Hopefully, your diabetes team has reassured your child and family that no one is to blame for the development of diabetes and that any guilt inherent during this time has been alleviated to a manageable degree. After this initial impasse,
anger and denial may become readily apparent during the initial discussion of the diabetes diagnosis, during the educational process or after discharge. Indeed, the stages are often fluid and do not necessarily proceed in a linear fashion.
After the diabetes education (survival skills) is completed and the child/adolescent is stabilized on an insulin regimen that works for the family, they are discharged and are asked to follow up with our diabetes educators to inform them of their child’s blood sugars and progress. I often grapple with denial and anger during my first interaction with the family and totally understand their feelings.
-This is impossible. He can’t have diabetes; he just ate too much birthday cake!
-Let’s repeat the blood sugar and hb A1c.
-We need a second opinion (in that case, I provide a list of other respected
diabetes care providers).
- This is a temporary situation, right?
Denial is a coping mechanism in a world of chaos and uncertainty. All healthcare providers and families should respect it as a means of digesting undesirable information.
-It is your fault! If you were a better parent, this would not have happened.
-The pediatrician clearly missed this a year ago.
-We do not accept your opinion, I am sure that you have been mistaken. We are leaving this hospital now. OR There is anger expressed directly at the healthcare team during the educational sessions or at the first visit.
Anger is part of the grieving process. The diabetes team understands and will make every effort to work with your family to achieve harmony. Indeed, our psychologist is clearly an essential component to work through these stages.
Bargaining often occurs during the early stages of diagnosis and even later as families try to adapt to the new normal.
-If we follow all the diabetes team instructions perfectly, maybe the diabetes
will go away.
-Maybe if we cut out all carbohydrates, all will be well, etc.
-We will follow the recommendation of the online guru who states he can cure diabetes.
Bargaining is universal and once again, our team will help support you as we navigate through this stage.
Depression may occur at any stage of the process in both the family members and child/adolescent as reality sets in: insulin will need to be injected and blood glucose monitoring is ongoing.
Reframing by the diabetes team is essential. Coping strategies are offered including counseling. Medication prescribed by a psychiatrist may be necessary as well in acute crisis situations. The team also is aware that until the child/adolescent comes to terms with his/her diabetes, it is unlikely that good glycemic control will occur (unless the parent is responsible for all the care, as in younger children).
The overarching goal is for the family and child/adolescent to accept the diagnosis and move forward to achieve previously existing goals and excellent quality of life. This takes time and acceptance may at times wax and wane.
Emotional support by the diabetes team is necessary throughout the diabetes journey. Without this support network in place, it is extraordinarily difficult to maintain glycemic control and most importantly, an excellent quality of life.
Please discuss your emotional (as well as medical) concerns with your diabetes team! WHY? Until these concerns are addressed, mastering the medical management will be more challenging and perhaps undermine moving in a positive direction towards the “new normal.”