Supporting a Child's Transition to Diabetes Self-Management

The journey to self-management of Type 1 diabetes is gradual and begins with fostering curiosity, critical thinking, and autonomy. This post offers practical strategies and real-life examples to help those with loved experience support children in developing the confidence, skills, and emotional resilience necessary for managing diabetes as they grow.

1. Social, Emotional, and Cognitive Development

Fostering Awareness and Curiosity

• Encourage children to notice how blood sugar fluctuations feel in their body:

• Ask reflective questions, such as, "How do you feel when your blood sugar is ###, in range, low, or high?"

• It takes time to become attuned to emotional, mental, and physical changes related to blood sugar. Continue to check in over time.

• Discuss physical sensations and emotions in real-time and during day-long reflections.

  • Real-time Examples: “Your CGM shows your blood sugar is 200, how do you feel in your body? Your CGM shows your blood sugar is 65; how do your mind and heart feel? What are your thoughts like?”

  • Personally, when my blood sugar is low, my thoughts can have an anxious or depressive tone. Sometimes, the anxious thoughts and feelings are out of the blue and unrelated to the present circumstances. Ask questions to help children identify and understand their experiences.

  • Day-long Examples: Extended periods with high blood sugar, several lows back-to-back, and many blood sugar fluctuations throughout the day can feel like a “blood sugar hangover.” It can be difficult for children to identify + understand the connection between their current physical, emotional, and mental state due to blood sugar changes over an extended period.

• Relate CGM readings (arrows, colors, numbers) to their bodily sensations.

  • People with diabetes can often feel the number, the direction, and the speed in which blood sugar is moving, but it can be challenging to discern between the different sensations.

  • Example: Blood sugar is 200 double arrows down after much movement. A child with diabetes asked me, “Why do I feel low, but my blood sugar is 200?” He was likely feeling the direction of the arrow and the speed at which his blood sugar was dropping.

  • Helping children understand their sensations empowers them to trust themselves - body and mind.

Building Connections

• Help and encourage children to engage with others living with T1D to foster connection, validation, and understanding.

• Connect with diabetes camps, nonprofit organizations, small businesses, coaches, mentors, and the diabetes online community. Seek out events and activities in the diabetes community that relate to the child’s interests and hobbies.

• Ask, acknowledge, and accept without judgment how they feel about engaging with others living with diabetes. If they don’t want to engage with others, you can offer the phrase: “No problem. You might feel differently at another time, and options will be available.” This is also a great phrase to offer if a child declines to use an insulin pump or cgm as part of their diabetes management.

• Be the example. Seek out your community + support. Share the experience of what it felt like before, during, and after you found your community. It is just as crucial for people with the loved experience to connect with one another.

• Share examples of emotional resilience with T1D or stories of other children managing diabetes.

Empowering Critical Thinking

• Involve children in decision-making, clearly explain options, and empower them with choices.

• Teach and ask children to read food labels aloud and how to do an internet search or ask Siri for carb counts.

• Teach children about their Insulin to Carb ratio + Correction Factor. Work through examples out loud. Try to incorporate the skills and concepts they learn in school and relate them to diabetes management.

Celebrating Wins

• Share and celebrate wins together to boost confidence.

• Wins can be time in range and/or time in happiness, even when blood sugar is out of range.

• Check in frequently about how they feel about their progress in managing blood sugar.

• Remind children (and yourself) that you’re doing the best you can with what you have and know at the time, and that is enough.

  • Mistakes + learned experience + self-compassion = Wisdom

2. Communication Skills and Emotional Expression

Encouraging Clear Communication

• Teach them to identify their needs from a holistic POV and how to use language to express and advocate for their needs.

Normalizing Emotions

• Help children express feelings constructively and hold space for their feelings:

  • Example: "Understandably, you’re feeling angry about ___. I get it. I feel frustrated about ___, too."

• Use the acronym SNAEL for processing emotions. Example:

  • See it: External + internal sensations

  • Name it: Anger

  • Accept it: Allow the emotion to be there

  • Experience it: What is a rational expression of this emotion?

