Psychological, social and financial issues

Effects on children, care-givers and siblings

• Diabetes in a young person has a profound impact on family life. It has the potential to cause serious personal and family distress
• Pre-existing psychological, social or financial problems in individuals and families are likely to be accentuated by the stress of caring for a young person with diabetes
• The cultural, environmental, developmental and personal circumstances of the child and family should receive high priority in diabetes care including a careful assessment at the time of diagnosis
• Attention focused only on metabolic control, with neglect of psychosocial influences is to be strenuously avoided
• Poor metabolic control is commonly associated with psychological and social difficulties. Appropriate and timely intervention may be the most effective way to improve control

The young person

• Each individual should be assessed on the basis of age, stage of development, maturity, and emotional and social wellbeing
• Each child’s situation in the family and the social environment (particularly nursery, school or college) needs to be recognized
• Young people should have equal opportunities in any type of school/college activity
• Apart from a few necessary exceptions, young people with diabetes should have equal opportunities in employment
• The diabetes care team should provide age-appropriate advice and education not only on diabetes itself but also on how to cope with
  • psychological stress, e.g. feeling different, bullying, jealousy, peer group pressures, discrimination
  • diabetes in daily life, e.g. at school, with friends, eating behavior, becoming independent

Parents and other family care givers

Overt psychological problems or psychiatric disorders in the young person or family members should receive support from the diabetes care team and expert attention from a social worker/psychologist/psychiatrist trained in child and family therapy

• At diagnosis parents, grandparents and other close care givers often pass through stages of grief, fear, guilt, anger, denial, resentment, bargaining and depression before adapting to the requirements of the condition
• These feelings may re-emerge at later dates, particularly when faced with crises such as hypoglycemia, diabetic ketoacidosis, intercurrent illnesses or worries about behavior, schooling, marriage, insurability, etc.

Parents should be invited to stay with their child in hospital at all times

• Parents (particularly of young children) fear both hypoglycemia and the long-term consequences of hyperglycemia
• Diabetes may cause extreme frustration because perfect control is never achieved and is constantly changing in childhood and adolescence
• Parents worry about the balance between retaining responsibility, being overprotective, and allowing increasing independence
• Grandparents and other relatives may have considerable difficulties in understanding diabetes, the different priorities for the affected child and the need for consistency in management to avoid family conflicts
• Babysitters or other temporary care givers of children with diabetes should receive specific instructions on dealing with diabetes from the parents or the diabetes care team

Siblings

• The diabetes care team should recognize that siblings may exhibit many different and strong emotions about their brother/sister with diabetes
• The care team may need to provide specific information, counseling and support for siblings exhibiting guilt, fear, jealousy, embarrassment or sadness
• Parents, siblings, other relatives and care givers all require accessible, consistent and skilled psychosocial support systems to improve their sense of understanding, self-efficacy and personal influence over the child’s diabetes

The diabetes care team should receive training in the recognition, identification and provision of information and counseling on psychological and social problems related to diabetes