Associate Chief, Division of Endocrinology
It comes down to the parent child interaction
All treatments are tailored to the individual. A lot of this depends on the parent child relationship. It is necessary that the parent and child communicate. For instance, if a teen is on an insulin pump and does not monitor his or her blood sugar, then he or she runs the risk of developing diabetic ketoacidosis. If this teen is unwilling to accept the help of his or her parent, then there could be some problems. Really, it comes down to parent child interaction.
Maryanne Quinn, MD, Physician
Several limits
Overall, parents need to be parents and not friends in this situation. They need to figure out where they can give the child choices, and which ones are not choices. First of all, the child has to learn from the very beginning that it’s time for a shot and they are going to get it. As soon as parents set that limit it helps the child, especially the small ones, to quit resisting because they just learn it is going to happen no matter what. That helps them to know that having a tantrum isn’t going to help the situation. The child feels better knowing this is something he or she can accept and can’t change.
Christina Luedke, MD, PhD, Physician
Interventions for children and adolescents
The most important intervention that I can provide for a child or adolescent with diabetes is introducing them to other children or adolescents diagnosed with diabetes through support groups, camps, or individual meetings. These encounters help to increase feelings of normalization, decrease isolation, and increase social support.
Lauren Mednick, PhD, Clinical Psychologist
Diabetes impacts the entire family
For certain, diabetes impacts the entire family. It is dependent on the age of the child. It will be different if the child is very young and is absolutely dependent on the parents. Older children, certainly teenagers, participate in their own self care. The research shows and my own experience certainly confirm that youngsters who have the support of their parents and family do better because this is a heavy physical and emotional burden. So if you have a cohesive, loving, warm, supportive family helping you, you’re going to do better.
Joseph Wolfsdorf, MD, Associate Chief, Division of Endocrinology
Parents’ attitudes make a major difference
Parents’ attitudes make a major difference. If parents feel guilty about having to prick their child for blood sugars or for insulin, the children pick up on this and as a result those kids may not test their blood sugar enough and may not give themselves enough dosages of insulin when needed. Once someone has backed off on blood sugar checks, which is our major tool for knowing how to treat them, it is very hard to get them to increase how many times they check their blood sugar. If this is the case, every time they come back for an appointment I say, “add one more check, one more a day.” I keep on saying the more the parents set the tone and help take this responsibility of the kids, the better.
Christina Luedke, MD, PhD, Physician