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Help! Need Documentaries About Diabetic Complications In Teens or Pre-Teens

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by TheDeltaBluesNurse TheDeltaBluesNurse (New Member) New Member Nurse

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I’m having a VERY hard time getting a 12 almost 13 year old type 1 diabetic to understand the seriousness of uncontrolled diabetes mellitus. She was diagnosed young but comes from a less than ideal home situation. We (home health nursing)  were actually brought in by CYS after the parents were reported for medical neglect. Her sugars spike and plummet, she will not do capillary tests when there isn’t staff present. She will be in the 300s,400s for days when unstaffed.  

   We’ve tried positive re-enforcement, reward systems,punishments, etc. Nothing has worked because we have no parental follow through. This little girl’s only shot at maintaining her sight and limbs, is for HER to care about her health. We’re looking into setting up  consoling and I feel that will help to so degree. However, she still doesn’t seem to understand why we are all so concerned about her glucose levels. I feel like seeing someone near her own age with  severe complications from uncontrolled diabetes might help her understand the seriousness of her condition and what this path of non-compliance  leads to.  She can be such a sweet girl, I don’t want to see these thing happen to her. 

 

Im open to ANY TIPS, SUGGESTIONS, OR ADVICE! 

Edited by TheDeltaBluesNurse

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AnnieNP has 20 years experience as a MSN, NP and specializes in Adult Primary Care.

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She may need to meet a diabetic patient who has lost limbs  / sight to this uncontrolled disease. 

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amoLucia specializes in LTC.

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How about contacting a 'peer support' type group that operates thru a Children's Hospital for some suggestions? Maybe a CDE (certified diabetes educator) can give you some direction. Or an endocrinologist's office has some suggestions.

You seemed to be trying your best but maybe these outside sources can be another resource.

I had 2 cousins that died as adults but experienced all the assoc comorbidities. It was so disturbing to see them at their viewings knowing that they were so young to have died.

 

 

 

 

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On 6/6/2019 at 4:49 PM, TheDeltaBluesNurse said:

We’ve tried positive re-enforcement, reward systems,punishments, etc. Nothing has worked because we have no parental follow through. This little girl’s only shot at maintaining her sight and limbs, is for HER to care about her health. We’re looking into setting up  consoling and I feel that will help to so degree. However, she still doesn’t seem to understand why we are all so concerned about her glucose levels.

 

I think you need to broaden your assessment of the situation. I don't mean to over-simplify, but with normal cognition a 13-year old is capable of understanding what she has been taught so far. Cases like this are why nursing philosophy/theory can be important!

This could be anything from an actual cognition issue to a straightforward case of denial, to a need for love/belonging/attention.

The key to this is to figure out if it's true that she literally doesn't understand basic information that she has been given so far (and its implications for her own life), or if the education was not appropriate or wasn't presented in a manner that she can understand....

...Or whether it could be possible that there are emotional and/or psychological components to the problem of her sugars being out of control whenever caring people who are concerned about her well-being aren't around.

Someone needs to assess what she actually understands about the facts of DM 1. The way you wrote your post it seems like it has been decided that she is capable of processing the information she has been given (otherwise showing her documentaries of people who have lost their limbs won't help control her blood sugars).

If she does indeed understand, then assuming that she doesn't believe you or doesn't care would be towards the bottom of my list of possible factors for her failure to control her BS.

I would first and foremost check out the idea that the presence of healthcare providers (and their interest in her well-being) is meeting physiological, safety/security and love/belonging needs.

Go from there.

Counseling is an excellent idea and should be facilitated pronto.

In the meantime, nurses are trained in various theories and techniques that could help get to the bottom of this.

Good luck! 👍🏽

(Don't assume!)

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8 hours ago, JKL33 said:

 

I think you need to broaden your assessment of the situation. I don't mean to over-simplify, but with normal cognition a 13-year old is capable of understanding what she has been taught so far. Cases like this are why nursing philosophy/theory can be important!

This could be anything from an actual cognition issue to a straightforward case of denial, to a need for love/belonging/attention.

The key to this is to figure out if it's true that she literally doesn't understand basic information that she has been given so far (and its implications for her own life), or if the education was not appropriate or wasn't presented in a manner that she can understand....

...Or whether it could be possible that there are emotional and/or psychological components to the problem of her sugars being out of control whenever caring people who are concerned about her well-being aren't around.

Someone needs to assess what she actually understands about the facts of DM 1. The way you wrote your post it seems like it has been decided that she is capable of processing the information she has been given (otherwise showing her documentaries of people who have lost their limbs won't help control her blood sugars).

If she does indeed understand, then assuming that she doesn't believe you or doesn't care would be towards the bottom of my list of possible factors for her failure to control her BS.

I would first and foremost check out the idea that the presence of healthcare providers (and their interest in her well-being) is meeting physiological, safety/security and love/belonging needs.

Go from there.

Counseling is an excellent idea and should be facilitated pronto.

In the meantime, nurses are trained in various theories and techniques that could help get to the bottom of this.

Good luck! 👍🏽

(Don't assume!)

  That was poor phrasing on my part, I apologize. She definitely understands her condition  and the implications, but she is in total denial that anything like that will ever happen to her. She believes it happens to the elderly and “older people” in general. 

