Carlos’s HbA1c had been above 10.2% for the last three clinic visits. We were frustrated because he was 16 years old, had a great personality and knew a lot about diabetes management. Every time he came to clinic without his blood-sugar records, he would promise to bring them next time and also promised to get his HbA1c down. It was hard not to believe him because he was such a nice guy.
When the team I was working with at the time sat down to figure out how we could best help Carlos and get him more motivated, it became clear that no one had ever met his father. His mother always brought him to clinic.
Carlos had switched over from another clinic and, since he was so knowledgeable and personable, we just thought that he would “turn around” soon—that it was just a phase he was going through. However, with these consistently high numbers, we decided it was time to schedule a clinic visit for the whole family.
I called Carlos’s home and spoke with his mother, who had been beside herself worrying about his numbers. I said that I wanted to schedule a family session the next week where we would all figure out a plan. I said it was essential that his father come too. Carlos’s mother wasn’t sure if Carlos’s father could make it, but she would tell him. I told her that we wouldn’t have the session without him and that I would be happy to talk with him if she felt that would help.
Everyone, including Carlos’s father, showed up for the session, and it was great that they did. After making it clear to the father that it seemed to me that both his wife and son needed his help in turning the situation around, he said that nobody had ever really taken the time or made the effort to make it clear just how needed he was. He also said he had not been educated about diabetes management.
As Carlos’s father was speaking, his wife began to cry. When I asked why she was crying, she said that she had wanted his help for such a long time but didn’t know how to ask for it. The father then took his wife’s hands and also began to cry. He suddenly realized how alone and frustrated his wife had been feeling.
Arrangements were made to educate Carlos’s father while the mother and Carlos were in the room so that everyone would be sure to have heard the same information. I also discussed how the parents needed to work together to get Carlos to adhere to his diabetes management. It was as if Carlos’s misbehavior in diabetes had been an indirect way of helping mom to get dad more involved.
After several combined educational and family-therapy sessions, Carlos was doing at least four BG tests per day. In addition, he was also recording the results and responsibly discussing his diabetes management with both mom and dad on a weekly basis.
It was moving to hear and see mom talk about how relieved she felt about the change. It brought tears to my eyes when I saw the father put his arm around Carlos’s shoulder, talk about how much he loved his son and express how grateful he was that he had become so much more involved in such an important part of his life. It was healing for me to watch, as that was something that I missed growing up with diabetes—that arm around the shoulder.
Within six months Carlos’s HbA1c came down to 6.9%.
Working with Children and Families with Diabetes
As a nurse educator and family therapist, I have two main treatment goals when working with children and families with diabetes:
- Teach the entire family enough about practical management (i.e., trips, sleeping late, committing dietary indiscretions, etc.) that they can successfully integrate diabetes into their lifestyle.
- Help them cope emotionally so that their life after the diagnosis looks and feels as close as possible to what it was before the diagnosis.