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Question:

From New Jersey, USA:

My seven year old son, who has had type 1 diabetes since he was four and a half years old and just started pumping is have a problem at school. His morning teacher states that at times he is obnoxious, fresh, and nasty to his friends, while his teacher vehemently disagrees with this. The afternoon teacher has stated that he is "delicious", "delightful" and "kind to his peers" (all of which I agree with!). Apparently, he is awful in the morning and wonderful in the afternoon.

As per the am teacher's suggestion, we had him see a therapist so we could figure out what was going on. I think part of the problem is that his numbers, for whatever reason, seem to fluctuate much more in the morning than in the afternoon, despite making many adjustments in dosing, what we feed him, etc. When he is low, the morning teacher has been understanding that he should not be penalized for acting out. This is what his endocrinologist had told us, and everything we have read says that kids with diabetes should not be held responsible for being difficult, stubborn and even physically lashing out when blood glucose is too low.

However, now the teacher and the therapist have said that perhaps it is too confusing for my son to differentiate between bad behavior caused by a low, and just plain bad behavior. (When he acts like this, he always tests right away, and it is documented on a chart if the behavior could be attributed to a low or even a sudden drop in levels.) He can also act like this and be perfectly in range. This is where it is confusing to them. They want to know if it is at all possible for him to control himself when he is low. The teacher says he thinks my son can because when he told my son that if he didn't stop pushing the kid next to him (when he was low), he would call the principal, he stopped. They think that he needs a clearer standard of acceptable behavior, no matter what his blood glucose level is. They want to say, "Okay, you feel low, but you need to keep your hands to yourself," but I don't think his brain is functioning so well at that point, and that makes it harder than usual to control his behavior.

We only punish (remove privileges, etc.) when his numbers are in range. When he is low at home and acting out, we treat and move on. I told the teacher and the therapist that I would consult the experts to see if it is at all appropriate to expect him to keep his hands to himself and a civil tongue in his head if he is experiencing a low. My opinion is absolutely not. What do you think?

Please don't tell me to get a 504 since he is not eligible for one (private religious school), and please don't tell me to home school. It may work wonderfully for you but it is not for us. Any other ideas?

Answer:

You never state how low he is when he tests and it's low, so it's hard to answer your question. However, here are some guidelines: First, please work very closely with your diabetes team to smooth-out his morning numbers. The advantage of a insulin pump is that you are able to manage the fluctuations in numbers better than with any other form of insulin administration. So, with close collaboration with your team, your son should no longer struggle with lows in the morning. (I'd even consider running him a little higher than usual for a week or two to see if his behaviors differ).

Second, misbehavior, especially physical aggression towards peers can just never be excused. It is rare for children, even if they are very low (under 60 mg/dl [3.3 mmol/L]) to become physically aggressive. However, it is common for them to become irritable, stubborn, and nasty.

That said, I agree with your strategy to check blood sugars immediately upon misbehavior to determine whether or not he needs treatment. If he is low (less than 70 mg/dl [3. 9 mmol/L]), then treat his low and have him do something nice to the person he harmed once his sugars are in a safer range (write an apology letter, carry that person's books to the locker, make them a picture, etc). This will teach your son that he must be responsible in some way for his misbehavior. However, if he is not low, a more immediate consequence such as loss of privilege in the classroom that day, should occur.

Third, ask the teacher or your son's therapist to observe his behavior in the classroom in the morning. Is there something about the course materials, his seating assignment, the structure of the class, that is more difficult for him in the morning than in the afternoon? Finally, observe your son's sleep patterns carefully. Does he get enough sleep (at least 9-10 hours per night)? Does he sleep through the night? Is he well rested? Many children are sleep-deprived and their behavior is a reflection of this.

JWB

DTQ-20021214234916
Original posting 15 Feb 2003
Posted to Behavior and Hypoglycemia

  
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Last Updated: Tuesday April 06, 2010 15:09:42
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