Six months ago, Jake and his family learned he has type 1 diabetes, which is usually diagnosed in children and young adults. Individuals who have type 1 diabetes do not produce insulin, which is necessary for the body to be able to use sugar. Sugar is the basic fuel for the body’s cells, and insulin moves the sugar from the blood into the cells.

Type 2 diabetes is the most common form of diabetes. Individuals with this disease either do not produce enough insulin or the body’s cells ignore the insulin. Type 2 diabetes usually develops in adults over age 35, especially in those who are overweight. As obesity rates increase nationally, however, type 2 diabetes has become more common in children and teenagers.

Overcoming New Obstacles

At the University of Michigan C.S. Mott Children’s Hospital, a program has been developed to help educate children and their families and to help them deal with the new obstacles they face when diagnosed with diabetes. After diagnosis, a child is admitted to the hospital for about 24 to 48 hours. “During this period, they receive what is called the CHUMS, which stands for carbohydrate counting, hypoglycemia management, urine ketone testing, monitoring, and shots,” explains Diana Barlage, R.N., C.D.E. CHUMS teaches the basic survival skills necessary for managing diabetes.

After discharge, both patient and family are closely managed by the diabetes team through phone contact. About two weeks after they are diagnosed, the child and their family begin the Pediatric Diabetes Self-Management Program, which is certified by the Michigan Department of Community Health and recognized by the American Diabetes Association. The multidisciplinary team involved in diabetes education includes three nurse educators, a registered dietician, and a social worker. There are two basic classes during which the child and family learn more self-management skills necessary to care for their diabetes. Topics discussed during classes include how to cope with diabetes, school issues, sick-day management, exercise, regulating blood glucose levels, and more details about proper nutrition.

Kids with Diabetes Not Alone

Jake’s family experienced the positive effects of participating in the Pediatric Diabetes Self-Management Program. Jake’s mom, Joy, says “I think it is helpful to be in a class with other kids his age. The one thing that is especially hard for Jake is being at a school of 600 children and no one else having diabetes. It helps him to know there are other kids in his situation.”

After the basic classes, there are two advanced classes—the Flexible Management Program and the Pump Program. The pump is a small device, about the size of a beeper, which houses a syringe filled with approximately three to four days’ worth of insulin. This device delivers a steady dose of insulin throughout the day, more like the body would normally do. At meal times, the device can be programmed to deliver the amount of insulin needed corresponding to the amount of carbohydrates consumed. “One of the major benefits of the pump is that it requires only a single poke of insulin every three days, unlike the previous method which required four to six shots each day,” says Nugget Burkhart, C.P.N.P., C.D.E. During the Pump Program, parents and children are taught the skills needed for successful management of the pump. There are approximately 300 child and adolescent Mott Hospital patients who participate as members of the Pump Team.

The educational aspect of treatment is especially important for diabetes patients. “Ninety-five percent of diabetes management is self-treated. Children and young adults—as well as their families—need skills to manage their disease. Diabetes is not a passive illness, patients must be proactive in order to be successful,” Barlage stresses.

Burkhart emphasizes the unique nature of the program. “Most programs educate families on diabetes care and treatment individually,” she says. “We educate families in small groups. This provides an environment for parents to support each other and allows children to realize they are not the only ones with the disease.”