In no disease is successful management more dependent on the attitude of the patient relationship with in the family and the relationship with the physician. The complex nature of control, the need for frequent monitoring, the dietary restrictions, and the limitations on activity all have an impact on the life of the individual and on other members of the family. The family physician can be a source of great support to patient and family on the other hand, the physician can be a hindrance to them if the or she fails to understand their problems, mismanages therapy, or neglects to call on available resources. When learning that their child has diabetes, parents are profoundly shocked. They often have guilt feelings about having done something to cause it or about hereditary factors. The family physician can help by ascertaining these feelings and by providing information about causation and inheritance.
Two mal adaptive parental reactions over protection and rejection are associated with problems in the children. It is not difficult to understand how anxiety can make parents over solicitous about diet and insulin and unduly restrictive of child's independence. At first the child may respond passively to over ptoectiveness but is likely to rebel when he or she reaches puberty. Rejection and hostility on the part of the parents is associated with serious behavioral problems in the child's changing needs, as he or she grows older.

A child or adolescent with diabetes can never forget for a day that he or she is different from other children. The child may go to great lengths to try to conceal his or her diabetes from friends. Children may need encouragement to be open & frank about their condition. Diabetes makes it especially difficult for adolescents to go through the often-turbulent process of becoming independent from parents. Their disease places restrictions on their social life. Eating, and use of alcohol, and they often have anxieties about future complications and their prospects for marrying and having children. Problems with diabetic control may be a manifestation of adolescent instability and rebellion. Like normal adolescent's instability and rebellion, like normal adolescents, however young diabetics with behavior problems usually settle down as they get older.
Since diabetes is so dependent on frequent monitoring and dose adjustment, it is very vulnerable both to emotional reactions and to self-destruction behavior. A disturbed patient may deliberately with hold insulin to precipitate ketoacidsis. There is some evidence that many patients with frequent attacks of ketoacidosis are interfering with treatment. Although more common in adolescents and young adults, this can occur at any age.

Impact on adults: -
The impact of diabetes on an adult and his or her family depends on the stage in the life cycle at which the diagnosis is made. Whenever it occurs, the sufferer will experience grief as he or she comes to terms with a chronic disease, loss of health and diminished expectations. For couples without children, there will be questions about whether they should have children. If the patient is a woman, there will be concerns about the impact of pregnancy on her health & her capacity to care for an infant. A parent of either sex may fear that he or she will not live long enough to see the child grow up or remain fit long enough to see the child grow up or remain fir long enough to provide for the child. For patients who develop diabetes before marriage, these issues should have been discussed with the spouse before the decision to marry. Much will depend on how long the patient has had diabetes and the presence of control problems & complications. Parents worry that their children may inherit diabetes. Given the complex inheritance of diabetes. It is difficult to give individualized genetic counseling.
Diabetes has an impact in several ways on relationships within the family. Like other families in which there is a member with chronic disease, the disease may come to be blamed for every problem. The patient with the disease becomes a scapegoat for all the troubles of the family.
Children of diabetic parents have fears that their parents will die or abandon them or that they will inherit the disease. The may also harbor guilt feelings about being responsible for the disease or for episodes of hypoglycemia or ketoacidosis. Children will not often express these feelings unless encouraged to do so. Parents may be completely unaware of them.