How to help children deal with diabetes-related stress

Daniel Sher suggests four psychologically-informed strategies to help children cope with diabetes-related stress.


As a parent of a child with diabetes, it is fair to assume that you are no stranger to stress. We all know how detrimental chronic stress can be for any child’s mental and physical well-being. When it comes to diabetes care, stress can make it that much harder for children to cope.

The signs of stress in children

Stress is a physiological, mental, emotional or behavioural response to a difficult situation.

  • Physiological signs of stress include muscle tension, shallow breathing, restlessness, sweating and an elevated heart rate.
  • Mental manifestations of stress are thoughts which seem overwhelming and disproportionately negative. Examples include “I’ll never get this right”, “I’m losing control” or “My readings are never where I want them to be.”
  • Stress also manifests emotionally, leading to feelings of shame, anxiety, irritation, fear or anger.
  • Finally, stress can manifest behaviourally, in the form of anger outbursts, social withdrawal, forgetting to take one’s insulin or falsifying one’s blood-glucose results.

Stress and diabetes: a vicious cycle

Stress can affect diabetes directly, by increasing the level of cortisol and adrenaline (stress hormones) in the bloodstream. These chemicals make it harder for insulin to work properly, which can cause a spike in blood glucose levels.

Stress also affects diabetes indirectly. A stressed child, for example, may be more susceptible to eating sweet treats, avoiding testing or skipping on insulin doses. Adolescents may engage in denial and avoidance, whereby they choose to take a break and pretend that they don’t have diabetes for a period.

Four ways to help your child fight stress

It is important to tailor these strategies according to your child’s age and temperament.

  1. Empathise and reflect

Humans are biologically hard-wired to seek out social support. While there are many practical tools (such as meditation and exercise) that can be used to manage stress, arguably the best way to help children de-stress is to make them feel heard.

This involves temporarily brushing aside your own, personal concerns about the situation and truly putting yourself in your child’s shoes. Ask yourself what he/she is feeling and why? Try to imagine their actual emotional experience.

Establishing true empathy will make it that much easier to connect with your child in a way that promotes healing, on a neurobiological level.

Once you have a sense of what they are going through, ‘reflect’ this back to them. So, that they have an experience of being heard and supported. Examples of reflective statements include:

  • “It sounds like this is really tough for you.”
  • “I can see how angry you are.”
  • “It’s clear that you’re feeling overwhelmed.”
  1. Help them name their feelings

To support your child, help him/her develop a vocabulary with which to express emotion. Research has demonstrated again and again that translating emotions into language (or namingfeelings) helps people to regulate their emotions.

Start by asking your child to help you understand what they are feeling. If they don’t have the vocabulary to describe their emotions, help them by proposing possible labels, such as:

  • sad
  • scared
  • hurt
  • angry
  • helpless
  • hopeless

If it feels like these concepts are too abstract for your little one, you can start by focussing on where in the body their emotion is felt. Emotions often manifest physiologically. Is the feeling warm or cool? Radiating, pulsating, vibrating or static? Does their emotion have a colour? Have interactive conversations about emotions. Don’t forget to reward them as they learn to develop this vocabulary.

  1. Model healthy behaviours and attitudes

Modelling means leading by example. Sometimes, the best way to help your little ones’ cope is by showing them how we manage our own stressors. How can you model healthy stress management to your child?

Know the difference between healthy and unhealthy coping mechanisms. How do mom and dad manage when things get tough? Do they go get some endorphin-boosting exercise, take a dip in the ocean, or attend a yoga class?

Or are they more inclined to get snappy, binge eat on junk food or turn to alcohol? When mom and dad get stressed, are they able to verbalise and own their experience, or do they withdraw into themselves?

Modelling healthy stress-reduction mechanisms is vital. Not only does this teach your children adaptive skills and techniques for coping, it also helps them to feel more secure in themselves.

Children who believe that their parents know how to cope with stress are better equipped, on an emotional level, to feel competent in doing so themselves.

  1. Treats are okay

Food is a big deal. The dietary restrictions that a diabetes diagnosis brings can feel incredibly limiting. It is important to recognise that as they grow, they will become increasingly independent. This means that before long, you will have no say whatsoever as to whether they choose to cheat.

In her excellent book The Emotions of Children with Diabetes, Rosemary Flynn describes the difference between ‘cheating’ and ‘treating’. Cheating involves deception, while treating is a form of self-care. If your son has an occasional portion of his favourite ice cream for dessert and accommodates by increasing his insulin dose, this is not cheating, but treating. But, if he sneaks a chocolate bar behind your back and doesn’t accommodate for it, that is cheating.

