Sweet Talk for Parents of Kids with Type One Diabetes

For many parents, with or without T1D, food triggers so much baggage and confusion. On the one hand, we want to serve what’s healthy and limit “junk” food. We also don’t want to be overly restrictive: We know that as children get older, it’s going to be up to them to start making their own smart choices.  And if we never give them chips or ice cream, there’s a good chance they’re going to opt for that when they finally have the chance.

And how much more complicated is this when we fold type 1 into the mix?  We want our kids to have good glycemic control – and it often feels like that’s about restricting food choices.  How’s a parent going to win this one? 

Together with fellow T1D mom Annie, JoAnne talks through a question written in from Health Food Mama in Detroit, who explains that she has started finding wrappers in her 9-year-old daughter’s room.

“She’s sneaking food,” writes Health Food Mama. “She also has high blood sugar often in a way that doesn't make sense. She’s eating junk.  Most of the stuff I don’t even keep in the house - I think she’s getting it from friends in school.”

How do I encourage her to make good food choices?” she asks.

Here’s what JoAnne has to say:

“I hear this kind of question often because parents often have concerns about how their kids should be eating. With T1Dkids, it’s about keeping good glycemic control and not being too restrictive.” 

This 9-year-old is feeding herself by getting her own food. What she is doing is eating without dosing, and not sneaking food. This is a really important distinction because sneaking makes it sound malicious and bad.

We don’t want to shame our children for feeding themselves. She is feeding herself and we need to figure out how to dose for it.”

How to make all foods are acceptable 

Another important topic in this episode is how to eliminate the idea that there are good and bad foods. This is especially important in preventing eating disorders, which is a risk factor for people with type 1.

Not to mention that it’s human nature for children to crave or want more of foods that are considered forbidden. The remedy? Make all foods acceptable. 

For Health Food Mama and other concerned parents facing this issue, the suggestion is to start stocking the pantry with some of the foods you find your child “sneaking.”

Say to your child: “You don’t have to sneak these foods. I see that you are eating this. It is now here in the pantry. We can eat them sometimes. This is not forbidden – it is a sometimes food.”

They get more choice in feeding themselves and as parents, we figure out how to dose for it.

For more on creating a balance with eating for your T1D kids, check out Sweet Talk’s free Sweet Talk Snack Course.

Sign up for my free The T1D Partner Toolbox webinar on May 17 at 5:30PT/8:30 ET.

Stay tuned for our next episode of the Sweet Talk podcast!  Like, subscribe, and share!

It is not an easy thing to let go of our kids as they grow up and become more independent. Having a T1D diagnosis only makes that process more difficult, and there is much anxiety, frustration, and fear in relinquishing diabetes management to other people. What if something happens and I’m not there? Will the caregiver know what to do? These questions flood our thoughts and can be paralyzing. Today’s question is from a mom who is experiencing a spectrum of emotions as the family prepares for her young son’s first stay at diabetes camp. Join us to hear the conversation. 

Show Highlights:

• Guest: Stella, whose son Nico (7) was diagnosed at eight months
• Since Nico is homeschooled, his T1D management is completely managed by family members within the household–and no one else at this point. 
• As Stella prepares for Nico to go away to diabetes camp for the very first time, she is feeling anxious about turning over his care to others. 
• Stella’s Question: “How does a T1D parent work through the feelings of anxiety and overwhelm when something new is presented as part of T1D management? Also, how do we prepare for my son’s first T1D camp with the fear that I feel in letting go of his management for those days?”
• JoAnne’s Answer: “Your ‘letting go’ muscle is not developed yet since he is within the family system all the time, so you are essentially starting from scratch here. All of us have anxiety about letting go of our kids, even with non-T1D kids; it is normal. With diabetes, we have to work more systematically because of the safety issues involved. Think of this process in terms of baby steps you can take to help lower your anxiety and regulate yourself within your window of tolerance. You could try to have a conversation with the camp director now about the camp’s philosophy and management plan. I think it would be good for you to do a controlled experiment of letting someone outside the family take care of him for  a time. This will give you practice, and it would be ideal if this could be one of the local junior counselors from camp. I love how you can recognize what you are feeling in your body and use that as a cue to not take those thoughts so seriously, knowing that things will likely be better than you think. Those are great tools to have in place. You could also take baby steps in leaving him in someone else’s care, like having them care for him while you are still in the house or possibly making a 30-minute Target run while they keep him at your house. One of your baby steps will be to practice not looking at his numbers when he’s with people you trust. I think it would be helpful to reach out to other parents who have sent their kids to that camp and learn about their experiences. A philosophy shift may be helpful in that course correction will happen if his numbers go too high or too low; nothing disastrous will happen if those numbers are managed as they get out of range. This is the reality of his stepping out into the world. You have to create a mantra and find a way to get to some kind of peace in accepting that ‘safe’ is different from ‘perfect’. You have to determine how you are going to react to the mistakes that are going to happen in his care. Part of diabetes management is about being flexible, and that goes for you and your son. In asking these questions, what you are doing is being attentive to the emotional side of diabetes, and that is important and very beneficial.”  

