+Diabetes Case Study

Presented By: Emily, Jane, Presented By: Emily, Jane, Kate M. and MargauxKate M. and Margaux

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+Agenda:oReview Case

oUnderstanding Diabetes:oWhat is Diabetes?oWhat is Type 1 Diabetes?oWhat is Type 2 Diabetes?

oHelping Kylie…oCope with her new diagnosisoUnderstanding her new diagnosisoPain management and RelaxationoGoing back to school

oIssues :oWith her Transition HomeoWith her ParentsoWith her BrotheroWith her Grandmother

oConclusion

oFeedback/Comments/Suggestions

+Learning Objectives:oBy the end of this presentation we hope you will understand:

oDiabetes.oHow to help children cope with a new diagnosis.oThe impact of a new diagnosis on the family.oPossible Child Life interventions.

+What is Diabetes:oDiabetes is a disease that affects how the body uses glucose.oGlucose is a sugar that is the body’s main sourceoThis is how it should work:

oYou eat.oGlucose from the food gets into your bloodstream.oYour pancreas makes a hormone called insulin. oInsulin helps the glucose get into the body’s cells.oYour body gets the energy it needs.

oYour pancreas is a gland in your belly that helps digest food and makes insulin.

oIf you have Diabetes, the glucose can not get into the cells normally, so the blood sugar level gets too high.

oHaving a lot of sugar in the blood makes people feel sick if they do not get treatment.oThere is Type 1 and Type 2 Diabetes.

+What is Type 1 Diabetes:

oIn type 1 diabetes (which used to be called insulin-dependent diabetes or juvenile diabetes), the pancreas can't make insulin.

oThe body can still get glucose from food but the glucose can't get into the cells where it's needed.

oGlucose stays in the blood, which makes the blood sugar level very high and causes health problems.

oTo fix the problem, someone with type 1 diabetes needs to take insulin through regular shots or an insulin pump.

+What is Type 1 Diabetes:oNo one knows for sure what causes type 1 diabetes, but scientists think it has something to do with genes.

oGenes are like instructions for how the body should look and work that are passed on by parents to their children. However, just getting the genes for diabetes isn’t usually enough, something else has to happen. Something like getting a viral infection, for example, can cause a person to develop type 1 diabetes.

oType 1 diabetes CAN’T be prevented.

oDoctors can not tell who will and will not get it.

+What is Type 2 Diabetes:oType 2 diabetes is different from type 1 diabetes. In type 2 diabetes, the pancreas still makes insulin, but the insulin does not work in the body like it should and blood sugar levels get too high.

oIn kids who have type 2 diabetes, insulin does not do its job as well, so glucose is less able to enter the cells.

oType 2 diabetes can be treated by:oGet to a healthy weightoEat healthyoBe activeoTake medicinesoCheck blood sugar levels

+The Role of Child Life:Child Life Specialists can help children and their families adjust to living with diabetes by:oHelping children to cope with injections, blood checks, and taking other medications

oAssisting families with management of medical treatments and schedules

oHelping families understand the child’s view of diabetes and his or her treatment

oEnabling siblings to understand a brother/sister’s diabetes

oProviding ideas on how to talk to diabetes with children’s friends and classmates

oEngaging children in meaningful play to reduce stress and increase comfort and coping during visits

+Developmental UnderstandingYoung children and Type 1 Diabetes oMay have difficulty understanding sudden changes in their lives (e.g. glucose monitoring, insulin injections, food restrictions)

oSome children may feel they are being punished for disobedience

oMay feel shame or guilt

oChild may act with hostility toward parents, feel that you have failed him or her

+Developmental UnderstandingYoung children and Type 1 Diabetes oChild may believe parents can make Type 1 diabetes go away

oChild may fuss or cry with blood checks and injections at first

oUnable to cooperate because they do not understand

oCan learn to cooperate over time and tell parent when he/she feels low

oMay have picky eating habits

+Age- Appropriate Management

oParents will have full responsibility for all aspects of diabetes care

oParental approval is important at this age

oNeed to supervise, encourage, and foster independence in child

oAvoid being overprotective, as it prevents child from developing a feeling of master over his or her environment

oImportant to involve child at early age, but with realistic expectations

+oCannot be expected to understand diabetes treatment fully until late childhood or early adolescence, thus some planning needed to support them at school

oChild may feel different from peers

oParents continue to be main caregivers, but often must share expertise with child and other responsible adults as children under supervision of parents less often

oChild should be encouraged to participate in school and other activities in same way other children do

School-age children and Type 1 Diabetes

+Child Life Interventions Using Medical Play and Behaviour Modification:

Let’s Play! oExplain what happens within your body when you have diabetes

oUse your paper doll for this activity

oWhat does sugar do? Who is its partner to make it work efficiently? oWhat happens when the pancreas stops making insulin?

