My 15 year old daughter recently diagnosed type 1 has been having mood swings. She doesn’t want to eat and says she hates food now. I understand how she can feel this way but I’m trying to find the best way to get her to keep eating with out fighting with her any ideas
More than thirty years after having been diagnosed as a type 1 diabetic at age 14, I was eating by myself in a restaurant and a woman at a nearby table said to her tablemate, gesturing in my direction, “Look at him, he eats his food as though it were medicine, with no enjoyment at all.” That can easily happen when you are trained from an early age that food has to be monitored, controlled, and disciplined by portion counting and injections. The sociologist Bruno Bettleheim once wrote that nothing is as psychologically important as eating with a sense of freedom and unhindered pleasure, but diabetes ruins that. The problem is that diabetes ruins so many things that the more subtle ones, such as this, are generally not even noticed.
15 year olds have mood swings. She’ll eat when she’s hungry. My suggestion, be lenient on the eating thing. Give her wide latitude on everything surrounding food. There are ‘food things’ that she’ll have to figure out. Subtle things. Let her eat what she wants and when she wants. That will give her the widest latitude for learning. Eating will affect how she feels, physically, more now. It’s not just eating, like it is for non-diabetics.
For the record, since sliding scale insulin, I have very much enjoyed eating and do so fearlessly. Let her be the Honey Badger. Put away preconceptions about ‘good’ foods vs ‘bad’ foods.
@Eric31 - I half agree with @mohe0001 (well maybe 3/4 agree) but at the same time you need to be watchful in case this develops into an actual eating disorder. IMHO, girls at this age are particularly vulnerable to eating disorders.
Take time to get used to the diagnosis and don’t try right away for the level of control you see with other people particularly some of the experts on these forums.
Although some times it does seem like a contest to compare this number and that and so on - the reality is everybody is in their own situation. It takes balance.
I find that the only way I can even approach decent control of my type 1 case is by stabilizing absolutely every single variable I can so that I can throw the spontaneous fluctuations of the insulin requirements into sharp relief against the background uniformity. That means eating exactly the same amount of the same kind of food every single meal and every single day, performing the same amount of activity every day, and carefully dosing insulin. Even then, the insulin requirements fluctuate insanely, because of physiological processes I cannot detect and I cannot anticipate, like changes in the weather, in the way the subconscious is processing stress, subclinical infections, etc. But if I let my diet fluctuate so I could enjoy eating “and do so fearlessly,” as has been recommended, then the instability in blood sugars would be crippling.
Just to be sure this is no misunderstanding and coming from somebody who actually has experience with teenagers, this would be seriously horrible advice for a newly diagnosed T1 teenage girl who is already struggling with eating issues.
I get wild fluctuations, but I don’t attribute it to food. Sometimes it’s definitely from food. Sometimes its purely endocrine variables. Are you kinda ‘type A,’ @Seydlitz ? Your system might stabilize with age.
I think I make a conscious choice to ‘eat to feel well/good.’ Laboring over the risks of how any particular food might affect my BG just doesn’t jive with my ability to feel like I’m living a high quality of life. Experience of eating something a couple times, and going high, teaches me that food might not be for me because I feel bad. I can reliably dose off intuition and I don’t think its increased the variability of my numbers, compared with measuring and calculating. I’m sure you could, too. But, that’s personal preference and it varies over time. I think that I get more system stability from accurate basal. I don’t think that my bolus dosages have really changed much in 15 years. I have other obsessive, strange, ritualistic hang ups with food. I quit eating meat at age 7. Long prior to diagnosis, I was regulating my own eating in strange ways. LOL, I couldn’t bear the idea of eating cute animals. What a pain in the a**, p*ssy I was. Poor parents.
Having had a lot of issues with food when I was 15, I would recommend to you to let her eat anything she wants, or to skip eating whenever she wants. Take food out of the equation of controlling her bloodsugars. So let her eat anything she wants and adjust the insulin accordingly. It’ll be hard enough for her as a fifteen year old who has been diagnosed with T1D recently to manage her bloodsugars in the time when her body is changing fast. Physicians who work with teenagers with T1D usually accept a wider range of glucose readings, because it’s also very important for teenagers to be able to develop as a teenager into adulthood. Because I didn’t have a communicative relationship with my parents and they tended to critize my food choices without speaking about it openly, I started to eat secretly and developped an eating disorder for many years.
