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Type 1 and adolescence

Discussion in 'Parents of Children with Type 1' started by earruda, May 21, 2007.

  1. earruda

    earruda Approved members

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    My daughter is 13 and has had diabetes now for almost 2.5 years. She is on an insulin pump but we still can't seem to get her A1C under 7.1. She got her period a few months ago and it is really throwing her diabetes crazy. She is also hiding food... forgetting to check her blood sugar sometimes. I am pulling my hair out. We have an apt with the diabetes center on Weds and I am not looking forward to going..... bad mother...... Why can't we get this under control better?? It was much easier when she was younger. I wish we could afford the continuous glucose sensor because maybe that would help. Anyway blah, blah, blah........ I am frustrated tonight.

    thanks,
    Elizabeth
     
  2. Tamara Gamble

    Tamara Gamble Approved members

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    Our doctor say's an A1C of under 8 is awesome for an adolescent. Ty's was 7.6 at last visit, he is almost thirteen and I am thrilled with it given the fact that he is so hormonal right now and we were dealing with faulty infusion sets etc. and a growth spurt.

    If she is on the pump why would she be hiding food? If there is something that she wants so badely she is willing to treat it as contriban, I think I would find a way to bolus for it whether you need to super bolus or whatever. I often wonder how many of our kids will have eating disorders due to this disease.

    Are the alarms set on her pump for checking her BG? I guess what I'm asking is she really forgetting or just not doing it. The alarms would stop the forgetting part. If the alarms go off and she ignores them then you know she is just not doing it.

    You are not alone. The teen saga is a trip for all of us I think. Ty hasn't quite gotten to the point that he is doing as you described but I'm waiting for it to happen. I do notice that when he is at his friends he will ignore his alarms and cut down on the checking unless he is about to eat. Of coarse with boys running and running that could be hours in between so it irritates me.

    Adolescence is just tough. Hang in there. They haven't pulled all of the tricks out of the bag yet. I do not look forward to this time at all. In fact it frustrates me and scares me a little too.

    Just be consistant, keep the lines of communication open, make sure she is checking her blood glucose and work on the right bolus for whatever food she is hiding. I am learning that it is not all about the almighty number. A well rounded child is the main thing, the number comes second.

    Hang in there and keep plugging away. It's hard when you are doing everything that you can to keep them healthy and they are doing everything they can to just be normal.

    God Bless!

    Tami
     
  3. badshoe

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    Our endo would agree, 7.1 at 13 is outstanding.

    Don't let the could have - would haves get you down. That one of diabete's tricks. 7.1 in adolecence is great. I would be looking to praise the positive behaviors that are getting to 7.1 for both parent and child.

    Tami I think your comments on eating are very interesting, I agree we need to focus on feeding the kid and not the insulin. Kids grow, they need food and the pumps let us tweak the insulin to the food.

    I try not to get worked up about food, they should eat when they want like anyone else and bolus.

    I think the goal is long term management, missing a bg text here or bolus there is IMHO isn't a big deal if the communication, educatuion and effort are ongoing. I try not to let perfect become the enemy of the long term good.
     
  4. Boo

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    Well said Bennett and Tami. My son is also just entering adolesence (he'll be 12 in July). Though he is quite tall for his age (over 95th percentile), he hasn't really started puberty yet. This thought scares me as we already see some big swings.

    Just last week, I found my son eating food without my knowledge. I'm not sure how to word it, as I don't require him to run every snack by me before he eats it. But he was literally HIDING the snack from me, knowing that I would say something since he had already had an after school snack. He was right, I guess...I would have said something about it...but proabably only to encourage him to eat something healthier if he was still hungry after his normal snack. I refrained from the lecture and simply asked if he had bolused for it, and told him he didn't need to sneak food. I don't think he has done it since then.

    When is she forgetting to check her blood sugar? Is it when she is away from home/with friends? My son is pretty good at home (because I am always there to remind him :D ), but will "forget" when he is out with friends. He will usually test before he eats though. If he'll be out for an extended period of time, I now give him very specific instructions about when to test, and I will often check in with him around those times to discuss his number/meal/activity level. He is very good about making decisions regarding his pump settings based on activities...but he needs to make those decisions with the knowledge of his current BG reading. It is great to bolus for carbs eaten, but even better to include a correction if necessary (including subtracting insulin for lows).

    I try very hard these days not to harp on him when he forgets to do something or makes a bad choice. I acknowledge it and move on. I try to remember to give him credit when he does things right, but I'm sure I don't do this often enough.

    I do not look forward to those teen years. He is my oldest, so I'm not sure what I'm in for, and D will just complicate it all that much more!!
     
  5. badshoe

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    Well we have three teens, 15, 14 and 13 and so far they are still a lot of fun. OK they disapear into their rooms, chat on AIM with their friends or play video games all the time but all in all teens don't seem all that bad.

    I think it is important to keep the end game in sight when dealing with the teen diabetic, that end game is atonomy. So I try not to get on him much about checks, eating and such. I try to position it as checking in, not telling him what to do. If the numbers are off, we ask why he thinks that is.

