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Nursing Excellence

The Online Newsletter for Children's Nurses
e-Edition, Issue 4 

Jennifer Le
Working for a Living

By Jennifer Le, NP-C, CDE

The job of being a kid goes something like this: get up early, get dressed, eat breakfast, and arrive at school just as the bell rings. Sit in class all day, listen to teachers, take tests, have lunch, and deal with other kids. Then it’s off to lessons, sports, on to homework, chores, dinner, shower, brush teeth, get ready for bed, sleep. Then do it all over again. With the transition into adolescence, the daily stressors are magnified ten-fold. They have the additional challenge of the psychosocial and biologic changes of puberty.

For adolescents with diabetes, the job advertisement now goes something like this:

Help Wanted: An ideal candidate is highly motivated and must be willing to work independently. Individual may be working under the direct supervision of an adult. Mathematic skills are a must. All equipment required for job duties will be provided and must be kept with the individual at all times. This position will last a lifetime and includes multiple daily needle sticks and the risk of complications such as renal failure, amputation of lower extremities, blindness, slowed gastric motility and incontinence. Shifts are all 24 hours per day, 7 days per week.

This job of managing type 1 diabetes is not likely to appeal to anyone. Due to the demands of day-to-day diabetes management, the burn-out rate for teens is high, translating to poor glycemic control (1). Typically a strong, supportive family with sound leadership is helpful in this situation. As adolescents seek their independence, they are less willing to seek support from family members, making proper management of diabetes challenging. Further complicating matters is that the quality of life (QOL) from the prospective of an adolescent is linked with social networking and mastering electronic technology. Basic healthcare needs come secondary to any of the above.

The Pediatric Diabetes Care Center at Children’s Hospital Central California has taken a unique approach to working with adolescents with type 1 diabetes (2). By understanding the needs of the adolescent and incorporating key components of traditional diabetes management (based on well established data from the Diabetes Complications and Control Trial), a transition to improved glycemic control and diabetes self-management has become clearly apparent.  

Intensive blood glucose control in type 1 diabetes reduces the risk of:

  • Eye disease by 76 percent
  • Kidney disease by 50 percent
  • Nerve disease by 60 percent

Intensive diabetes management is a requisite to achieve this level of control and includes monthly or more frequent visits to a healthcare team comprised of a physician/nurse practitioner, nurse educator, dietitian, social worker, and behavioral therapist.

  • Needs of an adolescent with type 1 diabetes include:
  • A trusting relationship with the diabetes care team
  • Open discussion of responsible risk taking behaviors
  • Distinctly differentiating diabetes management task performance from individual character
  • Guidance in clarifying priorities to achieve personal targets in diabetes management
  • Proof of the power of oneself  (cause and effect of diabetes management choices)
  • Comprehensive support and encouragement (external support systems)
  • Open access to the healthcare team
  • Gradual self-reliance
  • Continual recognition for self-efficacy (building internal support system)
  • Developing and refining negotiation skills of diabetes management with parents as care behaviors improve
  • Assistance in transitioning parents in their changing role to cooperative care when appropriate (3).

Diabetes management is dependent on maturational readiness to perform self-management (4). As with many developmental milestones, not every adolescent progresses at the same pace, nor does management readiness correlate chronologically with age. The above approach allows adolescents gradual autonomy based on individual response to self-paced goal setting, in a supportive environment. As a result, adolescents who were previously considered to have out of control diabetes with a hemoglobin A1C of greater than 10 percent, have reduced their A1C by an average of 3.9 percent. This dramatically reduced their risks for diabetes complications. Not only are these teens on the road to independence, they now have bragging rights – they have officially accepted the most important job they will ever have…life.


1. Kyngas, H., & Rissanen, M. (2001). Support as a crucial predictor of good
    compliance of adolescents with a chronic disease. Journal of Clinical Nursing, 10,

2. DCCT [Diabetes Control and Complications Trial Research Group]. (1994). Effect of
  Intensive treatment of diabetes on the development and progression of long-term
  complications in adolescents with insulin dependent diabetes mellitus. Diabetes
  Control and Complications Trial. Journal of Pediatrics, 125, 177–188.

3. Anderson, B. J., Auslander, W. F., Jung, K. C., Miller, J. P., & Santiago, J. V. (1990).
  Assessing family sharing of diabetes responsibilities. Journal of Pediatric Psychology,
  15, 477–492.

4. La Greca, A. M., Follansbee, D. J., & Skyler, J. S. (1990). Developmental and
  behavioral aspects of diabetes management in children and adolescents. Children’s
  Health Care, 19, 132–139.


In This Issue

A Decade of Difference

National Certifications

The Benefits of Certification

A Journey to National Certification

A Vision for Advanced Respiratory Therapist Credentialing

The PICU's National Certification Journey

Working for a Living

Success - A Team Effort