Living with diabetes

Your child’s responsibility… how much is too much?

Children must have adult supervision for diabetes-related tasks but as they get older they will gradually begin to take on some of these tasks themselves.

Try to encourage some responsibility (for example, ask them to go and collect their meter) but ultimately you are responsible. Your child may not have much concept of time, so you will need to make sure snacks and insulin for instance, are given on time.

You may gradually transfer some tasks to your child. This varies according to their abilities and interest. Sometimes children become over-enthusiastic, then get fed up and want to give back the task or don’t do the task very well.

Breaking up the tasks into smaller steps rather than learning too much at a time may help your child to feel more confident.

When your child is younger handling small things such as syringes/insulin pens may be difficult as fine motor coordination is still in the process of development.

Your child is able to cooperate with you by sitting still for a finger prick and insulin injection. Being able to choose a finger or a site for injection makes them feel as though they’re helping and have some control.

Your child can tell you when they feel hungry but they may be a bit vague in their description of hypo symptoms. They may not say “I’m having a hypo”, they are more likely to say “I feel wobbly, funny”.

You can never be sure that your child knows their hypo symptoms. It is a good idea to draw attention to symptoms straight after a hypo occurs so that your child can talk them over with you. This will help them to remember how they feel and the warning signs of a hypo.

As your child gets older

Helping children with diabetes is a challenge for most parents. You may feel guilty or angry (sometimes both) and you may become over protective or very critical. This may result in asking your child to take on too much responsibility before they are ready, or may squash their expression of interest in helping with diabetes related tasks.

Common questions asked are:

• When should my child take on more responsibility?
  Am I asking too much or too little?

Some tips:

• All children are different – what works for one child may not work for another.
• By the time your child is 8 years old they will usually have the skills to physically do the task but not the maturity and knowledge to take on full responsibility. Taking on some of this responsibility requires that your child learns more about diabetes.
• Group sessions with children of a similar age may help. Check what is available through your diabetes team.
• There is no special age when your child should give their own injections/work their pump.
  Health professionals agree that by age 11–13 years, most children can perform most diabetes related tasks but this varies from child to child. As a guide, a child of 10 may be giving the injection and at 11 they may be drawing/dialling up the insulin. If your child refuses to give their own insulin – reduce the steps to one at a time, encouraging your child to join in at each point, but allowing them to ‘opt out’. The steps could be:

1. Check the dosage
2. Dial up the insulin
3. Select the injection site
4. Inject the insulin

• These steps may need to be introduced a few days apart and should be done when you have time to spare and you’re not too rushed – on weekends for example.
• Sharing tasks between both parents and the child is useful – for example Mum a.m., Dad p.m., child on weekends. Often children will be keen to help.
• Concentrate on your child learning one task at a time, otherwise demands are too great and your child will be confused and unwilling to stick at it.
• Your child’s skills may not be as good as your own, so patience is needed to increase their confidence. This is another reason for choosing a less rushed time of the day to try out new steps and tasks.
• Encourage involvement when your child shows an interest in learning new tasks. It’s still important to observe your child’s ability and technique to avoid possible mistakes and short cuts. Aim to be positive and focus on the things they do well.
• Make it clear to your child that you will slowly introduce responsibility, and that you realise they may sometimes need a break. Let them know that you will help them with diabetes tasks for short periods of time.

It’s very easy for you as a parent to carry on doing everything for your child whether they have diabetes or not, but it is vital for your child’s self-esteem and confidence, and your sanity, that you encourage the beginnings of self-care.

Coping from day to day

• Use simple terms and answer questions simply, as they arise.
• Don’t overload your child with too much information. Give a step by step introduction to tasks. Do one task at a time, and when neither of you is too tired.
• Acknowledge your child’s feelings especially when they’re frustrated, tired and fed up. Setting limits as you would for your other children is very important. It helps children to feel safe.
• Children often absorb more than we think – they take in information along the way.
• Give your child some relief, share injection and blood glucose tasks.
• Quietly praise your child when they take on any new responsibility.
• Try not to expect perfection.
• Children can benefit from you directing them to help express their frustrations.
• Be positive and give lots of hugs.
• When your child gets older you can gradually increase responsibility.
• Watch for things which encourage your child; at home, at school; with friends.
• Help, support, and supervise your child.
• Choose a quiet time of the day to start a new task.
• Remind your child that diabetes is not their fault.
• Too much responsibility too soon can lead to burnout and poor diabetes care /management.