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Teen DD, New Endo, Tears and No Talk

Discussion in 'Parents of Teens' started by MAsDad, Aug 31, 2012.

  1. MAsDad

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    Sounds fun doesn't it?

    New Endo appointment today. The Dr. is very intelligent, knows his stuff and has a ton of experience with kids, and adults. Pioneered pump therapy as part of his early training.

    Anyway, his style didn't mess well at all with my 15 year old daughter. She began to cry about 2 minutes into the appointment. She thought he was criticising her carb counting (he was) and overall managment of her diabetes (he was not) and as a result she shut down.

    Bottom line is her A1C level of 8.3 is down from 8.5 in June, but she's got some spike highs as a result of not counting enough carbs. He made a suggestion to try for a couple weeks and see if we can't knock off some of those peaks.

    My thought is that she knew her highs were going to be noticed and commented on going into the appointment. The anxiety around seeing a new Dr that she's heard isn't very nice to kids (not true), and her knowledge that she's been silent about these high BGs just overcame her when he pointed it out.

    So, bigger issue here is, how can I help my high achiever not see corrective suggestions or requirements, or questions even, as criticism?

    As background, in our family I am the talker and the emotional one. She's worried about her weight (not an issue but she's critical of gaining weight) so she avoids bolusing enough sometimes.

    Dr. pulled me aside after the appointment and asked me what I thought was the cause of MA's reaction. We talked and he asked if she's ever spoken with a professional about her feelings around her condition. She hasn't, and wouldn't without a fight.

    Just venting, but I am worried that by being silent about diabetic issues (either because she wants to just be normal, or wants to ignore it) she won't be as happy and well-adjusted as life goes on for her.
     
    Last edited: Feb 7, 2013
  2. pianoplayer4

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    I don't really know how to help you, but I wanted to offer some encouragement. 14 is a really hard age to be at, even without diabetes=( maybe she would be willing to have a diabetic pen pal? I know for me it's easier to talk to people about this stuff over the internet because I don't have to worry about them repeating it to my other friends cause they don't know them.

    I've had several younger pen pals whose parents I met on CWD, IDK if this is something she would be comfortable with/ want to do... but if you pm me I'll give you my email (I'm a seventeen year old girl dx at 14)

    About the not bolusing to loose weight, that's very serious and could be dangerous. I would suggest you (or your wife) talk to her about it and stress that she MUST bolus for food.

    Is she on the pump? I forgot to look in your siggy... if so maybe the carb counting problem is really stemming from not entering the carb count and just dialing up insulin manually. I know I'm guilty of that and I often don't really count the carbs when I do it that way ( something I'm working on)

    this must be really hard for her ( and you!) I hope things get better...:cwds:
     
  3. skimom

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    Sounds to me like your daughter was feeling guilty that she was not doing things right all of the time ( ie not bolusing enough) and felt embarassed for being called on it. i assume that she is doing all of her own care, so sometimes these kids who try so hard to do what is right etc and are actually doing a pretty darn good job, instead hear what was done wrong and miss all of the things they are doing right...symptoms of being a teenager....
    The doctor sounds really caring in that he was concerned about her reaction, etc and that he was trying to give her suggestions.
    One thing that our doctor does which really helped my son was to ask my son how he handled various situations and why. The doctor really listens to the "solution"and rationale and then explains why things may or may not be working and compliments him on his ideas ie " that sounds like a great idea" .or "I hadn't thought of that" . He then frames any corrections as "well have you thought about ...." or says " well I had another patient who had similar problems and he found that XXXX worked really well - why don't you give it a try?". Together they agree on a plan . My son feels really empowered , respected and feels that he is part of his team - he is more willing to try things out.
    Hope things improve for your daughter....
     
  4. Helenmomofsporty13yearold

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    I hope I am wrong, but I fear the bigger issue here is her withholding insulin to lose weight. Please read about "diabulimia". It is much too prevalent among Type 1 teen girls and can be a struggle to overcome. I would do whatever I had to do to get her to counselling.
     
  5. kiwiliz

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    I would also be careful about this. It might be worth mentioning to your high flyer endo - I would think it was the fact that he hit a raw nerve by spotting the highs that caused the reaction. It's not the right way for a kid to feel in control - especially with body image - he is sure to have some good ways to deal with the problem before it gets out of hand.
     
