Having a child or teenager with diabetes adds a new and different dimension to parenting. To love and care for the child and promote all his or her potential is one dimension – to take good care of diabetes is quite another. Often these goals seem to contradict each other, yet they need not do so.
This is the view of Rosemary Flynn, a clinical psychologist at the Centre for Diabetes and Endocrinology (CDE). She says that while major advances have taken place in recent years in the management of young people with type 1 diabetes, one cannot step away from the psychological repercussions of a challenging, never-ending condition that needs constant management. “Advances have helped lessen the burden of everyday living for youngsters and reduce their risk of long-term complications but the condition still has an impact on behaviours, self-esteem, sibling and peer relationships, and family dynamics,” she adds.
Flynn says that an understanding of the needs and emotions of children at various stages of development can help us to better identify and understand a child’s specific needs and emotions at each age. “This is particularly true for children between birth and 12 years old. Diabetes management in adolescence needs to be tacked very differently,” she says. “Teenagers have a lot to deal with just being teenagers. When diabetes is added to the process, they need both resilience and resourcefulness to manage successfully. Emotional turmoil at times is inevitable.”
Flynn says it all starts with seeing the child as more than just a physical being. “There is more to managing diabetes than coping with the physical aspects,” she says. It involves the whole of the teen – the physical, the emotional, the social, the spiritual and the mental dimensions. How well the body copes with the diabetes is strongly linked to how the child thinks and feels and relates to others. Each of these dimensions will have an impact on how the child behaves. She says although changing emotions are a normal phenomenon for anyone, in children with diabetes they have the potential to make blood glucose levels unstable. The body reacts to emotional trauma or even emotional excitement by triggering chemical reactions which make blood glucose levels rise. “When working with a child with diabetes, it is thus so important to try to understand the child holistically to achieve and maintain optimum health. Focusing only on the physical aspects of the diabetes will never be sufficient to ensure a well-balanced and healthy child who is at peace with managing his or her diabetes”.
Flynn offers some crucial insights for parents raising a child with diabetes:
- Initiative and self-control: Initiative and self-control develop progressively with age and maturity and are often influenced by the parenting style of their parents. Both initiative – being able to make the right decision as needed- and self-control – being able to follow the regimen of managing diabetes – will be needed to enable the child to negotiate his or her diabetes.
- Developing a conscience: So much of the successful management of diabetes depends on a well-integrated conscience. Every day of their lives, children with diabetes face the temptation to eat too much, to avoid eating, to eat the wrong foods, to avoid injections or finger pricks, to have extra insulin, to avoid exercise, to over-exercise, to falsify blood glucose results and so on. For children to take responsibility for their own health and make the right choices depends to a large extent on values such as honesty, success, achievement, self-reliance and being co-operative. Having a well-integrated conscience is the key to developing these values.
- Family balance: Parenting that is flexible but firm, works well in all families. Power and responsibility is gradually given to the children as they grow and develop. Children react better when they have clear limits, expectations and rules which adapt as they move into their teenage years. The relationship is always respectful and kind and it is one in which the family can solve problems together. Feelings are valued and the connection between parents and children is of utmost importance. Like sailing a boat, your family must roll with the wind and weather the storms and make continuous adjustments as you try to keep the boat balanced. If you can get this right, you will truly be a flexible family and be blessed with the benefits of that.
- Sibling Relationships: While siblings can play a significant role in the process of managing the condition they can also take a great deal of strain because of the diabetes. Parents should find a balance in the way they handle their children. Somehow, they need to give each of their children quality time. They need to find a way to divide the time they have available between all their children without jeopardising the health of the child/children with diabetes, to make each of the children feel loved and nurtured and to make sure their own needs as a couple and as individuals are met.
- Managing anxiety: Research on children with diabetes has found that if too much anxiety is present, such children cope either by avoiding management altogether to reduce their anxiety, or else by becoming so frenetic in their approach to self-management that their stress levels become intolerable. In either case, control of diabetes is lost. Coping with diabetes is always a family affair. Parents can play a substantial role in how much anxiety is experienced by the child with diabetes whether it be specific fears related to diabetes or fears that arise in their life context. All fears have an impact on how well the child will cope with having diabetes.
- Anger: Another deterrent to good management is anger. Angry children may sabotage their diabetes management. Even those children who have accepted their diabetes and usually manage well, sometimes become angry because of the impact diabetes has on their lifestyle. It is important to acknowledge this anger and work with the child to enable them to reduce their anger. “Anger gives rise to a chemical response in the body and unfortunately for the child with diabetes, this response means that the child develops high blood sugars,” she says.
- Depression: Another difficult emotion is depression. Depression takes away any motivation to succeed, so handling depression and suicidal feelings is a necessity for children with diabetes. Three ways to help children become more resistant to depression includes building their self-esteem, encouraging physical activity and finding a support group. Support groups and camps for children with diabetes provide a sense of community, particularly when they can see that other children handle their diabetes well.
“Children with diabetes have to learn to live a lifestyle that promotes their health and enables them to function in the best way possible. This lifestyle includes eating foods that are healthy, doing some exercise and taking medication. However, despite all good intentions, they may still falter. It is so important for parents to provide guidance on how to change, and encouragement to sustain the positive changes they make,” Flynn concludes.