ParentingDiabeticKids.com

I have a 16 year old daughter with Type 1. She was dx'd at 10. Her endo Dr. will not sign a medical release for her to get a drivers license because her A1c is an 8.She has never had any hospitalizations or complications. I think they don't understand a teenager living with Type1. Am I being too biased?

I can see why you'd be frustrated - with an A1C of 8.0 it's obvious that your daughter is doing the best she can and is really working to take care of her diabetes. From the doctor's perspective, I would wonder if he's using his intuition and trying to use that driver's license as a motivational tool to encourage your daughter to reach further for an A1C of 7.0. While I don't know anything about your daughter, I do know that 16 years old can be an age when teens begin to slip out of their diabetes management habits. Anger and resentment take over, and diabetes becomes something a teen purposefully ignores in an effort to gain control over her life while she can't control that she has the disease in the first place.
 
 
But maybe this doesn't sound like your daughter at all. Maybe the doctor is making assumptions that don't fit with her. I know a doctor did the same to me when I was in college, before he even got to know me, assumed I was lying about my insulin doses. In defense of your daughter, my feeling about this doctor's method of "motivation" is a negative reinforcement. He's taking something away from her instead of finding methods to encourage and support good diabetes management. I hope his well-meaning actions don't backfire.
 
 
At the end of the day, if his decision just seems truly ungrounded and illogical, it's always worth trying to talk to him further to find out where he's coming from.

My 10 year old son has had diabetes for 3 years and has been on a pump for 9 months. Two times while on the pump he has had what I call a growth spurt that has dramatically affected the amount of his basal insulin. It seems to take me a week to 10 days to increase his basal insulin appropriately. I have been told by the Ping representative that I need to have him fast for three mornings; fast for three lunches; and fast for three dinners and evenings to evaluate his basal. I see the logic behind this. I can't imagine implementing this because: 1. His days aren't the same (school days, sport days,less active at home days). 2. He seems to have these growth spurts 2-3 times per year. Once I evaluate his basal he'll grow (or change his sport choice of the season) and we'll start all over again. 3. The number of days involved three breakfasts x three lunches x dinners x three evenings = 12 days. 4. Very busy schedule (Piano, Church, Tae Kwon Do, etc.) How beneficial is this whole process for a child? Is it worth the disruptions to his life? What can I glean that will give me the best information with the least amount of effort and upheaval?

This is exactly what my book is on!

I suggest:  If fasting is too difficult, then your next bet is to make changes in his insulin needs and closely observe while he goes through his day-to-day life.

Don't be afraid to make your own insulin adjustments. You don't have to find all the answers tomorrow. It's a process, sometimes a gradual one, and it's a process he will need to learn how to do for his entire life. Your insulin  needs change throughout your entire life.

I recommend never increasing an insulin dose by more then 1-2 units for a child. If you're adjusting his basal rates, that means that the total
increased amount changed in his basal will amount to 1 or 2 units for that day. Observe the next day, and adjust the insulin doses further as needed.

Focus on one particular time of day if you need to, or it sounds like he
really just needs more insulin overall as well. Remember, this is a process and you don't have to have it all figured out in one day.

This is a big one. My daughter was diagnosed 1 year, 10 months, 2 weeks and 6 days ago… Since then it has been a nightmare with a moment of clarity and then back to our nightmare. First part of our night mare is our daughter becomes more stubborn every day; she gags on her food when she doesn’t like it or is done and we already gave her insulin. She isn’t picky by far, she just hates certain things; like mushrooms… okay so maybe not that picky. She takes ages to eat when she does eat, unless she really loves her food. Her I:C is 1unit:10 carbohydrates, but I have notice with some things that ratio leaves her either too high or too low after meals. I feel so lost and confuse on how to please everyone at the dinner table and make everything healthy. Her doctors said after keeping her blood sugars stable (between 100-160) for 60 days she could get put on a pump, testing would be the same but insulin delivery would be easier. My question is with healthier foods such as pure apple juice, apples, strawberries, cucumbers; would her blood sugar rise and fall faster with her bolis? And the same with un-healthy foods like pizza, burgers fries. Would the un healthy foods make her bloods sugars stay elevated longer before coming down? How do I deal with that?