Resources:

Visit my website for available resources and upcoming courses/webinars: www.diabetessweettalk.com

*Visit my website to get my Self-Care Kit to bring more ease and balance into your diabetes management routine! 

*For help with the emotional and parenting challenges of facing T1D management, join one of our live recording sessions by clicking the banner at the top of the website homepage.

*For help in diabetes management, check out Sweet Talk’s Put Diabetes In Its Place coaching course. This is the course I wish I’d had when my kids were diagnosed. 

*For a more hopeful future for you and your T1D child, consider the After Diagnosis coaching course. It’s designed specifically for parents whose child was diagnosed within the last year. Let me help you find a faster path to calm. 

Mentioned in this episode:

Need help getting your kid the right snacks?

That's why I've created the Sweet Talk Snack Course. It's a free mini-course to give you 6 snack sized lessons on making sure you're giving your kid the right foods to keep them nourished and their blood sugar in check. Get it at https://diabetessweettalk.com

Being skeptical and fearful of the new technology of an insulin pump is real for many T1D parents. Is it reliable? Will it do what it’s supposed to do? Annie, a friend and fellow T1D mom, joins us to read a listener question from “Resistant” in California. Join us!

Show Highlights:

• Listener Question from “Resistant”: “I’m feeling a lot of pressure to put my six-year-old daughter on a pump, and I really don’t want to. The only downside to multiple daily injections for us is that the back of her arms are a little bruised. I don’t want to learn something else and have to manage the ins and outs of new technology. Is it bad if I say NO? I just don’t trust it and am afraid it will fail.”
• JoAnne’s Answer: “Some people put their kids on pumps as soon as possible, and others don’t want to do it. It is possible to have ‘good enough control’ with multiple daily injections. Even with all our diabetes technology, the truth is that A1C averages for diabetics have not changed much across the decades. Multiple daily injections can accomplish the same thing as an insulin pump. When first going on a pump, there is a learning curve with a lot of new things to figure out. It’s understandable that someone might feel overwhelmed with having to learn new things. It sounds like this mom is only hearing the pump horror stories, so there is nothing wrong with saying NO to the pump as long as other strategies are working. If the bruising on the arms becomes painful, she might want to shift to a pump, if possible. There is a lot more flexibility for your kids out in the world when they are on a pump because there is a phobia about giving shots to a child; I think there is more partnership available with the use of a pump. Both school and playdates become problematic as a child gets older without a pump. The mom might need to stretch and consider what is best for the child at that point and what the child might want. We do our kids a disservice when we ALWAYS take their lead, but we have to look at the bigger picture of what’s best for everyone involved. The mom should be careful about voicing her resistance to the child and influencing the child’s opinion about the pump. Some kids like technology and the idea of being the ‘cool kid’ wearing ‘the thing’ and are open to the pump. When the situation is reversed, the parent has to convince the reluctant child to wear the pump. Different parenting styles (authoritarian, permissive, and authoritative) come into play in setting limits, but validation is always the key in acknowledging their feelings about what they have to do. Again, as we discussed in the previous episode, a ‘pump vacation’ is possible to allow more flexibility in their lives.”

Resources:

Visit my website for available resources and upcoming courses/webinars: www.diabetessweettalk.com

*Visit my website to get my Self-Care Kit to bring more ease and balance into your diabetes management routine! 

*For help with the emotional and parenting challenges of facing T1D management, join one of our live recording sessions by clicking the banner at the top of the website homepage.

*For help in diabetes management, check out Sweet Talk’s Put Diabetes In Its Place coaching course. This is the course I wish I’d had when my kids were diagnosed. 

*For a more hopeful future for you and your T1D child, consider the After Diagnosis coaching course. It’s designed specifically for parents whose child was diagnosed within the last year. Let me help you find a faster path to calm. 