If your child wants the occasional treat, don’t make them feel shamed or shunned. Support them in their choice to treat themselves occasionally, if they are taking appropriate measures to compensate with insulin or exercise.

At the end of the day, it is not our job as parents to dictate our children’s choices to them. But to support them in making safe and informed decisions for themselves.

When to seek professional help?

While stress and anxiety often go hand-in-hand, they are not the same thing. Anxiety disorders are mental health conditions that may be triggered by acute or chronic stress. If you think that your child may be developing an anxiety disorder, it is important to seek help from a licensed mental health professional.

Do your child’s stress levels feel out of control? Are they stressed-out for extended periods of time? Are they unable to cool-off and regulate their emotions? Is their stress significantly impacting on their grades, social lives, relationships or physical health?

If the answer to any of these questions is ‘yes’, your child may benefit from a consultation with a psychologist who can help them set up an anxiety treatment plan.

Taking back control

Stress is inevitable. Everyone experiences it. We know that stress can negatively affect mental and physical health, making it harder for children to effectively manage their diabetes.

However, stress in and of itself is not a bad thing! If we feel equipped to cope, small doses of stress can make us feel energised, focussed and motivated.

The answer, therefore, is not to try to completely eliminate stress from the lives of your kids. This is impossible. Rather, we need to support them in developing the tools and feelings of competency that they will be able to draw on to manage stress effectively.


References:

Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in psychiatric treatment, 11(5), 338-346.

Flynn, R. (2000). The emotions of children with diabetes. Creda Communications: JHB.

MEET THE EXPERT


Daniel Sher is a registered clinical psychologist who has lived with Type 1 diabetes for over 28 years. He practices from Life Vincent Pallotti Hospital in Cape Town where he works with Type 1 and Type 2 diabetes to help them thrive. Visit danielshertherapy.com


Header image by FreePik

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Back to school (with Type 1 diabetes)

Going back to school can be a stressful time for anyone. For people with Type 1 diabetes (T1D) this can be even more so, especially returning to school after a new diagnosis. It’s important that teachers are aware of T1D so they can ensure the wellbeing of their students.


Education

It’s so important that your school teachers are aware of your T1D and know what to do when you need assistance. If they are educated, they will be better prepared to help you.

It’s also advisable to keep a Glucagon kit at the school office, therefore it’s best to educate the school secretaries or the school nurse.

If you feel comfortable, it’s also great to make your friends aware. That way you can ask them for help too.

Educate your teachers on the symptoms of high and low blood glucose so that they can keep an eye out for you.

If you play sports, educate your coaches on how you may need to take breaks if your blood glucose drop and eat and rest until your blood glucose returns to a good level.

Know your rights

It’s important to educate your teachers that you need to eat during class. No excused from your teachers, you are the exception. If you write exams, make sure the teachers are aware of your T1D!

Be as open about your T1D as possible

The more open you are about your diabetes, the better. People are often very inquisitive and unfortunately T1D carries a lot of misconceptions so try to be as patient as possible

If you wear a medical device, wear it with pride

NEVER be ashamed of a CGM or pump being visible. People are more likely to ask you questions but use it as an opportunity to educate people and create a positive conversation about T1D.

Be prepared

Make sure you ALWAYS have glucose sweets or a juice box with you. Lows can happen at the most unexpected times. It’s also important if you leave the classroom to carry your ‘low’ treatments with you.

Drink plenty of water at school too. Pack your bag the night before; that way you are less likely to forget important things at home. Be prepared for more than one low a day and pack enough supplies.

Remember that your T1D doesn’t define you

Know that diabetes doesn’t make you different from everyone else 🙂

Click on the image to make use of a printable PDF from the JDRF which is a great resource to give to your teachers.

T1D

MEET OUR YOUTH WARRIOR


Sarah Gomm (16) has been living with Type 1 diabetes for nearly 13 years; diagnosed at age four.


Sarah’s story

My family knew something was wrong with me due to my symptoms of thirst and weight loss, etc. They took me to the doctor and I was immediately sent to the hospital where I was diagnosed with T1D. I spent a few nights in hospital where my family and I learnt all the ins and outs of T1D.

For the next eight years, I did insulin injections and finger pricks. My mom would come to my school during break to do my injections until I was able to do them myself.

The past five years, I’ve been fortunate enough to use a CGM and insulin pump, which I’ve found to assist in lowering my HbA1c and improve my overall control.

As I get older, I’m becoming a lot more responsible managing my diabetes and it’s made me a very independent person.

However challenging T1D can be, I still count it as a blessing. I have experienced so many amazing things I never would have, it’s made me mature and, most importantly, I’ve met so many amazing people.

T1D does not define me, though, it has made me the person I am today, and for that I am grateful!