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Age-appropriate targets for self-care education

for children with diabetes

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The newly-diagnosed child• Admission to hospital:

• duration normally 3–5 days, depending on the child’s condition and the family situation

• treatment for ketoacidosis• starting subcutaneous insulin-treatment and

diabetes education

• The education:• co-ordinated by the diabetes nurse and

carried out by members of the multi-disciplinary diabetes team

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Starting diabetes education 1

• First conversation with the family:• try to establish good contact and create

confidence• talk about the experiences before and during

the stay in hospital• try to remove any sense of guilt• promise:

• “it can be done”

• 24-hour hot-line service

• good life with minimum restrictions

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Starting diabetes education 2

• Necessary knowledge before discharge from hospital:

• administration and injection of insulin• testing blood glucose• knowing acceptable blood glucose values• symptoms and treatment of hypoglycaemia• simple principles for food administration• talk to the social worker about reimbursement of:

diabetes devices sick-leave for one parent for a short period

• Instruct about daily contact by telephone

to discuss adjusting insulin dose

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Out-patient diabetes education 1

• Starts 1–2 weeks after discharge from hospital

• Lasts about 6 months

• Primarily carried out by the diabetes nurse and the dietician

• Includes training/visits to childcare institutions, schools etc.

• Home visits also possible

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Out-patient diabetes education 2

• Who is educated?• patient and parents

• brothers, sisters and friends

• other members of the family

• personnel in childcare institutions/school

• other 'baby-sitters'

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Out-patient diabetes education 3

• Qualifications of the educator:• great practical and theoretical knowledge

• open and good listener

• able to treat each family individually according to the family’s abilities

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Out-patient diabetes education 4

• Important to find the balance between optimum and sufficient knowledge

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Special problems 1

• Age:• infants

• young people/adolescents

• Culture/language/religion:• immigrants/refugees

• Social problems

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Special problems 2• Aim of education:

• to secure good diabetes regulation without complications but at the same time create possibility of a good childhood/youth – 'development without tripping'

• Small children:• achieve normal physical, psychological and intellectual

'milestones'

• Young people:• knowledge and experience + family trust and support =

better accept and compliance

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Other offers of education 1

• Groups:• social activities for children arranged by a local

section of the national diabetes association

• group for parents with very young children run by psychologist and social worker

• group arrangements for children of the same age together with their parents – combination of out-patient clinic and education.

• special projects for small group of young people in puberty

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Other offers of education 2

• Groups:• education on different topics for young

people aged 12–15 and 16–18 years – each twice a year

• This year’s topics:• pizza, hamburgers, alcohol and parties• physical activity• good regulation/insulin management• sickness/ketoacidosis

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Written material 1

• Coping with Diabetes:• large numbers of papers on different topics

and levels

• intended as short and precise guidelines in practical diabetes management

• always handed out in connection with oral instruction

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Written material 2

• Age-appropriate education and evaluation material:• created by teachers, psychologists and

diabetes nurses

• describes practical and theoretical knowledge of diabetes for children and young people aged 16–17 years

• goals are adjusted and adapted to the educational level, abilities and psychological development of the child

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Written material 3

• Age-appropriate education and evaluation material includes:• age-appropriate goals for members of the

team

• guidelines for the diabetes patient and family

• evaluation of material/methods

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Transfer to the diabetes out-patient clinic

• First visit maximum 6 months after diagnosis

• Visits every 2–3 months until aged 18 years

• Meets:• doctor/paediatrician• diabetes nurse• dietician• laboratory technician• chiropodist• social worker (if needed)• psychologist (if needed)

• If needed, re-education should be offered (e.g. as the child grows older or metabolic control is poor)

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Age-appropriate goals:general 1

• 6–7 years:• parents are responsible for the daily diabetes care

the child could be encouraged to help

• 8–9 years:• child takes over a larger part of the practical responsibility

for diabetes care the parents, however, still have the main responsibility

• 10–11 years:• child needs only limited theoretical background, but should

be able to take practical responsibility for diabetes care the parents should assist in dosing insulin

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Age-appropriate goals: general 2

• 12–13 years:• the child takes practical care of the diabetes and

begins to acquire the theoretical background

• 14–15 years:• the young person takes care of the diabetes and has

now acquired the requisite theoretical background

• 16–17 years:• preparations are made for adult life, as the diabetes

becomes a matter between the young person and the diabetes team

he/she is motivated to obtain further knowledge and experience, practical as well as theoretical

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Age-appropriate goals:detail

• Knowledge of diabetes

• 'Rules of the game':• food, insulin and exercise.

• Blood glucose:• testing• hypo- and hyperglycaemia

• Special precautions:• sickness• eating/sleeping away from home• hyperglycaemia

• Complications of diabetes