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parenting conflicts

Discussion in 'Parents of Children with Type 1' started by sugarbear, Nov 16, 2016.

  1. sugarbear

    sugarbear New Member

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    Hoping for suggestions. My 3-year-old has lately been refusing to eat his food after we have given insulin, which is a fairly new occurrence. If our son requested the food specifically but won't eat it, my husband says our son will have to get a glucagon shot to counteract the insulin. My husband's logic is that if we let him say no to meal food and then feed him sweets, then we are training him to not eat healthy food just so that he can get sweets. A few times our son has even had a hypoglycemic episode because my husband refused to offer fast-acting carbs but our son resisted the shot until it was too late to prevent a low. My son is on a pump so shots are relatively rare.

    I'm troubled by the punitive tenor of these exchanges, worried it's dangerous, and fear this will lead to issues down the line with our son resenting diabetes care. Our son is also overweight so force-feeding him this way seems like it could lead to disordered eating.

    I'd like to bolus for at least part of the food after he eats, and reserve glucagon for illness or times when our son explicitly rejects eating anything else, even fast-acting carbs. I try not to contradict my husband or micromanage his diabetes management decisions because we want to project a united front on parenting decisions, but this has really got me worried. We are pretty evenly split on how often we are doing his diabetes care, so even if I don't resort to glucagon, my husband is using this threat a few times a week. He goes through with it about once every two weeks.

    Do people think my concern is worth worrying over, or is this normal? And if it is concerning, how would you go about changing opinions? Are there other strategies that could help prevent this situation from coming up?
     
  2. Snowflake

    Snowflake Approved members

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    Our daughter is a picky eater and we've encountered a lot food refusal over the years.

    We had a particularly bad spell when she was around 3 1/2, partially caused by other health issues that we hadn't figured out yet. In frustration, we did occasionally drop suggestions -- that we had no intention of backing up -- that we might need to use glucagon if she wouldn't eat her food. I don't think she had any idea what we were talking about but in hindsight I still regret ever saying it, since I don't think it set the right tone. During that period, we did go back to post-bolusing some of her meals, which seems like a good idea in your case.

    Our daughter still has a very limited palatte and a small appetite. But these days if she won't eat what's put in front of her, I don't make a battle out of it. We have a few reasonably healthy go-to options to round out the carb count, such as grapes and pretzels. I want her to have a healthy relationship with food and a sense of control about it. I've let go of the feeling that food is a power struggle between her and us parents, and I have started thinking of it more of as a project to convince her over many years to broaden her diet. I want her to have the same prerogative not to finish her dinner that my other kids have. It's not like she gets dessert or juice if she doesn't finish her dinner carbs -- just a few substitute carbs we can easily grab from the fridge or pantry.

    You and your husband might consider engaging a psychologist or social worker for a few sessions to discuss this issue? My husband and I were never able to find the right person when we looked into that possibility a few years ago, but it seems like other T1D parents have success with that route.
     
  3. kim5798

    kim5798 Approved members

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    I do not personally feel anything good will come of threatening with glucagon. My daughter was diagnosed at age 3, 15 years ago & quickly figured out that meals meant shots...so she would refuse to eat. I vividly remember her hiding under a table in our living room, because she knew shot time was coming. We would have to wrangle her from under the table & if I was alone, due to my husband being traveling for work, it meant I would be basically sitting on her feet, holding her arms down with my feet, so that I had my hands free to inject her with insulin. She was a willfull child!

    I remember many occasions, my husband basically telling me to go visit my mom in order to avoid the conflicts that would erupt when she refused to eat her food. Over time, we learned, to make sure that there was always something in the meal we knew she would eat, be it milk, bread, or a starchy vegetable. The child is not going to starve if they don't eat a balanced meal. If you are fine with it, offer pb &j as an alternate to what is offered for dinner. My daughter did not get on a pump til closer to 5 or 6...so you are lucky. You can basically avoid this issue altogether. Dose for the meal afterward. If you hesitate to do that, then dose HALF up front & the balance at the end of the meal. With fast acting insulin, your a1c is not going to suffer all that much & your SANITY will be worth it.

    I dealt with my share of bulimic issues with my daughter as a young teenager. Food is all about CONTROL. You need to remember to let them have some control of something with diabetes. Food is a central part of our lives. They will be dealing with it forever. Let it go.
     
  4. samson

    samson Approved members

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    yes, I agree, but how do I get my husband to see this?
     
