American Diabetes Association Complete Guide to Diabetes: The Ultimate Home Reference from the Diabetes Experts

CHAPTER 20

Family Life and Children with Diabetes

• Family Issues

• Children with Diabetes

It may be easier to eat what you want and to exercise when you want if you live alone, but friends and family still enter into the picture. You need their support and understanding, and they need yours. If you live with others, you need to take their needs into account as well as your own.

People who are most successful at managing their diabetes have the cooperation and support of their family and friends. It helps when you don’t feel alone in meeting the challenge of learning to live with diabetes.

Family Issues

Maybe at first it seems as though you should be able to handle things on your own. After all, your family can’t hold your hand and watch you do everything. It is still up to you to manage your diabetes, right? Yes. But having diabetes is bound to affect your family.

Scheduling, family meals, and exercise plans can become sources of conflict when someone has diabetes. Diabetes affects the whole family. Here, you’ll find strategies for approaching the most frequent sources of tension in families.

Scheduling

Life can be demanding. Finding out you have diabetes may upset the delicate balance of your juggling act. You can’t tend to your 2-year-old when you’re in the middle of giving yourself an insulin shot. Your partner may begin to resent having you check your blood glucose and take insulin just as you’re getting dinner on the table. Sex can lose some spontaneity if you have to eat a snack just when the mood is striking.

One way to enlist your family’s support is to look at your schedule and routines. Probably the best way to approach this is to enlist their support right away.


Tip for Scheduling

It’s often helpful to write down your usual activities or sit down with your day calendar and try to figure out how to best fit it all in.


Tips for Family Scheduling

• Hold a family meeting and explain how important it is to coordinate insulin doses, physical activity, and meals.

• Ask for suggestions as to how your needs can fit into the family routine.

• Perhaps other family members can do a little more, or it may mean enlisting some outside help.

You may already feel stretched to the limit. Planning meals, checking your blood glucose, and physical activity all take time. Don’t be afraid to acknowledge that you can’t do it all and that something is going to have to give.

Family Meals

Scheduling might not be the only change. Maybe you decide to eat or cook differently. Again, open communication will help. Explain that you are not going on a diet and you are not going to force your family into meager eating conditions. The eating recommendations for people with diabetes are basically guidelines for healthy eating.

The key is getting your family’s input. No one likes to be forced into doing something they don’t like to do. Your family can also help with your eating plan. For many people, this is the most difficult adjustment to make after being diagnosed with diabetes.

You may want to change some of the foods you eat and when you eat them. It will help you tremendously if the members of your family are willing to accommodate your new plan.

Common Meal Conflicts

• If you’re trying to lose weight, you may need to eat smaller portions of certain foods or to avoid some high-calorie foods that your family enjoys. If sticking with your meal plan gnaws at your willpower, ask your family not to eat these foods in front of you, to have them less often, or to not always keep them in the house.

• Your family may object to eating different food and may resent eating on a schedule.

• Always remember that eating well for diabetes is not really a special diet, it just means eating sensibly. Whether you have diabetes or not, eating large amounts of sugar, fats, and salt isn’t good for your health.

Physical Activity

Physical activity is also an important part of diabetes management, and your family can participate. Working out benefits everyone, not just those with diabetes. The more you can get your family involved in exercise, the easier it will be for everyone.

Tips for Getting Active with Your Family

• Ask your family to join in! They can walk or jog with you. If not, tell them how they can encourage your efforts.

• Plan family activities that involve some form of physical activity—walking the dog, a nature walk, or a bicycle trip to the corner store.

• An evening stroll or bicycle ride might enhance the quality of life for all family members.

• In addition, helping your children stay fit and at a healthy weight lowers their risk for developing diabetes.

Feelings and Concerns

Let your family know that you might have mood changes. Recognize that your family members will also have feelings about your illness. Learn to talk about your feelings, and try to establish open channels of communication.

Common Feelings and Concerns

• Sometimes you’ll be cranky because of diabetes, and sometimes you will feel cranky because of life’s demands.

• Your family may express their concern for you by frequently asking about your diabetes or trying to pretend it doesn’t exist.

• They may also express their concern by reminding you to take care of your diabetes. It may feel like nagging or that they are becoming the “diabetes police.”