Mentioned in this episode:

Get Help After Diagnosis!

Get back to being the calm and sturdy parent you were before your child's diagnosis with the After Diagnosis Course to help ease your mind and return you to calm parenting. Go to https://diabetessweettalk.com/courses.

Dealing with your child’s additional health diagnosis on top of T1D can ramp up the stress and anxiety for parents. Today’s question comes from a parent who is navigating this difficult road with her teen. Join us to hear the conversation.

Show Highlights:

• Guest: Janelle, whose daughter Michaela (16) was diagnosed with T1D at age 12
• Testing has recently revealed that Michaela has a very rare antibody syndrome in which 75% of her dosed insulin is not usable, which leaves her needing unusual amounts of insulin.
• The unpredictability of her levels with this antibody syndrome adds a new layer of stress, and her doctors aren’t even sure of what to do.
• Janelle’s Question: “Why does this new diagnosis feel like we are going through the initial T1D diagnosis all over again, including the grief and other strong emotions that we have felt before?”
• JoAnne’s Answer: “There is a fear of the unknown with this new diagnosis, and I applaud you for the way you are talking about it. I think that getting connected with support can be helpful in many ways, and you can often find these people on various social media platforms. It is also important to find medical providers who may be at the most elite institutions and have knowledge of her rare condition. It is scary to be dealing with something like this fluctuating and life-threatening condition without having the right care team in place. Since you have said that your daughter doesn’t want to wear an insulin pump, now might not be the right time to take that step. With that being said, if the short-acting insulin does not induce the antibody syndrome and the long-acting insulin does, that would be a very good reason to put her on a pump. I’m all for letting the child make the decision on that, but it’s not just ‘her body’ if you, her parents, are deeply involved. As with any other illness or disorder, people don’t always get to choose their treatment. Regarding the emotional piece of this situation, this is a stressful experience, and you are having to navigate and manage this as the rock for your family. I encourage you to hold steady and know that you are advocating for your daughter and holding the line for your family. Being there for your family is powerful, but it’s not a permanent situation. You need support. Having more resources and more community around you can help, even though it would be a very small community who also deals with this rare condition. As always, the larger T1D community is always helpful for support.” 

Resources:

Visit my website for available resources and upcoming courses/webinars: www.diabetessweettalk.com

*Visit my website to get my Self-Care Kit to bring more ease and balance into your diabetes management routine! 

*For help with the emotional and parenting challenges of facing T1D management, join one of our live recording sessions by clicking the banner at the top of the website homepage.

*For help in diabetes management, check out Sweet Talk’s Put Diabetes In Its Place coaching course. This is the course I wish I’d had when my kids were diagnosed. 

*For a more hopeful future for you and your T1D child, consider the After Diagnosis coaching course. It’s designed specifically for parents whose child was diagnosed within the last year. Let me help you find a faster path to calm. 

Worrying about how your T1D child is adjusting to the new routine of diabetes management is common. How do you convey the seriousness of diabetes management while not overwhelming them with anxiety and fear? Is there a way they can take a “break” without endangering their safety? I’m joined again by Annie, a friend and fellow T1D mom, who will read and discuss a listener question on this issue from “Worried” in Oregon. Join us!

Show Highlights:

• Listener Question from “Worried”: “My 11-year-old son was diagnosed about five months ago and seemed to be taking it all in stride and doing well. Recently, he expressed a desire to take a break from some of the management steps and stated that he was ‘tired of diabetes.’ How do I make him understand that T1D is a lifelong thing and breaks like this can be fatal? How do I show him that he has to do the hard things even if he is tired?”
• JoAnne’s Answer: “These feelings that he is having, as reality has set in, seem incredibly normal to me. It is important to make room for this child’s emerging T1D experience in not ‘liking’ what he is going through. Strong and good validation of his experience is critical in stating that he didn’t ask or want this–and the parent understands. The parent should acknowledge that, of course, he would rather have his ‘regular old life’ back as opposed to what it’s become. The keys in validation are using ‘of course’ and ‘that makes so much sense’ language. Helping him feel seen, heard, and understood is the most important thing to help him not feel as burdened and alone. Parents usually fear that in validating their child’s experience, they are giving them permission to fall apart emotionally–and the opposite is true. Parents of newly-diagnosed kids usually learn over time that there is more flexibility in T1D care, even though there are certain things that the child cannot take breaks from doing. There can be variations in giving shots, changing Dexcoms, and doing finger-sticks that his mom can implement to give him a ‘break’ every once in a while. This is where parents need to carry as much of the burden for the T1D child as long as possible because they are going to do this for their whole lives. A common fear for the parent is that the child is NEVER going to be able to do their care on their own, so they need to demonstrate NOW that they can do it. We have to realize that they still have many years before they have to do it all on their own as adults in the world, and we don’t want to push our parental worries onto our children. I encourage this mother to pause, take a breath, and think about where her worry is coming from so she doesn’t put it all on him. A lot of people in the T1D community encourage a ‘diabetes vacation,’ which allows someone to step away from as much of their management as possible for a day or a week. A loved one can shoulder as much of the care as possible to give the T1D person a break. We should think about how kids can do this safely while viewing it as an exception to the well-established good habits in T1D care. One suggestion is that maybe once every ten days or so, the child can go without the Dexcom at night while the parent does finger sticks to give that break.”