    From his dx at 9 years old we have been trying to move the diabetes care out from the realm of teen rebellion. That will come and that is a good and natural thing, to rebel against us is OK not against his D care because that isn't ours it is his.

    To do that we have tried to prosition D as his prior to adolecence. A big part of that was the pump and opening up freedom to eat. "Dude you bolus for that?" is about all I say. Freedom to go out with friends just take a kit and a cell. All the kids carry cells so the D isn't any different.

    Another part is to try to down play our roll and avoid judgements. Try to avoid negative feed back on out of range numbers, the number is what it is, what are you going to do about it? Ok numbers in the 90 to 120 range are a cause for a wohoo! followed by what do you think caused that? Same with eating. Teens eat like.... Teens. That fine, "what you going to do about it" and "Hey save me a piece of the key lime pie."


    I will ad that we didn't try to make him manage his overnight basals and if there was ever a reason for the pump it is a growing adolecent. Peak insulin needs are just after he falls a sleep for about 2 hours than the basal drops way off. On the plus side he's asleep and so there isn't any issue of who is managing the numbers. IMHO getting the overnigh right is the key to good A1C.
     
    Last edited: May 22, 2007
  6. Hollyb

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    Hi Elizabeth,

    I have to agree with the others, your daughter's BG is not way out of control but just a little higher than ideal which is pretty much expected through puberty. It's just really tough to manage with all those other factors going on in their lives, especially for girls. If your daughter can hold in the low 7s through adolescence, it's very likely her "young adult" A1c will settle into a great place as long as she's been able to keep her attitude positive.

    I hope they aren't giving her (and you) a lot of grief at your centre. I think teens really need a lot of support and acknowledgement for all the things they DO do, not flack for a result that they may already feel upset about.

    And... I think the comment about nighttime BGs being the key has a lot to recommend it. You might ask if she would mind if you did some intensive nighttime checking, building up a profile over a couple of weeks of what her BGs do through the night and fine-tuning her night basals accordingly. If you can get that part working well most nights, that's 1/3 of the day at a good level without her having to do anything!
     
  7. Ellen

    Ellen Senior Member

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    Where is the pressure coming from to get her A1C below 7.1? It would be helpful if the endocrine team assists in identifying how to adjust basal rates and bolus ratios surrounding the various aspects of menses in the month (before, during, after). We were in close and frequent contact during puberty with the team. Rates change frequently and insulin resistance is normal. It's important to recognize that puberty, female hormones, diabetes, and adolescence is a monumental challenge when it comes to diabetes care. If you aren't already doing it, please try to often praise her for her efforts, for remembering to bolus, for trying to estimate carbs in foods she isn't familiar with, for checking bg when she doesn't feel like it etc. (Catching our children doing the right things can go a long way in keeping the lines of communication open. )

    Why do you think she's hiding food? What if there were no forbidden foods - would she still feel a need to hide it? You may want to explore what and who triggers the need to hide it.

    You're likely a very good mom with lots of challenges. Keep your hair in your head - it's probably quite lovely:).

    (There ought to be a bumper sticker Diabetes Happens.)
     
    Last edited: May 22, 2007
  8. Amy C.

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    I have accepted the fact that my 13 year old son is incapable of always remembering to do his diabetes tasks. Until he grows a little less scatterbrained, I know that it will be my responsibility to remind him to test and bolus.

    He remembers some things, but not consistently.

    That is OK. He is 13 and has many other things to deal with. I will wait to panic if he isn't self sufficient when he goes off to college.

    It makes life a whole lot better when I take the pressure off of him.
     
  9. Tamara Gamble

    Tamara Gamble Approved members

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    I think that there are so many good points here. I wanted to reiterate the autonomy or self governing aspect of this. We have always worked as a team with this diabetes thing. Ty and I talk about what transpired during the day, the whole cause and effect thing. He really does amaze me. I will get a call from school, mom, my bg is this but this is why, I think I should whatever because of this. He's usually right on the money. Success! The number was not good but his troubleshooting was perfect.

    Also I think Ellen mentioned the success celebrations. I think this is also worth mentioning again. I know that it's hard sometimes when you work so hard to get it right and they do something less than desireable to mess it all up but they are going to mess up. It's learning and growing and really just being human, so celebrate.

    I wanted to add that sometimes you just have to grit those teeth and bare it to a degree. I don't say anything to Ty about not testing often enough when he is at his friends because I notice that when there is a problem he does test more often and if he were to hit a high 200 or any low, he will give me a call. So I chalk this one up to him knowing and growing.

    God Bless!

    Tami
     
  10. earruda

    earruda Approved members

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    Diabetes and Adolescents Continued

    Went to the diabetes center.......A1C is now 8.5.... and I am a nurse!! They gave us 30 days to get back on track but told Margo if she doesn't check her blood sugars 5 times a day she can't stay on the pump. She sometimes was only checking 2-3 times a day....... I wish I knew why she was hiding food.... we never punish for high blood sugars.... Although I found out she had a high of nearly 350 and she didn't tell me or check ketones............ We started keeping a blood sugar log again and that is helping with objective communication. Boy I am dreading going back to the endo in 30 days.....
     
