No bolus

J. is my 12 yr old daughter. She was dx with type I in December 2006 and is now in 7th grade. She’s been using the minimed/medtronic insulin pump since March 2007.

We’ve had a few ups and downs with J.'s blood sugars. Her last A1C was awful. Over 14.

I’ve been encouraging her to work diligently since May to bring her A1C down, to get better control by bolusing each time she eats, checking bg regularly, logging bg numbers. Some days she does well, some days are a struggle from the time she wakes up until she goes to bed.

Here’s what happened this afternoon:

J. was very mean and not her usual happy self when I got home from work and asked her to help bring in some things from the car. Then when I saw her having a snack- right before dinner - I asked if she’d done an insulin bolus to cover the carbs in her snack. When she started yelling, I asked her to check her blood sugar. She threw down the snack and started yelling for me to leave her alone. I made her let me check her insulin pump and saw that she’d not done a single insulin bolus (to cover food) since yesterday at 5:45pm. We ate dinner around 7pm on Monday. It’s now almost 7pm on Tuesday.

I made her check her blood sugar and it’s 245. Not as high as I thought it would be. Her higher afternoon bolus and her mile walk home from school must have helped lower it some.

I’m worried about her. And exhausted from worrying about her health and her attitude regarding herself and diabetes. It’s so hard to know what to do to help, to encourage good behavior, to discourage poor choices, to discourage self-harm and encourage healthy habits.

I don’t know how else to help her. Any advise? What do you do to help your child gain better control? If you have diabetes, what did your parents/family members do that was helpful to you?

Ok, so I am sorry your daughter is having a rough time/rebellion to caring for her diabetes…middle school/that age is so stressful and awkward already
Here are my takes on a few strategies, take em’ or leave em’

  1. Has she ever been to diabetes summer camp,or teen support groups?? That is a must~~ Does she have friends/contacts with other diabetics??
  2. Maybe, have a loving/calm/supportive motherly sit down conversation with her expressing your concern love… and to just lend an open ear without, nagging/blaming ect. give her a chance to express her feelings and ask her what you could do that would help her or motivate her let her know it’s ok
    3.maybe having her hear from an adult/older diabetic of the importance of care now…and how they lead a normal life since caring for diabetes due to the reality of complications
  3. If this cycle continues, you may need to talk to the school nurse and have her daily check in with her, and have her keep a log to monitor her lunch boluses and blood sugar checks to make sure she does it which I know she’d hate but if she won’t do it herself…

just stay positive, try not to worry too much, know she’ll come around with time more than likely it’s just a stage, she should grow out of it and see the importance of her care
hope this helps some~~~~

Also, do you know the reasoning behind her not taking the insulin? Was she just forgetful,is so set alarms or call to remind?? or was it on purpose… I have heard(their have been magazine articles on the such) of girls skipping insulin dosages for attempt at weight lose idk just a thought

Do you think she didn’t bolus because she forgot or is she concerned about her weight? I have been reading about girls who do not take their insulin because they think it will make them fat. It seems to be a kind of eating disorder. Do you think some counseling might help, or even family therapy to help you all through the upcoming teenage years? My heart goes out to you. We had some rough times with my stepdaughter when she was 12-13 and some harder ones with my son at 15-16 years. But they are both doing well now in college. A friend once said that we want our children to make their mistakes when they are still at home so we can help protect them from the worst consequences. The hardest part for me is that you really can’t make someone take care of themselves. My son tore his ACL and didn’t follow through with his physical therapy. He just didn’t show up to appointments or do his exercises. Now, several years later, he is much more responsible and has managed to get most of his range of motion back, but it was agony for me at the time. I hope things improve soon. Let us know how it goes.

Thanks, Joy! Good suggestions. She’s been to diabetes camp and LOVED it! She’ll go again next summer and most likely for winter session (the week between Christmas & New Year’s) too. She has a few really good friends who have type I, but they don’t live in the same city as us. She texts and emails them, but doesn’t get to see them as much as she’d like. Ithink I’ll work to help make more visits possible.

I think the reason she’s not bolusing at school is because when she pulls out her blood sugar meter or insulin pump, she’s different from other kids. She’s the only Type I in her school.

I’ve heard about girls skipping boluses to lose weight, too. They talked about it at camp… about how unhealthy it is.

I’m going to call the school nurse and J’s school counselor tomorrow and ask them to help us with this. Last year, the school counselor was VERY helpful with a teacher who wouldn’t let J. go to the bathroom to check her blood sugar before lunch, since she didn’t want to test in class.

Please post additional ideas if you come up with any!

Thanks, Libby. We’ve worked with a counselor who specializes with kids who have type I diabetes. I think it’s time to call for another appointment. I’m not sure that it’s diabulemia (is that what it’s called?)… I think it’s more of wanting to not be different from her friends. I will speak with her about it, though.

Knowing possible complications never got me on the straight and narrow and I think at the age of 50 and haviong Type 1 for 42 years, I still don’t have an overwhelming fear of complications otherwise I would be eating like a saint and never touching a drop of carbs. I have feared complications all my life, but I hated when that subject was brought up and obviously it did not stop me from walking the straight and narrow with my diabetes. I still have not figured out why not. I do aim now for good bgs, but I don’t try to avoid them by not eating carbs or exercising when I am high. Complication talks to me are not a good tool it just frustrates us more and makes the guilt enormous at least for me. I am not saying that we should not be made aware, but using that talk as a tool to compliance is not the way to go. The feeling good talk is a better route. How great we feel when are bgs are under good control. Man I have a lot to say tonight :wink:

Thanks, Karen. (this is much easier than twitter - since we can type more than 160 characters, huh?) :slight_smile: There’s a fine line with J. between what works and what completely turns her off when talking about diabetes. Telling her that I’m asking about her numbers because I love her (when she’s yelling that I don’t need to know) works better than telling her I’m asking because I want her to still have her legs in 50 years.

