Grandparents have an Important Role on the

Diabetes Team

Barbara J. Anderson, PhD

Professor of Pediatrics

Baylor College of Medicine

Houston, TX

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Overview

I. Normal developmental tasks of child & parent & lessons learned from research with type 1 diabetes (T1D) in early childhood, in school-aged youth, & during adolescence.

II. Pay attention to communicating about T1D in the family! Understand diabetes burnout. Try to prevent diabetes related family conflict.

III. Focus on what is going well. Where are the diabetes-related strengths in the family?

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I. Special Roles of Grandparents

•Creating Shared Stories

•Windows into past lives and history

•Strengthening Sense of Family Ties

•Teacher , Role Model

•Supporting your Children as Parents

•Other roles You enjoy as a Grandparent?

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Your Grandchild….

…is first -- and most importantly -- a child.

…is secondly -- a child who happens to have type 1 diabetes (T1D)

…is not a “diabetic” or a “diabetic child”.

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Normal Developmental Tasks•Age-related milestones in physical, cognitive, psychological & social functioning

•Must be considered when parenting or grandparenting a child or teen with diabetes in order to have realistic expectations at different ages

•Grandparents can have the important role of remembering normal age-related behaviors!

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Tasks of Early Childhood: Infants (0-1 yr.) and parents

•Physical growth

•Develop trusting attachment or bond with caregiver

•Parent must develop confidence in their ability to care for (‘read’ and respond to) their baby. Balance care of self with care of baby (‘bonding’).

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Tasks of Early Childhood: Toddlers (1-3 yrs.) and parents

•Physical growth; Brain development

•Mastery of Physical world

•Autonomy, Sense of separate ‘self’

Parent provides responsive yet safe environment; sets realistic limits;

allows for separation

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Tasks of Early Childhood: Early school age (4-6 yrs.) and parents•Cognitive growth, cause-effect thinking begins

•Social relationships/comparisons outside family (peers & adults)

Parent must support child in new environment; allow for exploration & new attachments while maintaining involvement.

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Lessons from research on T1DM in Early Childhood (0-6 yrs.)

•Extremely high-stress period for parents.

•Recurrent severe hypoglycemia or chronic hyperglycemia can affect developing brain.

•Parental fear of hypoglycemia can lead to over-restricting toddler-preschooler.

•Parents can feel very isolated; few resources; difficult to find relief caregivers

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Tasks of School Age youth (6-10 yr.) and parents

•Explosion of skills (cognitive, athletic, artistic, physical)

•Importance of “best friend” and team play

•Foundations of self-esteem

•Child must participate with peers

Parent must balance child’s expanding world with setting reasonable limits; foster autonomy while maintaining involvement in child’s world.

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Tasks of Young Transitioning Teens (11-13 yr.) and parents

•Pubertal changes impact self-image.

•Peers increase in value (young teen is very vulnerable).

•Privacy is important.

•Power shifts in P-C relationship increase family conflict.

Parent learns to acknowledge this is a period of insecurity and intensity, to negotiate, to have consistent expectations, to set limits, to maintain involvement & support.

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Lessons from research on T1DM in Young Transitioning Teens

•Normal insulin resistance of puberty complicates DM control & mgt. (Amiel, 1986)

•DM mgt. becomes more complex at the time child normally begins to resist parental help.

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Lessons from research on T1DM in Young Transitioning Teens

• Parent-child teamwork & low family

conflict around DM tasks over the transition

to adolescence predict better control

across adolescent years.

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Developmental Tasks of Mid-Older Teens (14-18 yr.) & parents

•Develop own sense of identity & values, separate from parents.

•Strengthen peer bonds; Explore intimacy.

•Take on increasing (not complete) responsibility for self in many aspects of life.

•Make decisions about ‘life after high school’ .

•Parent learns to accept this is a period when teen needs to strengthen sense of identity. Although privileges may increase, trust must be earned. Parent must have consistent expectations, set limits, maintain involvement & support.

