In her 30-year experience in caring for children and adolescents with diabetes, Rita Reinhardt has had close contact not only with her patients, but also their parents. She knows both sides and appeals for understanding – especially from the side of the parents, who tend to sometimes overlook just how much their child is actually achieving. Rita Reinhardt’s thoughts on the subject, resulting from her experience in the diabetes station at the Augsburg Children’s Clinic, can help to ease the burden of living with diabetes.

It breaks the hearts of many parents of 1-to-3-year-olds with diabetes to see their children suffering – crying and shouting – at the time of their insulin injections. But, at a closer glance, the needle prick doesn’t usually upset them that much, and when everything is over, they snuggle up to enjoy the body warmth of their parents. Toddlers do not tend to hold grudges. When the uncomfortable procedure is over, they are smiling and laughing once more.
In other words: If the child is so willing to forgive, so too should the parents be willing to forgive themselves for the fact that they have to inject their kids.

Content at the Kindergarten
Kids at kindergarten age tend to develop their own ways of coping with difficult situations. Recently, a 5-year-old girl handed me a good luck charm before her blood test. She gave me the good luck charm so that she wouldn’t feel so much pain. It actually worked! She held the good luck charm so tightly in her hand, i.e., she was so distracted, that she hardly felt the needle prick. Never before had we ever been so relaxed throughout a blood test. The charm did indeed bring luck to the both of us. Later, her mother told me that she had had nothing to do with this idea. The child had thought of it all by herself. I have since taken over the idea myself, and guard that good luck charm with my life!

Many kids at kindergarten are already quite at ease with their diabetes. They are often able to test their own blood sugar, remember to have snacks at the right times, and seldom eat anything other than their prescribed diet without asking first.

In other words: I can only take my hat off to such discipline and sturdiness – but not without a slight pang of sadness. They are, after all, still only kids. Think about this when your children have to forego the jelly babies yet again.  

School Children as Managers
School children are constantly being exposed to new challenges that they have to learn to deal with, for instance, the friend who wants to swap his lunch with him/her; the sports lessons with their different levels of intensity; hypos during class ...

Day in, day out, the kids have to come to grips with the daily plan: Do I need a snack now? How many carb exchanges is that? What is happening this afternoon, anyway? What if things turn out differently to what was previously planned?

At some stage, the child has to take over responsibility for his/her own diabetes management for one whole week. This is a huge achievement for any infant school child, despite our living in the age of the cellular phone. 

Everybody Makes Mistakes
We expect a lot from our children – maybe sometimes a little too much. Even we, ourselves, are not able to fulfil the best laid plans. How often do we binge, although we are on a diet? How often do we sneak open the fridge, or have midnight snacks of chocolate and ice-cream after the kids have gone to sleep. We have a thousand excuses as to why, just for now, we should be allowed to break the rules. This same tolerance for our own lapses we should also apply to our child’s lapses – when, for example, the sugar reading happens to be elevated after a friend’s birthday party, etc.  

Don’t Only See the Negative Side
I think that we adults should learn to encourage our children to look at their daily efforts positively.

It often hurts me to ask 10-to-12-year-olds what they think about their blood sugar control. They immediately start explaining, in all earnestness, the reasons they think are behind their ‘bad’ results. In so doing, they overlook the fact that, for example, out of 28 measurements taken throughout the week, 24 of them were good! Are these children relaying their parents’ attitudes, or are we, the diabetes team, at fault?

In other words: Delighting in the good readings with your child is equally as important as enquiring as to the reasons behind the bad readings. 

Then Comes Puberty
Prior to puberty, children usually do pretty much what the parents expect them to do. Like we adults who look forward to our holidays in which we can switch off for a while, so our children yearn to be able to ‘switch off’ from their diabetes for a while. I know that adults also cannot take ‘holidays’ from their diabetes, but they are grown up! 

Diabetes in puberty presents the family with a whole set of new challenges: “Adults are just a nuisance.” “Diabetes is embarrassing.” “I don’t care about good blood sugar control...” Maybe some of these statements sound familiar.
With all due respect, Dear Mother, allow me to ask you how you were at the age of 14 or 15? Do you remember idolizing the latest pop group? Do you remember how, for days on end, you worked out complicated strategies with your best friend as to how you could contact HIM without looking foolish? During this time, i.e., between jubilation (“He actually looked at me!”) and the blues (“He’s interested in someone else...”), diabetes is not exactly number one on the hit list of important things.

On the other hand, young boys tend to take things more in their stride. They are more concerned in fitting in with the gang. “Am I fit enough to excel in sport?” “Am I cool enough?” “Can I hold my drink along with the others?”
It is not easy to be different: foregoing having pizza with the gang or dropping in to the nearest kiosk for a kebab if you forgot your insulin pen, or drinking mineral water or diet coke instead of the “real stuff”. How would you have decided at that age? Even now, think about how you yourself act when you want to be accepted – be it at work or at the fitness centre. Don’t you also try to show yourself from your best side?

Have respect for those adolescents who, despite all of the above, still manage to keep their diabetes under relatively good control. Keep in mind also that, by the time the kids become adolescents, they have already had diabetes for several years and may also want to take time out from their condition once in a while.

To top things off, at that age, there is an increased release of hormones that play havoc with blood sugar levels. This serves to discourage and demotivate teenagers. You are probably already aware yourself that many high readings are simply not explainable. You’ve done everything right, injected properly, eaten properly, no stress ... and still the reading is 300! If this wouldn’t steal your motivation, what would? This leads one to ask as to why it is worth all the effort. 

We all know that the only time one can really rely on good readings is at the beginning of the illness (remission phase). After this, it is a constant struggle.
I have great respect for adolescents that manage to bounce back from such situations. I remember, years ago, when a 12-year-old at that time wrote in a questionnaire: “Diabetics are more intelligent than the other children, because they know more about their bodies.” I find that children with diabetes are way more than just smarter; they are more mature and conscientious than a lot of adults.

Respect Despite Struggle
I hope that my ideas have served to help parents view their child with diabetes again with pride and respect. In the daily struggle with blood sugar levels, one should not lose sight of the enormous achievement that children and adolescents with diabetes attain in the face of such adversity. 

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Rita Reinhardt
Diabetes Consultant DDG
Augsburg Clinic 
Children’s Clinic I
E-mail: rita.reinhardt(at)klinikum-augsburg(dot)de