ISPAD Newsletter - June 2026

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President's Message:

By all accounts Isaac Newton was a curious chap. His Third Law of Motion states that for every action there is an equal and opposite reaction. This principle of physics has metaphorically drifted into behavioural science in the realm of ‘unintended consequences’ or Janus-faced affordances. The latter are events or things that simultaneously have two opposing or paradoxical properties (Janus being the Roman God that simultaneously looks forwards and backwards).

 

In a series of (by today’s standards ethically questionable) psychological experiments from the 1960’s, Martin Seligman subjected dogs to repeated mild electric shocks that were unavoidable. In response the dogs became passive and inert, increasingly showing no attempt to evade the painful stimulus when the opportunity subsequently arose. This observation gave birth to the notion of the conditioned response - “learned helplessness”.

I hope none of you are subjecting your patients to electric shocks. I wonder though, if one of the Janus-faced affordances of paediatric diabetes care is a degree of learned helplessness. One of the paradoxical outcomes of wrap-around care and support can sometimes be loss of agency, motivation and initiative. I see small examples of this in my clinic most weeks. One inquiry to a teenager about their insulin doses- the response “I don’t know, ask her”- nods to mother. Asking a family to log in to their technology support webpage “We don’t know our username and password. The nurse set them up”- all too often associated with never accessing their data file for a proactive review of their metabolic status. An insulin dose change that did not achieve the desired result but was not amended- “Yes, I know what should have been done, but I didn’t want to be the one responsible for doing it in case something went wrong. I wanted you to do it”. In my experience these observations do necessarily not align with social determinants of health status. Incongruously, families who are very capable in other aspects of life sometimes become incapable in diabetes care. Reliance on high levels of health care support by diabetes care teams and technology seems to undermine therapeutic curiosity and enterprise by some parents and patients. This phenomenon is not isolated to health care. In the era of 24/7 road-side assistance, how many of us can now confidently change a flat tyre on a car?

In life it appears that learned helplessness might be passively or actively taught. During the Second World War many merchant ships were sunk in the Atlantic Ocean. When crew members took to life boats, it was not the physically fit who survived. Rather it was the older, but more psychologically fit with greater life experience, who were the most likely to withstand the rigours of an open boat on the ocean. The younger, fitter sailors died in part due to passively learned helplessness. Recognition of this led to Kurt Hahn and Lawrence Holt forming the Outward Bound program of experiential learning, fostering character and resilience. The success of this program ensured that it continues to this day. Alternatively, learned helplessness can be actively taught. In a farming context, machinery companies with policies of warranty restrictions, software locks and proprietary diagnostics actively prevent farmers from servicing their own equipment. Farmers are being forcibly taught not to show initiative or solve their own problems. The “Right to Repair” movement shows though, that farmers are poor students when it comes to learning helplessness.

Learned helplessness has been little studied in diabetes in youth. A recent systematic review found that it may be underpinning factor contributing the diabetes distress, whereas a much older paper (one of Alan Delamater’s early works) indicated a link with co-morbid depression. A small Canadian study though, concluded that youth with T1D were not more susceptible to learned helplessness than healthy controls. This is self-evident to many- groups such as #dedoc° (“Nothing About Us Without Us”) and the Looping community are the antitheses of learned helplessness. It is hard to imagine more empowered groups than these!

So, learned helplessness appears to be a significant issue in diabetes for some people with diabetes whilst not being an innate part of diabetes per se. Where is it coming from then? Are we inadvertently prescribing both insulin and inaction in these patients? Are we caring too much? Rather than empowering, is automation disabling agency and engagement? I don’t have the answers but my clinic interactions underpin my Newtonian curiosity. I wonder if we should be challenging some of our patients a bit more, tapping into that Outward Bound philosophy “there is more in you than you know”.

In the same vein of mining untapped personal resources, I would also encourage ISPAD members to consider stepping up and contributing to our society. Nominations are now open for 6 new members for the Advisory Council (2026-2029) and for the new Treasurer (2026-2027). These are critical roles and we need you!

Best to all,

Fergus