Fostering Resilience in Type 1 Diabetes Management

 

Group photo

“It is no fun getting diabetes, but you must be able to have fun even if you have diabetes”, Professor Johnny Ludvigsson.

Under the directive Dr. David Leboho (President – Midlands Diabetes Interest Group); Mr. Ngoni Muzondo (Project Coordinator – Midlands Diabetes Interest Group); Joyline Chipo Chihota; Ruth Hlongwane; Annastacia Makundo (team SolidarMed); and myself. We hosted a Diabetes camp for children/adolescents and their parents/guardians. This initiative was conducted, under the theme: “Fostering Resilience for Type 1 Diabetes Management”. We believe in working in teams, hence the camp was brought up by the Midlands Diabetes Interest Group, in collaboration with Zimbabwe Diabetes Association, at Mkoba Teacher’s College and The Village Escape, in Gweru. A huge thanks to team SolidarMed for the amazing donation of insulin for every insulin user, that attended the camp (at least every child/adolescent walked away with 2-4 vials/pensets of insulin).

Diabetes is extremely complicated, however, patients should be referred for diabetes self-management education and support, medical nutrition therapy, and assessment of psychosocial/emotional health concerns if indicated, suggested American Diabetes Association, 2020. Fortunately, we had access to a Pediatrician; Dietician; Psychologist; Certified Diabetes Educator; Nurses; Health Fitness trainers. We emphasized the goals of treatment to our audience, throughout the sessions: no symptoms or discomfort in everyday life; good general health and well-being; normal growth and development; normal puberty and peer-group relations; normal schooling and professional life; normal family life; prevention of long-term complications.

Firstly, our first presenter covered a topic on the basics of diabetes: (as of today we do not know what causes type 1 diabetes). However, we covered the possible causes of diabetes, such as but not limited to a viral disease that can trigger the onset of diabetes; if a mother has certain viral infections during pregnancy, her child may have an increased risk of developing diabetes; and impaired insulin production in the beta cells of the pancreas can be found several years before the onset of diabetes. Environmental factors that trigger the disease process may start early in life, many years before the onset of diabetes. Further, we touched on diabetes complications and the ways to identify hypoglycemia/hyperglycemia, etc. It was stressed, that children and adolescents with diabetes must continue taking their insulin and other medical treatment as prescribed by the doctor, otherwise, their health will be in serious danger.

Additionally, the Dietician delivered a session on Healthy eating patterns: to promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, to improve overall health. However, families were invited by the dietician to book individually, to address individual nutrition needs based on personal and cultural preferences, health literacy and numeracy, access to healthful foods, willingness and ability to make behavioral changes, and existing barriers to change;

More so, with the presence of our Certified Diabetes Educator (also a person with type 1 diabetes lived experience), we had the privilege of learning about getting used to injections; taking the pain out of injections; possible injection sites; whether it’s necessary to disinfect the skin; and the storage of insulin. It should be noted that, if parents/guardians can overcome their fear of needles, the child will find it a lot easier to learn how to self-inject. It was pointed out that Insulin requirement is known to increase during puberty and as the person grows, so does the total daily injections (considering that people in Zimbabwe rarely adhere to their Doctor’s dates for further assessments/review. Key things that were emphasized were: Insulin should be given by subcutaneous injection, i.e. into the fat beneath the skin, not into the muscle; the disadvantage of always using the same places for injections is that you will soon start to develop fatty lumps; Insulin in use should be discarded after 4 weeks at room temperature (not above 25°C); and The insulin uptake from the tummy is quicker, followed by buttocks then from the thigh/arm.

Managing a long-term condition like diabetes is a major source of anxiety for some, as was postulated by the Centers for Disease Control and Prevention, in 2023. In most cases, when someone develops a long-term illness, the situation for the whole family is always a difficult one. Professor Johnny Ludvigsson describes the different phases of crisis: the shock phase – where it is difficult to think clearly and you cannot take in information; the reaction phase – a reaction of sorrow with tears, sleeplessness, aggression, and bitterness will also take time; repair phase – Systematically, a little bit at a time, you can absorb facts and start to rebuild your life and Reorientation phase – one where diabetes is an important part but by no means everything. It was critical that we involved a Psychologist in our slots, to dive deeper into positive parenting. It was/is argued that, if, as a parent, you are discussing what the “rules” are at home, it is important to consider what is actually provoked by your child having diabetes, and what is a part of a normal upbringing. However, Dr. Ragnar Hanas articulated that, if you are always referring to diabetes when it comes to rules and prohibitions, the young person will hate the very thought of diabetes since it puts an end to so many nice things.

Above all, we had so much fun during the diabetes camp. Every morning, we started off with Aerobics and in between sessions, we would perform some exercises as energizers. The moral of the story was that developing such a routine-like lifestyle would be beneficial because exercises are extremely important, not just to people living with diabetes. Yin and yang are conceptions in Chinese philosophy of two principles that are in balance and harmony. “Try to see your diabetes as a part of yourself that can melt into balance and harmony with the rest of your personality. Your attitude is a very important part of diabetes treatment. Those who hate their illness will soon begin fighting against it”.

Aerobics session

It may be a good idea to be apprenticed to someone who has had diabetes for many years and has had time to learn how to live with it in a positive way. In that regard, we had the opportunity to invite our dear brother, Tinovonga (a person with 24 years of type 1 diabetes lived experience). He helped to inspire the youngsters and encourage the parents/guardians that, if people instead what kind of life you/they want to live, and your/our diabetes team will help you/us to adjust your/our treatment according to your/our wishes and we could thrive, regardless. We recognize that it is difficult to live with diabetes, often very difficult. However, if we hate our diabetes it will be difficult to make friends with it!

In conclusion, for people like us, to manage our diabetes well, we must: become our own experts on diabetes; have more knowledge about diabetes than the average doctor; and accept our diabetes and learn to live with it. The more motivated you are, the better you will be able to manage your own diabetes.

Disclaimer: This camp would not have been possible without the generosity of Panorama Global with seed funding from The Leona M. and Harry B. Helmsley Charitable Trust. Through the Type 1 Diabetes (T1D) Community Fund, Midlands Diabetes Interest Group was able to host such a camp, in the hope to invest in a future where people living with type 1 diabetes can lead healthy and fulfilling lives.