Keep Calm and Carry Insulin: Why -- and How -- to Stay Neutral About Out-of-Range Numbers

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Let's face it: We live in a world where, starting from a very young age, certain numbers take on a great deal of emotional significance. At school, getting a 100 on a test is worthy of a gold star and a proud feeling of accomplishment. A 65? For most kids, not so much.

And school grades are just the start. Think about how you feel when you consider numbers like your age, the amount in your bank account, or the cost of that unexpected car repair. Is any number really just a number?

There is one, says Korey Hood, Ph.D., associate professor of pediatrics at the University of California, San Francisco (UCSF) and staff psychologist at UCSF's Madison Diabetes Center: It's the number currently showing on your child's glucometer.

Whether it's 131, 68, or 400, its function is the same. "A glucometer reading is really just information," says Hood -- not a moral judgment, a pass/fail test score, or anything worthy of more than a neutral reaction. "If you see a high or low number, it's not anybody's fault. It's simply information to help you figure out what to do next."

Really, just a number? Hood knows how difficult it can be for parents and kids to detach emotions, both negative and positive, from blood sugar readings. "We're not trying to eliminate discussion of emotions about diabetes," he explains. "We just want to remove emotion from the daily tasks of diabetes management, because it doesn't help anyone when there is anger, frustration, or nagging."

Putting Numbers in Perspective

In the months following her son's diagnosis, Jennifer B., a mom from Newburgh, N.Y., admits to obsessing over what the glucometer said. Each and every test became a moment to rejoice, worry, or feel exasperated.

"When the numbers were high, I combed through everything he had just eaten. When I couldn't find the culprit, I demanded to know if he was sneaking extra food. When the number was low, I berated myself for screwing something up with his insulin," she recalls. "I started to feel my son's dread when it was time to test. He didn't know what was coming next."

Jennifer, like so many other parents, seemed to miss the big picture. "Managing blood sugar is not a simple matter of just taking insulin and counting carbs," says Beverly Adler, Ph.D., C.D.E., a clinical psychologist and author in Baldwin, N.Y. "Other factors affect blood sugar, such as exercise, illness, stress, and hormones. Sometimes, the reason blood sugars are higher or lower than expected is unknown -- what I call the 'X-factor,' something out of your control."

Perfecting a Little Detachment

For Jennifer, a frank conversation with her diabetes educator about her son's numbers finally gave her some much-needed perspective. "She told me that if I kept reacting like this, I would be setting the stage for him to lie to me about his blood sugar when he was old enough to test for himself. Getting so emotional all the time also put both of us at risk for burnout. Since I didn't want either of these things, I tried to find a better way."

When Hood works with parents struggling to keep their emotions in check, he encourages families to think about testing with the same level of emotion as counting carbs, pricking a finger or calculating an insulin dose. All of these are simply tasks to get done. Try this as a mantra, suggests Hood: "The only bad blood sugar number is one that we don't know."

When trying to stay neutral, language matters. Jennifer was taught by her diabetes educator to start referring to her son's numbers as "in range" or "out of range," rather than good or bad. Using the terms high, low, or normal also works, says Adler.

Knowing When It's Time to Talk

Another good rule of thumb is to treat first, and ask questions later. "When blood sugars are higher or lower than expected, your child may not feel well physically," says Adler. "Treat the high or low to correct it as quickly as possible. When things have returned to normal, then parents can discuss with the child what may have caused the issue," keeping in mind that a cause may not always be known.

When it's time to talk, think about your tone. "An angry parent does not appear supportive to a child. It can make a child feel isolated and alone and contribute to low self-esteem. When parents get angry, use punishments or make threats, it only encourages a child to hide their blood sugar readings," says Adler.

What works? "Parents should discuss clearly and calmly the situation and options, and not let their own frustration spill out onto their child," says Adler. To do this, she encourages parents to focus on praise and encouragement, pointing out what children are doing well when appropriate.

To uncover the reason for the high or low, try taking a more matter-of-fact checklist approach. Ask if your child feels sick or light-headed, whether anything unusual happened, or if he or she ate a little more or a little less than what was planned. In measuring your response, focus on the future by saying something like, "Whenever you think you will want an extra slice of pizza at lunch, just let me know and we can work that in." Or, "If you don't have enough time to eat in the morning, let's try packing the rest up for a midmorning snack."

These kinds of responses also work to gently educate your child about how to make good choices on their own. Even simply letting a child know, "Looks like that cold is starting to affect your blood sugar. Let's see what we can do," can offer reassurance. "Most importantly, parents should not blame the child for a high or a low blood sugar reading," says Adler.

Being a Parent... Not a Pancreas

Elizabeth P., a mom from Buxton, Maine, is also parenting a child with type 1 diabetes. Some valuable advice from her son's pediatric endocrinologist has helped her keep things in perspective. "He told me, 'You can't be his pancreas. You're his parent. So be a parent, and do your best.'"

For Elizabeth, this means coming to grips with the simple fact that no person with diabetes is going to have perfect numbers all the time. "No matter how careful you are, there are always going to be highs and lows. The trick is to figure out at least some of the triggers of those highs and lows so you can learn how to avoid or limit them."

Being a parent rather than a pancreas also means not resorting to guilt trips.

"If I start guilt-tripping my child about the numbers, I'm putting the expectation on him that he should 'be a pancreas' -- and that is grossly unfair. Do I use highs or lows as a learning experience? Sure. But as a punishable offense... absolutely not," says Elizabeth.

Jennifer agrees. "When I talk to other parents, I know I can rant and rave all I want. But in front of my child? Part of staying neutral means I won't put more burden on him than he already carries. Doing this actually makes me feel very good."


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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