   You’re on to something about the need for love and attention. She has quite a few siblings(some have specials need), and parents that have pretty much checked out. It’s definitely a fatigue of chronicity situation with the parents, but they won’t acknowledge they need help. 

    I KNOW she enjoys the attention she receives from adults due to her condition. I honestly don’t think we’ll make much progress until we address all the psychosocial issues at play here, but it seems like it’s taking forever to get the ball rolling due to parental disinterest and red tape.

  I’m honestly just grasping at straws and looking for someway to reach her in the meantime. I’m one of two nurses willing to work the case, so there are MANY unstaffed days. I’m genuinely worried about her on the unstaffed days. I’ve reported all the necessary information  to my superiors and CYS. I’m just looking to explore some other avenues to reach her. 

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On 6/8/2019 at 4:38 PM, TheDeltaBluesNurse said:

I’m honestly just grasping at straws and looking for someway to reach her in the meantime. I’m one of two nurses willing to work the case, so there are MANY unstaffed days. I’m genuinely worried about her on the unstaffed days. I’ve reported all the necessary information  to my superiors and CYS. I’m just looking to explore some other avenues to reach her. 

Thanks for the clarification and I'm sorry, it sounds like a tough case. It's great that you are looking for creative ways or other angles that might help her make a change. There's no magic potion for this but I do think anything that increases overall sense of personal value/self esteem can only help the cause. Also anything that helps her feel empowered to control what things she actually can control.

This must be so incredibly difficult for her.

And, this case also sounds like it might be difficult to maneuver for other reasons, like the risk of unhealthy attachment on the part of the patient or nurse. Use all of your professional tools but also be careful how you feel about things that are out of your control.

Best wishes ~

 

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hppygr8ful has 15 years experience and specializes in Psych, Addictions, Elder Care, L&D.

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On 6/8/2019 at 1:38 PM, TheDeltaBluesNurse said:

  That was poor phrasing on my part, I apologize. She definitely understands her condition  and the implications, but she is in total denial that anything like that will ever happen to her. She believes it happens to the elderly and “older people” in general. 

   You’re on to something about the need for love and attention. She has quite a few siblings(some have specials need), and parents that have pretty much checked out. It’s definitely a fatigue of chronicity situation with the parents, but they won’t acknowledge they need help. 

    I KNOW she enjoys the attention she receives from adults due to her condition. I honestly don’t think we’ll make much progress until we address all the psychosocial issues at play here, but it seems like it’s taking forever to get the ball rolling due to parental disinterest and red tape.

  I’m honestly just grasping at straws and looking for someway to reach her in the meantime. I’m one of two nurses willing to work the case, so there are MANY unstaffed days. I’m genuinely worried about her on the unstaffed days. I’ve reported all the necessary information  to my superiors and CYS. I’m just looking to explore some other avenues to reach her. 

Perhaps see if you can hook her up with some social support through something like project sister or girl's club, maybe a fun diet and exercise program like martial arts that stresses discipline and balance.  Also a rewards system - My one touch meter is linked to my iPhone and gives me instant feedback with each blood sugar check.

Just some thoughts.

Hppy

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FolksBtrippin is a BSN, RN and specializes in Psychiatry, Pediatrics, Public Health.

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On 6/8/2019 at 8:22 AM, JKL33 said:

 

It's likely not about whether or not she is capable of understanding the information.

Developmentally, it is quite normal for a 13 year old to simply think "that won't happen to me." Their brains are wired that way. Human brains don't start thinking about the potential negative consequences of behavior until after adolescence.

Get the therapy, yes. But you will still have to control this for her until  she can control it herself. Not as a reward or as a punishment. As a neutral intervention. 

Get staff on board to show no emotion regarding BG levels. You explain to the kid that this is a numbers game. Staff is here every day until we see BG value below x. Then staff is here every other day until we see BG value below x-50. And so on.

The worst thing you can do is show too much emotional response. For a kid who is feeling neglected at home, that emotional response can meet a need that can eventually create a bond that is dependent on the child staying ill. I hope that hasn't happened already.

Good luck.

 

 

 

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I am a type 1 diabetic, and honestly the best thing that ever happened to me was going to a diabetes camp like The Barton Center for Diabetes Education. The Barton Center is in Massachusetts and kids go from all over the world, but there are also camps in other regions of the US too. Its set up like a regular summer camp but theres tons of diabetes education woven into it. There are also weekend programs in the fall, winter, and spring where you can bring family or friends. They have a lot of scholarship funding for disadvantaged kids, and I think if its your first time at camp you can go 2 weeks for free. We have had many kids come from DYS or difficult home situations and the staff are great at working with these kids. They have nurses (many of whom have diabetes too) who oversee care 24/7, but what was most impactful for me was being surrounded by hundreds of kids and counselors who had diabetes. They became a positive support system and were healthy role models for me. As a teen, I would get upset when people/providers who didn't have diabetes would tell me what to do because I felt like they really didn't understand. I felt like they were looking at me as just my numbers and not as a person. Camp was a place where I felt normal, and I learned so much about how to take care of myself without it feeling like a burden. It changed my life, gave me confidence and life long friends, and ultimately gave me skills and motivation to lower my A1C. I highly highly recommend this to all kids with diabetes, but especially those who are struggling. I hope this helps! 

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