That diabetes is perceived as a negative event in an individual’s life is a fact documented widely in both clinical case documentation and research publications. The negative connotations of diabetes are not unexpected given the incessant medical demands (insulin, meal planning, activity, self-monitoring of blood glucose) and decisions (for e.g., balancing the meal with amount of activity, treating fluctuations in sugar, selecting appropriate foods over, as the case may be, preferred ones). In addition are the risks of long-term health complications (damage to the kidneys, nerves, eyes amongst others). Diabetes is omnipresent, encountered in just about every situation of daily life, and appropriate planning is required to integrate diabetes care with the processes of daily living. Thus, the negative perception of diabetes is a crucial aspect that cannot be ignored by the health professional more so as it influences the emotional and motivational response of the individual to therapeutic requirements.
The diagnosis of diabetes in a child brings with it a state of shock for the family members. The family balance is shattered and the whole family is presented with a crisis. It is also, in a sense, a loss. A normal child is so to say, replaced by a child with diabetes. The family is pushed into a zone called “GADBAD”.
- G – Guilt – “I must have committed some mistake that is how my child got diabetes. Is it that I gave him too many sweets and chocolates?” Or “I gave him a severe thrashing and just two days later, he developed diabetes. It’s my entire fault.”
- A – Anxiety – “What about my child’s future? Will he be able to live a normal happy life? What about marriage? What about his career?”
- D – Denial – “Well, This diagnosis must be wrong. Nobody, in our family ever had diabetes. How could my child have got it? I am sure it is some minor problem, not diabetes.”
- B – Bargaining – “Doctor, you have advised insulin injections twice a day. Won’t once a day do?” Or, “this injection business sounds so painful. Can’t we try Ayurvedic or homeopathic medicines, instead?” Or, “Can I not allow my child to eat sweets sometimes?” Or, is it not enough to test blood glucose just once in a month?”
- A – Anger – “Why did I develop this disease? Why me only? What do you mean it’s not curable?” Or, “I am following all your instructions and my sugars are not yet controlled; why is that so?” Or, “Why should I suffer so much pain?”
- D – Depression – “I am the only unfortunate one. It is a hopeless situation. I don’t know how my child is going to live with this dreadful disease. It’s my fate after all, what else?”
Feelings described above certainly interfere with the management of diabetes. Well, then what are the possible effective coping mechanisms? The answer to this question can be pointed out like this:
- A child with diabetes needs support, encouragement, and empathy; and NOT overprotection, tears, and sympathy.
- A child can and does adjust much more easily than the adults to the daily schedules of injections, diet, exercise, and monitoring.
- Discipline is the key word in the management of diabetes. If parents themselves include discipline in their life-style, it enables and encourages the child to do the same.
- Parents should help the child to achieve independence in managing diabetes on his own.
- Regular visits to the diabetes clinic, and regular participation in meetings and educational camps for children with diabetes, is essential.
- Diabetes is an illness, but if it is well controlled, what results is a state of good health. It always helps to have positive attitude to the management of diabetes. For example, “I know how to make suitable corrections in my insulin dose and diet only because I monitor my blood sugar regularly”, rather than “Whenever I test my blood sugar is high, so why should I check at all?”
- One should recognize one’s all negative feelings associated with diabetes.This should be openly discussed with the clinic team with other ‘senior’ patients with diabetes and their parents who are more experienced.
- Regular communication with other children with diabetes and their parents is helpful, apart from the interaction that takes place the clinics, meetings, and camps.
The JDF Maharashtra Chapter, has been running clinics at Oshiwara providing services by doctors specialized in diabetes management, dieticians, counselors and mental health professionals. It has been conducting annual camps for diabetic children regularly for the past many years. The purpose is to provide intensive practical education in diabetes related self-care skills, to help them with the social and emotional problems of the JDs and their families. It is seen that with the help of the therapeutic process of counseling and group meetings, the management of diabetes becomes extremely effective.