Okay, well first of all, it is not uncommon to need more than just one
 insulin-to-carbohydrate ratio (ICR). Many people are more insulin resistant  in the morning, so they need an ICR like 1:8 or 1:6. Meanwhile, some people are more insulin sensitive in the second half of the day because they've been running around all day, working, at school, etc.. So you can adjust your ICR to 1:12 or 1:15. It's all about noticing when you're clearly getting too much insulin (through low blood sugars) and not enough insulin (through high bloods sugars). Keep track of the day and time and try to determine the patterns. They're are always patterns, and somewhere in there is a clear reason why her blood sugar is fluctuating so much.

Secondly, yes, foods like pizza and other junk that is high in both carbohydrates and fats tend to require more insulin because the fat slows
down the absorption rate of the carbohydrates. My advice to counteract this (without an insulin pump) is to give a little extra insulin for every 15
grams of fat. For example, I give myself about .5 units more insulin for any meal high in fat. For every 15 grams of fat, I give .5 units more insulin in addition to the insulin I gave for the carbohydrates. Be persistent, Marie! There are answers to her blood sugar fluctuations, it's just about building your knowledge so you can understand them.
 -Ginger

(p.s. I'm publishing a book this January that covers a lot of this in even
more depth....stay tuned!)

At what blood sugar level do you suggest giving a correction?

Well, technically, anything over 120 mg/dL is considered "high," right?
But if we were to obsess over getting every number below 120 mg/dL we would not only lose our minds, but we'd also probably experience a lot of low blood sugars. Personally, I will correct anything over 180 mg/dL. If my blood is 170 mg/dL and I'm about to eat, then I will definitely include extra insulin to help correct that, but if it's the middle of the day and several hours after a meal, I won't correct a blood sugar of 170 mg/dL because I'm active and don't want to drop low. This also depends on your insulin sensitivity, because for me 1 unit of  insulin can reduce my blood sugar by 100 points sometimes, so correcting a 170 mg/dL would definitely leave me pretty low an hour later. I believe it's about deciding what you're comfortable with. While "diabetic  perfection" is the ideal goal for everyone, you also have to live your life  with diabetes in a way that is manageable and doesn't cause you more anxiety and stress than diabetes already brings.

No specific question other than tips for handling the transition to middle school, high school, and then college life.

Ginger wrote a blog,  Stepping Back is Hard to Do which is about
helping prepare your diabetic child for the day you aren't there every day!

My 7-year-old daughter was diagnosed 4 months ago and is in a major honeymoon period. She has weeks where she will only need a half unit of insulin all day and her blood sugar stays in the 80s and is often low. When her blood sugar levels start to rise into the high 100s and low 200s...and I can tell another batch of beta cells are gone, it's like she becomes a totally different kid. She refuses to pay attention in school, do her homework, help around the house, do her blood tests and she is mean to her siblings. Then she has a couple of days where she is a complete mess. She has a 3 hour long meltdown... and then on the day after her meltdown, her blood sugar levels are back down in the 80s and 90s and she is often low. She will be in a great mood and catch up in school, help around the house, do her homework without us asking, etc. This will last for a few weeks and then as her blood sugar levels start to rise it starts all over again. Is this normal? I didn't think anything of it until I started to pay attention to the timing of the change in her behavior and in this fourth month it happened like clockwork. Can the honeymoon period cause mood and behavior fluctuations too?

Simply put, blood sugar fluctuations can and will impact behavior whether it's during the honeymoon period, or twenty years from now when you're daughter is a grown adult and experiencing the kind of fluctuations we all experience from time to time. With age, maturity and experience, she can gain more control of those behavior changes, but at the same time, your brain relies on second-by-second delivery of glucose, and when we mess with the amount of glucose being pumped through our bloodstream, it effects our mood, our behavior, how we literally feel.

As an adult I can tell you that when I have low blood sugars, I sometimes feel impatient, irritable, and I always feel very tired and grouchy. When my blood sugar is high I feel like maple syrup is running through my veins and I don't have enough energy to think thoughtfully and clearly. When my blood sugar is too high, I just want to curl into a ball and pull a blanket over my head.