She seems to think I’m badgering her when I ask her to check her bg or how much insulin she thinks she needs for certain foods. I’ve found, though, that if I don’t ask, she doesn’t bolus at all. Not sure if I can let go on that one, knowing that she will very likely not bolus for days on end…

I will keep talking with her about how good she feels when her bg is in range. Hoping that will be the key.

I don’t quite get the not bolusing thing and yes of course you have to check, sounds like hourly. I do know sometimes I hate the fact that it is time to eat and I have to bolus and that my outcome might not be good and I might go low, which feels so gawd awful, so that might be a thing she is dealing with, but hunger always wins with me.

I use to make sure I was high going into a social situation or even to the doctor so that I would not have to worry about dealing with a low in a public situation.

For 6 years pumping I have never forgotten to bolus, I have not wanted to bolus for the reasons described, but I so hate how I feel on a high. She had a few good weeks so remind her of that, this might just be some sort of fear factor, and I feel for her. Bye for now. :slight_smile:

She just told me that she doesn’t bolus at school because she’s mad at me. I’m not buying that one.

I’m sure the truth will come out. She tends to come talk to me when I don’t ask or act like I want to know, so I will let it lie and see what happens.

I was still on MDI’s when I was in high school (and college) and wasn’t taking very good care of myself. My mom pretty much had handed my diabetes care over to me totally by the end of freshman year of high school, so she didn’t ask too many questions. I wonder what would have been different if she had? I did okay in high school (most of my friends had known me since kindergarten, since we live in a small town, and it wasn’t a big deal), but college was a different story.
I let life get in the way. I didn’t not take my shots for a particular reason. I just didn’t do it sometimes. It wasn’t to loose weight or for controll or because I was hiding it. I think I was just lazy.
But a very wonderful doctor (and friend of my family) told me that with my A1c of 12.1 I might as well not finish college cause I was going to die. Some people tell me this was too harsh and horrible bedside manner, but it’s what I needed to get back on track.
Tell her about TuDiabetes. And search some diabetes blogs. These are all places that she can read about, talk with, and get to know other diabetics who are in her place, or have been in her place.

I will do that, Cara So far, she’s not been interested in diabetes communities online. I’ll mention them and she will search when she’s ready. You know… that whole “you can lead a horse to water” thing.

At this point, she’d probably not participate if I acted like I want her to. Maybe I should say it’s forbidden for her to visit here. You all might see her around 24/7 that way! :slight_smile:

hhowdy Natilie,

It sounds like J is in a rebellious stage. Probably the best think you can do is let go. She is old enough and expeienced enough that she can handle the day to day routine of her own maintenance. If she has any problems I’m sure she can recognize them and solicite your advice if it is too much for her. She maybe perceiveing your concern as meddling.
I am a grandpa now, but I remember the difficulty of transitioning from my children’s director to their cheerleader.

Good luck and best wishes

Hi Natalie!

This is such a hard age for any kid-- with or without D. D makes it even harder.

I can relate to the feeling and I used to intentionally not bolus out of rebellion. It took me a while to realize that it didn’t make any sense to do that.

One idea is to get the remote for the Minimed pump. That way, she can give a bolus without pulling out the pump.

I definitely agree that nagging doesn’t help-- but perhaps expressing to her that you trust her to manage her diabetes, but ask her to let her know how you can help. Although she is old enough that it is good for her to be taking responsibility, it may help to know that she’s not totally on her own??

Thanks, Danny and Kristen, for taking time to reply!

We have a remote for her pump that I got for her last year thinking it would make lunchtime easier for her. She says she cannot hear it very well in the noise of the cafeteria. I will encourage her to try it again.

I’m working on letting go, letting her know I’m here and just being the cheerleader. It’s really hard, though.

I sound like a control freak when I read those two sentences, but I don’t feel like one. Hmmm… maybe that’s something for me to think about. :slight_smile:

I am with her on this one… I was diagnosed when I was 10 and I was the only one with diabetes in my school of about 500. No school nurse was present either. So it was really rough. I was on MDI’s in highschool, and I would skip doing a shot because I knew the other kids were watching, and I hated being different. I regretted later, when I shot up and felt horrible. My mom was always there for me…but I would get mad when she was so caring. I guess it was just those rebellious years. I never got a chance to meet other kids with T1 or go to a camp…She is very lucky to have those opportunites and I hope she realizes it =) She is also very lucky to have such a caring, well-knowledged mother! I know quite a few younger ones that totally dismiss their diabetes, because the fear of being different. She will embrace it in her own time…Hope all goes well =)

Sugarrbabie05, Thanks!

She did better yesterday and mentioned how much better she felt all day when I asked how her day went. I’m hoping that realizing how much better she feels when she’s in her goal range will encourage her to be more careful.

GREAT NEWS!! Yes, how you feel now is a good incentive to keep those numbers in range! Sounds like she will be just fine :slight_smile:

Diabetes is hard and especially hard when you are young. It can take many years for someone with D to really decide to take care of themselves. She is probably going through that stage where it is transitioning from you handling it all to her handling it. Just support her and be there. One day hopefully she will decide that feeling better is more important than hiding or using D as a way to hurt you.

I hope so, too, Erin. Thanks. :slight_smile: She still feels good today and has been testing. I asked her how her day was today and she said she’s feeling really good. Her bg before dinner was a little over 100 (her goal range is 80-150).