This is a presentation authored and presented by my friend and colleague at Baylor College of Medicine, Dr. Barbara Anderson. This is a module in the 2014 Advanced Diabetes Seminar at Texas Lions Camp. During this presentation, Dr. Anderson dives deeper to provide insight into the timely and relevant topic: “Grandparents have an important role on the diabetes team.”

1. Grandparents have an
Important Role on the
Diabetes Team
Barbara J. Anderson, PhD
Professor of Pediatrics
Baylor College of Medicine
Houston, TX

2. Page 1
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Overview
I. Normal developmental tasks of child & parent &
lessons learned from research with type 1 diabetes
(T1D) in early childhood, in school-aged youth, &
during adolescence.
II. Pay attention to communicating about T1D in the
family! Understand diabetes burnout. Try to
prevent diabetes related family conflict.
III. Focus on what is going well. Where are the
diabetes-related strengths in the family?

3. Page 2
xxx00.#####.ppt 4/21/2014 8:48:16 PM
I. Special Roles of Grandparents
•Creating Shared Stories
•Windows into past lives and history
•Strengthening Sense of Family Ties
•Teacher , Role Model
•Supporting your Children as Parents
•Other roles You enjoy as a Grandparent?

4. Page 3
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Your Grandchild….
…is first -- and most importantly -- a
child.
…is secondly -- a child who happens
to have type 1 diabetes (T1D)
…is not a ―diabetic‖ or a ―diabetic
child‖.

5. Page 4
xxx00.#####.ppt 4/21/2014 8:48:16 PM

6. Page 5
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Normal Developmental Tasks
•Age-related milestones in physical,
cognitive, psychological & social functioning
•Must be considered when parenting or
grandparenting a child or teen with diabetes
in order to have realistic expectations at
different ages
•Grandparents can have the important role of
remembering normal age-related behaviors!

7. Page 6
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Tasks of Early Childhood:
Infants (0-1 yr.) and parents
•Physical growth
•Develop trusting attachment or bond with
caregiver
•Parent must develop confidence in their
ability to care for (‗read‘ and respond to)
their baby. Balance care of self with care of
baby (‗bonding‘).

8. Page 7
xxx00.#####.ppt 4/21/2014 8:48:16 PM

9. Page 8
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Tasks of Early Childhood:
Toddlers (1-3 yrs.) and parents
•Physical growth; Brain development
•Mastery of Physical world
•Autonomy, Sense of separate ‗self‘
Parent provides responsive yet safe
environment; sets realistic limits; allows for
separation

11. Page 10
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Tasks of Early Childhood: Early school
age (4-6 yrs.) and parents
•Cognitive growth, cause-effect thinking
begins
•Social relationships/comparisons outside
family (peers & adults)
Parent must support child in new environment;
allow for exploration & new attachments while
maintaining involvement.

12. Page 11
xxx00.#####.ppt 4/21/2014 8:48:16 PM

13. Page 12
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Lessons from research on T1DM in
Early Childhood (0-6 yrs.)
•Extremely high-stress period for parents.
•Recurrent severe hypoglycemia or chronic
hyperglycemia can affect developing brain.
•Parental fear of hypoglycemia can lead to
over-restricting toddler-preschooler.
•Parents can feel very isolated; few
resources; difficult to find relief caregivers

14. Page 13
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Tasks of School Age youth
(6-10 yr.) and parents
•Explosion of skills (cognitive, athletic, artistic,
physical)
•Importance of ―best friend‖ and team play
•Foundations of self-esteem
•Child must participate with peers
Parent must balance child‘s expanding world with
setting reasonable limits; foster autonomy while
maintaining involvement in child‘s world.

15. Page 14
xxx00.#####.ppt 4/21/2014 8:48:16 PM

16. Page 15
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Tasks of Young Transitioning Teens (11-13
yr.) and parents
•Pubertal changes impact self-image.
•Peers increase in value (young teen is very vulnerable).
•Privacy is important.
•Power shifts in P-C relationship increase family conflict.
Parent learns to acknowledge this is a period of
insecurity and intensity, to negotiate, to have
consistent expectations, to set limits, to maintain
involvement & support.

17. Page 16
xxx00.#####.ppt 4/21/2014 8:48:16 PM

18. Page 17
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Lessons from research on T1DM in Young
Transitioning Teens
•Normal insulin resistance of puberty
complicates DM control & mgt. (Amiel, 1986)
•DM mgt. becomes more complex at the time
child normally begins to resist parental help.

19. Page 18
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Lessons from research on T1DM in Young
Transitioning Teens
• Parent-child teamwork & low family conflict
around DM tasks over the transition to
adolescence predict better control across
adolescent years.

20. Page 19
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Developmental Tasks of Mid-Older Teens
(14-18 yr.) & parents
•Develop own sense of identity & values, separate from
parents.
•Strengthen peer bonds; Explore intimacy.
•Take on increasing (not complete) responsibility for self in
many aspects of life.
•Make decisions about ‗life after high school‘ .
•Parent learns to accept this is a period when teen needs to
strengthen sense of identity. Although privileges may
increase, trust must be earned. Parent must have
consistent expectations, set limits, maintain involvement &
support.

