Managing your child's diabetes is one of the greatest challenges of your life. You are instructed by the diabetes team and doctors to keep "tight control" in order to help avoid devastating complications in the future. Many parents dislike the word "control." It implies that, with the proper effort, the parent can mimic the workings of the pancreas. However, parents are dealing with too many unknown variables, ranging from weather to hormones, to determine the exact amount of insulin their child needs at every moment in every day. Keep in mind that managing diabetes is more an art than a science. Try to not be too hard on yourself when your child is out of target range. It is estimated that even the best controlled T1D patient's blood glucose may be out of range up to one third of the time.
Management
Blood Sugar (a.k.a. Blood Glucose)
Any seasoned parent managing diabetes will tell you, once the honeymoon period ends, many days become akin to riding a roller coaster. I always likened my son's good blood sugars to my drives in golf: I remember the good ones and try to forget the bad ones. Even the most diligent of parents will find complete frustration at times because they couldn't hit a good number if it were on the broad side of a barn. That being said, there are those amazing few days, every so often, that hitting the target range is relatively easy. But don't be fooled! You did not suddenly figure everything out: those pesky variables will once again make themselves known and you'll be correcting blood sugars again before you know it.
So how is a parent supposed to maintain a healthy attitude toward blood sugars, knowing that perfection is needed but not always attainable? I don't know. How can a parent not become obsessed when constant monitoring is necessary? I don't know the answer to that either. It's something I work on every day. The best advice I found on this subject came from a conference I attended recently. The speaker suggested we look at the number on the meter objectively, without emotion, as if it is simply data that requires an action or inaction. So, if a blood sugar is high, we don't judge our performance, but rather take the corrective action necessary when this situation arises. No regrets--just data gathering for adjustments in treatment. I hope to one day be able to have this attitude toward my child's blood sugars. Because wincing at the glucose meter and dreading the second beep isn't helping me.
A Moving Target
What is your child's target range for blood sugars? It all depends on your child's age and endocrinologist. And the answers vary widely. The three, yes three, pediatric endocrinologists with whom I consulted for our toddler gave three different target ranges. The first recommended 100-150. The second was horrified by the first's recommendation and insisted I move the target to 150-250. Lastly, the third endo encouraged a target in the 100-125 range.
You have to choose a target with your endocrinologist that you are comfortable attempting to achieve. Many would argue that 100 is simply too low and hypoglycemia will not only be frequent, but detrimental to growth and development. Others would counter that argument by saying a higher target is setting the child up for complications later in life. The problem is that no one really knows. As your child's advocate, do your research and discuss this issue with your child's endocrinologist. And remember your child's A1C results will be affected by that decision.
Quick tip: Your child should wear a Medic Alert bracelet, or a facsimile thereof. It may save their life one day.
Nighttime Hypoglycemia
"Dead in bed" is an unsettling term and unfortunately occurs in approximately 6% of all deaths in persons with diabetes aged less than 40 years. Not many things about T1D scares a parent more than undetected severe nighttime lows. So much so, that sleeping with one eye open just becomes the norm. I have personally woken up in the middle of the night and found my very young son unexpectedly in the 30's and having tremors.
So what is a parent to do other than test every hour? This is definitely one of those discussions you need to have with the medical professionals in your child's life. Some parents were given the following suggestions by their doctors:
- Give Lantus® at dinner or breakfast, not just before bed
- Break Lantus® into two doses, half to be given in the evening and the other half in the morning
- Provide a snack before bed (one doctor highly recommended a Dove® ice cream bar)
- Invest in Continuous Glucose Monitoring (CGM)
But take heart: a well-respected pediatric endocrinologist remaked once that none of his pediatric patients had ever died in the night because of hypoglycemia. This is more a worry for their young adulthood and especially when they go to college. Then, he added, they should never sleep alone.
A more comprehensive discussion of this topic may be found at childrenwithdiabetes.com and http://www.diabetesselfmanagement.com/Articles/Diabetes-Definitions/nighttime_hypoglycemia/.
Constant Vigilance
There is an article in the Journal of Pediatric Nursing that is very much worth reading if your T1D child was diagnosed under the age of five. It discusses the constancy of managing our children's condition. One mother said the following in the article:
"It is constant vigilance, thinking of, you know, constantly,where’s your next meal coming from, do you have enough snacks, do you have all the insulin supplies with you that you need—sleeping with your eyes open. What’s going on in the back of your head is, “OK, 2:30 I gave him 2 Humalog and 1/2 lente and I cut the Ultra 2 1/2, but you know, he wanted eggs and bacon for breakfast, he played outside, we’re not going to be home in time for dinner,what time did he eat last, is the lente peaking right now. . .?” As you’re saying he can go outside to play, this is notwhat I’m saying and this is not even on the forefront of what I’m thinking, but in the back that’s what’s going on. And as I’m doing things, I’m thinking about meals and carbohydrates and insulin levels and you know, growth spurts . . . ."I have only one comment after reading her quote: Amen, Sister! You can read the whole article at the link below.
"Promise me you'll always remember: you're braver than you believe, and stronger than you seem, and smarter than you think."
-Christopher Robin to Pooh
New Product for Tweens & Teens:
