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Question:

From Samos Island, Greece:

My 14-year-old daughter has had type 1 diabetes for about four years. For the last 16 months, she has been using an insulin pump. We never had a problem with her from the first day we found out she had diabetes. She has a very strong character and has taken it very well. She doesn't mind telling she is diabetic. She used to do shots in front of anybody and still talks to everyone about her diabetes and even informs her friends, family and teachers all about diabetes, how her pump works, etc. Her doctor even once had her on a t.v. show to show other kids how normal it is to have diabetes. I am very proud of her. However, for the last four or five months, she has been forgetting to bolus after meals or snacks. I try very hard always to remind her, but as a mother of four children, I am not always around when she has a snack. Now she is saying that I am overprotective! I don't want to cause her problems, but please give me a suggestion about how to help remind her to bolus. Her A1c is high, 10.2.

Answer:

Your daughter has been remarkably mature and independent with her diabetes care and the whole family should feel very proud. Diabetes is exhausting and the fact that she has done so well for so long is a testament to the support she has received from her family as well as her own independence and strength. However, almost everyone with diabetes experiences a time when the demands of the illness are just too much. It may be that this is that time for your daughter. In addition, the most common concern for individuals using pumps is that they miss boluses for their meals. So, it's important to know that your daughters struggles are very common, even if they are concerning.

My recommendation is to read Diabetes Burnout by William Polonsky, published by the ADA. My other recommendation is to take over bolusing your daughter for every meal for which you can possibly be there. That will minimize the missed boluses and improve her A1c without giving her more to do. This will take only a minute of your time or less for each meal, so if you are available at breakfast and dinner, then that's two-thirds of her meals!

JWB

Additional comments from Dr. David Schwartz:

It is a normal developmental stage for early teens to want to be more independent from parents and want to fit in completely with their peers. Any perceived "difference" often is magnified many fold to the teen, who thinks that their peers really give a darn. So, while your daughter has been great up to now, this is exactly the time, in my mind, that she needs MORE parental oversight, especially in regards to her diabetes. I agree with Dr. Weissberg-Benchell: give your daughter a "diabetes vacation." YOU take over ALL (or as much as you can really can) her daily diabetes routine: sugar checks, insulin dosing, etc. Tell her you understand that she's worked so hard for the last few years and she deserves as much of a break that you can give her.

While insulin pumps are fantastic, teens (and adults) often get into the mindset that the pump is "an artificial pancreas" and will fix things. One particular pump, the Cozmo pump, will alarm if there has not been a bolus in a while to help remind the patient. You could set an alarm watch to ring with meals, too.

Ultimately, maybe she needs to take a break from pumping and go back to shots!

Furthermore, I would do all this with a "contract" with your daughter that spells out specifically what you will do and what she will do and also details the rewards and consequences if you do not uphold your end of the negotiations.

My experience is that the young people usually get the message and do, in fact, want their parents to butt out and then start to be more responsible again. But, this might not happen until she turns 17 or older.

DS

DTQ-20080121053753
Original posting 28 Jan 2008
Posted to Behavior and Daily Care

  
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Last Updated: Tuesday April 06, 2010 15:10:16
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