21. Page 20
xxx00.#####.ppt 4/21/2014 8:48:16 PM

22. Page 21
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Lessons from Research on Mid-Older Adolescents
with Type 1 DM
a. Older adolescents & parents need to plan ahead
for diabetes care ―after high school‖.
b. Create a gradual plan to transition all tasks.
c. Some teens may have ―Diabetes Burnout.‖

23. Page 22
xxx00.#####.ppt 4/21/2014 8:48:16 PM
―Burn-Out‖
•―A common
response to a
chronically difficult
and frustrating job,
where the individual
works harder and
harder each day and
yet has little sense
that these actions
are making a real
difference. ―

24. Page 23
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Living with Type 1 Diabetes
•Goal of diabetes self-management: Near- normal
blood sugar ranges.
Child/Teen/Family balance on a tightrope between
low blood sugar (can cause behavioral & mood
changes, & acute emergencies) & high blood sugar
(can cause behavioral & mood changes, & if
sustained, long-term problems)-- a chronic &
impossible task, as the tools to manage diabetes are
not perfect.

25. Page 24
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Living with Type 1 Diabetes
•Psychological consequences of ―tightrope
balancing‖:
Feelings of chronic frustration and failure
from striving for near-normal (―perfect‖)
blood sugar numbers, & from criticism from
providers, family members & self.

26. Page 25
xxx00.#####.ppt 4/21/2014 8:48:16 PM

27. Page 26
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Family Communication
and Conflict
 How you think about DM...
- ―What does a blood sugar of 400 mean for my child?‖
- ―Why is his/her DM getting worse?‖
 How you feels about DM…
- ―I‘m scared when I see a blood sugar of 400. Why
can‘t s/he have stable blood glucose levels?‖
 How you talks about DM…
- ―That blood sugar is so bad! What did you eat?‖

28. Page 27
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Talking about Blood Sugars
That scares
me! A high
blood sugar
like that
could cause
problems!
Dad, my
blood
sugar is
385.
Dad‘s really
mad at me!
He‘d be
happier if my
blood sugar
were 120 or
if I didn‘t
check at all!
385?! Why so
bad? What
did you eat?
1) OCCASIONAL HIGH BLOOD SUGARS DON‘T LEAD TO COMPLICATIONS. It is
normal for growing children to have out-of-range blood sugars. An occasional blood
sugar of 300 or even 400 or more will not cause complications.
2) THERE IS NO SUCH THING AS A ―BAD‖ BLOOD SUGAR. Any result from blood
sugar monitoring is good because it gives helpful and important information that
lets you make the best choices in insulin, activity, and food.

29. Page 28
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Growth/Puberty
Stress
Illness
Dawn
phenomenon
Too little insulin
Food
Unknown
Exercise
Stress
Illness
Insulin
Not Enough
Food
Unknown
Factors the Cause Out-of-Target Range
Blood Sugars

30. Page 29
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Communicating about diabetes in the family
•Family Teamwork means Follow the parents‘
guidelines and practices in diabetes care
•Use the same language ―high‖ & ―low‖ BG, not
―good ― & ―bad‖.
•Know what tasks adults must always supervise
•Follow the same rules/attitudes around food

31. Page 30
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Communicating about diabetes in the family
•Understand when to call Mom or Dad (or 9-1-1)
•Ask questions of parents; practice injections/BG
checking with them.
•Remember ―Courage is not the absence of fear‖*
*B. Brackenridge Draw Wide the Circle of Love, 2008

32. Page 31
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Preventing conflict as you share in the care
of your grandchild
• Keep a log; Write down everything!
•Suggest you & parents make a ―visit book‖ * with all
contact numbers, meal snack times and carbs, when
to do BG checks, signs of high & low BGs.
•Strive for balance between DM mgt. routines and
enjoying time with grandchild.
•*B. Brackenridge Draw Wide the Circle of Love , 2008

33. Page 32
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Summary
1. Grandparent‘s role is important—
-support parents in diabetes mgt.
-keep focus on the child & normal
age–appropriate behaviors.
2. Your Grandchild with diabetes is a child first!
Remember normal behavior for child‘s/teen‘s
age.
3. Pay careful attention to your language &
communications around diabetes in the family.
Focus on what is going well (strengths).

34. Page 33
xxx00.#####.ppt 4/21/2014 8:48:16 PM
Resources for Grandparents
• Brackenridge, Betty. Draw Wide the Circle of Love:
How to Unite Your Family in the Care of a Child with
Diabetes. Phoenix, AZ: Learning Prescriptions 2008.
• Websites:
www.grandmasandy.com = website with games and books
about diabetes in a young child for downloading.
www.diabetes.org= American Diabetes Association website
for Parents and Kids; resources for families & schools.
www.jdrf.org = Juvenile Diabetes Research Foundation:
research information; newsletter for families

35. Thank you for your
attention!
Comments? Questions?