Fortunately, I don’t suffer from an eating disorder any more, but I still try to eat everything I want and adjust my insulin accordingly, because I hate the feeling of being restricted in what I want to eat or am allowed to eat. As I have grown older, I find it’s becoming easier to make choices of what I’m going to eat or drink because of the effect it will have on my glucose readings (like deciding to eat a cereal with less added sugar in the morning because the bloodsugar spike which happens everymorning anyway because of hormones will be a little bit easier to manage), but I still try to eat whatever I feel like, without being too obsessed with the effect it will have my glucosereadings the best way to manage my T1D.
So if her bg is below her target number and I let her skip a meal it’s ok for her to go with out the bolus for that time,that is what scared me yesterday when she didn’t want to eat dinner.
I think with teenage girls a lot of the faddy eating is an attempt at taking control from the parents. I understand how you feel, but if you fight over it I reckon it will get worse. Do the whole family eat like she is supposed to eat, it would make things a lot easier for her if so. Good luck!
If it works for you it’s cool, but I could never eat that way. My sister makes great pies, my brother-in-law has learned how to bake bread like a pro. True, I only partake of their food two or three times a year, but how could I NOT eat a slice of apple pie with Calvados (apple brandy) pooling at the bottom of the crust!
I am eating the way nutritionists recommend we do. Balanced diet. Limited portion sizes for my carb totals. Not low-carb at all!
My A1C is fine (6.2% a week ago). Food is not the enemy. Too MUCH food, poor nutritional choices and not enough exercise or insulin is the enemy. Oh, and hand bell choirs.
@Eric31 - It is certainly possible her Endo has her on a different insulin therapy approach then us. I can tell you how it works for us and you can decide if it is similar or not?
We are running a basal (background insulin) to keep her BG steady in the absence of food. So if she doesn’t want lunch - it doesn’t matter. She does not need the bolus for lunch because the bolus is specifically for the food - not for that time of day. Her basal keeps her steady through lunch whether she eats or not. When she does eat lunch and if she has the bolus at the same time as lunch then her BG will rise up as the food hits first then slowly come back down as the bolus starts to work. To mitigate this, we will try to pre-bolus but that is where the fine tuning comes in and not something you need to tackle right out of the gate.
Point being - not eating is fine (from an insulin perspective). The bolus goes with the food. Or if no food then no bolus. Either way is fine.
Now when you say “… her BG is below her target number …” well - that is not quite the same as saying her BG is low. What is her target number and is it a range or a particular number. As well, what number do you consider to be going low which should be treated?
Again for us, perhaps a daytime target is 100 +/- 10. So if she is at maybe 85 at lunch, she would be below target. But not low. So if she feels fine with no symptoms and is not hungry - no big deal. No food, no bolus.
The other reality is that trying to get the basal actually proper to maintain a level BG without food is not the easiest thing. You are on MDI (multiple daily injections) - correct? So you would likely be having one basal (long acting insulin) per day for the basal.
Sorry for being wordy but hopefully it makes sense and helps a little?
I’m not sure this is anything but a “me too”, but I was diagnosed at age 14 and the thing I hated the most early on was the concept that I had to eat even if I wasn’t hungry. Because my bg was low or if I didn’t eat my bg would be low. Hated hated hated the concept.
Now, it probably didn’t help that when my bg was low I was jittery and irritable from the hypo, either.
Somehow I got used to it. Maybe I got more used to it as I felt more in control with bg testing and insulin dosing being m responsibility instead of a forced fixed schedule.
Today with basal/bolus insulin (either pump or MDI) things can be a little more flexible but they aren’t really all that flexible.
If her BG is below target, then she needs 15g carb. But, it is probably OK for her to skip meals. Depending on what the doc set up. If she’s a new diabetic, then she might not have ALL the tools and tricks that the rest of us have. Is she on Lantus and Humalog that she injects with a syringe?
Yes lantus at night hemlog for meals and she is very new we haven’t seen anyone since leaving the hospital. They have her taking shots after meals untill we see them next and talk about pre meal bolus. I’m getting advice from both sides to let her eat what she wants but I believe the healthy lower carb meals are helping.