  5. Manuel

    Manuel Approved members

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    My son have 2.5 years old, and dx 5 month ago. Before the dx he was a picky eater, and the first two month after the dx were difficult for that reason. Some times he just didn't want to eat, then he started to love food...and now we don't have that problem. But in thouse two months when he refused to eat we have different strategies, they were:

    1- As kim5798 said always put at least one thing that you know she is going to eat (not sweets). For example for my son is fun to eat corn (not in grains) with his hands, he enjoys picking the corn and eat it. You can add some natural juice of apple or peach, or buy some juice with stevia (usually they have 5 carbs per small can). You can make faces with food on her plate, and said "now lets eat the eyes". If she has a light dinner (in carbs) you can give her a more heavy healthy dessert (in carbs), like banana.
    2- I used to pick him in my arms with the plate and start talking and playing with him and at the same time giving him the food. Try to change threats for games, it is healthy and she wont realize your are just cheating her to eat. Try to make dinner time a fun moment.
    3- Cartoons can help, is not ideal, but is better than an hypo. You can try feeding her while she is watching cartoons.
    4- If all that didn't work, we just made usual threats like any parent. "If you don't eat, you will have to go to sleep", "you will not go to play tomorrow"....etc..

    We used to manage it with those strategies, and some times still use them.

    Regarding your husband, maybe both can read more about glucagon together. It is a powerful drug, and it can be dangerous too, specially in a small kid. It is designed for emergencies and as a last resource. Maybe that can convince him that it is not something you should be using as a threat. But maybe the best way to go with him, is that he try to make the dinner fun for your child, he will have some fun too!

    Hope it helps
     
    Last edited: Nov 17, 2016
  6. Beach bum

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    Log on and show him the thread. Many of us have done that.

    We've been at this a long time. Daughter #1 was diagnosed nearly 12 years ago, daughter 2, 2 years ago.

    In my humble opinion, nothing good will come by threatening glucagon. Main reason, glucagon is your friend, not your enemy. Many of us have had to resort to using mini-gluc for stubborn lows, during illness etc. And lets face it, that thing is scary looking to an adult, so imagine how it is to your child? If anything, I would talk to your team about this. We found that when my daughter was small, pre-blousing just didn't work. So what we did was, correct for BG if needed, then bolus about 15 min in for half the meal, and then the rest after. This way, if she decided she was done, we weren't force feeding her food, or filling her up with juice. We could give her a box of raisins or grapes and generally all went well.

    Remember first and foremost, your child is 3. It's their prerogative to be picky. Getting into battles will only make things worse. If they are hungry, they will eat. My neighbor will eat a bowl of oatmeal for breakfast, cheese and grapes for lunch and if they are lucky, a PB sandwich for dinner. The same the next day, then the next, she eats like a horse that just finished the pony express!

    I'd suggest working with your team and a nutritionist to have a plan for picky days. I'd also suggest family counseling. We, as parents, like to be in control, and at one point or another, have all had this struggle. But as I said, threatening the glucagon will just create more problems, especially on the day you need to use it.
     
  7. Mimikins

    Mimikins Approved members

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    If I were in your situation, I might switch to bolusing after a meal. The spike that might follow is a lot less concerning than having to fight off excess IOB if he refuses to eat (and for some food combinations like pizza bolusing later might be better because of fat delaying carb digestion). At a diabetes camp I was at over the summer, one of the things that we had to do for our youngest campers (as young as 4) was have them come to the nurse's station after they ate to get their lunch boluses so that we were not fighting of a lot of insulin should they decide that they don't want to eat what we just bolused for.

    Could you offer foods that are less carb dense? A half cup of baby carrots is about 4.5g net carbs compared to 2g net carbs in a half cup of green beans or 12g net carbs in a half cup of potatoes. If he refuses to eat the green beans, at least then he's only short 2g of carbs (versus having to fight off 12g if he didn't want the potatoes). Instead of mashed potatoes use mashed cauliflower instead (though what kid would be fooled by it? ;) )? Bulk up the meal with low-carb stuff like cheese and proteins and then let him pick out how much of the carby stuff he wants (and then bolus him after he's done eating)? If he really doesn't want what he just bolused for, could you offer him a carby food that he doesn't associated with as a treat? Milk? Saltine crackers? Juice? Toast with jelly? Glucose tablets? Plain packets of sugar?

