Cara is a 13-year old figure skater.

Cara is a 13-year old figure skater.

As a nurse practitioner at our Diabetes and Endocrine Clinic in Neenah, Wis., I have the privilege of providing diabetes care to Cara — a 13-year old figure skater. She eats a healthy diet, exercises and tries hard to get plenty of rest. But she struggles with fitting it all in while maintaining good grades in school.

I asked Cara, “Who’s on your diabetes team?” Listing people who could help her manage her diabetes was a great reminder that she is not alone in diabetes care. We discussed the importance of the team in synchronized skating and the importance of a team in diabetes management. If you’re part of a team, you’re more likely to do your part.

On the diabetes team, parents and guardians are the head coaches and health care providers are the assistant coaches. While health care providers know a lot about diabetes, the parent is with the child the most and sees firsthand the relationship between food, activity, stress and sugar variations.

Motivation is vital

With skating, Cara is motivated by her love of the sport and knowing there are alternates in training who are ready to step in if needed. In caring for her diabetes, she is motivated by energy. If numbers are high she gets tired more easily. If numbers are low, she has to stop skating until they improve. These are powerful motivators for her.

Attention to the game plan is key to achieving goals

To evaluate how anything in life is working, I follow the PDCA process: plan, do, check and adjust. To encourage review of the game plan, I recommend family “time-outs” to look at what is working and what may need to be adjusted. Time-outs should be held when the family is able to focus. They should be brief, and what you learn (what worked, what did not) should be used to direct future care. This allows the family to adjust the care plan as needed between appointments, keeps the home team vested and can prevent surprising negative results at clinic visits.

Whether it’s tightening skates or evaluating the diabetes plan, we can use the PDCA model for successful management. Evaluating and adjusting the plan is important to achieving goals in any area of life.

Shari Liesch, MSN, APNP– Shari Liesch, MSN, APNP, Children’s Hospital of Wisconsin

The Diabetes Clinic at Children’s Hospital of Wisconsin is one of the largest in the nation, serving more than 1,700 children with type 1 (juvenile) and type 2 diabetes. The clinic treats patients in Milwaukee and Neenah, Wis.

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