• If any of these become a problem, let your family know how they can express their concern in a way that feels supportive to you.

Learn to work with your family members to talk about how you and they are feeling and what to do about it. Maybe you just need a snack or maybe you need to go for a walk. Or maybe your spouse or children need a break. Recognize when there is a problem, and talk about solutions.

Educate Your Family

Sometimes problems arise among family members when they don’t really understand the disease. If your teenager is grumpy because he has to wait for you to take an insulin shot before you drive him to the mall, it may be because he doesn’t understand how important it is. If your spouse is waving potato chips under your nose when you are trying to cut back, she may not understand the importance of your goal to eat healthily.

Many people think that treating diabetes is as simple as taking insulin a few times a day. Keep in mind that you have the right to ask for the support you need. As a first step, each family member needs to understand what diabetes is, how it is managed, and how to handle emergencies.

Tips for Educating Your Family

• Books, magazines, pamphlets, libraries, support groups, online message boards, and medical professionals can all be of assistance.

• Take a family member with you to some of your health care appointments. By keeping a running list of questions or issues with which they may be concerned, your family can get answers to their questions firsthand.

• Many diabetes education programs encourage family members to attend. The more information they have, the more they can help you and learn to integrate your diabetes management plan into the daily family routines.

Finally, your family should know what to do in an emergency. Make sure they understand the signs of hypoglycemia. Often people with diabetes having a low blood glucose episode will deny that there is a problem or refuse treatment, even though they may be in danger. Make sure your family members can recognize the signs of hypoglycemia and know how to deal with it.

Depending on your family, you can expect different responses to your diabetes and different levels of enthusiasm for helping you work toward your food and exercise goals. Some may join in wholeheartedly, looking at this as a team effort. Other families or family members may resent making changes when they aren’t the one who is sick. You need to find the approach that works best for you. In some situations, you may be better off if you go it alone.

Don’t Forget Your Partner

If you have diabetes, you know that it can take an emotional toll. But you’re not the only one who may feel the stress. Your family members, especially your partner, are likely to share the burden.

The stress on your partner can work two ways. If you shut out your partner completely, he or she may feel isolated and helpless. He or she may feel a need to “rescue” you and resent being left by the wayside. However, if you shift too much of the burden to your partner, he or she may resent having to spend too much effort trying to help you and feel that you should be doing more to help yourself. Many spouses dislike being put in the position of parent or nursemaid.


Talk to Your Partner

Try to honestly share your feelings when neither of you is feeling pressured or stressed out. By sharing your feelings and communicating openly, you and your partner may be drawn closer together rather than driven apart.


Common Partner Concerns

• Your mate may worry when the decisions you make about caring for yourself seem wrong.

• He or she may fear the consequences of what will happen, either in an emergency situation or down the road, if you neglect your health.

• Maybe you feel that your spouse is nagging too much.

• Maybe your spouse feels that you are deliberately undermining his or her efforts to support you.

However you are feeling, it is important for both of you to realize that nobody is perfect. Often many of these feelings are due to love, concern, stress, or fear. It is important to acknowledge that these feelings—and probably many other conflicting emotions—do exist.

You may need help learning to communicate. Admitting this is a sign of strength, not a weakness. Confide in your friends. Speak with your spiritual counselor. Consider seeking the help of professional counselors who are trained in coping strategies for people with chronic disease. Your health care provider may be able to help you find the skilled professional with whom you need to talk.

And finally, don’t forget to lighten up. Humor can help you get through stressful times. Laughter helps lighten the load.

Finding Other Sources of Support

Support is important, so if your family isn’t able to be supportive or you live alone, you may need to look elsewhere for an extra boost. The American Diabetes Association, counseling, group therapy, and even joining a health club can help you find support outside your family.

American Diabetes Association

One place to start is the American Diabetes Association (ADA). ADA can tell you about support and educational groups that you can attend. By participating in these groups, you can meet other people with diabetes and health care professionals. Whether you are seeking more information or want to talk to people who share your experiences, a support group may be just the thing. You may be able to find a diabetes care partner, and you can support each other.