Resources:

Visit my website for available resources and upcoming courses/webinars: www.diabetessweettalk.com

*Visit my website to get my Self-Care Kit to bring more ease and balance into your diabetes management routine! 

*For help with the emotional and parenting challenges of facing T1D management, join one of our live recording sessions by clicking the banner at the top of the website homepage.

*For help in diabetes management, check out Sweet Talk’s Put Diabetes In Its Place coaching course. This is the course I wish I’d had when my kids were diagnosed. 

*For a more hopeful future for you and your T1D child, consider the After Diagnosis coaching course. It’s designed specifically for parents whose child was diagnosed within the last year. Let me help you find a faster path to calm. 

Nighttime alarms for your T1D teen’s blood sugar levels are difficult. They bring fear and stress, besides robbing the family of good sleep. How much should the parent be involved in nighttime dosing, and how much ownership should the T1D teen take? Join us for today’s listener question about how that partnership might work. 

Show Highlights:

• Guest: Alaina, the mother of Jesse (17) who was diagnosed at age 13
• Their struggles are not in diabetes management but in the social and emotional areas.
• Alaina tries to handle nighttime duties to allow him to get as much sleep as possible so he can be his best for school.
• Alaina’s Question: “How much should I share with him about how much sleep I am losing in managing his care during the night? I don’t want to make him feel guilty, but I do need some sleep!”
• JoAnne’s Answer: “I think every T1D teen is aware that their diagnosis has a huge impact on their parents. I think we can do a better or worse job in managing this and using strategies. Diabetes is a family disease that affects everyone. The most important thing is that you have this conversation with him, and you need to identify what worries you have in being clear with him about the impact his nighttime care is having on you and your sleep. It is good to give him a chance to respond honestly about how this conversation lands with him; it’s fine that it brings discomfort to him, but it’s important to have this assessment. Approach the situation from the viewpoint that you want to partner with him in better nighttime management regarding late-night snacks, etc. Since you have a budding adult on your hands, it might be good for him to suffer the consequences of his blood sugar highs, including overnight. He needs to learn how that feels and affects him so he can make better choices for late-night snacks. You could even set the ‘high’ alarm even higher so that you can get some sleep but be aware if his numbers go above a certain level. When he’s in college, he will have to handle this on his own, so it is good for him to know why it’s good to make better choices. In the conversation, it’s OK to let him know that, even though not intentional, his late-night snack choices are currently robbing you of sleep. Use the language about ‘thinking together about being partners’ in this issue. If he lets you know what he has eaten at night, you can make different responses to the high alarms based on what he has eaten. If dinnertime is the issue (or certain dinner meals), you can discuss how to partner with him to think through his dinner dosing–because of the impact on your sleep later. Another piece of the conversation with him is whether or not he still wants nighttime support. You have to ask him how he imagines self-management for himself when he goes to college. It’s time for you to feel out that conversation with him.”

Resources:

Visit my website for available resources and upcoming courses/webinars: www.diabetessweettalk.com

*Visit my website to get my Self-Care Kit to bring more ease and balance into your diabetes management routine! 

*For help with the emotional and parenting challenges of facing T1D management, join one of our live recording sessions by clicking the banner at the top of the website homepage.

*For help in diabetes management, check out Sweet Talk’s Put Diabetes In Its Place coaching course. This is the course I wish I’d had when my kids were diagnosed. 