The best thing you can do, I think, is to help your daughter become aware of the feelings and changes that come with those fluctuating blood sugars, so she can not only control the impact it has on her behavior, but also so she can stop and think, "Oh, I'm suddenly feeling very impatient, maybe I should check to see if my blood sugar is out of range...."

I need some help, tips or advice. My daughter is 2 and diagnosed 3 months with diabetes. Since then we have had to change our dialysis routine and diets. Now they say she has Celiac's Disease which means she cannot have gluten in her diet. I have to restrict her diet even more and I don't even know what foods have gluten in them but I'm told a lot of them do. I'm feeling very overwhelmed with all these changes and upset that my daughter has to go through life this way. Any words of encouragement as this is all new to me.

Well, I don't blame you for being overwhelmed! I was fortunate enough to have a year between my T1 diabetes and Celiac diagnoses at the ages of 13 and 14. You and your child are facing a lot of changes and new responsibilities all at once. My first word of advice for you is the hardest one: take a deep breath. I've lived with diabetes for 12 years and I'm still learning new things about it on a regular basis. You don't have to learn it all tomorrow (or even by next year), and you definitely don't have to do it perfectly.


Living gluten-free is doable, but yes, it's a pain in the butt and sometimes a true challenge and test of willpower. Gluten is the protein found primarily in wheat (even when processed into white flour), barley, and rye. This covers most common breads, cookies, crackers, pastas, and some cereals. Fortunately there are so many more gluten-free foods available in the average grocery store compared to even just ten years ago. Usually, you'll find these things in the "natural foods" section of the larger grocery stores. If you live near a "Whole Foods" store, you're in luck, as they have some of the best selections I've ever seen of gluten-free foods. You can also check out places online like Pamela's Product, and Glutinos (there are many more!). Also, look up "Betty Hagman" for great cookbooks on gluten-free baking, from breads to pizza dough to desserts of all kinds.


For a full list of foods containing gluten, and more on Celiac, visit: http://diet.lovetoknow.com/wiki/List_of_Foods_Containing_Gluten


I make videos on living with Type 1 diabetes here: www.YouTube.com/user/GingerVieira


Other great sites to learn and read about life with diabetes include: www.SixUntilMe.com. www.Living-in-Progress.com. www.ScottsDiabetes.com. www.DLife.com. www.DiabetesDaily.com. www.DiabetesResource.com.


I don't know how old your daughter is, but I know she can do this. I know because I've been doing it happily since I was 13 years old, and I know many, many others in the diabetes community who are living well with both of this diseases. Living happily! While you continue to learn and read about these diseases, I believe it's important for both of you to remember that life is full of challenges. These diseases are a few of the challenges your daughter is going to face in her life--and she can do it.


Deep breath!

My son was diagnosed at 5 1/2 and is now 8 1/2. I can see him struggling with having diabetes lately, like sneaking food. In the beginning of diagnosis, I use to feel bad for him and always sorry for him. Just lots of hugs and tears. I still feel the same way but I feel I am a bit confused on how to discipline him. Do I do the tough love and tell him.... "this is how it is and always will be so lets move on and deal with it" You always hear the stories of " My mom was tough ... never let me give up . Made me keep going forward" I feel I should be that way. Maybe it will make him strong and gain control more when he is older, BUT he is only 8. I know he wants to be independent. I know he is struggling not being "normal" like his friends. I feel that approach my be too tough at this age. On the other hand I do not want to coddle him. So confused and was wondering how everyone else treats their children with the disease.

As a person with Type 1 diabetes myself, I know one of the most important things I've done for myself is to never make any foods "off-limits." No matter what age you are, when you tell someone they can't have something, they want it even more. And further, we don't need to stay away from candy and junk 100% of the time...as a "treat" in the diet, it's okay, even for a child with diabetes, to enjoy sweets and dessert.

Here is a blog, Cookies and Candy for Kids with Diabetes I wrote, that discusses this exact aspect of raising a child with diabetes.