In addition to education and support groups, ADA can mail you a packet of information on request. They can also answer any questions you may have about diabetes or some of the practical issues in managing diabetes: health care, health insurance, and referrals. They also have books, magazines, and other publications that may help.

Message Boards and Blogs

The Internet is often the first place people turn for information—and support. Message boards can help people with diabetes share feelings, concerns, and strategies. With a message board, you can post an anonymous message and receive comments and advice from other readers.

The ADA hosts several message boards where people with diabetes can discuss specific topics, such as type 1 or type 2 diabetes, parenting a child with diabetes, recent diagnoses, and diabetes technology and equipment.

It can also help to read blogs by other people with diabetes—or even launch your own blog. A blog is an online journal where a person makes regular, often daily, postings about their feelings and activities.

Make sure to read material on the Internet with a critical eye. People may post information that is inaccurate or may not be appropriate for your personal needs. Review Internet-based advice that you find on message boards, blogs, and chat rooms with your health care team before you try it.

Health Clubs

You might also consider joining a health club. Although this is a source you may not have considered, developing a diabetes management program really means developing healthy living habits. People who actively participate in the local health club or fitness center may share similar goals, whether they have diabetes or not. The club may even offer a personal trainer, who can be a tremendous help to you. You might also meet other people with diabetes.

Counseling

Sometimes, despite the help of support groups, and even with a supportive family, you might need extra help. Coping with diabetes and all of the feelings that go along with it is not an easy process.

There are bound to be times when you will need extra support. Your friends and family may not have all the skills you need. Also, new issues may arise during the course of your life or the course of your disease.

Whatever your situation, you may want to consider some form of individual or group counseling for those times when you need extra help. It might help to sort out any difficulties with a professional who can be an objective source of support. A professional therapist can help you examine your problems. Depending on your individual needs, you may want individual, marriage, or family therapy.

You might seem a little put off by the idea of seeing a therapist. Maybe it conjures up negative images, or maybe you think seeing a therapist indicates that there is something wrong with your mental state. Nothing could be further from the truth. Counseling is a healthy way of helping people deal with some of life’s difficult problems.

What to Expect from a Therapist

• Counseling involves an ongoing conversation between you and your therapist.

• Your therapist will help you explore your thoughts and feelings and examine how you interact with others and the decisions you make.

• Your therapist may encourage you to tell your story, starting from the beginning. This may help you find a new perspective on the problems in your life and discover the patterns in your actions.

• He or she may also offer suggestions that may help you see the situation from another viewpoint and may help you find new ways of coping.

One of the most important aspects is to find a therapist you trust. You need to feel comfortable with your therapist and feel that he or she is helpful. It often means finding the right personality match. Someone who works well with one person may not necessarily be compatible with someone else. So don’t be too discouraged if the first therapist you see doesn’t fit your needs. You may need to talk to several before you find one who feels right.

Living with diabetes means adjusting to the complex interplay among family relations, personality, emotions, lifestyle habits, and diabetes management. Therapy will help you learn to take the initiative and necessary action to take charge of your diabetes as well as the conflicting emotions that go along with it.

Group Therapy

While some people benefit from one-on-one encounters with a therapist, others gain more from weekly group therapy sessions. Many people find the combination of approaches to be a double benefit. These groups can foster mutual support, encourage camaraderie, and help combat the depression and isolation that often goes along with a diagnosis of diabetes. Sometimes talking things out with other people helps you find fresh solutions.

What to Expect in Group Therapy

• There are many types of settings and formats for group therapy.

• Some meet in hospitals, clinics, community agencies, and even in therapists’ private offices.

• Group therapy should include a trained therapist, a careful selection of group members, and a social structure that includes rules for behavior.

• All therapy groups share the principle that talking about feelings, ideas, and experiences in a safe, respectful atmosphere increases self-esteem, deepens self-understanding, and helps a person get along better with others.

• The group setting gives each member a chance to see how others react to his or her feelings about diabetes and observe how he or she incorporates diabetes into family, work, and play.

Advantages of Group Therapy for People with Diabetes

• It can help you learn that you are not alone.

• You can discuss feelings, worries, and concerns that you may never have dreamed of discussing anywhere else.

• You may discover new approaches to old problems.

• It can help you explore who you are and who you are not.

• It may reduce stress, which in turn may lead to better health.

