By:
Jayne Chatterton, RN, CNP, CDE
Jill Campbell, MA, RN, CDE
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• Diabetes self-care is vital for optimal diabetes management and to reduce the risk for complications
• Diabetes is a family disease
• Shared responsibility and support of diabetes management is linked to better outcomes (Helgeson,
2008; Wysocki, 1996)
• You are the expert on your child and his/her diabetes
• The roles and responsibilities of diabetes cares changes throughout child growth and development
• Understanding growth and development is an important factor in determining the roles and responsibilities of diabetes cares
• Each child is an individual
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• Overview of Stage
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Building trust with caregivers
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Explore environment
• Caregiver completes all diabetes cares is responsible for diabetes management
• Role of caregiver
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Make child feel safe
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Comfort and console
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Educate others
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• Overview of Stage
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Motor and brain development
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Language development
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Thinking and problemsolving
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Child may respond better to limits
• Caregiver completes all diabetes cares and is responsible for diabetes management
• Role of caregiver
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Reassure child
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Incorporate diabetes into daily life
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Provide clear and simple directions/explanations
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Set limits
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Give time and space for thinking and processing
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1.
• Overview of Stage
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Imaginative thinking
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Concrete thinking
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Development of individual identity
• Caregiver completes all diabetes cares and is responsible for diabetes management
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Give child choices regarding diabetes cares
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Discuss body sensations
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Develop games around diabetes
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Affirm and praise child
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Answer questions
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• Overview of Stage
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Logical thinking
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Cause and effect
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Beginning to think about past and future
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Master situations
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Acceptance of peers important
• Strong caregiver involvement and ultimately responsible for diabetes cares and management
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Parental involvement strong in early years, moving toward shared responsibility, and adjust to more supportive care
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Set rules: be clear about who is responsible for what
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Teaching child about diabetes
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• Shared responsibility is linked to better diabetes outcomes, management and self-care (Helgeson,
2008; Wysocki, 1996)
• Diabetes cares by age
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Help with testing blood sugars around ages 8-10 years
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Help with insulin injections/boluses around ages 10-11 years
• Avoid too much responsibility too soon to avoid diabetes burnout
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Children (ages 6-11) are not able to fully understand diabetes and complete cares on their own with out adult involvement
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• Overview of Stage
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Develop independence from parents and sense of self
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Aware and focus on body image
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Acceptance of peers
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Changing priorities
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Self-care transferred to teen
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Limited long-term thinking
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Independence with diabetes cares takes a long time
• Diabetes cares largely completed by teen
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Parents remain involved and assist
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Shared responsibility between teen and parent
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Parent role is to help, provide support, stability, set limits
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Verify cares are being completed
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Reminders to assist with increasing independence
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Diabetes re-education
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May be difficult to ask for help if expectation is set
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• Overview of Stage
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Independence from parents
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Forming strong relationships with others
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Moving out, college, starting career
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Self-care management
• Diabetes cares and responsibilities are completed by young adult
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Check in as needed or as asked
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On-going support
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• “I am just too busy to think about diabetes.”
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How do you balancing multiple priorities?
 School, friends, job, after school activities, homework, etc.
 Parents keep diabetes in the balance, may not be as important to the child
• “I don’t like to give shots in front of my friends.”
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How do you approach embarrassment of completing diabetes cares in public or around friends?
• “I don’t know why, I just forgot.”
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How do you manage forgetfulness?
• Other complicating factors: ADHD, depression, anxiety
• Other chronic health conditions
• “I am just sick of diabetes!”
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How do you support your child, teen or young adult through diabetes burnout?
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• Assertive care vs. supportive care
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Assertive care: parent completing diabetes cares
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Supportive care: parent supporting child/teen as they complete cares
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There may be times to provide assertive care to child, teen or young adult: illness, burnout, increased A1c
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• Set realistic goals
• Discuss Rules:
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Negotiable rules: when to test blood sugar, who administers insulin
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Nonnegotiable rules: testing blood sugar, taking insulin doses
• Regular check-ins with child, teen or young adult: 5minute meeting, regular review of meter and/or pump
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• Shared responsibility of diabetes cares
• Encourage and empower: set your child, teen or young adult up for success
• Discuss thoughts, feelings and understanding related to diabetes
• Remember: transition of diabetes cares and responsibility is a process that takes time, reminders, support
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• Support Groups
• www.typeonenation.org
• www.childrenwithdiabetes.com
• http://justforparents.behavioraldiabetes.org
• http://hscweb3.hsc.usf.edu/studentswithdiabetes/
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• Chase, H. & Maahs, D. (2011). Understanding Diabetes: a handbook for people who are living with diabetes. Barbara Davis Center for Childhood Diabetes.
• Christian, B., D'Auria, J., & Fox, L. (1999). Gaining freedom: self-responsibility in adolescents with diabetes.
Pediatric Nursing, 25(3), 255.
• Dovey-Pearce, G., Doherty, Y., & May, C. (2007). The influence of diabetes upon adolescent and young adult development: a qualitative study. British Journal Of Health Psychology, 12(Pt 1), 75-91. doi:10.1348/135910706X98317
• Hanna, K., & Guthrie, D. (2000). Parents' perceived benefits and barriers of adolescents' diabetes selfmanagement: part 2. Issues In Comprehensive Pediatric Nursing, 23(4), 193-202.
• Helgeson, V., Reynolds, K., Siminerio, L., Escobar, O., & Becker, D. (2008). Parent and adolescent distribution of responsibility for diabetes self-care: links to health outcomes. Journal Of Pediatric
Psychology, 33(5), 497-508.
• Kelo, M., Martikainen, M., & Eriksson, E. (2011). Self-care of school-age children with diabetes: an integrative review. Journal Of Advanced Nursing, 67(10), 2096-2108. doi:10.1111/j.1365-2648.2011.05682.x
• Lowes, L. (2008). Managing type 1 diabetes in childhood and adolescence. Nursing Standard, 22(44), 50.
• Roper, S., Call, A., Leishman, J., Ratcliffe, G., Mandleco, B., Dyches, T., & Marshall, E. (2009). Type 1 diabetes: children and adolescents' knowledge and questions. Journal Of Advanced Nursing, 65(8), 1705-
1714. doi:10.1111/j.1365-2648.2009.05033.x
• Schilling, L., Grey, M., & Knafl, K. (2002). The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis. Journal Of Advanced Nursing, 37(1), 87-99. doi:10.1046/j.1365-2648.2002.02061.x
• Williams, C. (1999). Gender, adolescence and the management of diabetes. Journal Of Advanced
Nursing, 30(5), 1160-1166. doi:10.1046/j.1365-2648.1999.01168.x
• Wysocki, T., Taylor, A., Hough, B., Linscheid, T., Yeates, K., & Naglieri, J. (1996). Deviation from developmentally appropriate self-care autonomy: association with diabetes outcomes. Diabetes Care,
19(2), 119-125.
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