The goal, I believe, in raising a child with diabetes, is to teach them about their options, about the benefits of healthier foods, and that desserts should be enjoyed in moderation once in a while. It isn't easy to raise a child with diabetes, but you're doing a great job, and hopefully you can help your son grow up with a very positive relationship with food instead of feeling like food is the forbidden enemy.

How do you handle a 20 yr old who is terrified of going low so she keeps her b.s. too high and is afraid to be independent? She was diagnosed at age 10 and has never had a severe low where she needed assistance. Everything she learned years ago is being ignored, it's as if she needs are-booting. Are there any programs for college students to address this issue?

This is a common problem, and as a Type 1 diabetic, I have to say I understand that fear! Hypos can be terrifying. I think the main aspect to focus on is not the blood sugars, but the fact that is afraid of losing control, afraid of having a low and feeling helpless. She needs help to dig deeper into not only understand the fear that's developed there, but also the full-spectrum of how she's now harming herself in a different way.
As a cognitive health & diabetes coach, I would absolutely be able to work with your daughter in gradually decreasing her blood sugars and changing her diabetes management habits to help her address both the emotions and the fear of hypos, as well the blood sugar readings themselves. If you'd ever like to speak on the phone in a FREE consult, please e-mail me at Ginger@living-in-progress.com and feel free to visit my diabetes & coaching website at www.Living-in-Progress.com.

Recently I saw this family talking about having reversed Type 1. What they seem to be saying is a very strict low carb/plant based diet. What is your view of this and what does Laura think given the efforts she made with her son when diagnosed. Thanks

Unfortunately, a healthy and low-carb diet does not REVERSE Type 1 diabetes. (If it were that easy, we'd all cure ourselves!)

"Reversing" diabetes would imply that my pancreas has suddenly begun to produce its own insulin again. Instead, a low-carb, healthy diet can be very helpful in MANAGING Type 1 diabetes because food is the first thing our bodies have the most trouble handling. I need insulin to digest food...the more carb-heavy and unhealthy the food is that I eat, the more work I have to do in my diabetes management to balance my blood sugar around this.

Eating a low-carb, healthy diet is definitely important for your son to learn, but it will never reverse his diabetes. It will, however, make life easier in many ways if he can build and continue those healthy habits.

Our Endo is really pushing us to try the pump. My son is 15 - soon to be 16. He is type 1 with Addison's Disease. He is a competitive swimmer / triathlete. He spends at least 2 hours a day ( sometimes 4 ) in a swim work-out. I am concerned about having the pump off for 2 hours 15 minutes at a time on a regular basis. I am also concerned about site infections - he swims open water from June - Oct. Any input you could give me would be great .

HI Melanie,

You know, there are many athletes who use pumps, including Olympian swimmer Gary Hall Jr.! As an athlete myself, I did not like wear the pump and I stuck with daily injections. However, another example of a swimming, pump-using, triathlete is Team Type 1's Bradford Gildon (http://youtu.be/xmpCLlac5FI).

For many other reasons, outside of sports, the pump is an incredible device that makes many parts of life with diabetes so much easier. It's not a cure, an easy fix, and it still requires a lot of work, but it's absolutely worth a try.

My daughter is almost 13. She was diagnosed with Type 1 diabetes at the age of 9. She has been wearing a pump since age 10. Just tonight, I realized that for the past week or two she has barely been checking her blood sugar during the day, if at ALL! She pretends and tells me a fake blood sugar and pretends to boulous. I am devastated and I have taken away her privileges. I do not know what to do with her...help!

There are so many ways you could handle this. And it's really important, absolutely, that you take the time to help your daughter change her habits/attitude around this now. Too many teens continue this habit long through high school to the point where their lifestyle and health is used to high BGs and neglecting their diabetes.

First thing to do: have a conversation with her. Try not to make it feel as though she's being attacked or scolded. Instead, try to let her speak so you can see what's really happening in her head that's making her purposefully neglect her health. It is so easy, especially as a kid, to resent diabetes and want to deny how important it is to take care of it.

YOu may find that just really needs a second support system to get back into the habit of checking. Maybe she needs you to help her remember to check.