Children with Diabetes

Any kind of change can upset the family dynamic. How you treat your children and how they interact with each other can be influenced by many factors. Having a child diagnosed with diabetes is a big change that is likely to affect the entire family in ways you never thought possible.

At a time when you, your child, and other children are probably fearful about what the future holds, you will likely be confronted with feelings of anger, resentment, and jealousy upon hearing of a diagnosis of diabetes. While you are trying to gather information and help your child manage his or her diabetes, it is difficult to keep all of the family relationships running smoothly at the same time.

If you have a child with diabetes, your top priority will be to help your child manage the disease while trying to live as normal a life as possible. You will also want to help the rest of the family make a smooth transition into accepting the changes that are inevitable.

Your Child’s Health

The first step in helping your child manage his or her diabetes is to learn all you can. Other chapters in this book and Internet resources are a good starting point (see the Resources section at the end of this book for ideas).

Health Care Providers

Some of the first people you’ll probably talk with are your child’s care provider and diabetes educator. In general, you will need to know how to check your child’s blood glucose, how to give insulin if needed, how to use a meal plan, and how to be physically active.

You will also want to know the extent to which your child can begin to take responsibility for his or her own care. If your child is only 2 years old, it is unrealistic to expect her to give herself insulin or check for blood glucose, but if your child is 10, she may very well be capable of checking her own blood glucose. Children mature at different rates. Some may be ready to give their own injections at age 7, but others may not be able to do it until age 11 or older.

In doing your research and helping your child develop a treatment plan, don’t forget that every child is different. What works for one child may not work for your child. You already know a lot about your child and what will work best for your family.

Your health care provider should take into consideration your child’s age when designing a blood glucose management plan. For example, less stringent goals may be appropriate for younger children.


Health Care Appointments

Try to schedule appointments that are long enough so that all your questions and concerns can be addressed.


Type 1 Diabetes in Children

Type 1 is the most common form of diabetes in children. Children with diabetes are not just “small adults,” and your health care provider should have specific recommendations based on your child’s health and age. The American Diabetes Association also publishes books on raising children with diabetes. However, here are a few things to keep in mind.

Children with type 1 diabetes are at risk for complications such as eye, heart, kidney, and other diseases. Therefore, your health care provider should recommend screening for complications based on your child’s age and family history.

Common Tests for Children with Type 1 Diabetes

• Test for kidney problems, such as annual screening for microalbuminuria in children aged 10 and older (and who have had diabetes for at least 5 years).

• Test for high cholesterol, including fasting lipid profile in children aged 10 or older. Children with a family history of high cholesterol or cardiovascular disease may be screened earlier.

• Dilated eye exam in children aged 10 and older (and who have had diabetes for 3–5 years).

• Celiac disease screening soon after diagnosis.

• Thyroid disease screening at diagnosis.

• Blood pressure assessment.

Blood Glucose Goals for Type 1 Diabetes by Age-Group

Age

Before Meals (mg/dl)

Bedtime/Overnight (mg/dl)

A1C

Toddlers and younger than 6

100–180  

110–200

<8.5%  

School age (6–12)

90–180

100–180  

<8%

Adolescents and young adults (13–19)  

90–130

90–150

<7.5%*

*A lower A1C (<7%) is reasonable if it can be achieved without excessive hypoglycemia.

Type 2 Diabetes in Children

Type 2 diabetes is still relatively rare in children. However, it is becoming more common in minority populations. Children with type 2 diabetes should aim to keep blood glucose levels as close to normal as possible, which may be achieved with food and exercise programs or medication. At diagnosis, children with type 2 diabetes may already show signs of complications, so ask your health care provider about appropriate tests and treatments.

Common Tests at Diagnosis for Children with Type 2 Diabetes

• Blood pressure assessment.

• Test for high cholesterol, such as fasting lipid profile.

• Test for kidney problems with microalbuminuria assessment.

• Dilated eye exam.

Children with type 2 diabetes may be at risk for polycystic ovary disease or problems related to obesity, such as sleep disorders, foot problems, and psychosocial concerns. Ask your health care provider if these problems may be affecting your child.