    I feel like at that age it might be good to start introducing that he needs to eat what he took insulin for to prevent a low blood sugar (to prevent him from feeling bad/sick?), but I also agree that threatening him with glucagon isn't going to work. Glucagon is like using a fire hose to water delicate flowers (it's super powerful, and you might then be dealing with highs), but it's expensive to be using for non-emergency purposes and also has some side effects that might be uncomfortable for your son (pretty bad nausea or vomiting).
     
  8. quiltinmom

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  9. Snowflake

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    I'm jumping back in because this is a subject that really resonates with me, and because we still struggle with some of these issues.

    The difference between age 3 and my daughter's current age of 6 is vast in terms of understanding diabetes, and especially lows (and at age 6, she still has a LOT to learn). When she was a toddler and preschooler, the line "If you don't eat, you will go low" meant nothing to her. I caught lows as low as 38 where she was playing happily with not outward signs of being or feeling low. She still doesn't feel all her lows, but she has had some bad ones, and she knows enough now that she wants to avoid them.

    I also want to second what everyone else has said about glucagon. It's an emergency medicine, not a parenting tool. The one time we had to use low-dose glucagon -- when my 3 yr old daughter was sick, low, and running ketones -- was one of the most distressing parenting moments that I have ever experienced. My daughter immediately started vomitting profusely. And then she ran in the high 300s all night. I'm glad we have it but hope to never have to use it again. We've never mentioned it as a bogeyman since that experience.

    While I think you're in the right here, I do sympathize with your husband's perspective. My husband and I are both working parents and it is extremely frustrating to make dinner after a long day at work and then watch the kids turn their noses up at it. We do ask our older children to follow a two-bite rule with everything on their plate to be polite and to expose them to new foods, and I think they (mostly) follow that rule because we've moved away from forcing anyone to eat all of what is front of them.
     
  10. Nancy in VA

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    I would definitely move the bolus to after the meal. If you are worried about the peak, dose half up front and then the rest after eating. That's what we did, and honestly, we still do. If my daughter gets seconds, she boluses again. If she doesn't know how much she'll eat, she half doses.
     
  11. MomofSweetOne

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    My kid wasn't diagnosed until 11, so I never dealt with toddlerhood. It sounds like your kiddo is being a typical kid with food at that age, and I know our team recommended not making eating a food battle for the littles. From the perspective of a mom with a teen, I'd have your husband read up on eating disorders and T1D so that he understands the concerns...but there is the balance of expecting them to try things and not short-order cook. The most valuable things I remember from our dx counseling appointment was 1) she's a kid and they WILL try to get away with whatever they can; just look at her and say, "Nice try!" and 2) to keep Diabetes as the common enemy, not each other. That's true in the parent/child relationship and the parent/parent relationship.

    I'm with everyone else, though, on glucagon is our friend and should be kept that way.

    Do the little ones not feel the urgency to eat when low? My daughter battled me on using silverware after dx, and I told her she could eat appropriately or be dismissed from the table. She informed me I couldn't do that or she'd go low. I told her she obviously knew her choices and I would allow her to make that choice. (I was sweating bullets she'd call my bluff.) Fortunately, she didn't want a low any more than I did...and ate appropriately...and surrendered the "What can I now get away with because of T1D?" testing immediately.
     
  12. Ali

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    Bolus after and work with someone to help this not turn into a food/control issue.
     
  13. wilf

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    This is misuse of glucagon, and is not something you want to keep doing. Glucagon forces the liver to dump its sugar into the bloodstream, meaning it's missing later on which could get dangerous if there's a bad low. Glucagon is also bloody expensive.

    I'd switch to dosing after meals with Apidra. This is a phase, and he'll move on as soon as the confrontations stop. :cwds:
     
  14. ecs1516

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    Mine were diagnosed young. One at 3 years old and the other at 10 months old. I soon found for us I did two shots for a meal. I would give 50% percent up front or the amount needed for what I thought they would eat. Any remainder I gave a second shot. Not desirable, but I never knew if they would finish. I remember sometimes I might have used applesauce or yogurt to finish out the carbs. Don't remember doing that often though. This was a pain. More shots never are fun, but easier than forcing them to eat. At the end of their first year of diagnosis, we got pumps for them.
     
  15. Sarah Maddie's Mom

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    To the OP, I do hope you've shared this thread with your spouse. Please ask him to note the # of posts these members have to their names( upper right corner) These are not simply long time D parents but folks who have hung in and shared their experience over years and thousands of posts. This level of experience matters, these are not just random internet people.

    Good luck. I wish you well and hope your partner takes the time to read what others, living the life, have shared.
     

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