The Art of Managing Diabetes in Public
All diabetes healthcare providers write of the need to perform self-care skills. What does that really mean? The diabetes team prescribes the insulin regimen and dosing scheme, the blood glucose monitoring schedule, the suggested carbohydrate counts/meal and snacks based on age and weight (and the amount needed for growth, if you are a child or teen). We conclude the visit with written instructions and then send you out into the real world. For a child or teen, the real world consists of the home, school and other (like the shopping mall, sports arena, playground, friend's house, theatrical event). Each of these environments plays a role in diabetes self-care skills. What may be really easy to do at home becomes an entirely different matter at school or in the shopping mall. One may be more comfortable to check blood sugars at home, take insulin before meals with accurate carbohydrate counts, but not necessarily feel the same at school or on the baseball field. We are aware of this disconnect and continue to try to address these real world concerns.
For some children and teens, performing self-care skills in public is NO BIG DEAL. These kids are comfortable doing this sort of thing and it is not a problem. I have even known kids to whisk up their shirt (in public) and give an injection on their way to the concession stand at The Nationals Ball Park in Washington, DC. "No Worries," they quip! But, if you are not that kind of person, or still are trying to embrace all that is necessary to take good care of yourself, performing self-care skills in public may be a huge obstacle. In many cases, this obstacle clearly poses a problem in diabetes management.
Each stage of development may change the way the child or teen manages his/her diabetes. An 8-year old may check his blood sugar on the school bus when he feels low; whereas a 15-year old may ignore the symptoms (or treat with rapid acting carbohydrate discreetly) just because they don't want anyone to notice they are performing SBGM. This is totally understandable in terms of development. The problem, therefore, is how do we make our children and teens feel comfortable enough to perform the necessary diabetes related self-care skills in public?
There is no one response to this rhetorical question; but I have several thoughts in this regard. It all starts at diagnosis when all this stuff is introduced. My diabetes team approaches these new self-care behaviors along the lines of routine self-hygiene and activities of daily evening. You wake up, take a shower, brush your teeth, check your blood sugar, go down to breakfast, count your carbs, take your insulin injection. Grab your lunch and run for the school bus: the NEW normal. Yes, easier said, than done, but absolutely necessary if one is to re-enter one's previous life. I do think about this a lot. I know I ask my families and patients to assume a huge burden when they have to add diabetes self-care skills in addition to what they do in their everyday life. And then I ask myself, "is there any other alternative?" Not yet.
How can we encourage successful and adaptive ways to manage diabetes self-care skills in public and outside the nest of home?
1. The obvious: one must perform diabetes self-care skills to optimize glycemic control and attempt to avoid complications in the future. (This really will not work with many teens, I know.)
2. Be prepared: have all diabetes related supplies in one place, in a cool kit with compartments for everything that you can carry about at all times. Girls: you would not go anywhere without your purse, right?
3. Let people know that you have diabetes! The longer you wait to tell people, the harder it becomes to "re-enter" your old life. You are still the same person you were before. Your friends will embrace you and welcome you back. They will even help you to remember to test bloods sugars and take your insulin. They also will tell you that your sarcastic remarks may mean you are getting a bit low and that you need to check. The peer group is incredibly important. THEY NEED TO KNOW! Your teachers, professors, and coaches, etc., also need to know (so they don't ask you to stop texting on your cell phone when you are actually entering your blood sugar into your insulin pump!) Or when the baseball umpire asks the pitcher to remove his cell phone when it is the pump that is attached to his belt!
4. Yes, be discreet, if you are more comfortable. It is ok to go to the bathroom (in a stall, if you must) to administer an insulin injection. You also could do it under the restaurant table (my nurse educator does this all the time). She even tests in the middle of an airplane flight when she gets extremely high due to her love of flying (high anxiety). No one cares!
5. Encourage your school and favorite eating holes to have carbohydrate postings available... There are carbohydrate applications for smart phones that are intended to be used on site (like when you are sitting down to eat your meal/snack).
6. Try not to be secretive about your diabetes: that makes it more of a big deal to others. What are you hiding? Yesterday's headlines are old news, after you have made the big reveal, something else tomorrow will become more interesting and you can go back to being "you" and performing your necessary diabetes related behaviors without anyone giving you a second glance.
7. Diabetes camps and retreats are great! Why? Because everyone feels the same as you do and networking together will elicit further ideas with which to blend in and take care of yourself.
8. There are tons of other ideas that I hope you will list in the comments below to help us all help each other.
(This blog is dedicated to a certain 12 year-old young lady who is successfully tackling these self-care skills with the strength and support of her family and friends along with her dedicated diabetes team!)