+Child Life Interventions Using Medical Play and Behaviour Modification:

Medical Equipment o Introduce needles and finger pokes

oBlood Glucose Meter (BG meter): is a small machine that can read the level of glucose in your blood. You supply a tiny drop of your blood on the test strips made for the meter. It's important that you don't mix and match test strips.

oLancet: is this to do the finger poke Place your drop of blood on the test strip

oThe adult will wait for the meter to give you your reading

oRecord your reading in a journal or diary

+Child Life Interventions Using Medical Play and Behaviour Modification:

Medical Equipment oInsulin: is what your body needs to use the food you eat for energy. Technically, insulin is a hormone made by beta cells in your pancreas. It acts like a key for the food (glucose) to leave your bloodstream and get into your cells.

oNeedle: used to put the insulin in to your stomach

oInsulin Pen: closely resembles a pen but instead where the ink comes out of the pen, it is a needle under the cap and the pen is full of insulin

+Procedures: Finger Pokes and Insulin Injections

oDemonstrate the procedure for finger pokes and insulin injections on the doll oUse pain scale oGive Choices

oWhich finger would she like to use for her finger poke?oWould she like to look, or look away?

oDistraction techniques oGive her a special job while the adult is doing the finger poke or injection oHave her blow bubbles for distraction

Child Life Interventions Using Medical Play and Behaviour Modification:

+Child Life Interventions Using Medical Play and Behaviour Modification:

Behavior Modification: Reward and Tracking system : oHave the child trace their hand and use their paper doll

oEvery time they get a finger poke they will receive a sticker for their hand

oEvery time they receive an insulin shot they will receive a sticker for their paper doll

oThe sticker will act as a reward for her compliance

oIt will help her keep track of how many times she has had finger pokes and insulin injections

oShe may want to make a new hand and paper doll for every week or month

+Re-integration to School:oSW is talking to school staff

oDevelopmentally appropriate activities for the class

oKylie can help with the presentation if she would like to

oHelp Kylie understand how to explain her Diabetes to her peers

oActivities, games, and books to incorporate information

oProvide teacher with information necessary

oHave medical play available if necessary

+oHow will the parents ensure consistency in Kylie’s care?

oNeed to equally adhere to the treatment plan

oIt can be emotionally draining for the parents to have to give insulin injections and blood tests, especially when the child is resistant

oGive Kylie some control over the situation

oPrepare the materials out of her view

oGo get Kylie when it’s time for her injection, rather than calling for her to come

oFocus on distraction techniques that the CLS taught her

oExplain why you have to do it

oProvide her with praise

Transition to Home:

+Coping With A New Diagnosis-Sibling:oAdam may be confused by the changes in the family

oParents & Kylie are at the hospital, being cared for at his grandparents

oParents may be withholding information to protect him until they fully understand the disease and its management

oHe may feel anxious, fearful, resentful or neglected due to the attention his parents are giving to Kylie

oMay also be jealous of the attention Kylie receivesMay think he did something to cause the hospitalization and illness oMay fear that his sister may die

oHis feelings may be manifested as behaviour

oMay be afraid that he will get diabetes

oMay feel guilt that brother/sister has diabetes and they don’t

oNeeds to understand what diabetes is

+Age-Appropriate Management

oNeed to know that they are still loved

oSiblings should be encouraged to join in the education program

oSpecial time with parents may ease the impact

oTalk with Adam about his feelings about diabetes and the changes in the family

oAllow him to be involved in Kylie’s care, where appropriate – can assist with making snacks or participating in her care routine, distraction during injections, and watch for signs of hypoglycemia

oEncourage him to call, write letters or visit Kylie

+oGrandmother may not understand the differences between Kylie’s diabetes and her own diabetes

oThere may be misunderstandings related to diet and insulin

oGrandmother may want to restrict food, which is not appropriate for a growing child

Coping With A New Diagnosis:

+oMay assign blame for the illness.

oParents may mourn their old way of life.

oMay experience a variety of feelings including shock, denial, anger, sadness, anxiety, fear, anger and guilt.

oStress related to managing Kylie’s care – giving injections, diabetes management, worrying about blood sugar reactions.

Coping With A New Diagnosis- Parents:

+Tips for the FamilyoBoth parents need to be involved in all aspects of Kylie’s care

oFeelings of resentment, fatigue and stress can build up if the parents are not being consistent

oParents will need to work together to manage her care

oMembers of the extended family will also need to learn how to be responsible for her care

Coping With A New Diagnosis:

+oA child with diabetes can still be healthy, happy and secure, with normal patterns of growth and

development

Conclusion:

+A child with diabetes can still be healthy, happy and secure, with normal patterns of growth and

development

Conclusion:

Questions? Suggestions? Feedback?