OHSU

For Parents

Dad

Parenting is hard enough without having to deal with diabetes. Adding diabetes to the mix makes your job as a parent even harder. The attached tips might help make this enormous job a little easier.

Parenting Youth with Diabetes

Parenting a child with diabetes can be very complicated. For example, if you have a child or teen with diabetes, you have to decide whether or not to punish behaviors related to diabetes. This is a difficult decision. However, it is well established that punishing for the sole purpose of changing behavior is only effective in the short term. In addition, punishing children for any kind of misbehavior can lead to their developing more crafty ways to violate rules.

Our experience at the Harold Schnitzer Diabetes Health Center tells us that most children with diabetes already feel punished because they have diabetes. Punishing your child for poor diabetes management will result in feelings of resentment and anger.

Another challenge is being a single parent. Parenting is more difficult and complex in single-parent homes, and this likely affects a child's diabetes management. While every family's experience is unique, every family faces some of the same challenges. For example, conflict in the family makes it harder for a child to manage diabetes and keep it under control. We encourage you to keep conflict to a minimum, and get help if this becomes a problem. Routine and structure help children manage their diabetes better, so we recommend that families establish a regular routine.

Depression, Anxiety and Diabetes

Depression and anxiety seem to be more common in people with diabetes. While we don't yet know why, you should know your child may be at risk. If you know the signs of depression and anxiety, you can get these conditions treated sooner rather than later.

Signs and symptoms of depression include:

  • Changes in sleep, eating and behavior (too much or not enough)
  • Sadder than usual
  • Unable to enjoy pleasant activitites
  • Acting withdrawn
  • Expressing hopelessness
  • Not taking care of diabetes

There may be other signs that your child is depressed. If you notice unusual behavior or have concerns, you can talk to your child's doctor, diabetes educator or our social worker or child psychologist.

Signs and symptoms of anxiety include:

  • Frequent worry, panic and sometimes irritability
  • Feeling overwhelmed with anxiety
  • Feeling unable to handle basic diabetes care

The recommended treatment for depression and anxiety is a combination of cognitive-behavioral therapy (counseling) and medication. While both of these can be effective on their own, studies show that they work best together.

Families and Diabetes

Research tells us that family support can help people with conditions like diabetes. However, studies also show that families can have negative effects, especially when there is conflict. Often, parents of children with diabetes have conflict with their children over diabetes management.

Why is the family so important to people with diabetes? Family members are the most likely to help children with diabetes with day-to-day care. They are also most likely to give advice about diabetes care and general health. Parents and other family members set the example-good or bad--for diet, exercise and working with the health care team. Finally, family support (or family stress) directly affects the health of people with diabetes. For example, constant stress makes blood sugar harder to control.

Social Support and Diabetes

Humans are social beings. We can also experience social barriers. For example, we may be overly concerned about social acceptance. If a child with diabetes is concerned about what people think, they may not want to maintain diabetes care because it makes them stand out. Teens often have this problem, because they are very concerned about what their friends think of them.

Lack of support can also be a social barrier. Having diabetes often means making lifestyle changes. This can be especially difficult for you and your child if you don't have family members and friends to cheer you on or join you in living a healthier lifestyle. Lack of social support can keep people from making positive changes.

On the other hand, some social factors can result in better self-care. Support from friends and family can have very positive effects. Many studies show that support from friends and family helps people with diabetes avoid some complications like depression, and can help them stay healthier. There are many other potential sources of support, including your doctor and health care team, your religious leader and other people in your community.

Managing Your Child's Diabetes at School

When your child has diabetes, it is important to work with your child's school for successful diabetes care. You may work with the school nurse, principal, teachers and coaches. Some schools are new to working with kids who have diabetes. They may need extra training and coordination with you and your child's Harold Schnitzer Diabetes Health Center team to make sure your child's diabetes plan is in place. You can also refer them to the American Diabetes Association for more information.

The rights of your child with diabetes at school are based on Section 504 of the Rehabilitation Act of 1973, the Americans with Disabilities Act and the Individuals with Disabilities Education Act (IDEA). These laws provide federal protection against discrimination for your child with disabilities or medical conditions in any program or activity that receives federal assistance, such as public schools. Your medical team will provide school orders that are part of your child's diabetes care plan. The plan will vary depending on your child's needs and the situation.

