The Nanny Diaries: Managing Type 1 Across Two Households


Something I never considered when I took a job as a nanny and caregiver for a seven year old with Type 1 diabetes was managing care between two households. In hindsight it seems obvious, but from the outside I was being hired to work in only the mother’s house, so I didn’t expect to have much contact with the dad’s house, outside of cordial coordination and did-you-remember-to-pack-his-soccer-stuff? That light interaction might work for other households, but with Type 1? Not an option. It didn’t take me long to realize that constant communication, excellent record keeping, trust in each other and the need to “play on the same team” were going to be paramount to Kai’s health.

Excellent training and clear expectations

Kai’s dad and stepmom trained me in the family’s system of diabetes management. The time I spent in their house was crucial to building a team relationship that has endured. After training, I left on a two week international trip with Kai and his mom. At the beginning, I texted with dad’s house … a lot. After seven months on the job, we text a lot less, but dad and stepmom are always available for me to sanity check a dosing decision, even at 4 a.m. Knowing that they have their phones on “Just In Case” means the world.

Logbooks, check lists — just do them!

How do we keep the quality of communication up? We write a lot down. Lists come naturally to me, but after reading Atul Gawande’s “The Checklist Manifesto,” I’m an even bigger fan. As Gawande explains, checklists revolutionized quality in large-scale construction projects, surgery and flying planes. He left out the chapter on small boys with autoimmune diseases and divorced parents, but I’m sure he would back me up. We have checklists for quality care as well as transitioning between the houses so we don’t waste or duplicate gear. The lists are helpful every day, but especially after a rough night or before a busy day, it takes the “Did I remember …” out of the equation. Check the list.

The team approach is helpful in many ways. We all get time off to get rest. We have many sets of eyes to analyze the CGM records and many brains problem solving in order to stay nimble when Kai’s body changes. That extended dose doesn’t work for dinner anymore? Time to try something new, and let me know if it works when I pick Kai up for the week so I don’t have to reinvent the wheel. The clear systems we have in place run the same in both households, which leads to more consistent management.

Remember — it’s not just about the numbers

Beyond more consistent overall care of the disease, there is something more important, and it has more to do with the heart than the pancreas. Kai knows the adults in his life are a team. He sees us scribbling notes, packing up, talking, texting and he knows he is safe.


Read “The Nanny Diaries: Now I Understand,” also by James Austin, HERE.

WRITTEN BY James Austin, POSTED 01/07/16, UPDATED 12/09/17

James Austin was raised on a sheep farm and is still surprised to find herself residing in the urban jungle of San Francisco. She is an educator, adventuress, and modern day Mary Poppins. She's lucky enough to have fallen in love with, learned to kiteboard from, and been a caregiver for Type 1 diabetics. She hand writes over 100 letters and postcards every year, is enthusiastic beyond her ability at all outdoor sports, and volunteers as a doula.