Pediatric Diabetes

Type 1 Diabetes

Occurs in about 1 in 500-600 children Results from autoimmune destruction of

pancreatic cells that produce insulin, resulting in permanent insulin deficiency

Insulin regulates glucose metabolism, which is essential for growth, activity, wound healing, and brain function

Type 2 Diabetes

Rather than insulin deficiency, insulin resistance occurs in T2, impairing cellular uptake of insulin

This can eventually lead total destruction of pancreatic cells and thus insulin deficiency

Blood Glucose Level

As a result of insulin deficiency, blood glucose levels often deviate from normal range, resulting in…– Hyperglycemia (high blood glucose level)

• Too much food• Too little insulin• Illness• Stress

– Hypoglycemia (low blood glucose level)• Too little food• Too much insulin• Extra exercise

Hyperglycemia: Symptoms

Extreme Thirst Frequent Urination Dry Skin Hunger

Blurred Vision Drowsiness Nausea Ketones

– Acid in blood

Hypoglycemia: Symptoms

Shaking Fast Heartbeat Sweating Anxiety Dizziness Hunger

Impaired Vision Weakness Fatigue Headache Irritability

Long Term Complications

Heart attack due to reduced blood flow to heart

Stroke due to reduce blood flow to brain

Loss of circulation causing slow wound healing

Diabetic retinopathy caused by broken blood vessels in eye (loss of vision)

Diabetic nephropathy (kidney damage/failure)

Neuropathy (nerve disease) can cause pain, loss of feeling

Good News: Treatments

Treatment to manage blood glucose levels– Eat healthy foods

• Too many carbohydrates raise blood glucose levels

– Get exercise daily– Check blood glucose levels– Take medications

• Different types of insulin medications

Diabetes Management

Knowledge Skills Treatment adherence

– To all parts of regimen!!!

Diabetes Assessment

Self-report instruments– Johnson’s 24-hour Recall Interview

• Reconstruct diabetes-related events• Conducted separately with child/parent

– Self-Care Inventory• Completion of 14 diabetes-related tasks

– Caution of over-reporting Direct Observation

– Meal-time Observation Schedule– Interaction Behavior Code

• Family interactions

Diabetes Assessment

Technological Alternatives– Memory in blood glucose meter

Family measures of functioning– Responsibility measures– Communication

The Psychology of Diabetes: Risk Factors Adherence is related to family factors

– Perceived nagging– Conflict– Ineffective communication

Stress may affect glycemic control and adherence– Patients in poor metabolic control have been

found to exhibit maladaptive ways of coping with stress

The Psychology of Diabetes: Risk Factors Adolescents with T1 may be at higher

risk of eating disorders, due in part to weight gain associated with the initiation of insulin treatment– Purposeful omission of insulin treatment

The Psychology of Diabetes: Risk Factors Degree of perceived interference in

daily life– Management requires adherence to

multiple daily tasks at home, school, and in other social settings

Social pressure may negatively affect adherence

How Psychologists Can Help: Family Factors Supportive (but not “nagging”) parental

involvement– Praise, warmth, encouragement, and empathy– Appropriate for child’s maturity level– Examples

• Gentle reminding• Assistance in diabetes tasks

– Balance with needs for autonomy• Gradual yielding of responsibility associated with

increased self-confidence and personal ownership of regimen

How Psychologists Can Help:Family Factors Family problem solving and conflict

resolution1. Define problem

2. Set a goal

3. Brainstorm ways to accomplish goal

4. Evaluate Ideas

5. Action plan

6. Revise the goal

How Psychologists Can Help:Family Factors Communication

– Didactic Instruction– Feedback– Modeling– Behavioral Rehearsal– Monitoring

How Psychologists Can Help:Family Factors Communication

– Encourage members to talk directly to one another rather than using third parties

– “I” statements– Decrease interruptions, yelling, name-

calling, “mind reading”– Improve non-verbal communication

• Eye contact, fidgeting, smiling

How Psychologists Can Help:Coping with Stress Support from health care professionals

– Encouraging, empathetic, flexible Coping skills training for maladaptive coping

responses– Social support– Problem solving skills– Cognitive restructuring

• “It’s not fair that I have diabetes and can’t eat what I want.”

Psychotherapy for psychiatric disorders

How Psychology Can Help:Advocate Talk with day care/school/camp officials

to advocate for special needs– Provide general information– Describe child’s regimen and its potential

impact on the setting– Identify barriers to adherence and problem-

solve ways to overcome them– Address problems that may arise

UF Telehealth Program

Family focus– Parent-child interactions– Positive parenting principles– Setting reasonable goals– Changing home environment

• Stimulus control

UF Telehealth Program

Child Focus– Injection strategies (e.g., sliding scale)– Blood sugar testing (e.g, watch alarm)– Nutrition (e.g., food intake monitoring,

measuring portions)– Communicating with medical team– Handling high/low blood sugar levels– Exercise (e.g., setting reasonable goals)

Treatment Effectiveness

Overall, treatments have been shown to increase adherence

However, not all treatments have been proven to be effective in achieving metabolic control