A 504 Plan includes your child's medical treatment plan. The Individualized Education Plan (IEP) lists what the school will do to carry out the treatment plan. For example, the 504 Plan might say that the child can test their blood glucose level, and the IEP will say that they can test in class or be able to leave the class.

Another valuable resource for parents is the Safe at School Campaign, sponsored by the American Diabetes Association. For more information

Managing Diabetes at Sleepovers

Children do sleepovers at different ages. Whether your child has diabetes or not, you should make sure your child is interested in doing a sleepover, and feels comfortable spending extended time away from home. If you take overnight trips away from your child, or if your child may spend extra time with other families, those families may also want to meet with a certified diabetes educator.

If your child has diabetes, you may feel more comfortable having sleepovers at your home so you can make sure your child has consistent diabetes care. Some parents let their child have play dates at a friend's home, and plan sleepover dates at their own home. This way, the kids can spend time at both homes.

When you are comfortable letting your child sleep over with another family, make sure you give them the information they will need about your child's diabetes and diabetes care. Let them know you are available if needed. Your child may also want to know they can call you if they need to.

Sleepovers can be a fun way to spend time with friends, but if you are not comfortable with them, you can do extended play dates and let other parents know that your child does better with more sleep.

Healthy Eating on a Budget

It can be a challenge to find, buy, prepare and eat healthful foods. It is very challenging to provide an entire family with healthful meals. It's even more challenging to do this without spending a lot of money. Planning healthy, affordable meals and snacks takes a little extra time and effort, but it is possible.

Some money-saving tips for healthful meals:

  • Plan meals and snacks for several days. Think of all the different types of foods for ideas: Bread, cereal, rice, pasta, vegetables, fruit, milk, yogurt, cheese, meat poultry, fish, dry beans, eggs and nuts.
  • Figure out what food you already have. Check newspapers for specials, and use coupons only for items you'll use.
  • Make a grocery list.
  • Gather your list and coupons. Try to avoid shopping when hungry, tired or rushed.
  • Once you're at the store, stick to your list, compare prices of different brands of the same item, and look above and below eye level. Less expensive items are on the high and low shelves.
  • Shop at the outside edge (perimeter) of the store for basic foods, such as milk, eggs, bread and produce.
  • Don't forget to store and prepare food safely!

Need more tips?

Here's a link to a great publication from the Alabama Cooperative Extension System called 101+ Ways to Save Food Dollars

Ideas for Healthy Eating

The United States Center for Disease Control (CDC) has a helpful program called "Fruits and Veggies: More Matters." You can learn about the many benefits of fruits and vegetables and how to include them in your family's meals. Look at their recipe database, which includes information on carbohydrates for each recipe. CDC Fruits & Vegetables Recipes

Have a preschooler? Here is a website about nutrition just for them: My Pyramid for Preschoolers

If your child is not a fan of vegetables and fruits, remember that you often have to offer a new food up to 10 times for them to even try it. This definitely applies to vegetables. So keep serving vegetables to your child. Here is a helpful article on 10 ways to include fruits and vegetables in children's snacks and meals: Tips for Kid Friendly Vegetable Dishes

Recipes for Healthy Eating

You may want to try Cooking Light magazine. A yearly subscription costs about $20, or you can buy individual issues at the store. Their goal is to provide healthful recipes and nutrition facts. Carbohydrate information per serving is provided for each recipe. They also have a website where you can get free recipes, read about cooking techniques or read other articles: http://www.cookinglight.com/.

Below are a few more recipes that have been adapted from the National Institutes of Health "Stay Young at Heart" program.

CORN CHOWDER

1 Tbsp
2 Tbsp
2 Tbsp
2 Tbsp
1 package
1 C
2 Tbsp
1 C
1/4 tsp
to taste
1/4 tsp
2 Tbsp
2 C
vegetable oil
finely diced celery
finely diced onion
finely diced green pepper
frozen whole kernel corn (10 oz)
peeled, diced, 1/2-inch raw potatoes
chopped fresh parsley
water
salt
black pepper
paprika
flour
low-fat (1%) or skim milk
  1. Heat oil in medium saucepan.
  2. Add celery, onion, and green pepper and saute for 2 minutes.
  3. Add corn, potatoes, water, salt, pepper, and paprika. Bring to a boil; reduce heat to medium; and cook, covered, about 10 minutes or until potatoes are tender.
  4. Place 1/2 cup milk in a jar with tight fitting lid. Add flour and shake vigorously.
  5. Add gradually to cooked vegetables and add remaining milk.
  6. Cook, stirring constantly, until mixture comes to a boil and thickens. Serve garnished with chopped fresh parsley.

