Parent’s guide to introducing self management
The never-ending, complex, daily demands of the diabetes regimen impact your child and your family. That can sometimes feel overwhelming, but it is important to take comfort in the fact that you know your child best. So, use your judgment about what your child is ready to do, and when they are ready to do it. In addition, use that knowledge to gradually introduce your child to the different aspects of diabetes self-management at the appropriate time. It’s important to remember that children mature (physically, emotionally, and cognitively) at different rates, and that sometimes children with diabetes need more help and support during times of stress. When it comes to managing diabetes, parents can gradually share the responsibility with their children.

Research shows that when children in the preschool, elementary school, and even high school age-range are given responsibility for independently caring for their diabetes, they make more mistakes in their self-care, they are less adherent to their diabetes care tasks, and they have worse diabetes control than children whose parents remain closely involved.  Therefore, encouraging your child to take on some responsibilities and tasks without overwhelming them is a difficult balancing act. Although research clearly states that children do best (both emotionally and physically) when their parents and caregivers remain involved in their diabetes care, it is still important to encourage your child to have a role in their own care.  How big a role they play will depend on a lot of things, including where your child is developmentally. Remember that even the smallest child can be empowered to take part in her diabetes care by unzipping a supply case, washing their hands, choosing which finger to poke, or choosing an injection site.

Research shows that between the ages of 11 and 12, most children have shown mastery in basic diabetes management skills and comfort in talking about their diabetes in social settings. However, mastery of skills is different than being independent and responsible for getting those tasks done. Most studies show that when parents and children share in the responsibility for making sure things happen (e.g. blood sugars are checked, insulin is administered, sites are changed, carbohydrates are counted), children show better diabetes outcomes. Here are some basic diabetes management skill sets, and general guidelines on when your child may be ready to take them on:

Checking blood sugar levels: Somewhere between ages 5 and 7 children may start expressing an interest in checking their own blood glucose levels. As long as a parent supervises them and their checking method is correct, feel free to encourage your child to take on this task. By age 8, unless they’re newly diagnosed, most children have mastered this task, which is vital in the sucessful management of diabetes.

Parents should not merely “remind” their child to check, but should be an active part of this shared activity. Once children poke their fingers, it is helpful for parents to praise their child’s behavior by saying something like: “Thank you for checking!”. This helps children associate the behavior of checking with something positive, which increases the chance that they will keep on checking blood sugars, even when they do not feel like it.

While many children are able to master the tasks of blood sugar checking, few are able to monitor their schedule to know what time they need to check. So, watching the clock is a parent job. In addition, using the blood sugar numbers to make treatment decisions is a parent’s job. However, as your children get older, it is helpful to “talk out loud” about your treatment decisions, and ask your child for their input as well. For example: “Thanks for checking!  It looks like you’re at 293.  I’m thinking that means we need to give you a correction dose. What do you think?”  Or: “Thanks for checking! It looks like you’re at 76. I’m thinking that means you need some fast acting carbs. Would you like some juice or some glucose tabs?”

Counting carbohydrates: Between ages 7 and 9 children may begin asking about carbohydrates and engaging in simple carb counting. Child-geared systems that use visual aids such as flashcards, photos of foods and refrigerator magnets may help your child understanding carb counting earlier. Some children enjoy the challenge of “owning” specific meals. For example, how many grams of carbohydrates are in your favorite pizza from your favorite restaurant? Or how many grams of carbohydrates are in your favorite hamburger and French fries?  Working with your child to “master” those specific meals helps them feel more engaged in their own care and more confident in their skills.  As you child grows, encourage them to “talk out loud” and let you know what they are thinking as they try to count the carbohydrates in their foods. Praise them for their attempts – even if they make a mistake. Ask them what they’ve learned and how they would do things differently the next time.

Taking insulin: Between the ages 8 and 12 most children should be able to administer injections. Parents are expected to still oversee dose calculation and drawing up of the insulin, although slowly encouraging your child to do more of these tasks themselves is helpful. The key is to do so in a way that does not overwhelm your child while they learn the skills and build their confidence in their own abilities. Remember that most adolescents still need support in remembering to pre-bolus insulin, correct their numbers, and calculate how long their insulin is working. The same goes for regulating insulin pump therapy.

Over time, children can become quite adept at managing their diabetes. Parents should remain involved, however, to navigate the difficult times and offer that all-important support.

1. Silverstein, J., Klingensmith, G., Copeland, K., Plotnick, L., Kaufman, F. Laffel, L. (2005). Children and Adolescents with Type 1 Diabetes. Diabetes Care, 28, 186-212.

2. Wysocki, T., Meinhold, P., Abrams, K., Barnard, M., Clarke, W., Bellando, B., (1992). Parental and professional estimates of self-care independence of children and adolescents with type 1 diabetes. Diabetes Care, 15, 43-52.

3. 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, 119-125.

4. Weissberg-Benchell, J., Goodman, S., Antisdel-Lomaglio, J., Zebracki, K. (2007). The use of continuous subcutaneous insulin infusion (CSII): Parental and professional perceptions of self-care mastery and autonomy in children and adolescents. Journal of Pediatric Psychology, 32, 1196-1202.

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