This morning I came across a common discussion point for parents of children whom live with Type 1 Diabetes. That of the pre-teen or teenager and the human condition known as “invincibility”. I believe it can manifest at around the age of 12 in boys, and younger in girls. It set me thinking about, not the data sets or graphs, or numbers which we constantly live with (being constant finger prickers that we are) but of the gentler side of approaching feelings and emotions. I know from my standpoint I strongly desire my son to always be pricking his finger (at least 10 times a day please John!) to gain at least part of the days picture of his glycaemic control – but what does he feel/think about this? I know that he sometimes subconsciously gets the finger pricker out, loads the strip into the device and then makes up a song about the number “5.2, eyes are blue you are sweet but I am too” – that’s one of his favorites. However, at times I have also seen the dark shadow under his eyes, the look of “not again!” or “I’m sick of this” or “mum, stop nagging I’ll do it when I am ready”.
So, although technology is advancing with insulin pumps, increased number of daily finger prick tests (incl night checks) artificial pancreas closed loop trials, and continuous glucose monitoring systems such as the Abbot Freestyle Libre system, we also need to ensure patient compliance is met with as much continued support – support that is going to deal with issues as they appear and sometimes, in some cases, as you forecast them.
For example, I see mood swings in my daughter – aged 16 (Non-Diabetic) and I know to run and take shelter at times, but what do you do when this mood swing involves a teen who may or may not wish to face controlling their diabetes? Have you, over the years, allowed for a trustworthy open relationship to build where your child will feel accepted, or have you unconsciously shown judgement on them “why are your blood sugars so high, have you been eating sweets in your bedroom again?” Ashamed to say, that last one was me – or maybe it was his dad… Yes, on recollection it was him, not me! There have been times when I have been a bit of both and have had to “wing it” just as much as other parents, but I do hope that as he approaches teen years – and technology advances, that services will allow for greater support for both him and me. I am his care giver at the end of the day and so much responsibility lies with that.
Being proactive as a parent of a child who wears an insulin pump is always on the cards. For example, he brings home a letter from school to say they are having a fun inflatable’s day. Already my brain is preparing for the calculations to lower basal rates 2hrs pre-exercise and a quiet phone call to the school to plead with them for him to store said pump in a safe place (his equipment costs thousands you know) whilst he does double front flips up and down the length of the gym hall. But proactive support from HCP can be helpful too, to foster an inclusive approach to growing up with Type 1. As an example, if you have 50 patients almost reaching age 13, why not invite them for an evening chat session with other parents and perhaps the dietician. An informal evening, away from clinic where the kids can maybe hear from a mentor? And maybe lock the parents away in a safe, padded room whilst all the teens moan about how awful we are as parents. That kinda thing? And I realise our current healthcare system is already ‘run of it’s feet’, and HCP do an amazing job – and that this would yet another task, to add to them – but local support groups can help with this, and getting communities to volunteer their help also adds to the numbers of helpers – willing to tackle these issues together.
All these “soft skills” may eventually help shape the teenage brain, and try to soften the edge of the harsh, self-critical, teen mood swings to come. I realise this may sound a tad indulgent, I mean if kids don’t look after themselves there are threats given to take the pumps away from consultants etc, but if it can be prevented and the complete melt down or “head in sand” approach can be tackled, it may just be a small miracle. I speak with limited evidence of this, as it is yet to come for me and I have heard many a threatening tone ” just wait til the teenage years, hold onto your hat” etc, and I know it is fast approaching so I write all this preemptively as a parent who is sitting in the wings with a very big, tight hat on indeed. I realise a person has to want to help themselves, but come on, as a teen I remember having a strop if a new zit appeared before school photo day – it’s hardly on the same scale as what my son will have to face. Short from turning myself into a dragon lady and adopting a slightly browbeating personality – I fear I may start looking for a small gite downwind of the cote des Alpes.