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[IPp] Family Fun Day March 2, 2002..diabetes focus
I tried hard to take good notes for those not able to attend theFamily Fun Day
event in Dartmouth, Nova Scotia yesterday. This event was hosted by Minimed
and Roche Diagostics. A sincere thank you should be given to them for the
great day we all took part in.
Dr. Michael Vallis was the first speaker for the adults while the kids went to
see magic shows and clowns. Dr.Vallis is a Psychologist with the Diabetes
Management Centre at the QE2.
Dr. Vallis spoke on " Learning to Adapt"
This was for the short term and the long term for families living with
1. Psychological Factors
- highlight challenges of parents with children
- identify common psychological traps that impede self care
Diabetes is ....purely a biomedical disease
....purely Behavioral (impact involves
how, what, when, where, in managing)
"The more we(medical world ) know, the more the work load for the parent and
child with diabetes.
The kids were introduced to Intensive treatments...4 injections a day...often
the kids hated this as well as the school systems and others. Often needing
insulin at noon time made it harder for parents.
It's Not Your Disease!!!!! Most distressing as you cannot be in charge
Diabetes is also not the Only Issue in your lives or theirs.
Bottom Line: Individual Behaviors , personal beliefs, feelings, and intentions
(self regulation )
When Doe The Child Develop Self Control?
Their behavior is not based on our recommendations (the medical model)
-Tight control is a good thing they say...To Whom??
As parents, how do you and your child develop the same beliefs? How do these
beliefs match the medical people involved (HCPS)?
The tighter the control, the more chances of hypos.
What is it all about ???
- self care
Quality of Life
- meaningful, dignity
- wellness (are you having fun yet is very important) ....The physical,
emotional and psychological.
What determines Self Care?
- must be viewed as serious but not a death sentence
-must be viewed controllable but not pin point control
We cannot always know what will affect our blood sugars but we do know the
liver releases glucose often in relation to stress, sicknesses.
- Must Take Personal Responsibility
Coping With The Burden:
- Don't let anyone tell you it does not produce positives things.
1. It produces good perspectives on life
Don't Sweat The Small Stuff
2. Diabetics make very good friends
...as we know what it means to be sick and have problems so we are often
better listeners and can understand more.
Burden - Emotional (sadness, grief, anxiety, frustrations)
- Financial / Time Management
- Readiness to change / deal with things.
Parents of Child
Emotional Well Being
- take good care of yourself before the child
-you cannot help the child if you are sick
Facing The Guilt (especially the Moms)
Hope***The Cure is right around the corner***
- marriages are affected and conflicts are common under these stresses
Uncertainy- How will you deal with it
How do you help the child ......stay Calm
Determining the Responsibility
- Self Care
Knowing when to back off
- How much control do you give a child and for how long...
Allow for Trial and Error. (1-2 MONTHS) to evaluate & see how they are doing.
How do you deal with the Choices the child makes?
- can have excessive distress(anxiety,anger, depression)
Mom and Dad affected by this as well
-How are other kids feeling in the family?
- Don't turn your house into a clinic...
Don't expect things to be normal!! it cannot be so find what works to make
your own normal.....
Diabetes is hard to adjust to
Social issues are ever present.
People with Chronic illnesses have fewer friends alot of the time but they
have deeper friendships that last usually.
Kids may be at risk for Emotional Problems.
- Don't let this frighten you.
- Develop buffers to help with coping.
EXAMPLE: if you have family history of high cholesterol and Heart Disease,
live with a low fat, healthy diet and exercise is one buffer to help prevent)
SPECIAL CHALLENGES FOR ADOLESCENTS
Tasks of Adolescents are inconsistent with he principles of diabetes
**Individuation** need own sense of self worth
-Defying rules / regulations
-Identifying with the opposite of parent's beliefs.
-unique ( I want to be just like my friends, peers, TV stars, fashions)
- fitting in with peers of Paramount importance
HOW DO YOU AVOID THIS CONFLICT TRAP??
- when they were little, you played with them and made life fun, interesting.
Often by age 12, this has stopped. You need to make family life living more
fun.Play games, do things together, go places and enjoy things together.
Being Cool is far more important to them than being Healthy!!!
Forget long term goals as adolescents just don't see that far ahead.
The Medical world sets us up for failure.
- For too long, the medical worlds forgot, ignored or expected us too much to
follow through on their demands and expectations. Things are changing now for
1.Psychological Reactions. The tendency to act the opposite to what you are
asked to do.
Related to the issue of control and self determination. If a person feels you
are taking away controls or limiting their free will,It is very normal to see
that person to resist.