After you meet with your child’s diabetes care provider, you will also want to meet with a diabetes educator. A diabetes educator can help you learn to coordinate your child’s overall diabetes management plan. This includes balancing your child’s meals with his medication or insulin schedule and physical activities.

You will also want to meet with a dietitian and work out an eating plan. Make sure to take into consideration your child’s likes and dislikes, how your family usually eats, any cultural or religious influences, how to include treats, and how to handle special events.

Tips for Meal Planning

• You will help your child and your family if you all eat the same foods.

• Don’t prepare one dish for the rest of the family and a special meal for your child with diabetes.

• Make sure to involve your child in the meal planning, and ask him what foods he would like to include in his eating plan.

Also talk to your child’s teachers and school officials or day care providers about any special needs your child has. (For more on diabetes at school, see the next chapter.) Once you and your child figure out the daily routine and work out ways to deal with special events and circumstances, you will both feel better about living with diabetes.

Parents’ Attitudes and Feelings

When you first find out that your child has diabetes, you may be overwhelmed with feelings of shock, disbelief, sadness, anger, or even guilt. It can seem so unfair. You may experience self-doubt as you wonder whether you can give your child the care he or she needs. With all the stresses in your life and all the demands on your time and energy, it may seem that you just won’t be able to handle it all.

It can be overwhelming, especially at first. As you learn more about diabetes, you will also learn how to help your child live like any other child. It may take a little work as you figure out how to balance your child’s meals with insulin injections and physical activities. You may find that your child takes it all in stride and that the hardest part may be coming to terms with your own feelings.

Don’t forget that your child is looking to you for guidance. Your attitude will have a direct impact on how your child sees himself and how he or she comes to terms with this new lifestyle. If you take your child’s diabetes in stride, it will be easier for your child to accept it. If you react with anxiety, apprehension, and fear, so will your child.

When you are anxious and concerned about your child, it is tempting to do everything for your child. But even very young children need to have some say in their diabetes care plan.


Be Straightforward

Deal with diabetes in a matter-of-fact way. Don’t downplay your child’s fears or concerns, but address them in a straightforward fashion.


Tips for Encouraging Your Child’s Responsibility

• Let your child assume some of the responsibilities of managing diabetes, such as helping to plan meals or snacks.

• Gradually increase the amount of responsibility your child has. But at the same time, make sure your child is able to take on this responsibility.

• Treat shots and blood glucose checks as givens, with no exceptions. You aren’t really doing your child a favor if you let diabetes care slide.

• The best way to establish diabetes care habits is for them to become a way of life. As soon as your child sees that these are nonnegotiable, he or she will be more likely to cooperate.


ADA’s Family Link

The American Diabetes Association sponsors a program called Family Link, which allows parents to connect with other parents of children with diabetes. It also sponsors events in local communities. This can be a valuable resource for parents of children with diabetes.


Taking Care of the Rest of the Family

If you have more than one child, the time you spend taking care of diabetes is bound to cause some tension in the family. Siblings may feel jealous of the child with diabetes because of all the attention that he is getting. On the other hand, siblings may give your child with diabetes too much attention, and your child may feel like his siblings are on his case. He may feel that everyone is breathing down his neck.

The best way to deal with diabetes in the family is to treat it openly. Explain to the other children and other family members what is happening, and ask them to be patient as you work things out. Even young children can understand simple information.

In general, you will want to treat your child’s diabetes matter-of-factly. Once your child and her siblings come to accept diabetes as a part of your family routine, feelings of anger, jealousy, and fear usually begin to subside.

However, if you continue to experience family turmoil, you might want to consider family counseling. Talk to your child’s provider and diabetes educator for help finding a family counselor.


Make Siblings Feel Special

Try to schedule special times with your other children who may feel left out, or ask if they want a job in the overall care of your child with diabetes. A sibling could help record blood glucose readings, for example.


Your Child’s Changing Role

Just how much you can expect your child to handle with respect to his diabetes care will change as he matures and will depend on his personality. If your child is an infant or toddler when diagnosed, you will be completely responsible for your child’s care. But you can and should still keep him involved. You will have to see that your child gets his shots at the right time, and you will have to check his blood glucose and evaluate the results, but you can give your child a voice.