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Lessons from Research on Mid-Older Adolescents with Type 1 DM

a. Older adolescents & parents need to plan ahead for diabetes care “after high school”.

b. Create a gradual plan to transition all tasks.

c. Some teens may have “Diabetes Burnout.”

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“Burn-Out”•“A common response to a chronically difficult and frustrating job, where the individual works harder and harder each day and yet has little sense that these actions are making a real difference. “

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Living with Type 1 Diabetes •Goal of diabetes self-management: Near- normal blood sugar ranges.

Child/Teen/Family balance on a tightrope between low blood sugar (can cause behavioral & mood changes, & acute emergencies) & high blood sugar (can cause behavioral & mood changes, & if sustained, long-term problems)-- a chronic & impossible task, as the tools to manage diabetes are not perfect.

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Living with Type 1 Diabetes

•Psychological consequences of

“tightrope balancing”:

Feelings of chronic frustration and

failure from striving for near-normal

(“perfect”) blood sugar numbers, &

from criticism from providers, family

members & self.

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Family Communication and Conflict

How you think about DM...

- “What does a blood sugar of 400 mean for my child?”- “Why is his/her DM getting worse?”

How you feels about DM…

- “I’m scared when I see a blood sugar of 400. Why can’t s/he have stable blood glucose levels?”

How you talks about DM…

- “That blood sugar is so bad! What did you eat?”

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Talking about Blood Sugars

That scares me! A high blood sugar like that could cause problems!

Dad, my blood sugar is 385.

Dad’s really mad at me! He’d be happier if my blood sugar were 120 or if I didn’t check at all!

385?! Why so bad? What did you eat?

1) OCCASIONAL HIGH BLOOD SUGARS DON’T LEAD TO COMPLICATIONS. It is normal for growing children to have out-of-range blood sugars. An occasional blood sugar of 300 or even 400 or more will not cause complications.

2) THERE IS NO SUCH THING AS A “BAD” BLOOD SUGAR. Any result from blood sugar monitoring is good because it gives helpful and important information that lets you make the best choices in insulin, activity, and food.

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· Growth/Puberty

· Stress

· Illness

· Dawn phenomenon

· Too little insulin

· Food

· Unknown

· Exercise

· Stress

· Illness

· Insulin

· Not Enough Food

· Unknown

Factors the Cause Out-of-Target Range

Blood Sugars

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Communicating about diabetes in the family

•Family Teamwork means Follow the parents’ guidelines and practices in diabetes care

•Use the same language “high” & “low” BG, not “good “ & “bad”.

•Know what tasks adults must always supervise

•Follow the same rules/attitudes around food

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Communicating about diabetes in the family

•Understand when to call Mom or Dad (or 9-1-1)

•Ask questions of parents; practice injections/BG checking with them.

•Remember “Courage is not the absence of fear”*

*B. Brackenridge Draw Wide the Circle of Love, 2008

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Preventing conflict as you share in the care of your grandchild

• Keep a log; Write down everything!

•Suggest you & parents make a “visit book” * with all contact numbers, meal snack times and carbs, when to do BG checks, signs of high & low BGs.

•Strive for balance between DM mgt. routines and enjoying time with grandchild.

•*B. Brackenridge Draw Wide the Circle of Love , 2008

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Summary1. Grandparent’s role is important—

-support parents in diabetes mgt.

-keep focus on the child & normal age–appropriate behaviors.

2. Your Grandchild with diabetes is a child first! Remember normal behavior for child’s/teen’s age.

3. Pay careful attention to your language & communications around diabetes in the family.

Focus on what is going well (strengths).

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Resources for Grandparents • Brackenridge, Betty. Draw Wide the Circle of

Love: How to Unite Your Family in the Care of a Child with Diabetes. Phoenix, AZ: Learning Prescriptions 2008.

• Websites:www.grandmasandy.com = website with games and

books about diabetes in a young child for downloading.

www.diabetes.org= American Diabetes Association website for Parents and Kids; resources for families & schools.

www.jdrf.org = Juvenile Diabetes Research Foundation: research information; newsletter for families

Thank you for your attention!

Comments? Questions?