What Can We Do...
See the world through the individual's eyes.
Give them choices
Be Non Defensive
Watch your Own Expectations
- Have good sugar controls
-How long should it last
-If it doesn't last, how do you feel.How do the doctors feel, parents feel...
- degree of Adherence---it will not last forever.
Too many things affect how your blood sugars stay
Everything Affects Controls!
They do their best, try, fail, try harder, fail, Give up.
Repeated behavior is learned behavior.Feelings of failure build up.
Be careful when they cannot achieve
LEARNED HELPLESSNESS & ABSTINENCE HAS A VIOLATION EFFECT!!
Avoid Be Careful
Abstinence: I vow to abstain
Violation: despite my vow, I gave in
(Like a diet... you need to lose weight but you eat one thing you should not
often leads to eating more things)
What we see before our faces and surrounds us has this effect. We blow it/ get
out of control/ say get it out of our system/ will start again tomorrow with
clean slate but often don't.
No Behavior lasts Forever
But the problem takes too long to get back on.
The real problem is How much and How Long
What Happened...What can we do about it...
We limit behavior to 100% compared to 0%.
Be constant/ expect cycling to happen
Work with it and don't give up.
Accuchek display was presented.
Dr Beth Cummings
Good Glycemic Control
What is it? Why is it important?
This is a Balancing Act.
Food..demands of life..stressors...insulin activity....
Hypos - low blood sugars and DKA- High Sugar controls
Promote Normal growth and development
A1C's are markers on the red blood cells. They usually stay around 120 days /
2-3 months so checkups every 3 months help determine the A1Cs UNLESS you were
The A1CS have a variable to the average Blood sugars.
Example A1CS Average Sugars
Sugars stick to everyone' hemaglobin. The glucose sticks to the protein in the
red blood cells. Everyone has some , controlled diabetics have more and
uncontrolled diabetics have alot more.
Changes happen...complications start to happen
- nerve damage in blood vessels relating to Feet/ limbs
- Blood damage to the heart in later years (heart attacks and strokes)
Eye exams for Retinopathy
- Should be yearly and with dilated pupil examation
Kidney ( nephropathy)
- Blood vessels thicken
Filtering is blocked or slowed down
Normal bumimuria- 60%
Microalbuminura- 30% (300 mg /d)
can get better or worse
Macrolbumimuria (7300 mg/d)
End Stage renal disease.
50% OF Long term diabetics had lower limb amputations
By Age 15, annual foot examinations should start
-?PAIN OR TINGLING
Test sense of touch
Atherosclerosis- Heart disease
- most common causes of deaths in both women and men, especially when
-happens in much younger ages of diabetics 20's to 30's
-if family history, more care is needed.
Coronary Arteries become narrow.
Blood flow slows
Watch the healing of any sores.
Can affect your Sexual ability
This is a good one to talk to teens about they suggested...
Lower the RISKS
- Try for good controls
- Don't smoke
- watch for High Blood Pressure
- watch for High Cholesterol
Modifiable Non Modifiable
glycemic control family genetic factors
hypertension duration of diabetes
smoking hormonal factors
diet and fat
Diabetes Control & Complication Trial 1993
-adults had better controls than teens
- risk prevented by 75% with intensive management
- Kids under 13 not in these tests
Look for patterns
Respond and adjust insulin as needed
More or Less Food
1. Multiple Daily injections- humalog before each meal and at bed time
2. Wear the pump.
Maintain good A1CS
-beware of more risks of Hypoglemcemia
- Can be associated with weight gains
- Goals A1CS = 8.4
Target for kids in puberty 4-8
under age 6. target for 8-12
- BE SERIOUS
- BE HONEST
-Tell them what to do
-You make the rules
Should not drive when under 6.0 mmol/l
Before driving Test and eat.Test alot while driving if gone a long time
Many diabetics drive and appear as bad as a drunk driver.
Hard work but reasonable goals
Any improvement is Good
Keep in touch with he diabetic Team as they are there for you.
I end here saying that I might have made some errors here but this was the
best I could do for writing long hand at the event. This was a good event and
we appreciated all we learned today.
I hope this is something you can read and get more help from.
The most important thing to remember is each child is different and so are
each family so keep in good contact with your doctors and diabetes Teams.
Warm wishes to all
R.R.2 Falmouth, NS, B0P 1L0
To Laugh often and much; to win the respect of intelligent people and the
affection of children....to leave the world a better place..
.to know even one life has breathed easier because of you.This is to have
- Ralph Waldo Emerson.
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