Diabetes: Children Adjusting to the Illness

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Guest: Dr. Sharon Schwarz - Diabetes CDE

Host: Dr. Linda Austin - Psychiatrist.

Announcer: Welcome to an MUSC Health Podcast.

Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Sharon Schwarz, who is a Diabetes Educator at the Children’s Hospital, Medical University of South Carolina. Sharon, we have talked some in an earlier Podcast about very young children getting the diagnosis of diabetes. Let’s talk now about elementary school age children getting that diagnosis, kids who are let’s say not yet in middle school, but they still may be very involved in after-school activities and wanting to be like all of the other kids. What are some other psychological issues that those kids that age have in adjusting to this diagnosis?

Dr. Sharon Schwarz: Well, all children want to be just like their peers, so certainly having just to take their finger and take injections makes them feel very different. So, we try to work with the school system and the family to include the child as much as possible with any school parties, birthday parties, and after-school events. We look at the whole child and try to make sure that if the needles are problem, we show them different options. We have insulin pens, we have insulin pumps; we have so many options now that at least if the child is given a choice, they usually feel a little better about it, especially the school age child. They want choices. They want to feel part of that decision making process, and even though they would rather decide not to have diabetes at all, of course, at least if they could have a small part in making a decision of which therapy, they typically do a little bit better, but we have to work with the whole school and the church and the family and make sure that everyone is aware and that they always include the child and don’t really treat them differently if at all possible.

Dr. Linda Austin: Let’s talk a little bit about the choice between the insulin pump versus the injections; how do you explain that to a child?

Dr. Sharon Schwarz: What we do is we have the child come in and we actually hook them to a saline pump, which is just saltwater, so it’s a real pump, but it has got saltwater in it and then we let the child or the teenager wear that for a couple of days. I put it in, they go home, they wear it, and they may think they want an insulin pump until they walk around with this thing attached to them. So, they wear that for a couple of days and that helps them to decide what it’s really like to have this thing attached and they explain to other people what that thing is and it helps them from a mental standpoint make sure this is what they want to do. Often times, the parent skill is the best thing for them, but we really let the child have a big part in that decision making process because they have to wear it.

Dr. Linda Austin: How big is the pump?

Dr. Sharon Schwarz: It’s about the size of a beeper, a smaller beeper or a small cellphone and there is a tube that connects to the child and there is a needle that we put in initially, but the needle comes out and they wear it 24 hours a day, which, you know, some children think, oh! I will just wear that during the day and take it off at night, but they wear it when they go to school, when they sleep, so, we let them practice that and explain the pros and cons to the parents before they make that decision.

Dr. Linda Austin: Do you find that there are particular groups, say boys more or less than girls or athletes more or less than non-athletic children, who prefer the shots over the pump?

Dr. Sharon Schwarz: I would say, if you are on a swim team. Our biggest challenge with the insulin pumps were the pump sites because they are held in with tapes, so you can imagine in Charleston where the humidity and the beaches and swimming. If you have a child on a swim team, it’s not impossible and certainly some children still choose a pump even if they are on a swim team, that would be something that I would consider that if I have a child on a swim team now with some of the newer insulins that are much more like an insulin pump, some children just prefer not to have that pump connected to them that people will ask them what is that and why do you have that on you? Some children think it’s so cool because they have this neat pump that no one else has and they are very happy to explain it and they are very cute when they explain it whereas other children really don’t want to bring anymore attention to their diabetes, that might would be a problem for them, so its? very individualized.

Dr. Linda Austin: In your experience, your personal experience, roughly what percentage of kids choose the pump versus injections?

Dr. Sharon Schwarz: I would say may be 30% to 40% what choose an insulin pump. We have many more patients on injections than on pumps. I think some of our younger children, the parents early on see the benefits of having that insulin pump and not having to give their children four to five insulin injections a day whereas I guess our adolescents, they really need that time to wear that pump and make sure their body image issues, they are really thinking about that before they get that pump and they wear that and where they can wear it with their prom dress, where they can wear it with their jeans, and so it’s really good for them to wear that saline pump first and some of them just choose to stay on the injections, it’s very variable.

Dr. Linda Austin: But, they have to choose one or the other, in other words, they can’t use the pump most of the time and then on prom nights switch to injections.

Dr. Sharon Schwarz: Actually they can, because I had lots of young ladies call me before school get out for the prom and we would just put them on a new long acting insulin, Lantus for a day or two so that they could be without the pump for that day or two for their prom and then they would just reconnect to the pump and we just instruct them how to do that. As well, if a family is going on a cruise or a snorkeling trip and they really want the insulin pump, they want to come off that pump for a week. We have lots of instruction sheets that we have developed on how they can do that even for a vacation, so they really can do both.

Dr. Linda Austin: Let’s talk now little bit about the camps for diabetic kids. I know that we have that available here in South Carolina as well as other states where folks may be listening to these podcasts. What are those camps like, what is special about them?

Dr. Sharon Schwarz: Well, we are going out for camp now, it’s the last week of July and I just can’t say enough good things about the camp. We have awesome nurses and physicians that volunteer their time for that week. It’s just so much fun. There is kids get to be just like everybody there. They don’t have to worry about their diabetes or feeling different. They just play, they have a blast. It’s sort of on-the-job training for the kids at camp. We don’t have structured class time, but they are learning so much from their peers and from us as we give them their injections and we eat healthy and everybody is eating the same and it’s just -- it’s awesome for their self-esteem as well as they learn so much at camp, and they form lifetime friends. They email each other when they get home, they call each other, and they can’t wait till camp, you know, the next year and they just have a blast and the kids are awesome.

Dr. Linda Austin: What ages are these camps available for?

Dr. Sharon Schwarz: It starts at age seven and it goes up to 16 and then they can become a counselor-in-training, our adolescent patients. They are a good role model for our little kids and they fill out an application and they come to camp with us for a week and they have a group of children that they help with, so they can actually use their years of experience as a camper to help other children. We always them it looks on a college application to use them. We would love helping them, help others.

Dr. Linda Austin: Are there any particular issues in the school, in the environment that parents should really think about that they have a child with diabetes?

Dr. Sharon Schwarz: Yes, you want to make sure the medication forms that every school has, you want to make sure you meet with your school nurse before the school year, you want to make sure you sit down you explain who your child is, explain what they look like, may be even send a picture. I have had parents make wonderful notebooks with the picture of their child emergency treatments. South Carolina has school forms that are legal forms that they send to us and we fill out so that really the school is ready to take care of your child when they get to school that first day and they have the medications and they have a plan. It’s extremely important for the child to feel safe and to be safe at school.

Dr. Linda Austin: Sharon, thank you so much for talking with us today.

Dr. Sharon Schwarz: Thank you.

Announcer: If you have any questions about the services or programs offered at the Medical University of South Carolina or if you would like to schedule an appointment with one of our physicians, please call MUSC Health Connection at (843) 792-1414.

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