  6. Sarah Maddie's Mom

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    I don't think it's the job of the teen patient to adjust to the Dr's approach. It's the Dr's job to counsel and listen to and provide assistance to the patient. Especially with Type 1 which is little more that an endless stream of quantifiable opportunities to feel like a failure. Maybe he's just not the right person for her. Perhaps she needs to see a woman or skip the endo and see a CDE or APRN who is a better match for her personality.

    I think 14/15 is a critical juncture - it's a great time to establish healthy practices or to not establish healthy practices. Don't waste that time trying to change your daughter.
     
  7. Joretta

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    Okay, I think since I just went through this with my DD ( mine is now 16 and I thought i would go crazy last year.) she might need counseling, but part of it could be age, time of the month, trying so hard to be grown up and not really ready or is just adjusting to the reality of all the changes are coming - then add the diabetes. I sent my daughter to counseling while I don't believe her counselor helped. I do think my modeling you have to talk to someone as it is part of growing up. After 7 months of trying counseling I let her stop on the agreement we spend time together and she communicates to me, her school counselor or another person who gets what she is feeling. Today being a teen girl is hard. Self esteem, boys, school, thinking about the changes coming, and diabetes is enough especially when an a lowering A1C is not all you hope for I think she might have just had a girl emotional moment. But keep in mind she may still need an outsider to talk to while she figures out being a young adult.
     
  8. caspi

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    I agree 100%.
     
  9. nanhsot

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    I've been pondering this post for a while, I can very much relate but not sure I have any great answers, but I do have thoughts.

    My son had an endo who he actively disliked. Rather then enlist HIS intelligence she would display her own, which may instill confidence in adults, in a teen it just bristles. Her approach was one of superiority rather than teamwork, and for my son that was absolutely the WRONG approach. He likes to engage in intellectual debate, and he likes for adults to recognize him as a person, not a kid. He hates to be talked down to or told what to do, but he takes suggestions well when presented to his intellect, if that makes sense.

    Things came to a head when she threatened to take away his pump because he wouldn't do things HER way. I actually agreed with what she was saying but the way she said it and her lack of connection to him actually made him rebel more and his A1C steadily climbed until recently and now it's back to ranges we are comfortable with.

    We never went back to her.

    I think that if this endo is not a good fit, perhaps another in the practice would be worth a shot. Or, avoid this MD except for the once annual visit required and find a NP or CDE to see on the other visits.

    As far as talking things out, what helped my son the most in that area was diabetes camp. IMO it turned his entire outlook around. We have taken him to a counselor though, because he was having pretty stark rages related to highs and didn't feel it was something to ignore, his counselor has T1 so was helpful and he only went maybe 3 times or so.

    If I have advice I guess it would be to respect her feelings regarding this MD and see who she'd prefer to see, and make it happen. Do not ignore the weight issues, you've gotten advice on that already. Consider counseling, even for a short while and if possible find someone who has dealt with chronic health issues...but don't push the issue, my son actually asked to go see someone so that helped. Finally, see if there are any options for peer groups with T1 in your area, I know that just texting his friends from camp has been helpful for my son, just that connection and friendship.
     
  10. MAsDad

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    Thank you ALL for your thoughts. Very much appreciated. We are headed back to the endos office Friday for a progress check. Then we have her varsity volleyball tournament all weekend. I dont know which i look forward to more...:D
     
  11. VinceysMom

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    Totally made me chuckle! Hope all went well!:eek:
     
  12. wilf

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    Is she entirely in charge of managing the D? If so, you might take back some of that responsibility so it is not all on her shoulders.

    That can also give you a chance to quietly model (without saying that that's what you're doing) what needs to be happening in terms of the D management..
     
  13. MAsDad

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    This stopped me in my tracks.

    The update is that our practice brought on a new pediatric endo so our time with the other Dr. was short lived. She likes the new lady endo just fine. She's been to the psychologist at the practice a couple of times now to talk and has come away with some helpful and thoughtful ideas for improvement.

    She's still largely "non-compliant" as they say. Her Omnipod PDM revealed today that she often checks her Bg once a day, and on those days will run high. She's not managing things well at all. Today at the visit (her mom went with her) the counselor asked why the single check days and what's the cause of the hesitancy to check, etc. Sounds like she's self-conscious of being though of as different, so she avoids checking her Bg. She also says she's afraid of lows, so runs high. Not a great combination.

