The ADA Annual Scientific Sessions are a huge affair. Participants include physicians (all specialties), nurse educators, dieticians, psychologists, exercise physiologists, pharmacists, podiatrists, social workers, and people with diabetes. One estimated count was at least 20,000 attendees in one large conference center. There are different tracks of subspecialties that cater to different interest groups, such as cardiovascular, genetics, foot care, behavioral, etc., and lastly my particular area of expertise: pediatric diabetes.
Unfortunately, we are a little subset of the general group of participants and tend to find each other in our smaller conference rooms. On Saturday morning, we saw our first topic presented: "A1c Targets in Pediatric Diabetes: Ideal vs. Real." One of the presenters, a pediatric endocrinologist from The Barbara Davis Center in Denver, Colorado made an ad hoc comment in response to maximizing glycemic control in children: What about adding a "super nanny" to the diabetes team to assist in management? We all laughed in unison.
Often, when parents step into the diabetes caregiver role (or are dragged kicking and screaming), they are either unprepared or unwilling to completely embrace the necessity to do all of the required steps in a management regimen. Thus, upon diagnosis, parents understand what needs to be done from an informational stand point (check blood sugars 4x/day, adjust for carbs), but often are not prepared to enforce deviation and adjustments from a behavioral standpoint.
ENTER the SUPERNANNY!
In theory, from a behavioral point of view, A SuperNanny would be a member of a child's diabetes management team who coaches and guides the adult caregivers/parents.
A consistent theme that prevailed throughout the Scientific Sessions was an idea that assuredly was not traditionally believed to be scientific: behavioral change. Many efforts have been made to measure, evaluate, and alter this notion of behavioral change. Our psychosocial teams have been extremely successful at measuring and evaluating it; however, successfully altering behavior is more complex. In many previous blogs I discussed the importance of behavioral support and adherence to self-care skills that are essential to successful diabetes management. The pediatric population is a bit different in terms of diabetes self-care skills. Parenting/care-giving is a major component to help the child/adolescent adapt to the "new normal." Without the input and support of the caregiver, our special population would be essentially anchorless.
Day-To-Day Care Dilemmas:
One of the more difficult aspects of diabetes care, especially in children, is the need to perform the related tasks of blood glucose monitoring, insulin injections, pump catheter changes, etc. Parents/caregivers often feel guilty, sad, overwhelmed, and sorry for the need to perform these much needed acts of daily living. Thus, some caregivers, out of love or guilt allow their children to omit/slack-off/forget the need to check blood sugars at least 4 times/day, bolus for carbohydrates, and try to plan in advance. It is understandable; but not really acceptable in the long haul. As I have stated in the past, if the caregiver/parent models the can do attitude (actually MUST do attitude), there is a better chance that the child/teen will emulate the behavior and accept the "new normal," enabling him/her to move forward in his life journey.
Some parents/caregivers take on everything during childhood and when the child becomes pubertal and enters the realm of teenagerdom, they ask the child to take over self-care tasks without supervision. This is not a good idea, as this group is relatively uneducated and particularly subject to risky behavior even without the added chronic illness of diabetes. Thus, we may have two extremes of behavior in this instance.
Finally, there is another type of parenting/caregiving that has difficulty setting limits for all age groups.
1. Toddlers who act out at home or in public and the parent appears helpless/frozen, unwilling to attempt some form of discipline (for example: screaming, biting, hitting toddler who is not getting what he wants).
2. School-aged children who defy direct instructions from parents and there are no consequences for their behavior.
3. Teens, who, despite multiple rule infractions, are allowed to continue the behavior without recompense.
Do we recognize our own behaviors (without realizing the messages we are imparting)?
(Author's Disclosure: I am not immune to this enabling behavior; just ask my son).
And what does a super nanny do? S/he teaches parents how to parent. How many times do we see this behavior? "I will give your insulin later, or you don't have to check your blood sugar right now, or go ahead and have that coke (not diet- because the kid states it tastes better)." We, as parents, cannot enable this behavior with or without diabetes. We must parent. Isn't that what the SUPERNANNY is all about?
Next step: how to convince my departmental chair to hire a SUPERNANNY as a diabetes team member.
Published On: July 21, 2010