Coping with Diabetes
Kerri Brazzel, LCSW
Alexis Young, LMSW
Diabetes Team
at ACH
O Endocrinologist
O Diabetes Educators
O Nutritionist
O Social Workers
O Child Life
O Bedside Nurses
Diabetes Team Role in Overall
Adjustment
O Team works together to:
O Support, Educate and Provide
Resources/tools
O Assess barriers and strengths to fill in
any gaps
O SW conducts assessment of psychosocial,
developmental, behavioral history
Social Work Role on Diabetes Team
O Assess: coping, adjustment, stressors, current
utilized resources and resources available
O Emotional Support: at initial diagnosis, during
hospitalizations, ongoing through outpatient clinic
appointments
O Advocacy: with medical team, schools, community
settings, obtaining resources, insurance, legal
issues
O Resources: basic needs, other healthcare/mental
health needs, financial resources
What Happens at Diagnosis?
O Families notice increase of symptoms, yet typically
do not associate them with the possibility of
Diabetes
O Are often seen at PCP/family doctor for these
symptoms and receive the initial diagnosis at the
same time being told they are being sent to ACH
for admission. They often arrive feeling:
●shock
●sadness
●guilt
●fearful
●overwhelmed
●anxious
Emotional Impact
O A reaction to a diagnosis of a chronic illness
can be similar to a grief response (shock,
denial, anger, bargaining, depression,
acceptance)
O Family’s hopes, dreams, plans for the future
may change or the view of them changefamilies grieve this change and continued to
move through grieving “stages”
O Establishing a “new normal”-adds anxiety
to the grief.
Ongoing Assessment of Coping and
Adjustment to Illness
O Several adjustment phases and transitions
O
O
O
O
as family changes, child grows and develops
Previous and current stressors at the time
of diagnosis as well as on an ongoing basis
Development stages (toddlers, school age,
adolescence)
Can families problem solve appropriately,
re-frame, normalize, have family and social
supports?
Increased risk for depression and anxiety
Things to Watch for:
O Persistently decreased mood or changes
O
O
O
O
O
O
in mood
Irritability
Social Isolation
Change in sleeping habits
Decrease in school performance
Weight loss
Changes in eating habits, not eating
well
What we Can Do
O Be Supportive, aware of needs/concerns and
creative in interventions to meet individuals and
families needs. At School:
-help a child be discreet with care in school
-talk with school counselor about
support groups at school
-Educate teachers on Diabetes and
children’s needs, sensitivity to needs (504
Plans)
-refer to Diabetes Team
Resources
O Local Counseling agencies if adjustment issues
O
O
O
O
O
O
O
O
persist or concerns for depression arise
Online resources and support: American
Diabetes Association, childrenwithdiabetes.com
Support groups (might be for child, parents)
Ongoing supplemental education
JDRF
Medical Legal Partnership-ACH
Local Financial and other basic needs agencies
Financial Counselors-ACH
Prescription Assistance Programs
Advocacy at School: Written Plans
O Diabetes Medical Management Plan for School
(School Orders): health care plan from Medical
Team explaining medical procedures and needs
that take place at school.
O 504 Plans/IEPs: care plan designed by school
personnel and family explaining the
modifications and accommodations that need to
be made for a particular student.
504 Plans and IEPs
O Section 504 (American with Disabilities
Act) prohibits discrimination on the basis of
disability in programs or activities that
receive Federal financial assistance,
according to the US Department of
Education.
O Individual Education Plans, IEPs fall under
a similar Act, the Individuals with
Disabilities Act, IDEA which ensures
children with disabilities related to special
education needs have access to free
appropriate public education.
504 Plan, ADA & IDEA
O Section 504: available in public and private
schools receiving federal funding; “the
major life activity substantially limited does
not need to be related to learning”
O ADA: same as 504, covers daycares and
camps however does not cover religious
affiliated schools/programs unless federally
funded
O IDEA: law covering special education
services; must demonstrate that Diabetes
adversely impacts ability to learn and
progress academically
504 Plans
O Suggested Content to be included:
O Recognition and prompt treatment of high and/or
O
O
O
O
O
O
low blood sugars
Access to supplies/insulin
Unrestricted access to snacks, water and bathroom
breaks
Adherence to care schedule (regular blood sugar
checks, meals and snacks eaten on time)
Modifications to schoolwork/time frames for
completion as needed or time to make up work
missed
School excuses for Diabetes clinic visits (some
families travel long distances for appointments)
Accommodations for special activities: school parties,
field trips, etc
You know you're the parent of a child with diabetes when ...
☻You hear your teen say, "When I'm high I don't feel it" and your friends jaw
hits the floor when you respond, "Some people don't feel it.“
☻Your child holds up a box in the grocery store and, when you ask "How
much?", the nice bystander says "$2.99" and your child says, "15 carbs for one
serving.“
☻You get an advertisement online saying that they have the perfect pump and
you wonder, "Animas or Medtronic?", only to find out it is a shoe store
advertisement.
☻You spend several minutes on Christmas Eve reassuring your child that if
Mommy gets up for a 2 a.m. bg check while Santa is in the house he'll still
leave presents.
☻You go to tell the person in front of you that their pump tubing is hanging
out, only to realize that it's the headphone wire connected to their iPod.
☻You drink too much coffee in the morning and when you say, "Wow, I have
to go to the bathroom again!", your 5 year old looks at you and grins and says,
"Mom, are you getting diabetes too?"
☻You're the only mother at playgroup chasing around your 3-year-old yelling,
"If you don't come eat these jellybeans right now, I'll put you in time out!"
☻Your son gets a bloody nose and you reach for the glucose meter to check his
blood sugar.
☻You find parts of syringes in your son's room and he is now using them as
swords and granades for his action figures, after throwing away the needle
part, of course!
☻Your 10-year-old daughter looks at a beautiful, pinkish-purple sunset and
declares, "That is so pretty! It looks like an infected site!"
-from www.childrenwithdiabetes.com ☻
Resources
O American Diabetes Association:
O
O
O
O
www.diabetes.org
Juvenile Diabetes Research Foundation:
www.jdf.org
National Diabetes Education Program
www.YourDiabetesInfo.org
www.childrenwithdiabetes.com
US Dept of Education: www.ed.gov
References
O
Kaufman, Francine Ratner, MD. Diabetes at School: What a Child’s
Health Care Team Needs to Know about Federal Disability Law.
Diabetes Spectrum January 2002, v. 15. no.1 63-64
O
Guthrie, Diana W., PhD, CDE, et al. Psychosocial Issues for Children
and Adolescents With Diabetes: Overview and Recommendations.
Diabetes Spectrum, January 2003, v.16 no.1 7-12
O
Protecting Students with Disabilities: Frequently asked Questions
About 504 and the Education of Children with Disabilities.
www.ed.gov March 17, 2011; retrieved on 11-2-11.