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Question:

From Camarillo, California, USA:

I have a 12 year old stepdaughter with Type 1 diabetes. She was diagnosed when she was 7. She is with us every weekend and at her mother's house during the week. She comes to us with scores in the 200-300 range with a few "lows" scattered in. We try to maintain strict control over the weekends, and scores improve drastically; we still get the "lows" though. Are these fluctuations harmful?

Answer:

I would like to see her blood sugars under 200 regardless of who she is staying with! Fluctuations will occur for many reasons (including stress) but 300 is not acceptable during most weeks.

CMB

Additional comments from Dr. Lebinger:

When a child with diabetes alternates living with two parents who are separated, it is especially important to have good communication between the two parents regarding diabetes management and not to use the diabetes as a focus of disagreement between the parents.

If your child's control is markedly different at the two houses, both parents and the child have to sit down and figure out what is different and work with the child's doctor, nurse, and or educator to make any changes in diabetes management necessary to achieve similar control at both places.

Things to consider are:

  • More activity on weekends lowering blood sugar
  • More or different foods during the week that raises the blood sugar.
  • More low blood sugars either during the week or weekend leading to "rebound hyperglycemia" (Somogyi effect) after the lows. (The high blood sugar phase following the low can last up to 3 days).
  • Purposeful manipulation by the child to obtain different control with different parents.
If difference in diet or exercise is the problem, you need to work with your team to make adjustments to accommodate the differences. Your child may need different insulin doses on weekends than during the week or change in meal plan.

If rebound hyperglycemia is the problem, avoiding low blood sugars and sudden drops in blood sugar may help.

If the child is using the diabetes to either "split" or try to "reunite" his parents, family counselling may help.

TGL

Original posting 15 Mar 1998
Posted to Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:08:56
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