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Medicating ADD in CWD

Discussion in 'Parents of Children with Type 1' started by DavidN, Apr 18, 2014.

  1. DavidN

    DavidN Approved members

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    I know this topic can be a lightning rod for argument, but I’ll work hard not to go there and please do the same. You may disagree with me. I may disagree with you. But that’s fine. I just want to hear differing opinions from parents of CWD.

    So here’s my question - Does your child having T1D make you MORE or LESS inclined to medicate your child if he/she were dx with ADD? I know the decision involves many factors, but I’m trying to just isolate the T1D aspect of things.

    I’ll go first.

    In most instances, I am not a fan of medicating ADD and I don’t see why having T1D would change that. The argument can be made that a medicated child will manage his T1D more responsibly, but I’d counter with all the traditional arguments against medication.

    But am I underestimating the importance of medicating as it related to managing T1D? That’s what I wrestle with. Maybe better management of T1D (if this is even the case) is worth the drawbacks of medicating for ADD. I don’t know. But am open to hearing what you think (even if you do not have a child with ADD).

    And other than better management of T1D, what other T1D-specific factors should be considered when deciding whether to medicate a T1D child?
     
  2. StacyMM

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    My son has ADD and is on medication. It pre-dates diabetes, actually, so for us it was a non-issue. However, it would still be a non-issue for me. My son's brain doesn't work the way that the school system wants it to and until he can control the impulses that make him forget homework, get out of his chair, interrrupt, distract others, etc, he would continue to get in trouble for it. Without medication, his image of himself was bcoming one of being a failure - he was in trouble a lot, his grades were suffering, he was being viewed as a more difficult student. With medication, he can sit in a chair most of the time. He can listen better. He can remember things more consistently. I'm so glad that we had the evaluation and testing done and that we can find a way to help him. It's worth ever penny and ever appointment.

    We have found that the importance of finding the right medication has increased with the diagnosis of diabetes. Before, it was most important that he had an option that lasted through the school day and that didn't interfere with his appetite (he was a skinny, skinny kid when he was first evaluated). Now, we have to really work on finding a way to extend the time it helps and we really struggled with keeping the dosage right when growth spurts started. With the meds we had used in the past, after 3:00 he was simply unable to remember to bolus. Or think about carbs. Or look at his CGM for a number. Or remember what he ate. Or when. Or to know where his PDM was. Or his supplies. Or to remember to tell us that he felt low instead of just thinking it. It was miserable for him and us. We now have a medicine that is lasting until 6:00 and it gets him through an after school snack and homework and he and I both love that. He is far from being independent and his impulsivity is a huge part of that, but he's at an age where he wants more independence so it's really important to DH and I that we give him the best chance of being able to have more freedom as he gets older. We do reminders, routine, practice, consistent schedules, and all those other things that help but I can't imagine him not having those meds, too. There are days we forget to give him his pill because life gets in the way and it's so hard on him.
     
  3. mmgirls

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    Well All I can say is that unless you try the medication you will not ever know whether it is possible for your child to manage their T1D. But putting them on a med for ADD does not mean that they will be better able to manage their T1D any better than right now, but hopefully the symptoms of there ADD would be improved and it would be one less thing to be thinking about, but maybe not because side effects could directly impact how you currently manage T1D.

    What Type of ADD does your child have? it might be helpful to others who have been there and done that.
     
  4. TheLegoRef

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    My son has AD(H)D. He has a script for Concerta and Ritalin. The Concerta is for the morning, supposed to last until around 4pm. The Ritalin is a short dose, to help him get through the afternoon. I kind of agree with StacyMM, but not about school, about life in general. Without help, my son's brain cannot concentrate on things. He'll test, and forget to bolus. He'll test and bolus, but forget to calibrate. He'll read his checklist for the day, and read right over "site change at 4pm" and not do it. He'll put lidocaine on and then not remember to do a site change. He gets stressed when his brain isn't focusing on one thing at a time. It really is like, "So I was talking about the Titanic oh look a squirrel can I have some string cheese I'll get the mail what's that on the window the dog is standing on my foot." o_O Then he gets in "trouble" because he's not doing things (goes into the bathroom to brush his teeth, then doesn't, so when he's in bed, we'll say "did you brush your teeth", he says "shoot I forgot", and we'll be annoyed). The Concerta helps him focus on one thing at a time. He's said it "slows his thoughts so he can finish one before starting another". His bg's are lower with the Concerta, because he's more relaxed, and not stressing about trying to remember everything. We do not take it on weekends though. If he takes it 7 days a week and forgets one time, he has a lot of issues and meltdowns sometimes. So we intentionally take at least one day off a week that there isn't anything planned, so he can try to learn to manage "remembering" with things like checklists and post-it notes. When he's an adult, if he forgets his Concerta (if he's still on it), I want to know he'll have the tools to help himself get through the day without the meds.
     
  5. wilf

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    I think that generally it is prudent to carefully consider whether to add medications to the mix of many factors which affect blood sugars of T1D children.

    Of course if it is something that is a medical necessity (eg. antibiotics to fight a bad infection), then the medication should be given (albeit carefully monitored).

    But for medications which may or may not actually be needed (and for most children, I would include Ritalin on that list) it is worth really thinking hard before starting them. :cwds:
     
  6. moco89

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    If your child has ADHD predominately hyperactive-impulsive type or ADHD combined type (a combination of ADHD predominantly inattentive and predominantly hyperactive-impulsive type features) and has problems with impulsivity, medication would likely make a huge difference.

    If impulsivity from the ADHD is not managed with type 1 diabetes, impulsive and thoughtless bolusing can occur with an insulin pump, which is dangerous, along with other dangerous diabetes-decisions being made on the spur of the moment.

    I am a type 1 adult with ADHD combined-type, and I find that medication helps me prioritize by making me step back for a moment and letting me think about my diabetes for a few more moments, instead of making rash decisions. I can also set diabetes high on my priority list and put my health first, instead of living "moment by moment".

    I am not for or against you putting your child on medication, keep this in mind. If medication is not an option, your child is mature and able to prioritize and set long-term goals, and you can afford the (expensive) price, consider ADHD coaching. Make sure to spend lots of time finding the right coach to "fit" your needs, with proper credentials, such as with specific experience dealing with ADHD students for high school or college academic ADHD coaching. Most coaches offer his or her services online via Skype or FaceTime, due to the special nature of the coaching. Coaching can make lifelong differences and changes in somebody with ADHD and definitely teaches coping mechanisms.

    My ADHD coach was a former ADHD coach at Landmark College (college for students who have ADHD/Learning Disabilities/High Functioning Autism). She is focused on academic-related issues and coaches full-time for a living and a career.

    Also, according to the first edition (2011 version) of Think Like a Pancreas, on page 57, table 3-6, Ritalin (and other stimulants) tend to lower blood sugars.

    Anyways, I wish you luck!
     

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