Yield: 4 servings--Serving Size: 1 cup

Each serving provides:

Calories: 186
Total Carbohydrate: 33 g
Total fat: 5 g
Trans Fat: 0
Saturated fat: 1 g
Cholesterol: 5 mg
Sodium: 205 mg

BEAN & MACARONI SOUP

2 cups
1 Tbsp
1/2 lb
1 C
2 C
1 C
1 clove
3 C
1 tsp
1 tsp
1/2 tsp
to taste
1
4 C
freshly cooked great northern beans
olive oil
fresh mushrooms, sliced
onion, coarsely chopped
carrots, sliced
celery, coarsely chopped
garlic, minced
cut-up peeled fresh tomatoes or 1-1/2 lbs canned whole tomatoes cut up
dried sage
dried thyme
dried oregano
black pepper
bay leaf, crumbled
cooked elbow macaroni
  1. Heat oil in a 6-quart kettle; add mushrooms, onion, carrots, celery, and garlic and saute for 5 minutes.
  2. Add tomatoes, sage, thyme, oregano, pepper, and bay leaf.
  3. Cover and cook over medium heat 20 minutes. Cook macaroni according to directions on package using unsalted water. Drain when cooked. Do not overcook.
  4. Add 4 cups of water, beans, and cooked macaroni to vegetable mixture.
  5. Bring to a boil; cover and simmer until soup is thoroughly heated. Stir occasionally.

Yield: 16 servings--Serving Size: 1 cup

Each serving provides:

Calories: 112
Total Carbohydrate : 21 g
Total fat: 1 g
Trans fat: 0 g
Saturated fat: less than 1 g
Cholesterol: 0 mg
Sodium: 89 mg

CHICKEN RATATOUILLE

1 Tbsp
2
2 cups
1 cup
1
1 cup
1/2 lb
2 cups
1 clove
1-1/2 tsp
1 Tbsp
to taste
olive oil
chicken breast halves, skinned, and fat removed, boned, and cut into 1-inch pieces
zucchini thinly sliced
eggplant, peeled and cut into 1-inch cubes
medium onion, thinly sliced
green pepper, chopped
fresh mushrooms, sliced
fresh tomatoes, cut up
garlic, minced
dried basil, crushed
fresh parsley, minced
black pepper
  1. Heat oil in large nonstick skillet. Add chicken and saute about 3 minutes, or until lightly browned.
  2. Add zucchini, eggplant, onion, green pepper, and mushrooms. Cook about 15 minutes, stirring occasionally.
  3. Add tomatoes, garlic, basil, parsley, and pepper; stir and continue cooking about 5 minutes, or until chicken is tender.

Yield: 4 servings--Serving Size: 1-1/2 cup

Each serving provides:

Calories: 202
Total Carbohydrate: 16 g
Total fat: 2 g
Trans Fat: 0 g
Saturated fat: 0.5 g
Cholesterol: 137 mg
Sodium: 92 mg

SWEET AND SOUR SEASHELLS

1 lb
2 Tbsp
3/4 C
1/2 C
1/2 C
1/2 C
3 Tbsp
to taste
2 oz jar
2 medium
2 small
18
uncooked small seashell macaroni (9 cups cooked)
vegetable oil
Splenda
cider vinegar
wine vinegar
water
prepared mustard
black pepper
sliced pimentos
cucumbers
onions thinly sliced
lettuce leaves
  1. Cook macaroni in unsalted water, drain, rinse with cold water and drain again. Stir in oil.
  2. Transfer to 4-quart bowl. Place Splenda, vinegars, water, prepared mustard, salt, pepper, and pimento in blender. Process at low speed 15-20 seconds, or just enough so flecks of pimento can be seen. Pour over macaroni.
  3. Score cucumber peel with fork tines. Cut cucumber in half lengthwise, then slice thinly. Add to pasta with onion slices. Toss well.
  4. Marinate, covered, in refrigerator 24 hours. Stir occasionally.
  5. Drain and serve on lettuce.

