The psychological impact of youth diabetes

No one doubts today about the blow that a person supposes for a diagnosis of a chronic disease.But when we are also talking about children, the impact is even greater and very often not so much for the children themselves and for their parents, who automatically see their dreams of having a totally healthy child.

Type 1 diabetes is one of those chronic diseases that "assaults" the life of many parents knowing that their children suffer from it.And we say "assault" because silent disease almost always takes by surprise, so that its acceptance is even more difficulty.Hence the importance of making known what happens in general before this diagnosis at the psychological level and what can be done to soften its effects.

1.Psychological effects of the diagnosis of type 1 diabetes

We will differentiate and address separately the impact that the diagnosis produces on the child suffering from the disease and the one that occurs in the parents themselves:

a) Psychological impact on the child.

The effect of the diagnosis is different qualitatively and quantitatively depending on the child's age.These are the general characteristics:

Preschool age: At this age children cannot really understand what diabetes consists of or what a chronic disease implies.What they do perceive is that their parents suffer from something that they finally discover that it has to do with him, feeling guilty and understanding treatment as a punishment.

SCHOOL AGE: It is in this age when the first contact with the social consequences of diabetes occurs (it has to explain to others that is diabetic, refuse to take certain foods ...) they get used quickly to therapy, showing much interest in learning newknowledge and skills (and even proud of it).His attitude is sometimes more rational towards diabetes than his parents present, suffering less for it.As adolescence approaches the child is able to get involved more actively in his treatment, which gives him an active role and gives him a feeling of control over the disease.

Adolescence: Diabetes makes them feel different from others at a time when what they most want is to be accepted by others.Sometimes there is an affectation of self -esteem and can hide their disease to others.They are forced to adjust their rhythm of life and reject inappropriate habits and activities that other adolescents carry out (leaving alcohol, smoking ...) and combining age activities with proper treatment of the disease (e.g. camps, risk sport…).They are often found in the dilemma of deciding between "moving from everything" and taking care of their health strictly.They also find it difficult to promote a certain separation from their parents when it depends on them in the treatment.
Although we are not going to stop in the impact on the brothers, no doubt that there is a risk that they feel abandoned by the excessive cares deposited now on the child with diabetes, without obvious that sometimes the attention calls can bemultiply and sometimes surprisingly (e.g. we find brothers who pretend to have diabetes symptoms to claim their parents' attention).

b) Psychological impact on parents.

They are perhaps the most impacted by the diagnosis.They live it much more emotional than rational, being able to compare with a grieving process, since the loss of something very dear is perceived: the health of a child, in addition to some autonomy and life habits, hopes, dreams and expectations offuture for that child.Although the different phases that make up a duel will be explained below, each person lives this experience in a particular and unrepeatable way, so that inoccasions do not give all the phases and if they occur, it is not always in the proposed order.With this we want to relieve the weight of the imposition of having to live these types of situations in a certain way.The 3 stages that we believe more representative to a duel by diagnosis of diabetes are:
Shock: 48 hours to weeks.Cover the period in which the news is received.Characteristics: stun, evasion, denial of the situation ("It is not me"; "there has been an error"; "I am dreaming."), Which works as emotional anesthesia.Varied emotions, alterations of appetite and sleep and anxiety.

Confrontation: lasts from months to years.Characteristics: There is already awareness of the situation, intense (necessary) pain, anger, anger, stunning, guilt.It is the direct struggle phase to adapt to the disease, a very hard stage, so that depression, stress and immune vulnerability may appear

Recovery: last 6-12 months and appears at the two years of the diagnosis approximately.The negative effects of previous phases decrease and emotional acceptance (perhaps the most difficult) of the situation occurs.Life is normalized and a psychic strengthening is even noticeable.

2.What to do in each case?
In the case of children:

Our actions to soften the impact will clearly depend on the age and degree of maturity.But in general terms, the pattern to follow would be the following: we must try to make the disease and its treatment part of the child's daily life, differentiating their identity as people from the disease (giving priority to the first without forgetting the second)and making them see that they are valued regardless of the state of their illness.Some examples:

In preschoolers: we can include certain aspects of the treatment within the game (e.g. to throw a lot in which finger is going to click, that he is in charge of taking out the strip for the meter ...)

In schoolchildren: teaching them to speak with other children of their diabetes as a normal facet of their life, without regrets or faults.

In adolescents: P.E., favoring that you are part of all the activities of your group of friends and their age, coupling it in a balanced way with good diabetes care, without overprotecting.

In the case of adults:
Shock phase:

1. To health professionals in charge of transmitting the diagnosis:
Do not use labels (better say "your child has diabetes" that "your child is diabetic")
Empathize (getting in the place of the parents with whom we are talking with)
Ded time only to giving the diagnosis and clarify doubts (we do not do it while we write, e.g.)
2. To the parents:

Despite the chaotic of the situation, try that our emotional state and behaviors do not have negatively impact on family dynamics (e.g. over the other brothers, paying adequate attention to all, not abandoning basic needs, such as eating and sleeping ...)
Allowing to feel and express all kinds of emotions, including sadness, anxiety, concern, anger ... during the time that is necessary, since it is something perfectly normal and fundamental for a good assimilation of the situation.But be careful!Let's try that the child does not witness this type of negative emotional states.We will avoid unnecessary concerns and guilt.
Quickly search for all kinds of social support (family, associations, known in our same situation, medical, psychological and state resources within our reach ...)
Let's not let our previous knowledge about the disease (not always successful), as well as opinions of other people, rumors, etc ... affect our objective vision of the situation.

confrontation phase

Do not saturate with too much theoretical information.It is better to focus on theInformation provided by the medical team, the Diabetes Association, etc.If we need more information ... Let's ask the doctor!
It is normal for some aspects of diabetic control to escape our control and forecast.Let's not try to be perfect!

We do not invest our efforts in useless discussions with our children to negotiate if they have to undergo treatment.They must do it (in the same way that we do not discuss whether or not they should play with knives, p.e.)
Let's take care of our vocabulary.Let's be realistic and do not make value judgments (e.g. there are no good or bad controls, but high, low or normal).In any case, let's teach our children to value the results alone.
Try to involve your child in the treatment to the extent that your maturity allows it, make it the protagonist of your own situation (e.g. it allows him to speak with the doctor, to do the blood glucose ...)
Make an effort to get positive aspects of a negative situation and teach him to do so (e.g. not to live life as a tragedy, but as an opportunity to acquire healthier lifestyle habits, share activities together, enjoy the achievements together and shareThe sadness, with what this contributes this to the family ...)

recovery phase (to maintain our achievements ...)

Dump our energies in helping others who go through situations similar to ours.
Allowing to feel positive emotions as time progresses.That our child has diabetes does not imply that our duel should be chronic.Parents have the right and obligation to enjoy life and transmit that enjoyment to their children
Enjoy together the advances that have been achieved and of those that are achieved every day.

Accepting the diagnosis does not mean "nothing happens" but "I know how to live with it."

Acceptance of the diagnosis of type 1 diabetes mellitus

Article published in the Yearbook of Diabetes 2004 |Written by Isabel Moneo and Lidia Martín.Collaborating psychologists of the Pediatric Diabetes Unit of the Ramón y Cajal Hospital.Madrid.

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