PEDIATRICS Vol. 73 No. 6 June 1984, pp. 749-755
This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by White, K.
Right arrow Articles by Winter, R. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by White, K.
Right arrow Articles by Winter, R. J.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Unstable Diabetes and Unstable Families: A Psychosocial Evaluation of Diabetic Children with Recurrent Ketoacidosis

Kimberly White MD1, Mary Lee Kolman RN, PNP1, Phyllis Wexler MA, ACSW1, Gail Polin 1, and Robert J. Winter MD1

1 From the Departments of Pediatrics, Nursing, and Social Work, The Children's Memorial Hospital, Northwestern University Medical School, Chicago

To investigate the physical and psychological factors associated with labile diabetic control, 30 children and adolescents with recurrent diabetic ketoacidosis were included in a retrospective longitudinal review covering an 8-year period. The details of the ketoacidosis episodes and the psychosocial characteristics of the patient and his family were summarized from the medical record. Only a minority of the ketoacidosis episodes were overtly and solely related to intercurrent illness or poor compliance. A majority of the subjects studied lived in families with substantial psychosocial dysfunction, including chronic unresolved interpersonal conflict, inadequate parenting, father not in home, financial stress, and lack of family involvement with the diabetes. Many of the children displayed behavioral and personality problems. In most of these 30 cases, there was evidence that these dysfunctions existed prior to the onset of diabetes. These psychosocial problems were not immediately apparent in many instances, thus requiring more comprehensive psychosocial assessment and involvement by a social worker and/or a psychologist. Ongoing emotional support and counseling were instrumental in reversing the pattern of recurrent ketoacidosis, in coordination with care by all members of the diabetes team. The findings from this experience suggest that recurrent ketoacidosis warrants prompt evaluation from a psychosocial as well as a physical perspective.

Key Words: diabetic ketoacidosis • labile diabetes • psychosocial dysfunction

Submitted on June 20, 1983
Accepted on August 15, 1983


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 Clinical Case StudiesHome page
C. Martin, A. Southall, K. Liveley, E. Shea, and K. Whitehead
Multisystemic Therapy Applied to the Assessment and Treatment of Poorly Controlled Type-1 Diabetes: A Case Study in the U.K. National Health Service
Clinical Case Studies, October 1, 2009; 8(5): 366 - 382.
[Abstract] [PDF]

Home page
 Behav ModifHome page
T. Wysocki
Behavioral Assessment and Intervention in Pediatric Diabetes
Behav Modif, January 1, 2006; 30(1): 72 - 92.
[Abstract] [PDF]

Home page
 Diabetes CareHome page
D. A. Ellis, M. A. Frey, S. Naar-King, T. Templin, P. Cunningham, and N. Cakan
Use of Multisystemic Therapy to Improve Regimen Adherence Among Adolescents With Type 1 Diabetes in Chronic Poor Metabolic Control: A randomized controlled trial
Diabetes Care, July 1, 2005; 28(7): 1604 - 1610.
[Abstract] [Full Text] [PDF]

Home page
 Arch Pediatr Adolesc MedHome page
J. Patterson and R. W. Blum
Risk and Resilience Among Children and Youth With Disabilities
Arch Pediatr Adolesc Med, July 1, 1996; 150(7): 692 - 698.
[Abstract] [PDF]

Home page
 Arch Fam MedHome page
J. C. Konen, J. H. Summerson, and M. B. Dignan
Family Function, Stress, and Locus of Control: Relationships to Glycemia in Adults With Diabetes Mellitus
Arch Fam Med, April 1, 1993; 2(4): 393 - 402.
[Abstract] [PDF]

Home page
 The Diabetes EducatorHome page
J. McKelvey, D. A. Waller, A. J. North, J. F. Marks, B. Schreiner, L. B. Travis, and Jayn. Murphy
Reliability and Validity of the Diabetes Family Behavior Scale (DFBS)
The Diabetes Educator, January 1, 1993; 19(2): 125 - 132.
[PDF]

Home page
 The Diabetes EducatorHome page
G. Henderson
The Psychosocial Treatment of Recurrent Diabetic Ketoacidosis: An Interdisciplinary Team Approach
The Diabetes Educator, January 1, 1991; 17(2): 119 - 123.
[PDF]

Home page
 The Diabetes EducatorHome page
D. L. Gray, D. G. Marrero, C. Godfrey, D. P. Orr, and Michaelp. Golden
Chronic Poor Metabolic Control in the Pediatric Population: A Stepwise Intervention Program
The Diabetes Educator, January 1, 1988; 14(6): 516 - 520.
[PDF]

Home page
 Arch Pediatr Adolesc MedHome page
D. P. Orr and M. Golden
Surreptitious Insulin Administration: Is It an latrogenic Syndrome?
Arch Pediatr Adolesc Med, August 1, 1987; 141(8): 830 - 832.
[Abstract] [PDF]

Home page
 JAMAHome page
D. P. Orr, T. Eccles, R. Lawlor, and M. Golden
Surreptitious Insulin Administration in Adolescents With Insulin-Dependent Diabetes Mellitus
JAMA, December 19, 1986; 256(23): 3227 - 3230.
[Abstract] [PDF]