Yield: 18 servings--Serving Size: 1/2 cup

Each serving provides:

Calories: 133
Total carbohydrate: 29 g
Total fat: 1 g
Trans fat: 0 g
Saturated fat: less than 1 g
Cholesterol: 0 mg
Sodium: 30 mg

SAVORY POTATO SALAD

2 pounds
2 stalks
2 stalks
1/4 cup
1/4 cup
1 Tbsp
1 egg
6 Tbsps
1 tsp
1/2 tsp
1/4 tsp
1/4 tsp
cooked red potatoes
celery, finely chopped
scallion, finely chopped
red bell pepper, coarsely chopped
green bell pepper, coarsely chopped
onion, finely chopped
hard boiled, chopped
mayonnaise, light
mustard
salt
black pepper
dill weed, dried
  1. Wash potatoes, cut in half, and place them in cold water in a saucepan.
  2. Cook covered over medium heat for 25 to 30 minutes or until tender.
  3. Drain and dice potatoes when cool.
  4. Add vegetables and egg to potatoes and toss.
  5. Blend together mayonnaise, mustard, salt, pepper, and dill weed.
  6. Pour dressing over potato mixture and stir gently to coat evenly.
  7. Chill for at least 1 hour before serving.

Makes 10 servings--Serving size: 1/2 cup

Calories 109
Total carbohydrate: 16 g
Total Fat 4 g
Trans fat: 0 g
Saturated fat less than 0.6 g
Cholesterol 24 mg
Sodium 101 mg

Carbohydrate Counting and Cookbooks

The CalorieKing Calorie, Fat & Carbohydrate Counter by Allan Borushek is a good reference for counting carbohydrates. It includes information on fast food and food served at family-style restaurants, as well as information on common snack foods, fruits and vegetables. A new edition is published each year. Find it here: http://www.calorieking.com

America's Best Cookbook for Kids with Diabetes
by Colleen Bartley

101 Tips on Nutrition for People with Diabetes, Second Edition,
by Patti B. Geil and Lea Ann Holzmeister

The Complete Quick & Hearty Diabetic Cookbook: More Than 250 Fast, Low-fat Recipes with Old-fashioned Good Taste
by American Diabetes Association

Diabetes Meals On $7 A Day--Or Less!: How to Plan Healthy Menus without Breaking the Bank
by Patricia Geil, Tami Ross

Eating For Sports

Exercise is important and kids love to be active. However, if you have a child with diabetes, you may feel concerned about the possibility of your child having low blood sugar as a result of activity. For this reason, it is important for children with diabetes to have an activity and exercise plan. Some children need to have their insulin adjusted to compensate for their increased activity. Some children have snacks or drinks with extra carbohydrate depending on what type of activity they are doing, and for how long. For some children, a combination of insulin adjustments and additional carbohydrate before exercise works best.

Your medical team can help you develop an activity plan so the family is prepared and at ease. We can also help you decide on a blood sugar range at which it is safe for your child to participate in activity.

When your child is active:

  • Be sure they wear a diabetes ID, such as a bracelet or necklace.
  • Make sure your child drinks plenty of water, and have snacks ready if necessary.
  • Have a blood glucose meter handy.
  • Have sugar to treat lows: glucose tabs, juice, etc.
  • Make sure coaches know your child has diabetes and can recognize your child's signs of low blood sugar.

Books and Other Publications for Children

We recommend several books for children, depending upon their developmental and interest level. The website www.childrenwithdiabetes.com has a list of books for children, teens and parents that includes descriptions, reviews and ordering information.

For children with diabetes, feeling different can create even more problems. These books can help them see they are not alone and that support is available to help them cope.

Helpful books include:

Chris Dreams Big by Chris Dudley and Chris Love-Dudley. This book tells the story of Portland's own Chris Dudley, from being a kid with diabetes to a professional basketball player in the NBA. The book is written and illustrated for children from toddlers up to third or fourth grade.