YOu may find that she's doing it on purpose, as a form of rebellion. Whether or not we have diabetes, we want to rebel against our parents, but it's up to you to make it clear to her that using diabetes as a form of rebellion is not a choice. She can dye her hair when you're not home or tattoo her ears without your permission, but neglecting her diabetes is absolutely not an option.

If necessary, set up a routine that means you check her blood sugar meter at dinner every night to see what her numbers were during the day, and how many times she checked. If she refuses to check, she will have to face a consequence (no TV, no cell phone, no weekends out with friends). Whatever it is, set your rule and make it clear that this is not something you will ever budge on. This is her health, and it's seriously important.

Above all though, let her speak, and listen. This disease isn't easy.

I have a 20 year old daughter with type 1, She has had diabetes since she was 12. She was in ok control. Her A1c's was about 8.6 or around. She is living away from hm, for the first time. We got a terrible result of an 11.1 .She is planning a mission trip to India for two weeks in Sept. What advice do you have for me. As a concerned mother I want to say she cant go .She is not in good enough control.Am I crazy ?

You are definitely NOT crazy. If she can't acknowledge the huge importance of managing her diabetes, and making diabetes a priority, then it is simply unsafe for her to be traveling until that issue is addressed. In my opinion, diabetes is not negotiable. She either manages her diabetes as well as she can (no one is perfect, of course), or she pays the consequences. The fact that her A1c has made it's way to 11.1 shows very clear neglect. An 11.1 A1C doesn't happen by accident. There are too many people in the world who get into a comfortable habit of neglecting their diabetes when their young only to pay the price later on. She needs to know that this is not okay, and that diabetes has to be a priority in her life.

The first step: ask her why she isn't managing her diabetes. Maybe there is an underlying emotional struggle she's facing, and she needs some support to work through it. It's not uncommon for teens/college students with diabetes to go through this, but it shouldn't be taken lightly either.

Listen to your motherly instinct and do what you feel is best for your daughter.

I have a 13 year old daughter, diagnosed 6 years ago with T1. The past 2 years had several episodes of very high BM & Ketones, occasionally gone into DKA and has had 8 hospital admissions this year! Intially this was put down to puberty/hormones, so tried an insulin pump for 18 months, with little imrovement and now our consultant has put her back onto mutiple injections, again little improvement. I also have another diabetic child and myself which are all on insulin. Any help/advise, greatly appreciated.

I think the bigger problem is not what device or method your daugher is using to manage her diabetes, but the fact that whatever method she does have access to, she's clearly struggling with the overall responsibility of taking her insulin when she needs to and checking her blood sugar throughout the day.

Have you ever had the opportunity to ask your daughter how she feels about having diabetes? And beyond that, who is the main person in charge of her insulin doses? Does she take care of it herself or are you the one who helps make sure insulin is given at meal times? If a person, young or old, is in and out of the hospital that often, then you know right off the bat that her ability to handle the responsibility of diabetes needs attention...not the method of insulin delivery.

The next step might be to find a therapist/psychologist who specializes in teens with diabetes. As well as enrolling her in diabetes camp for next summer, ASAP! I promise the camp can do wonders for a young girl who feels like the only girls in the world who has diabetes. I'd also be happy to chat with your daughter through coaching at http://www.Living-in-Progress.com.

My daughter is in her honeymoon period and her bgs remain near normal. She has not had any low blood sugars under 60. What will happen to her levels once the honeymoon is over? Will she experience more lows?

As she gets out of that honeymoon phase where her body is still making someone insulin...and she transitions to the point where her body makes NO insulin, she is going to experience more high blood sugars. That means she's going to work with her doctor to increase her insulin doses. The more insulin we take, the more risk there are for lows, but it's really the overall balancing act that will be your biggest concern.

The biggest thing to know is that throughout your daugher's entire life, her insulin needs are going to fluctuate based on age, activity, weight, stress, etc. So her goal is going to be to learn how to adapt to those changes and make adjustments in her insulin regimen. My book discusses these changes and how to go about self-adjusting and studying your own blood sugars, Your Diabetes Science Experiment in the PDK resource section. 

