age appropriate targets for self care education for children with diabetes n.
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Age-appropriate targets for self-care education for children with diabetes. 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

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the newly diagnosed child
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
starting diabetes education 1
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
starting diabetes education 2
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
out patient diabetes education 1
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
out patient diabetes education 2
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'
out patient diabetes education 3
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
out patient diabetes education 4
Out-patient diabetes education 4
  • Important to find the balance between optimum and sufficient knowledge
special problems 1
Special problems 1
  • Age:
    • infants
    • young people/adolescents
  • Culture/language/religion:
    • immigrants/refugees
  • Social problems
special problems 2
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
other offers of education 1
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
other offers of education 2
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
written material 1
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
written material 2
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
written material 3
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
transfer to the diabetes out patient clinic
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)
age appropriate goals general 1
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
age appropriate goals general 2
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
age appropriate goals detail
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