*For a more hopeful future for you and your T1D child, consider the After Diagnosis coaching course. It’s designed specifically for parents whose child was diagnosed within the last year. Let me help you find a faster path to calm. 

Leaving your T1D child for an overnight or weekend trip for the first time brings up many anxious thoughts and concerns. The multitude of fears and “what ifs” can spiral out of control without a solid safety plan, but how do you put that in place? I’m joined today by Annie, a friend and fellow T1D mom, who is here to read and discuss a listener question about this topic from “Desperate for a Break” in Vermont. Join us for the conversation!

Show Highlights:

• Listener Question from “Desperate for a Break”: “In planning an NYC weekend vacation with my husband and another couple, I am filled with anxiety at the thought of leaving my T1D (7-year-old) daughter for an entire weekend. My mom often cares for her and deals with the diabetes basics, but she’s never done pod or Dexcom changes. Am I supposed to give up all vacations unless I bring my daughter along? What should I do?”
• JoAnne’s Answer: “Feeling trapped by diabetes is a common feeling for parents, but it’s important to remember that we, as parents and caregivers, are allowed to step away. If the grandmother is willing to learn to do the pod and Dexcom changes and there is enough time before the trip happens, that is the best-case scenario. Another option is that there might be a caregiver at the child’s school or a T1D babysitter in the area who would be willing to help with those changes and be available for the grandmother to call in case of an emergency. This backup plan could also include a trusted person in their T1D community who could be taught what to do for the child. This backup person would need to come over, get to know the child, and be around for pod and Dexcom changes for a few days. The online links with video instructions should be provided to the grandmother and the backup person. There are baby steps that can take place, if time permits before the trip, to plan for pod and Dexcom changes. The mother should also be clear about communication expectations while she is away and how much she is willing to ‘step away’ from her daughter’s diabetes management while on the trip. Another layer to this issue is the judgment a T1D parent receives from other parents; it’s all about feeling sturdy in your own decision to go away while leaving a solid and secure plan in place for your child’s safety. Another baby step in the planning would be for the child to stay overnight at Grandma’s house while the parents are still in town; this would be a good test for the grandmother AND the mother to practice. There might be stress and anxiety for the child in knowing Mom is away, so the need is great for Grandma to be well-trained and for good backups to be in place to help. This mom needs practice in stepping away because we don’t want T1D kids to feel like their mom is the ONLY safety in their diabetes care. We want them to feel safe in the world with lots of adults caring for them and looking out for their needs.”

Resources:

Visit my website for available resources and upcoming courses/webinars: www.diabetessweettalk.com

*Visit my website to get my Self-Care Kit to bring more ease and balance into your diabetes management routine! 

*For help with the emotional and parenting challenges of facing T1D management, join one of our live recording sessions by clicking the banner at the top of the website homepage.

*For help in diabetes management, check out Sweet Talk’s Put Diabetes In Its Place coaching course. This is the course I wish I’d had when my kids were diagnosed. 

*For a more hopeful future for you and your T1D child, consider the After Diagnosis coaching course. It’s designed specifically for parents whose child was diagnosed within the last year. Let me help you find a faster path to calm. 

As a T1D parent, you go through a flurry of activity and adjustment when your child is diagnosed. The years that follow can be very difficult with daily management and monitoring, and it may look like you have it under control. The truth is that we all need the support that comes from other T1D parents and other friends and family members—and we aren’t always good at asking for what we need. Join us for today’s question from a concerned mom who admits that she needs those check-ins from time to time. 

Show Highlights:

• Guest: Beth, whose daughter (Vanessa-age 8) was diagnosed at age 4
• Why the sudden T1D diagnosis and week-long hospital stay were extra traumatic experiences while Vanessa’s parents were away on a planned trip to Hawaii
• How Beth’s goal has always been to keep T1D in the background of her daughter’s life as much as possible
• Beth’s First Question: “Where and when can we start to give her more responsibility in handling her T1D management? I’m concerned about the technical side of things and the emotional side for her.”
• JoAnne’s Answer: “One thing that happens for kids is that when they want something, they learn to take more responsibility to get that something. That “something” can usually be the motivator or the fact that they just want to take on more responsibility in their T1D management. There is nothing artificial that you need to do for this to happen; your child’s normal developmental ability will gradually shift to her taking more control. If you put her in environments, like camp, where she is around more T1D kids like herself, kids usually come home feeling way more empowered to “do the next thing.” If she isn’t gunning to take on something new, I wouldn’t push it on her. If you are concerned, I would advise that you immerse her in an environment with other T1D kids, so she can think about what she wants to do. I would not be concerned about it at this point. As with most developmental things, these responsibilities are variable from kid to kid, and I’m glad to hear about your commitment to letting her be a kid for as long as possible. You will probably see her ask for more responsibility as she grows up. 
• Beth’s Second Question: “This disease is so invisible to family and friends. As the dust settles, do you have recommendations about reaching out and communicating our needs to get more support from friends and family?”
• JoAnne’s Answer: “I can’t plug family camp enough. If you’ve been, keep going. You will meet people that you’ll be friends with for life who speak the same language. My guess is that you are holding back with people who don’t have T1D in their families. I think you should identify what you need from people and be aware of where you are holding back and feeling isolated. Let them know that you feel lonely and sometimes need to share how difficult T1D is. Don’t be afraid to ask people to let you share when you feel down and to check in on you from time to time.”