  • Let it go.

• I like to use a metaphor of our bodies being houses that emotions come to visit. Sometimes it is not an ideal time for the emotion to visit, so we set up a later time to visit with emotion. Create structure and supportive boundaries to process hard-to-feel emotions.

3. Practical Tips for Building Autonomy

Daily Involvement + Supportive Lifestyle Behaviors

• Share your reasoning and involve them in planning:

  • "Here’s why we’re doing this. Does it make sense to you?"

  • Narrate/say aloud everything you are doing and why. Example: “I am checking your blood sugar levels and how much insulin and carbs you have on board before going on a walk. I’m bringing snacks with us. I chose these snacks because…

• During breaks in sports and activities, help children develop a habit of checking in with their blood sugar levels. Sometimes in moments of deep presence and engagement, people with diabetes experience delay or are less likely to feel + notice blood sugar changes.

Active Participation in Diabetes Tasks

• Encourage small, manageable steps:

  • "Can you type in the carbs on your insulin pump and check the suggested insulin dose? Does that sound right? Would you like to dose yourself?"

• Make it a game or collaborative task.

• Allow children to choose their level of participation:

  • Example: "Do you want to read me your CGM data or hand me your phone?"

  • If they choose to share, ask about:

    • Insulin on board (IOB)

    • Blood glucose (BG) number

    • Trend arrows

    • How they feel

4. Problem Solving and Decision-Making

Planning Food and Dosing

• Teach strategies for eating and dosing:

  • Example: "Your BG is [number]. What’s the best strategy to eat this snack? Consider timing, activity levels, and whether you want anything else with it."

Respecting Their Point of View

• Be sensitive to their reality: How children feel in the moment is as important as blood sugar levels. Provide options and empower them with choice as much as possible.

• Encourage flexibility:

  • "If you don’t want to change your CGM at the moment, we can use the glucometer. Here’s how often you’ll need to test."

Handling Challenges Together

• Frame situations with empathy and logic:

  • Example: "I understand that you feel frustrated having to wait to drink the hot chocolate until your blood sugar comes down. I’ll wait with you, and we’ll drink it together when your blood sugar is in a safer range."

• Deconstruct frustration:

  • "You’re upset because the situation feels unfair. It’s okay to feel mad. I’ve been there too."

5. Building Trust and Confidence

Consistency and Support

• Celebrate small victories together to reinforce their confidence in managing blood sugar.

Establishing Safe Boundaries

• Allow flexibility while maintaining safety in blood sugar management.

  • Example: "If you feel sick or nauseous, let me know so we can adjust the plan."

6. The Foundation: Create Partnership with Diabetes

Your Approach Shapes Theirs

• Your relationship with diabetes influences theirs. Strive for acceptance, compassion, resilience, and grace in your relationship with diabetes.

• Process emotions related to a diabetes diagnosis: body betrayal, guilt, shame, forgiveness, and trust. There is an energetic relationship that exists between the heart, mind, spirit, and body. Healing is necessary, not linear, and a journey unique to you

Fostering Lifelong Skills

• Build autonomy from day one by modeling and involving your child in the process.

• Encourage them to develop a healthy relationship with diabetes by respecting their feelings and helping them feel empowered.

• Language matters.

• We are not our blood sugar number. Our blood sugar management doesn’t define us. We manage diabetes and blood sugar, not control it.

• Instead of trying to “overcome” diabetes or live “despite” diabetes, try on a perspective of working with diabetes. This perspective fosters resilience + acceptance for challenging moments with diabetes.

• We are not diabetes, but diabetes is a large part of our lives.

• Diabetes is like a forever housemate. What is the best version of the relationship you can have with a forever housemate?

Closing Encouragement

Transitioning to diabetes self-management is a journey that takes patience and teamwork. With guidance, children will build the skills, confidence, and resilience needed to manage diabetes successfully while maintaining a healthy emotional balance.