    Anyway, I've been thinking all afternoon about ways to establish some guidelines for her to follow. You know, rules for managing the diabetes better that include text messages when she gets to school, required mid-day blood sugar reading texts, that sort of thing. All of this to be done at the risk of loosing her car for a day or a week and so on.

    Then I read the post above. The management of her diabetes IS on her shoulders, and hers alone. We've not done much as parents to help her carry the load. What we've done is ask, ask, ask, demand, ask, threaten, ask some more that she check her blood sugar, wear her bracelet, text us when she arrives at her destination. Empty threats to lose the car have gone down the drain.

    Talk about a failure as a parent.

    So what to do? I'm thinking about asking to review her PDA nightly, charting progress and suggesting adjustments. I don't know if she'd react to this idea any better/worse than the "check and text" rule or not.

    I'm see-sawing back and forth between tough love (or maybe just my blowhard way of taking charge) and something else.

    Help?
     
  14. KatieSue

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    Mine just turned 17. I wouldn't consider her non-compliant just lazy. I've seen the one test days. Mostly its around 3-4.

    One non-negotiable is not testing and driving. No test no keys. And I do check her meter when she gets home to see if she tested before she drove, if she didn't she looses the keys.

    Mine could care less who sees her test etc she just gets busy and doesn't do it. She does bolus just not test unless she feels off sometimes.

    I don't have a good answer for you. We're also struggling with grades/homework/studying. I do try to take what I can off of her care wise. We just put the paperwork in for a Dexcom. She trialed one and really liked it, and did test a lot more but it was only a one week trail so long term I don't know if she will.

    One thing her therapist had me do with homework, and would work for testing as well is instead of asking and having them lie to you. Just make them show you. So instead of asking "did you test" it's "show me your meter".
     
  15. Sarah Maddie's Mom

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  16. sugarmonkey

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    This is what I do. When DS is going through the not testing, not bolusing phase, I just say 'show me your meter' or 'show me your bolus.' Sometimes if it's getting really bad with missing boluses I'll insist on doing them for him for a while. Usually only a day is long enough to get him back on track. At school I get him to text me his number, if he doesn't by a certain time I ring him. And he knows I download the meter every night, so I'll see if he lies about the number, and I will go down to school if he does that too often. He doesn't want that.:p
     
  17. Megnyc

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    Not sure if you want the perspective of a teen but I will offer my 2 cents....

    I had a pretty tough time from ages 14-17 with diabetes. I had started high school and started dating and honestly after missing most of elementary and middle school due to cancer treatment I just wanted to be normal. And testing and bolusing just made me stand out.

    One tip I have would be to start small. It is really overwhelming to here a parent or endo tell you to test 10 times a day, bolus for every meal, and change your infusion and sensor site all at once. Maybe say something like: "You have to test 4 times a day." With the omnipod odds are if she tests she will correct just cause it is so easy. I would add in there that testing before driving is non-negotiable. Fwiw even when I didn't care if I got hurt while driving and low the thought of hurting someone else is what would always make me stop and test before driving even when I was totally ignoring diabetes. I am not a fan of "scare tactics" but you might want to bring that up.

    Once she is testing 4 times a day you could move onto bolusing for every meal etc.

    I am guessing she wouldn't go for a CGM but if so that could really help.

    If she wants an "email buddy" let me know and I will give you my email.

    Good Luck! I hope things get better.
     
  18. MAsDad

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    Thank you all! Great suggestions and feedback. I think we are on the right track...and have implemented many of the suggestions above.
     
  19. sugarmonkey

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    Thanks Meg. Great post.
     
  20. Bigbluefrog

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    My daughter is 17. The teens want independence and to fit in with their peers.

    I have noticed she does hide her testing, she keeps it in her bag and just sneaks her bg checks.

    When she went to diabetic camp. I think seeing she was not alone and there are other kids going through the same thing ....really opened her eyes.

    She does most of her D care, but I try to help her with adjustments and we go over her downloaded numbers together. Oh this number is high, never a judgement more like a puzzle...where is the pattern and what can we tweak.

    Teenage girls are a challenge,with hormones, growth spurts, and Diabetes.
     

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