After her daughter Brin’s diagnosis of type 1 diabetes at age 11, Colorado mom Sheryl put a great deal of time and effort into creating what she thought was the perfect meal plan. She carefully counted carbs in each of the ultra-healthy meals and snacks her daughter would eat that day, dosed insulin accordingly, and kept a menu chart on the fridge that essentially tracked everything that went into her daughter’s mouth. For the first year after diagnosis, this approach seemed to work: Sheryl felt, most of the time, like she had Brin’s diabetes under control.
Then, seemingly out of the blue, something changed.
“At first, I started to see these random highs on her meter, and I was stumped,” she explains. “And then I began to find junk food wrappers in the wastebasket or balled up in the pockets of her jeans. These weren’t foods on her menu chart. When I confronted her about what I was seeing, I would just get shoulder shrugs and answers like, ‘I don’t know where those came from.’ After weeks of more and more of these highs, my blood was boiling. How dare she lie to me about sneaking food?”
Sound familiar? Whether it’s sneaking food, lying about numbers, avoiding care tasks, or even acting out due to off blood sugars, type 1 diabetes can create some unique opportunities for misbehavior. However, in many of these cases, misbehavior isn’t just something to make you tear your hair out -- it can also put your child’s health at risk. Here are some ways to cope.
Find the Underlying Cause
To put an end to her daughter’s lying, Sheryl’s first instinct was to start doling out consequences every time she caught her sneaking food. This, she admits, only made the problem worse.
A better tactic? Put aside anger and frustrations and adopt a more neutral, nonjudgmental perspective before making any decisions about how to proceed, suggests New Jersey-based clinical psychologist and certified diabetes educator Clare Venus, Ph.D., R.N., C.D.E.
“When you think about the situation, rather than say ‘he lied to me,’ change that to ‘he withheld the truth.’ Or instead of ‘she’s sneaking food,’ try rephrasing it as ‘she fed herself,’” says Venus. This technique can help parents see things from their child’s point of view, she explains, with the ultimate goal of initiating a neutral dialogue to find out what’s really going on beneath the surface.
The reframing technique led to a light-bulb moment for Sheryl. “People eat food. It`s only ‘sneaking’ food to us because our kids have to cover everything with insulin. Once I made this connection, I sat down with my daughter and we discussed her eating, this time without anger. What came out was that she felt the diet I had devised was just too different and too strict compared to how she had eaten before her diagnosis. When I could take a step back, I realized that she thought she was being punished, and that in my fear of my daughter’s disease, I was being overly controlling. That week we sat down and made a family menu together. No more sneaking, just eating. We now follow the ‘rule’ that no food is off-limits, as long as we can count the carbs and cover it. It’s amazing the change a simple conversation made.”
Retool the Routine
For some kids, it may take a different approach to help them back on the right track. When Gail, a mom from New Jersey, was told by the school nurse that her 13-year-old son had stopped showing up to test, it was a tip-off that he had slid into some very bad habits.
“I would nag him to test and lecture him night and day about the dangers of not taking care of his diabetes,” she remembers, “but it just got worse. They didn’t know what to do about him at school, and we didn’t know what to do at home. It was a very dark period for us.”
According to Venus, teens who suddenly neglect their usual care routines or become very secretive about their diabetes may be demonstrating the need for more independence -- an important priority for this age group. “Teens also have an increased need for privacy and may want their diabetes to be handled much more discreetly now, even if they’ve had type 1 since they were very young. Leaving class early to test at the nurse’s office or needing to test when out with friends may make teens self-conscious, even if this wasn’t the case in the past,” says Venus.
However, giving teens more privacy doesn’t mean accepting skipped blood sugar checks. “Teens usually respond to a firm, consistent and clear message that lays out the non-negotiable expectations for the daily care tasks they are responsible for,” says Venus. For example, parents can set up a regular meeting with their child to discreetly go over numbers and make sure, in a very matter-of-fact way, that blood sugar checks and other tasks are being completed.
And this means no nagging, which, according to Venus, typically serves to drive kids further away. Parents can let the child know there will be consequences for lying, but on the flip side, “when you see your child doing something right, reward the heck out of them,” she adds.
Still don’t see any progress? “If, after this, your child is still not responding, he may not be ready to be so self-sufficient in his care, and you may need to take on more of these duties again,” says Venus.
It can also be a sign that it’s time to check in with a counselor to help facilitate communication. That’s what Gail and her son did, and as a result, Gail learned her son was very depressed.
“It was a long road for us, but when we finally got to the bottom of why he had let his blood sugar checks fall apart, we could finally start working together to make it better.”
Treat – Don’t Punish -- the Numbers
What happens when misbehavior may have led to a high or low blood sugar? As Venus points out, “Diabetes doesn’t play fair. There can be so many reasons for an out-of-range blood sugar. If you punish a child for having a high or low, the message they get is that it’s their fault they have diabetes.” The same goes for punishing negative behavior -- like irritability or difficulty concentrating -- that’s resulting from a high or low.
Gail admits she had resorted to such punishments -- like once taking away her son’s MP3 player when he had a high -- and can now see how this contributed to the problems they experienced. She has since come up with a new mantra: “Treat the blood sugar, don’t punish the blood sugar.”
And her relationship with her son seems all the better for it.
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the "typical" experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.
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