Empowering Your Child or Teen to Successfully Manage Diabetes Self-Care

By Beverly S. Adler, PhD, CDE

As parents, you strive to protect your children. The job of parenting is made even more difficult when your child is diagnosed with type 1 diabetes (T1D). The good news is that children with the best family support tend to manage their diabetes better and feel better about living with diabetes.

Parents generally have a great deal of anxiety, depression and guilt upon receiving their child's diagnosis. It is of utmost importance for parents and children to know that the diagnosis of diabetes was not their fault; they did not do anything to cause it. The parents' role is to help their child with diabetes learn how to make healthy choices for a lifetime, such as healthy eating habits. Remind your child that good self-care now will lead to good health in the future.

To successfully manage your child's diabetes self-care, here are the "4 P's" – Principles of Empowerment:

1 - Protect without being pushy

Be supportive, but don't push as your child takes on selfcare responsibilities. Encourage your child's gradual and progressive involvement in self-care based on his/her maturity, skills, readiness and interest.

Avoid being overprotective and reinforce the goal and expectation that kids with diabetes can do anything that kids without diabetes can do. Encourage your child with T1D to fully participate in all the same activities as other kids, such as playing sports and participating in academic and social activities.

A child's attitude about diabetes will be in large measure a reflection of their parents' attitude, so it's vitally important that you approach diabetes management as matter-of-factly as possible.

2 - Planning and preparing

It is important that parents allow their child to do activities that other children do. Your child can still play sports, stay overnight with friends and eat the foods that classmates do. It just takes a little more planning and preparation than it did before. A recent study of children with T1D found that 40 percent of the children in the study had unnecessary carbohydrate restrictions imposed on them by their caregivers. Children with T1D can eat sweets and any other type of food/drink, as long as they are giving themselves the appropriate amount of insulin to cover the meal.

As the Boy Scouts and Girl Scouts motto says, "Be prepared." In this case, depending on the child's age, they (or a supervising adult) should be prepared to care for the child's diabetes by carrying their glucose meter and strips with them, wearing a medical ID bracelet, and having glucose tablets (or equivalent) in case they need to treat a low blood glucose reaction.

3 - Be positive: praise proficiency and success of self-care responsibilities

Many parents are much more comfortable with attempting to influence their child through coercive or punitive approaches rather than through praise and encouragement. However, when parents offer praise to their child who masters a new self-care responsibility, it helps to boost their child's self-esteem.

Parents should actively supervise the diabetes management skills while promoting self-care. Parents should praise and encourage success and proficiency. Parents should solve diabetes problems with, rather than for, their child to empower him/her to be independent and self-confident.

Parents should be the first to applaud their child when they are being responsible. However, parents need to be careful to reward their child's efforts, not necessarily the outcome, because diabetes can't be managed perfectly.

4 - Plant seeds of confidence

If you want to raise a child with diabetes successfully, you have to learn to share your child's diabetes with them. By allowing your child to participate in their self-care, you are planting seeds of confidence, acceptance and independence for living a life with diabetes.

Children from families with more diabetes knowledge have improved diabetes management and a more positive psychological outlook on life. Knowledge is power, so parents need to talk to their child about diabetes. Teach your child the relationship between eating and exercise and how they affect blood glucose levels. Sharing food and exercise also creates a special bond within the family.

When your child begins taking on new self-care responsibilities of diabetes management, use baby steps, so that he/she will not feel overwhelmed. Each small success will help give the child the confidence necessary to assume total responsibility for self-care.

Three key aspects for parents to use when shifting diabetes responsibilities to your teen with T1D:

1 - Effective communication

Effective communication should be frequent, open, direct and respectful. Frequent and clear communication includes an understanding about who is responsible for which aspect of diabetes management. Communication is done regularly -- without nagging. Parents may express caring and concern for their teen in ways that may be interpreted by teens as overly anxious and negative, not as caring. Try not to react to blood glucose numbers by instilling guilt. Please remember: if your teen's blood glucose check reveals a number outside their target range, they are only numbers. Think through causes, patterns and solutions, and abandon perfection as a goal.

2 - A gradual process

When your teen is mature enough to begin taking some responsibilities for diabetes management, it's okay to give them control of their diabetes self-care…IF they are ready. Those teens with diabetes who do best as adolescents and adults have their parents working with them, allowing them some (but not too much) autonomy. Parents must find a way to maintain the right to at least partly supervise the process. Be consistent, yet flexible. At times, there may be a need to take a few steps back, when the burden of diabetes management becomes too much -- especially when other stresses take priority, such as illness, studying, peer pressures, or depression.

3 - Balance

Parents need to teach the importance of good self-care skills, but stress the fact that diabetes management should not be all-consuming. Emphasize to your teen that he/she is a person who just happens to have diabetes, rather than the illness. This way, your teen will grow up with an identity that is separate from the illness.

Final words of advice

  • Communicate regularly, but don't nag. Discuss clearly and calmly the situation and options. Preparing for situations as much as possible and knowing what to expect in advance helps reduce stress.
  • Safely shifting responsibility for diabetes self-care is a gradual process. Develop a positive relationship through praise and encouragement.
  • No guilt trips! If your child's blood glucose check reveals a number outside of their target range, remember to describe the result as high/low/normal - not as "good" or "bad." The number can become a discussion point, rather than a point of contention.
  • The primary parental role becomes one of providing encouragement and support to your teen with diabetes.
  • Be patient and calm. Don't let your own feelings of frustration spill out onto your child.

Parents and children and teens can overcome their negative feelings and destructive reactions with the help of Certified Diabetes Educators (CDEs), support groups (to learn how others are facing the same issues as you are), books and magazines, and online diabetes websites devoted to these issues of adjustment, to name just a few sources of support. Consider getting professional help with a diabetes-focused mental health provider (clinical psychologist or clinical social worker) for you and/or your child or teen to learn new ways to cope, if needed.