One of the most common concerns for parents (and their children) is allowing them to be independent and leave the nest. After beginning kindergarten and elementary school, most children enjoy visiting other children in their homes and attending events outside the family. These activities include after-school play dates, sleepovers, birthday parties (in the home or outside the home of the birthday celebrant), and school field trips. For most children these excursions are everyday occurrences; but for parents and children with diabetes, these events can be anxiety provoking and require a great deal of advance planning. According to most diabetes educators, the key to successful social endeavors involving food and treats is empowering the responsible adult with information about the attendee with diabetes.
Who should have this information and what kind of information do you give them? School personnel that interact with your child need to know the "plan" in regard to insulin, food, and treating hyper and hypoglycemia. Rapid acting carbohydrate (and/or glucagon) must be readily on hand for emergencies. We would suggest that the teacher contact the parent of the child with diabetes to discuss how they wish to include the child in the festivities. Most importantly, the child should not be left out. One easy way to handle these common day-to-day events is to include them in a routine. Many of our kindergarten and elementary schools include snacks as a routine for all students and provide them at the time necessary for the child with diabetes. This allows for a level playing field and all children are treated in the same way. No one is singled out and made to feel different.
Thus, for those on the traditional three-shot per day regimen with NPH/Regular or rapid acting analog at breakfast, Regular/rapid acting analog at dinner and NPH at bedtime, these birthday treats may be treated as mid-morning or midafternoon snacks. For those children on basal/bolus therapy, there should be no problem, just bolus insulin and eat those treats!
What about field trips? In our view, it is important the child and teen with diabetes attend all excursions with the availability of a trained chaperone. According to our diabetes team, we believe that it should not be a requirement that the chaperone be a parent or nurse, but it is essential that the individual at least know how to test blood sugars and treat emergency situations, particularly lows depending on the field trip's duration. For longer or overnight trips, the chaperone will need a primer on blood glucose testing, insulin administration, and emergency treatment as above, as well as a means to contact the parent/guardian at all times. The phone number of the diabetes team also is appropriate should there be any concerns.
The same is true for play dates. Most parents of your child's playmates wish to be helpful and are willing to learn basic tasks, including blood glucose monitoring and treating lows. Learning how to give insulin may be on the next level. Clearly, it is very helpful if your older elementary school-aged child could check blood sugars on their own and even in some instances use insulin pens. Learning to test blood sugars and giving insulin boluses independently (often with phone or direct supervision) is very liberating for these kids. The desire to be independent is often one of the main reasons for children to transition to intensive insulin therapy by multiple daily injections or the insulin pump. Thus, once again, it is important to plan ahead so that the parent supervising the play date or sleepover is educated and knows what to do, especially in an emergency. Many children have medical concerns that require other parents to be in the know, such as food or peanut allergies (use of an epi-pen), seizure disorders etc. Most parents feel more comfortable when they are prepared and it is your responsibility to ensure that they feel empowered. Please ask your diabetes team for advice in regard to preparation of other caregivers.
TEENS: Much more independence, much more risk, and much more anxiety! Our teens are quite capable of testing blood sugars, giving insulin injections via syringes or pens, managing their own insulin pumps, and treating lows/highs. Remembering to do so, however, is more problematic. Creative ways to remind your child/teen to perform self-care skills when away from the nest are essential. Examples include cell phone text-messaging, alarms, watches that beep when it is time to test blood sugars, notes, and simple phone calls. It is important, however, to allow our teens to try. You might be very surprised at how well they do (not the way we would do it, but nevertheless, it gets done-especially if the teen wants to go out again). As I have consistently stated in previous blogs, driving should be treated very seriously. A cell phone in the case of an emergency is essential as well as identification indicating that your child has diabetes with a phone number to call for help. Letting go is difficult enough for a parent of a child without chronic illness, let alone for a parent whose child has diabetes. Taking one small step at a time beginning in elementary school is essential so when the time comes for your teen to drive and stay overnight at a friend's home, you will hopefully be ready... and not follow him as he leaves the driveway.
Published On: March 30, 2009