It's Time to Learn About Diabetes by Jean Betschart. A workbook on diabetes for children. Parents and educators can help children learn about diabetes from the illustrated kids, Cindy and Mike, who have diabetes. The workbook is full of drawing, matching and fill-in-the-blank word searches as a fun way to teach elementary-school children about diabetes.

Making the Best of Life: Book 2: Learning to Live with Diabetes continues Caitlin Block's story. She describes being a 10-year-old with diabetes and facing challenges at school and with other children.

Taming the Diabetes Dragon by Anne Dennis is helpful for younger, newly diagnosed children. Two-year-old Preston was diagnosed with type 1 diabetes, and his mother wrote a story about a dragon named Diabetes to help everyone in the family come to terms with Preston's diabetes. When the village of Pancreas is invaded by the dragon Diabetes, a brave boy named Preston helps the villagers learn how to tame the dragon using insulin, exercise and healthy eating.

Taking Diabetes to School by Kim Gosselin. For elementary-school children who need help explaining diabetes to their classmates. The newer edition includes Ten Tips for Teachers and a Kids Quiz.

The Best Year of My Life by Jed Block tells the true story of Caitlin Block, a girl diagnosed with diabetes at age seven. Caitlin tells about being diagnosed and shares her anxieties as well as positive events.

Wizdom for Kids by the American Diabetes Association. This kit is free by calling 1-800-DIABETES or e-mailing wisdom@diabetes.org. It includes two spiral-bound notebooks to help educate newly diagnosed children and their parents-one for parents and one for kids. The workbooks are full of colorful illustrations and information about diabetes and diabetes management. The kit also includes three juggling balls, which represent juggling diet, exercise and insulin.

Books For Parents

Growing up with Diabetes: What Children Want their Parents to Know by Alicia McAuliffe. Written by a woman who was diagnosed with diabetes as a child, this book encourages the importance of diabetes education and making your child's life as normal as possible.

The Ten Keys to Helping Your Child Grow up with Diabetes by Tim Wysocki. A practical book for parents and caregivers of children with diabetes that addresses the psychological, social and emotional hurdles and offers solutions for families.

Publications for Kids

Countdown for Kids
Published quarterly; Free with donation to JDRF or $25 for both Countdown and Countdown for Kids.
www.jdrf.org

Diabetes Forecast (has a Kids Section)
Published monthly. Free with $28 annual dues to ADA.
800 806-7801

Additional Resources

The 100th Monkey Studio
110 SE 16th Avenue
Portland, OR
503 232-3457
www.the100thmonkeystudio.com
Art classes and diabetes support groups for children and adults.

American Diabetes Association (ADA)
800 232-3472
www.diabetes.org

American Diabetes Association, Oregon Affiliate
380 SE Spokane #110
Portland, OR 97202
503 736-2770
888-DIABETES
FAX 503 736-2774
www.diabetes.org
Information, support groups and online resources.

Children With Diabetes
www.childrenwithdiabetes.com
Online information and resources for parents and children.

Gales Creek Camp Foundation for Children with Diabetes
6975 SW Sandburg # 150
Portland, OR 97223
503 968-2267
FAX 503 443-2313
www.galescreekcamp.org
Camps for children, youth and families affected by type 1 diabetes. Registration begins in January.

Juvenile Diabetes Research Foundation (JDRF)
800 533-CURE
www.jdrf.org

Juvenile Diabetes Research Foundation (JDRF) Oregon & southwest Washington Chapter
7460 SW Hunziker, Suite H
Tigard, OR 97223 503 643-1995

(888) 598-9074
FAX 503 598-9087
www.jdrf.org/oregon
Information, resources, mentor program, research and online resources related to type 1 diabetes.

Kimberly Kraus, LCSW, Pediatric Social Worker
Harold Schnitzer Diabetes Health Center
Oregon Health & Science University
3181 SW Sam Jackson Park Road Portland, OR 97239
503 494-8788
Support, resource information and referrals to diabetes, mental health and financial resources in your community.

Parenting Diabetic Kids
http://www.parentingdiabetickids.com/
Website devoted to parenting children with diabetes.

U.S. Centers For Disease Control
www.cdc.gov/diabetes
Diabetes public health resource.

Well Arts Institute
www.wellarts.org
503 459-4500
A non-profit organization that uses storytelling and theatre to help people with chronic illness and traumatic life events.