Sixteen-year-old Daniella was diagnosed with diabetes only a year ago. Before she learned about her condition, she was a bubbly individual who affected anyone around her with her zest for life. She was active in her school work and other extracurricular activities—a familiar face during school plays and dance performances. However, upon knowing of her condition, she slowly lost her energy to do her activities. “It seemed as if I was losing interest in what I did. At the same time, I found it very taxing to monitor my blood sugar every now and then, most especially at school. Add to that, I have to refrain from eating sweets, or even fruit shakes, as they can raise my blood sugar!” she said.

Daniella is just one of the many adolescents, who, at an early stage in life, had to go through the ordeal of diabetes – physically and emotionally. And it is at this stage when she will need all the support from the people around her. This will enable her to face life positively, and to battle her condition with strong will.

The family is the basic unit in which a diabetic patient should be able to get that much-needed support. According to Dr. Susan McDaniel, professor of psychiatry and associate chair of the Department of Family Medicine at the University of Rochester in New York, “the family has to be involved in any chronic illness that has to be managed, but especially diabetes. The illness demands are so great. The outcome is so uncertain. And the constant blood sugar monitoring can be very stressful.”

However, family involvement in diabetes management can be complex, too. Meals, exercises, leisure and other family activities need to be carefully planned as these can greatly affect one’scontrol of diabetes. But first and foremost, a diabetic family member needs to be more open with other family members about his or her condition. And for some, this idea may not be that easy.

Individuals such as diabetes educators try to discuss different approaches that may help a diabetic individual and the family deal with the diabetes battle.

Family approaches to diabetes management
Joe Solowiejczyk, a diabetes nurse educator and family therapist who specializes in assessing ways in which family dynamics affect diabetes management, has formed the Family Approach to Diabetes Management (FADM) model. It stresses patient and family self-management by identifying and exploring patterns of family communication that hinder or support positive clinical outcomes. When dealing especially with adolescents, the idea of involving authorities in the family in helping patients manage their diabetes may prove to be difficult.

The main objective of FADM education sessions is to help families reorganize themselves around roles and responsibilities for diabetes management that will support responsible behavior in adolescents. It is entirely different from the approach of managing irresponsible teenagers in which parents are asked to stay away, and give adolescents more room and responsibility. The FADM model involves the diabetes educator, such as a counselor, a nurse, or a physician; the family; and the diabetic patient.

The diabetes educator acts as the session leader who checks in with all the family members, and follows up with the necessary practices that the family and the diabetic patient need to do. The family members act as consultants or supervisors that lead and motivate the diabetic patient.

Parents are asked to closely watch over the diabetic patient, give him or her “diabetic chores” for compliance. At the same time, the adolescent is asked to keep a written diabetes management record that parents can access. This makes parents more comfortable about checking on how their children are doing without nagging them about it. This also respects the adolescent’s need for autonomy.

Frequent sessions between the diabetes educator, the family, and the diabetic patient and the active involvement of each help everyone know about the emotional concerns and at the same time help the diabetic patient adhere to proper lifestyle. During the sessions, issues surrounding diabetes self-care are discussed. For example, the child with diabetes is told that it’s okay to hate monitoring blood sugar. It’s all right for him to whine about it, but he still has to do it. Let the child vent his frustrations, and let him know that his reaction is completely normal. Framing the frustration as a normal reaction frequently paves the way for solutions that the family can live with.

Porte et al. reaffirms this need for open communication between family members and the diabetic patient. According to them, it is important to involve family members in the educational process to clarify misconceptions. Teaching patients how to talk to family members about their disease and treatment plan is also helpful.

The Philippine setting
In the Philippines, involving the family in the process of diabetes management is not much of a problem. This is according to Dr. Roberto Mirasol, an endocrinologist and chair of the education council of the Philippine Diabetes Association. “The problem lies not in the support which every diabetic needs. In our country, caring and supporting a diabetic family member is inherent. The problem is in carrying out the necessary education to diabetics and getting them motivated in carrying out the proper regimen,” he said.

Diabetes education clinics staffed by physicians, nurse educators, dietitians and other healthcare professionals are sprouting in many areas across the country. Thanks to the efforts of organizations such as the Philippine Center for Diabetes Education Foundation and the Philippine Association of Diabetes Educators. These clinics frequently involve diabetes patients and their families for better, more holistic management of the disease.

Teamwork within the family is crucial for success in defeating diabetes. The person with diabetes needs to know that he is not alone in this battle. Parents, children, siblings and caregivers can all work together to conquer the diabetes foe.

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