Good luck! Remember, deep breaths! Nobody does this disease perfectly.

My son is now 19 and was diagnosed fours years ago. For the first 18 months he managed the blood testing and administraion of his medication very well. For the last few years he has really found managing his diabetes very difficult culminationg in a crisis in the last month. Fortunately he seems to have turned a corner and is very motivated at the moment to lower his blood average from the mid 20's upwards mmol/L it has been. However as a result he is now having far more hypos which is the main reason he cites for actively keeping his mmol/l high. This afternoon he has a reading of 1.6mmol/L so then had to take a significant amount of sugar to raise this. My question is what should he now do for the sugar he has eating to a.) prevent his bloods from rising and b.) to as far as possible prevent another hypo? Grrrrr sometimes I feel I know nothing at all about this which leaves me feeling inadequately placed to support my son so my heart felt thanks in advance for any guidance in this.

Okay -- first of all, your son is really lucky to have you in his life! Secondly, the biggest thing to remember about diabetes, blood sugars and insulin doses is that they are going to fluctuation throughout your son's entire life. In fact, even in YOUR body, your insulin needs fluctuate also, but you of course don't have to be aware of it because your pancreas still works! :)

Anyways, you and your sons goals should not be as much about trying to be "perfect" in diabetes managment, but instead to learn how to adjust and adapt to his body's needs. I wrote the book, "Your Diabetes Science Experiment" about exactly this, because when things change even slightly in our lives, our insulin needs change too. Gaining or losing 5 lbs has a huge impact on insulin sensitivity. Stress, changes in exercise and activity, how to balance your blood sugar around exercise, etc. 

My book talks about all of this and how to study your own blood sugars, and make changes in insulin dosing: Your Diabetes Science Experiment: I hope you find this helpful. Remember, take deep breaths and don't expect perfection! Throughout your son's entire life, his goal will be to adapt and make adjustments to his body's needs.

My daughter is 11 and was just diagnosed in August 2010. She wears the Omni Pod and she is VERY independent with her management,but she gets VERY angry when I ask her if she remembered to cover. Although I am proud of her independence, I feel it's my responsibility as her mom to confirm that she is taking care of her insulin doses. Her BG runs high on most days and I can't get her to check very often. I know this is a terrible disease for her to have to deal with and I don't want to "punish" her for not checking or covering,but, at the same time, I think, if she's responsible for doing the dishes and she doesn't, then there'd be a consequence for that. I don't want her "consequence" for not checking and covering or not allowing me to help her to be long term damage to her body! Any suggestions???

Hi Dawn!

Your daughter is lucky to have a mom who not only wants to help her manage her diabetes but also appreciates that she is very independent. I have a couple of suggestions for you:

1. Try this conversation:

MOM: Do you to manage your diabetes as healthfully as you can?

Daughter: Yes.

MOM: How can I best support you in your diabetes management? What can I do for you that will help you be the healthiest diabetic you can be?

Daughter: _____________.

Another conversation:

MOM: Did you remember to bolus?

Daughter: Yes, mom! Geez, stop pestering me. I can do this myself.

MOM: I know you are very smart and very capable, honey, but I'm your mother and I love you. You are 11 years old and managing diabetes is a really big job. As your mom, it's my job to take care of you. I only ask if you remembered your bolus because I love you and I want you to be healthy and happy.

Daughter: Okay, mom...I get it...but I don't need your help like that.

MOM: Does that mean you always remember to bolus for your meals?

Daughter: ....no.

MOM: Then is it okay if I help a little by simply asking in order to help you remember?

Daughter: ...I guess.

or

Daughter: No, I don't need your help.

MOM: What is the best way I can support you in your diabetes management?

Daughter: ___________.

I was a very independent teenager myself, and my diabetes was own responsibility from the age of 13. My mother never gave me an injection or counted my carbohydrates. Now, we're all different, but she gave me the freedom I needed because I like to take care of things myself. Maybe your daughter will relish the freedom and appreciate when you back off a little, then she'll take the reigns full herself. Either way, ask her what she needs. She's obviously a mature young girl, so she can handle the conversation.