Giving Toddlers a Choice

If your child takes insulin, maybe he or she can choose the injection spot or the finger to poke. This is a good way for your child to get used to having a say in his or her care. It will help him or her to develop a sense of responsibility, so you can gradually let your child assume more and more of the responsibilities of diabetes care as he or she grows older.


If your child is in preschool, you are still responsible for making sure your child has healthy foods, checks blood glucose whenever necessary, and takes the right type and dose of insulin at the right time. But there is nothing wrong with letting your child begin to take over some of these tasks, with supervision. Insulin pens may make it easier for your child to help with injections.

With your health care team, discuss the developmental stages of your child and when your child can assume some of his or her self-care. As your child matures, he can take on more and more of the tasks. As your child matures during this period, it is essential that she learn to take responsibility for her own care and decisions, because she will often be with friends or at school and out of your watchful vision.

Adolescence is bound to provide the greatest challenges to both you and your child with diabetes. Diabetes is often more difficult to manage due to hormone changes. Children are coming of age and want more freedom. There will be times when your teen resents you and blames you for all the ups and downs of diabetes. This is a normal part of becoming independent and would happen whether or not diabetes was a factor.


Insulin Pumps

You may want to consider an insulin pump. This can give your child much greater flexibility and independence but is also a big responsibility.


Teenage Diabetes Rebellions

• Your teenager may try to rebel by neglecting diabetes care.

• Your child may try to deny the presence of diabetes in an effort to fit in and appear just like everyone else.

• It can be hard to take insulin, count carbohydrates, and check glucose readings at school or when he or she is out with friends.

• It may help to remind your teenager that the best way to fit in and keep diabetes from interfering with life is to keep blood glucose levels on target. A bout of severe hypoglycemia or diabetic ketoacidosis will surely make your child feel different.

It is not uncommon for children and teenagers to feel depressed. Eating disorders, especially among girls, are common. One type of eating disorder among teens with diabetes involves skipping insulin. This allows a person to eat and not gain weight. If you start to suspect that your child is depressed or developing any sort of coping problem, eating disorder, or behavioral problem, seek the help of a professional counselor immediately (see chapter 10 for more on eating disorders).


Tip for Adolescents

You might suggest that your child visit a diabetes educator alone. This gives your child a chance to ask questions and establish a relationship that can be helpful in the future as well. When your child is treated like an adult, he or she may act more like an adult. It is critical that your child understands that it is up to her to take charge of her care.


Diabetes Camp

The ADA sponsors camps for children with diabetes. At camp, kids can make new friends, discover they’re not alone with diabetes, and share strategies for managing diabetes. Visit www.diabetes.org or call 1-800-DIABETES for additional information about camps.


Handling Emergencies

Whether your child is a toddler or a teen, it is important that you, your child, and those close to him be aware of the signs that could signal an emergency. Severe hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose) are both emergency situations. Hypoglycemia can lead to unconsciousness and coma. Hyperglycemia can lead to diabetic ketoacidosis (DKA), a life-threatening situation.

To prevent either situation, learn to recognize the warning signs, check your child’s blood glucose right away, and treat promptly. Talk to your child’s provider in advance about what to do if your child’s blood glucose levels fall too low or rise too high. Make sure your child wears an ID at all times that identifies her as having diabetes.

ID_jewelry.jpg

Hypoglycemia

Recommended blood glucose levels are different for children and adults, because of children’s high risk and vulnerability to hypoglycemia, relatively low risk of complications before puberty, and developmental and psychological issues.

The blood glucose levels at which hypoglycemia is treated are also often higher than the standard recommendations for adults. Any time your child’s blood glucose level falls below the value you have established, he or she may have hypoglycemia. See chapter 8 for more about hypoglycemia, including common signs and treatments.

Hyperglycemia and DKA

High blood glucose levels due to insufficient insulin can lead to DKA. This is a life-threatening condition that requires immediate action. Read more in chapter 8 about symptoms of hypergylcemia and DKA and how to check urine for ketones.


Helpful Websites for Parents and Kids

American Diabetes Association

www.diabetes.org/living-with-diabetes/parents-and-kids/

Children with Diabetes Online Community

www.childrenwithdiabetes.com

 


If you find an error or have any questions, please email us at admin@doctorlib.info. Thank you!