1. Presented by: Emily Aupperlee, LMSW
Diabetes On My Own: Age Appropriate Responsibility for Growing Children
Presented by: Emily Aupperlee, LMSW
Saturday, March 11, 2017

2. Agenda Review age appropriate expectations
Brain development and the teenage brain
Discuss mental and emotional health concerns
Discuss recommendations
Question and answer

3. Why do we discuss age appropriate responsibilities?
Create healthy diabetes care habits
Prevent diabetes burnout
Set our child/patient up for success!

4. Early Childhood Responsibilities Ages 0 - 7
Parent…
Parent or caregiver does all tasks. This includes:
Blood glucose tests
Carb counting
Insulin dosing
Injections
Early Childhood Responsibilities Ages 0 - 7
Patient…
Patient is not responsible for any part of the care plan.
Gradually learns to cooperate for blood sugar testing and shots
May be inconsistent with food choices
Gradually learns to recognize hypoglycemia (lows)
Undeveloped concept of time

5. Middle Childhood Responsibilities Ages 8 - 12
Parent… Parent or caregiver continue to provide assistance and supervision with diabetes care plan
Middle Childhood Responsibilities Ages
Patient…
Can learn to test blood sugars
Can make own food choices, initial learning of carb counting
Can recognize hypoglycemia and treat with supervision

6. Middle Childhood
Self confidence is a focus during this developmental time. Children are taking more initiative in the home, at school and with friends.
Parents work with child to learn and master certain diabetes care tasks such as blood sugar testing and carbohydrate counting
Parents and child practice dose calculations together
Parents positively reinforce cooperation with diabetes care

7. Adolescence Responsibilities Ages 13 - 18
Parent… The parent or caregiver provides support and assistance in areas of difficulty. There may be a need for renegotiation.
Adolescence Responsibilities Ages
Patient…
Capable of doing the majority of shots/pump management with parental support for dose decisions
Knows what foods to eat, can count carbs
Gradually recognizes the importance of good control to prevent later complications
May be willing to do multiple shots/boluses a day

8. Adolescence
Self-efficacy: the belief that one can carry out specific behaviors in specific situations successfully. Foster self-efficacy in our adolescents so they can feel more comfortable and secure with their diabetes care.
It is important as parents and caregivers to constantly remind yourself of the difference between “capable” and “should.”
If our child is capable, they are prepared and mature enough to take on their new role and increased responsibility.
If our child should take on more responsibility, but for reasons like immaturity, cognitive delay, environmental stressors, he/she is not capable, then that is when parents and caregivers are not helping the child build self-efficacy.

9. The Teenage Brain

10. The Teenage Brain

11. The Teenage Brain
Regardless what teens say, teens do not think the way adults do, simply because they are teens and their brains have not reached maturity. Teens tend to not consider longer- term consequences (so they aren't too worried about the possibility of long-term complications from diabetes), they live more in the here and now and they may not have a reasonable or consistent perspective on the future.
Teens tend to be much more emotionally reactive and emotionally variable than adults. All of this is normal and is a biological result of growing through the teen years. So if your teen acts like this, remember that it is simply part of being a teen.

12. What are negative effects if patient takes on responsibility too soon?

13. Diabetes Burnout
Diabetes burnout is what happens when you feel overwhelmed by diabetes and frustrations that come along with diabetes self-care. People who have burned out of diabetes realize that good diabetes care is important, but they just don’t have the motivation to do it. Who has experienced diabetes burnout?

14. Diabetes and Depression/Anxiety
A study published in Diabetes Care 2006, reported the association between depressive symptoms in children with Type 1 Diabetes. The study found that 15.2% of surveyed youths with T1DM scored at or above the clinical cutoff for depressive symptoms. The study also found with higher rates of depression, the youths experienced “…lower blood glucose monitoring frequency, have higher A1C values, have higher diabetes-specific conflict reported by both the youth and parent and have a higher degree of diabetes-specific burden reported by the parent.”
Managing diabetes may feel like a never-ending uphill climb. Constant blood sugar testing, corrections, carbohydrate counting and countless injections/boluses is a lot for patients and parents to focus on. This never-ending task can attribute to high levels of anxiety in our adolescents.

15. What to do to prevent diabetes burnout, depression and/or anxiety from happening?

16. Recommendations
Follow age appropriate expectations guidelines. Keep the level of care appropriate with the child’s developmental abilities and cognitive functioning.
If the child cannot complete a spelling test without assistance, then they may not be able to log blood sugars appropriately
Keep in mind environmental factors that can affect the child’s ability to take on more responsibility (ie. Break up with significant other, bullying, new school, added part-time job, AP classes, intense after-school sport)
If there is a period of struggle or “failure,” review and analyze with your child. Use the failure as an opportunity for parent and patient to learn.
Try to not be over-confident in your child’s ability. A child may be an “A” student, but struggles with diabetes care AND this is ok!

17. What recommendations do you have?

18. Bibliography
Hood, K. K., Huestis, S., Maher, A., Butler, D., Volkening, L. & Laffel, L.M.B (2006). Depressive Symptoms in Children and Adolescents With Type 1 Diabetes. Diabetes Care June 2006, 29 (6) 1389; DOI: /dc
Markowitz, J.T., Garvey, K.C., & Laffel, L.M.B (2015). Developmental Changes in the Roles of Patients and Families in Type 1 Diabetes Management. Curr Diabetes Rev, 11(4),