  11. 1luckymom

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    I wish I had some advice. I really feel all of your concerns and frustrations, but I am fairly new to this. My daughter is 12, and I know we will be going through this soon enough. All of your posts on this thread have been really enlightening to me. Thank you! My current plan of attack since I have only been at this about 4 mos. is to keep communication lines open and man oh man has a cell come in handy!! Good luck and keep us updated.
     
  12. Ellen

    Ellen Senior Member

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    I'm wondering how you feel about the threat to remove her from the pump with an A1C of 8.5. It seems to me she's still taking insulin and likely correcting for highs and doing plenty of the work involved with the diabetes self-care even if not "perfect". I'd like to understand why the team doesn't feel it's necessary to explore the ambivalence your child may feel with respect to all that's expected of her, rather than simply threatening to remove the pump. Unless of course your child would prefer to be on multiple daily injections, in which case that choice should surely be resepected.

    There have been some interesting studies out of Cardiff, Wales on using motivational interviewing with teens with diabetes. The latest one is in the June issue of the journal Diabetes Care. Perhaps your child's diabetes team would like to learn more about this technique with respect to working with patients with diabetes. :)

    Here's the latest abstract:

    Clinical Care/Education/Nutrition
    Original Article

    A Multicenter Randomized Controlled Trial of Motivational Interviewing in Teenagers With Diabetes

    Sue J. Channon, D CLIN PSYCH1, Michelle V. Huws-Thomas, MSC2, Stephen Rollnick, PHD3, Kerenza Hood, PHD4, Rebecca L. Cannings-John, MSC3, Carol Rogers, RGN5 and John W. Gregory, MD5

    [SIZE=-1]1 Department of Child Psychology, Cardiff and Vale NHS Trust, Wales, U.K[/SIZE]
    [SIZE=-1]2 School of Nursing and Midwifery studies, Cardiff University, Wales, U.K[/SIZE]
    [SIZE=-1]3 Department of General Practice, Cardiff University, Wales, U.K[/SIZE]
    [SIZE=-1]4 South East Wales Trial Unit, Cardiff University, Wales, U.K[/SIZE]
    [SIZE=-1]5 Department of Child Health, Cardiff University, Wales, U.K [/SIZE]
    [SIZE=-1]Address correspondence and reprint requests to S. Channon, Child Clinical Psychology Department, Children's Centre, St. David's Hospital, Canton, Cardiff CF11 9XB, U.K. E-mail: sue.channon@cardiffandvale.wales.nhs.uk [/SIZE]
    OBJECTIVE—We sought to examine the efficacy of motivational interviewing with teenagers aged 14–17 years with type 1 diabetes.
    RESEARCH DESIGN AND METHODS—In a randomized controlled trial analyzed by intention to treat, 66 teenagers with type 1 diabetes attending diabetes clinics in South Wales, U.K., were randomly assigned to the intervention group (38) and control group (28). Teenagers in the intervention group received motivational interviewing, and the control group received support visits. All participants received individual sessions over 12 months. The main outcome measures assessed at baseline, 6, 12, and 24 months were serum A1C and psychosocial self-report questionnaires including quality of life and well-being measures.
    RESULTS—At 12 months, 60 patients had complete data. At the end of the intervention (12 months), the mean A1C in the motivational interviewing group was significantly lower than in the control group (P = 0.04), after adjusting for baseline values. At 24 months (when n = 47), this difference in A1C was maintained (P = 0.003). There were differences in psychosocial variables at 12 months, with the motivational interviewing group indicating more positive well-being, improved quality of life, and differences in their personal models of illness (all P < 0.01). Some of these differences were maintained at 24 months.
    CONCLUSIONS—Motivational interviewing can be an effective method of facilitating behavioral changes in teenagers with type 1 diabetes with subsequent improvement in their glycemic control.
     
  13. jvoyles

    jvoyles Guest

    D Team sounds pretty negative

    My daughter is also 13, dxd at 8. First of all, I think an 8.5 following a 7.1 is POSSIBLY a trend toward something serious but NOT an immediate cause for alarm and threats. I think entering puberty and starting her periods is an excellent explanation for the change - it's much harder to keep up with blood sugars during this time. And like Ellen said, the team should be giving helpful basal/bolus changes and ways to stay on top of things rather than threats.

    But also, there is no way I could expect my daughter to take care of all of her testing on her own. She's responsible for it if she's on her own like at school and right after school before I get home from work. Or if she's at friends. But I consider it my responsibility the rest of the time. I will get her test kit out and either hand it to her or do the test myself.

    Also, like other parents of teens here, I don't get real upset if there are fewer tests when she is on an overnight or at friends. She has the added ability of knowing how she feels. She pays attention to that. ( I do expect a test before she goes to sleep if she's on a sleepover. That one is required)

    And lastly, also like Ellen noted, positive reinforcement works sooooo much better than criticism.

    Jana
     

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