This is a very difficult line for us to walk. We are right in the thick of it, right now, since my son is a precocious 13.5 year old, who has been in puberty for a year.
I can’t force my kid to do anything he does not want to when I am not around, even if I want to. But, really, my goal is multi-fold:
- I want to turn his body over to him when he is of age as unscathed as possible from the accumulating damage of diabetes
- I want his BG managed day to day as best as possible according to the above
- I want to teach him to manage it himself, so that he will do a good job when he is on his own
- I want him to survive college and young adulthood: survive with his life (I am using the precise wording I mean here: just survive through college is a goal of its own).
So I cannot afford to make diabetes a point of contention between us. I am a directive person, but this is something I sometimes tiptoe around.
What we have done:
We have never sugarcoated diabetes. I have explained to him, from day 1, that this is something that he can die from, that there are horrific complications that are possible, but that he is likely to avoid this fate if he does a good job at managing it.
We have told him that diabetes is like a savings account. You start with a certain amount of possible highs in your account. Every time you have a high, you deplete the account. When you get to zero, you get complications. There is no way to fill the account: it only goes down.
We speak to him like a full adult at all times about D, never like a child. And I go in detail about all the scientific issues we ever discuss, as if he was a scientist himself. Since I have always done that (not only about D), he is quite up to speed on these discussions, and holds his own.
From the moment he was diagnosed, we have let him make the ultimate decisions about dosing. I never override him. But I discuss the options and decisions with him from a technical point of view, like two technical experts would. He often takes my opinion, but I have also found that his gut feel is better than anyone in many decisions.
We deal wtih D as matter-of-factly as we can, as a part of our regular daily life. We eat what he eats and when he eats, we do what he needs to do, it’s just a part of life that has to be done. No drama.
We incent him to do a good job. He gets paid $$ when his day is good. He gets $5 for every flatline day, $3 for every day where he took all the right decisions (but it was impossible to flatline due to peaks), and $1 for every day where he did a good job but made easy-to-make (technical) mistakes.
We also have a rule at home, where he can eat anything he wants at any time IF HE DOSES. That includes, ice cream, cookies, whatever. But we also have many discussions about weight control as a PWD and other related subjects. We don’t want him to feel a need to binge in hiding.
How dow it work? So far, it has worked OK, although not perfectly. He does the best he can to control D, using all the techniques we figure out. Some techniques he is better at than others. He is not quite as skilled at stacking safely and as high as possible as we would like, but he does a very good job for a 13-year-old. Despite his uncontrollable daily peaks, his A1c is stil 5.5% right now (it started lower when he was not in puberty).
It is not perfect either. He does make eating decisions that are not always good. He is a kid, after all! He sometimes sneaks food that he thinks we would not want him to eat by dosing with a pen so we don’t know it (this way it does not show on his pump). I think this is very normal for a kid, and I am not worried. A couple of times, he has eaten something sweet without dosing. That stresses me out a lot. It is very rare.
We still determine the rails of his range (for us, 75-120, with a goal of 100), and, so far, he has not disagreed. We also do his night management. What will happen when these change? I don’t know. I hope it will be smooth, but, in my heart of heart, I feel it won’t be. So, right now, this is something that still is in the future and that I somewhat fear.
But not like I fear college. College is what I fear most. I have great hopes for newer technologies for closed-loop pumps, and I hope with fervor that, before college, he will be on one. Today, a 670G would not increase but decrease his control.