We generally try to shield young children from the scarier parts of life. As a parent of a child with type 1 diabetes, you know just how serious a severe low blood sugar can be — but how much does your son or daughter really need to know?
For children and teens becoming more independent in counting carbs and checking blood sugar on their own, talking about worst-case scenarios may seem like just too much for kids to handle.
That was what Lauren, a mom from Michigan, thought after her son’s diagnosis at age 12.
“In teaching my son Matt about lows, my message was that you treat lows so diabetes doesn’t slow you down. I didn’t want to force him to contemplate that a severe low could actually result in something much worse than being slowed down.”
For a while, this approach worked. Matt adjusted to his diagnosis and did a good job managing care tasks. Then, last spring, Lauren received a call from Matt’s school. Matt had developed a severe low and passed out. EMTs were called in for emergency treatment.
Matt quickly recovered, but Lauren was mystified how such a severe low developed in the first place. The mystery was solved when one of her son’s teachers called.
“Two of Matt’s friends told the teacher that Matt had been planning to get out of the big math exam and had not eaten anything that day so he would go really low right before class. He thought he could just spend the period in the nurse’s office drinking juice,” Lauren explained.
The information left her shell-shocked. “I couldn’t wrap my brain around my son’s decision to risk his life to skip a math test. But then it hit me. Did he even know he was risking his life? Did he truly understand the consequences of a severe low? It stopped me in my tracks, because I realized, why should he? This was a part of his diabetes that we never talked about.”
In the quest to help children with type 1 diabetes adjust to their diagnosis, parents may decide to skim over certain aspects of the disease to focus on the bright side: that counting carbs and calculating insulin and testing and adjusting to stay in range can help children with type 1 lead perfectly normal lives.
Helping children with diabetes develop a positive and motivated mind-set is a good thing. But leaving out certain information also creates a blind spot that can put them at risk.
What can parents do to help their children understand severe lows without becoming frightened of them?
Spotting the Signs
How you explain diabetes complications to children will depend on their age and maturity level. But as a first step, all kids with type 1 can be taught to recognize what a low blood sugar feels like — and how to get help.
“Even young kids can learn to recognize signs of a low and how to tell their caregiver so the caregiver can perform a blood sugar check [and treat as needed],” says Ronald Hoyler, R.N., a certified diabetes educator at Children’s Mercy Hospital in Kansas City, Missouri. “If you’re a parent of a newly diagnosed child, you’re learning to spot signs of a low right along with your child. Let your child know the signs and behavior changes that made you stop to check their blood sugar.”
How you treat the low is important too. As Hoyler notes, when kids come to view lows as a chance to receive a sweet treat, it can sometimes set the stage for less-than-ideal habits to form.
“If parents are treating lows with foods like soda and candy, kids are quick to catch on that ‘If I go low, I get a treat.’ Kids may then decide to only eat half their meal because they know they will get the treats when they go low. This can set up a dangerous pattern.”
Instead, Hoyler recommends choosing “non-treat” foods for lows, like glucose tabs or a glass of milk, which contain rapidly absorbed carbs but not the same sugary appeal as soda or candy. If you’re stuck for ideas on foods to treat lows, ask your diabetes care team to give you a list of foods that are convenient and effective. Sometimes candy or soda is the only available food to treat a low, and that’s okay.
Kids may also learn that lows can be a form of manipulation to avoid chores, homework, or virtually any activity they find unpleasant. Of course, out-of-range blood sugar can and does happen at inopportune times, even when kids have the very best of intentions. But look out for strange patterns that emerge. “When lows start to become a pattern at school, for example, it’s time for parents to get in touch with teachers and the nurse to find out what’s going on,” Hoyler advises.
After Matt’s incident at school, Lauren talked to him more about his math class. As she found out, “He had really fallen behind and was too embarrassed to ask for help. So we worked it out where he would go in after school for a few days to get extra help and take the math test that he missed. He needed to be held accountable for that.”
Lauren also stayed more tuned in with Matt’s blood sugar numbers throughout the day. “He agreed that he would text me his numbers at 9 a.m., noon, and 2 p.m. This helped us get through a tough time.”
Having the Talk
As kids take on more responsibility and independence in their care tasks, such as being able to access settings on their insulin pump or being responsible for checking their own blood sugar most of the time, then it’s quite simple: They need to understand the consequences of what can happen if checks are skipped or boluses are incorrectly administered.
“Talking to kids about lows can be hard. You don’t want a child living in fear of diabetes. You want them to understand diabetes so they can make good choices,” says Hoyler.
Approach teaching children about diabetes emergencies in a calm, clear way. You can enlist the help of your diabetes educator to use appropriate language and answer follow-up questions your child may have. Every child will be different in how they respond to this information, so provide follow-up support as needed.
“As a special way to connect with teens, talk to them about driving. Did they know that if they get pulled over as a consequence of erratic driving while low, they could end up being charged with a DUI and/or have their license suspended? Those kinds of consequences are very real to teens,” Hoyler notes.
“When I finally sat down and talked to my son about severe lows, I was amazed by the number of questions that it triggered,” says Lauren. “He wanted to know what would happen when he was on his own — how could he be prepared? It was such a good conversation. We ended up making an appointment with his diabetes educator to do additional teaching on preventing and treating emergency lows.”
As for waiting a few years after his diagnosis to finally talk about the seriousness of lows, Lauren now feels a little better about the timing. “That incident at school was the wake-up call that my son needed a lot more information about his diabetes. But it was also my wake-up call as a mom that he was ready for this information. In the end, he’s now more responsible with his type 1, and that’s a silver lining I will take.”
Disclaimer: The experiences and suggestions recounted in these articles are not intended as medical advice, and they are not necessarily the “typical” experiences of families with a child who has type 1 diabetes. These situations are unique to the families depicted. Families should check with their healthcare professionals regarding the treatment of type 1 diabetes and the frequency of blood glucose monitoring.