Thursday, May 3, 2012

Hellions, Heathens & Hyperglycemia


In the last 2-3 weeks I have seen a rise in the number of visits I have had with non-compliant tweens and teens. What gives? Its like they are getting friskier with this warmer weather down in Texas. I've been meeting with their harrowed parents, so frustrated that they are pulling their own hair out while trying not to strangle their sweet children.

As a teenager I was BAD. You've seen me mention my A1c of 16% when I was 16, and getting fired by Dr. Pedi Endo for continued non-compliance. My parents didn't know what to do with my ass. I would go weeks without testing, make up sugars in my meter (yes, it can be done)and miss insulin doses all over the place. In High School I was on UltraLente and Humalog..you know, whenever I DID decide to inject. My endo would bring up pumps and I would laugh at him. I couldn't have given less of a shit about my diabetes. My reality was...friends, boys, drinking and my grades, those were my world. Now, had insulin gotten me drunk...I would have walked around wasted face....but with good blood sugars. I was always on some form of activity restriction or grounding with my parents. Limited computer access, no phone, no weekends with my friends = no bueno. And as I reflect back to that point in my life, I really don't know that anyone could have said anything to me to make me change my behavior. Not my Dad, teachers, Dr. Pedi Endo, and least of all, my mom.

Recently, Nurse Cassie did a post about disciplining kiddos with T1 that aren't taking care of their bidness. Many parents feel that a chronic disease is enough of a burden, and that being punished for not checking sugars, omitting insulin or lying about their diabetes, is wrong. Trust Cassie & I: IT'S NOT. Kiddos require close diabetes supervision at least until age 16, and at that time, a few more responsibilities can be handed over to the lad. As a parent, it is your job to prepare your child for adulthood, and that includes taking care of their body. So if your child was lying to you about money..or cleaning..or grades..you would impose punishment, so why NOT for diabetes self management???? Take away that smart phone, turn off texting, deactivate FaceBook or have them sit out from athletics or team sports. Diabetes is serious, ya'll! And allowing one's child to get away with murder will not help prepare them for the long run.

In the words of the great Joe-Slo (Joe Solowiejczyk, RN, MSW): "The message from parents to young people needs to be, “It’s going to be difficult. We, as your parents, understand that you have issues with managing your diabetes and that you don’t like doing it all the time. And, we’re going to insist that you do it anyway. After you’ve done it, we can discuss how you feel about it.”
I think had my family made it THEIR diabetes, and we talked about the level of suckage diabetes is, I would have been much more receptive. A kiddo needs to feel supported, loved and able to come to you with issues...but they must also trust that you will stick to your guns, and in the end, you ARE an authority figure, and if you don't follow MY diabetes rules you will LOSE you age appropriate priveleges.

Make your terms very black and white: You WILL test your glucose no less than 4 times daily, you WILL dose your insulin prior to all carb intake and in return, I will allow you to (insert super fun teen activity). Failing to hold up either end of the agreement, and you will both end up angry, frustrated and with a crappy A1c. Make your home a "No-Nag" zone for diabetes, only ask questions when pertinent to the safety of the child. Have a diabetes round table discussion once or twice a week, where Mom & Dad get to look over meter and/or pump and ask sugar realted questions. All nagging does is piss kids off (Wives, however, are ALWAYS allowed to nag FYI) and further push them away from the bigger picture. Make your kid an appointment with their CDE to discuss WHY they must test, keep their sugars at goal and dose insulin correctly. Let them vent. Being a teenager is sucky, add a chronic disease state on TOP of that = a cluster (insert "F" word).

Also want to give a shout out to Kendall & Jocalyn over at Kendall's Hope, my new favorite blog (I seriously was 30 min late calling my last patient backwhile trying to catch up on Jocalyn's posts!!).