It’s Just a Number
One of the best messages I learned at diabetes camp is that there are no bad blood sugars, no bad numbers. Instead, the advice we got was to treat any blood sugar as a piece of information. “Just a number,” they taught. A bit of data to respond to: If high, add insulin. If low, add carbs.
My son used to joke about this. “Right,” he would say, snidely. “So if I’m 42, we’re totally calm about that. No need to hustle.” (Okay, so he was on to me; there’s still nothing that makes me more anxious than a solid low blood sugar.) And yet, the message is valid.
Blood sugars are just numbers. And we get lots and lots of them through the course of a day, so many that we’re inundated. It was a lot of data back before CGMs, when our kids were doing regular finger sticks; now it’s a flood. If we allow ourselves to get tugged around every time our kid is over 200 or hits 70, we’re going to spend way too much time in a high state of stress. It’s going to look like our life is a constant emergency. What’s more, we’re actually going to be communicating the wrong message to our kids. Of course we want them to know that diabetes is important and that they should pay attention to out-of-range numbers. We want them to learn how to take care of themselves and be independent. But we don’t want them to panic or get anxious.
And communicating that anxiety can backfire. I’ve worked with a few different people with type 1 who would never check their blood sugar. (Nope, they weren’t on CGMs, either.) But it wasn’t the discomfort of the prick that was the hurdle — it was the voice in their heads that told them that they were bad if their blood sugar was high. This is a common enough experience that I’ve run into it several times. These poor kids were worried about being a disappointment if they weren’t in range. And who is in range all the time? They had so internalized the “bad” of high numbers that they avoided basic self care. Definitely not what we want for our kids.
Another important consideration: Research shows that over ninety percent of kids — and teens especially — lie to their parents. The number one reason they do this? Because they don’t want to cause conflict or tension with mom or dad. You know where I’m going with this: If they think that you are going to be upset because their blood sugar is out-of-range, you can imagine what they will do. Sure, it’s harder for them to lie to you when you are tracking them on a CGM, but it’s still a good idea to think about how to create a safe environment for them to admit that they forgot to dose, or ate that extra cookie.
I know that all of this is tough, especially when your child is newly diagnosed and you still believe that if you work hard enough, you can prevent the highs and lows that you see on that CGM roller coaster. And it’s hard when your child is still growing (and aren’t they all?)— or in a particularly intense growth spurt — and the numbers never seem to be in range. We have panicky thoughts about the long-term medical consequences our kids will suffer if they don’t have a shiny A1c. But we have to think about their mental health, too. If we want our children to have a reasonable relationship to their diabetes, we need to shine a light in that direction. It might be that it’s a fake-it-till-you-make-it moment: You act calm about the numbers and talk calmly about the numbers until you actually recognize that the house isn’t burning down every time they are high, that there is no emergency. You just add insulin.