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Question:

From Washington, DC, USA:

My six year old daughter was diagnosed with type 1 diabetes seven months ago. Her father and I are divorced, and, although he attended the diabetes management class when she was first diagnosed, he has not played an active role in her day to day care. He has only injected her with insulin eight times and has tested her blood sugar around 20-30 times. She has not had an overnight visit with him since her diagnosis, but recently, he has talked about when these overnight visits might start up again.

My concern is his inability to manage her daily diabetes needs. Taking care of her is more than measuring insulin and testing her blood. On the days when he has had her for a few hours, he has made mistakes which he would not have made had he made an attempt to participate more actively and learn more about her disease. I am very concerned about his keeping her overnight, and I do not know the best way to handle this.

Also, I should mention, my daughter was diagnosed with separation anxiety, and I had her in therapy when she first started overnight visits after we separated because she did not do well with leaving me every other weekend. Obviously, I want her to have a relationship with her father or I would not have had her in therapy for almost a year even though her father refused to participate, and he was the problem. I was more willing to force her to go with him before her diagnosis, but now this is a matter of life and death, and I am horrified that he does not understand everything that goes into her diabetes management because he has never had to deal with it for longer than a few hours. Please help!

Answer:

I agree that it is important to know basic diabetes management skill when you care for a child with diabetes. You may wish to ask him to have frequent phone contact with you regarding her management until you are comfortable with his choices. However, it is beyond my purview to tell you if he is ready for that responsibility.

MSB

Additional comments from Lois Schmidt Finney, diabetes dietitian:

I think your concern is about low blood glucoses possibly occuring during the night, so perhaps the insulin that peaks during the night can be reduced and a bigger snack given. She will probably come in higher in the AM than you would like, but we have to start somewhere.

She really needs to know that she has two parents pulling for her, and I wonder if your "ex" feels he can never measure up. If he only will have her for one night, I think he will do fine with the above guidelines, but if he is to have her for a full weekend, it would be good for him to obtain additional training in diabetes care.

Kids spend nights at their friends' houses all the time, and we do not expect their friends' parents to take additional training. Your daughter may want and need to call you fairly often from her dad's since she has the separation anxiety, but as she sees that her dad loves her and wants her, that should lessen. Actually, his doing eight injections and 20-30 fingersticks for her, is quite impressive!! As stated before, keep all talk that is negative about your spouse out of her little ears.

LSF

[Editor's comment: If spending the night with her dad was a routine prior to your daughter's diagnosis, it is important that this routine be reinstituted as soon as is safely possible. Given your daughter's previous separation anxiety, delaying it will only make things worse. However, I do completely understand your concerns and have some suggestions.

  1. You need to discuss your concerns with your ex-husband and outline a plan. The fact that he cared enough to participate in the initial diabetes education is commendable (a lot of ex's don't). Keep in mind that giving eight injections and doing 20-30 blood sugar checks may not be as few as you think. How many did you actually do before you took your daughter home and started caring for her? Everyone gets better with time, and it is only with living with diabetes on a daily basis that people become "experts." Also, keep in mind that you, yourself, made some mistakes, everyone does.
  2. If you are concerned about your ex-husband's skills, ask him to have them evaluated by your daughter's diabetes team. They are the best people to assess his ability to care for your daughter, and can provide additional education if he needs it. If he refuses, this is a different matter entirely.
  3. Discuss these concerns with your daughter's diabetes team. If your ex-husband is unwilling to or cannot demonstrate competence, they can write a letter to the courts saying that your daughter is at risk if she spends the night.

While I realize how difficult it is to "let go", as you have said, your daughter's relationship with her father is important, and diabetes should not become a battleground. Rather, use it to demonstrate to your daughter that even though you and her dad don't live together anymore, you both care a lot and are able to work together to effectively to manage her diabetes. Try to put feelings aside, and give your ex-husband the opportunity to try. SS]

DTQ-20011022133025
Original posting 26 Oct 2001
Posted to Other Social Issues

  
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Last Updated: Tuesday April 06, 2010 15:09:26
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