If nothing else, lower carbs means less insulin which means less chance to “miss the target”.
“Aim Small, Miss Small.”
When you get advice, my suggestion is to bear in mind if the advice is geared towards an experienced adult diabetic or is it actually geared towards a newly diagnosed teenage girl diabetic?
As for my carefully controlled plan of eating exactly the same food at the same time every single day for years on end, as well as expending the same amount of calories everyday, I don’t do either of those things directly to control the blood sugar. Rather, I do those things because my insulin needs, even with all that discipline, still fluctuate wildly, showing the massive influence on blood sugar of internal physiological factors which cannot be measured, since they don’t depend on any factors we can count or control. If I didn’t do something to create a bit of stability, such as always eating the same thing at the same time and always expending the same amount of calories per day, then the intrinsically colossal blood sugar fluctuations would be so overwhelming as to kill me with hypoglycemia in short order. I simply can’t afford changing dietary intake, changing eating times, and changing activity levels to add yet further chaos to the intrinsic irregularity. But, as they say, your diabetes may vary.
Having been diagnosed in 1966, old ideas from the pre-insulin era still predominated among endocrinologists, so mine at the Joslin Clinic thought I had to be starved to be kept from ketoacidosis. As a result, photos of me from that era show a lad playing the violin who is so skeletally thin that he looks like the figure of death in the Danse Macabre. I was so hungry all the time that the only thing I dreamt of in those days was food. Everything I ate was predetermined by the officially prescribed diet, and all my food had to be weighed on a scale and consumed on a strict timetable. Not a good way to live as a teenager to cultivate a positive attitude toward eating.
Most important is to let her learn from experience. That bread made me go up. The brussel sprouts had cranberries in them. Walking this far burns off how many glucose numbers. Give her a meter. Let her experiment. It’s like a game.
In think it’s important to stress to you and your daughter that you are both on a huge learning curve about living with T1D and also the major task of developping into adulthood. Both tasks are daunting and you both should be as easy on yourselves as you can be.
When I was a lecturer for nursing students I used to give them an assignment of a (semi) fictional 16 year old teenager with T1D who wasn’t taking good care of herself by skipping insulin injections. I asked them what would be the appropriate advise for the young teenager in regards to her diabetes management taking into account her psychological development (this was a course on pediatrics). It was always very interesting to hear what the students (most of them where 18-20 years old themselves) had to say.
I tried to teach them that it’s very important to take a individualized approach: the one-size-fits-all doesn’t apply to T1D management and you have to be even more flexible when it comes to dealing with teenagers and T1D, because it’s also very important for teenagers to develop just like “normal” teenagers are alllowed to do.
I got the (semi) fictional case from a Dutch medical journal. You can find an english translation of the summary here: Diabetesbehandeling bij kinderen: intensief is niet altijd beter | NTvG
My type 1 daughter also has mood swings, she’s only 10 so I have a feeling it’s mostly personality. But when her blood sugar is high, watch out, then’s she’s super cranky! But most of the time she’s fun and lovely, so we take it as it comes.
The only advice I will give is to make sure she knows that you are on her side, that it’s not a her vs you thing. That you aren’t making decisions for her that make her upset etc, that its a partnership. You want her to succeed at this just as much as she does. But maybe now that she has type 1, she just sees food as confusing and frustrating. You can’t just go grab a snack anymore and eat on your way out the door. Food is work. It’s counting carbs, taking insulin etc. For her it might just seem not worth the effort.
So maybe for this first while, make a list of 15 carb snacks and stock the house with them. Or take her favourite foods and make a list of them with their portion sizes and carb counts and tape the list to the cupboard. Make it easy for her to eat by taking away all the work and effort, and give her some leeway. You could even help her create a meal plan the day before so she knows what she can look forward to the next day and have portion sizes and carbs figured out for her so eating doesn’t seem so much effort, does that make sense?
You just need a plan to get through this difficult time to the point where it becomes your new normal. And it does, counting carbs becomes second nature and my 10 year old daughter barely needs help from us to decide how many carbs to program into her pump, she’s a pro.