Resources:

Visit my website for available resources and upcoming courses/webinars: www.diabetessweettalk.com

*Visit my website to get my Self-Care Kit to bring more ease and balance into your diabetes management routine! 

*For help with the emotional and parenting challenges of facing T1D management, join one of our live recording sessions by clicking the banner at the top of the website homepage.

*For help in diabetes management, check out Sweet Talk’s Put Diabetes In Its Place coaching course. This is the course I wish I’d had when my kids were diagnosed. 

*For a more hopeful future for you and your T1D child, consider the After Diagnosis coaching course. It’s designed specifically for parents whose child was diagnosed within the last year. Let me help you find a faster path to calm. 

Mentioned in this episode:

Get Help After Diagnosis!

Get back to being the calm and sturdy parent you were before your child's diagnosis with the After Diagnosis Course to help ease your mind and return you to calm parenting. Go to https://diabetessweettalk.com/courses.

I’m honored to be joined by two guests today. One is a mom who has questions about substance use and her T1D teen. Because I’m not an expert on this topic, I invited Dr. Justin Altschuler to join us. Besides having T1D himself, he has a private practice that specializes in addiction and T1D, and he is the medical director of Diabetes Youth Families (DYF), which is the organization in the Bay Area that hosts the diabetes camps that you hear me mention frequently. Join us for this important conversation!

Show Highlights:

• Guest: Sarah has a 17-year-old son who was diagnosed with T1D at age four.
• After navigating many different T1D issues over the years, the questions now are around alcohol and drug use. 
• As he will probably become a social drinker with friends and family, Sarah wants her son to use strategies that will keep him safe.

• Sarah’s First Question: “Is beer better than mixed drinks as far as having well-defined carb counts?"
• Dr. Justin’s Answer: “For teens and young adults, the thing I worry about the most is not high blood sugars and carbs but low blood sugars. When someone drinks alcohol, it goes straight to the liver, which becomes preoccupied with processing the alcohol and stops releasing sugar into the bloodstream for several hours. As regular glycogen isn’t being released when alcohol is present, the implications are that blood sugar lows will happen when someone is drinking, and a sugar release will happen to combat the low. The challenge is that, when someone is drinking, the normal body-rescue mechanism isn’t there. This persists for several hours. The risk with teenage drinking is NOT having them wake up at 300 but their blood sugar going so low that they don’t wake up. The carb counts of beer vs. mixed drinks really don’t matter in this context; the key is to keep them in the safest zone possible with alcohol use. Because you don’t know what’s in a mixed drink, it’s a way of taking in a lot of alcohol very quickly and not recognizing it. From that perspective, I would say beer is preferred.” 

• Sarah’s Second Question: “So how do you avoid the lows?”
• Dr. Justin’s Answer: “I tell teens to put their smart pump device in exercise mode and to eat before drinking. Their blood sugar should be around 200-250 before drinking. While they are drinking, I tell them not to bolus, because I’d rather their blood sugar be too high than too low. If they have to bolus, I recommend entering half the amount of carbs that they otherwise would use. It’s a good idea for kids to eat snacks while drinking, and there are good strategies kids can use to fit in socially and not have to drink excessively. They can open a beer, pour half of it out, and walk around with the rest of it throughout the night. They can still fit in without putting a bunch of alcohol into their bodies.

• JoAnne’s Question: “What about those kids who want to get drunk? What do you recommend for them in staying as safe as possible?”
• Dr. Justin’s Answer: “Recognizing that spectrum and knowing what your kid wants in their relationship with alcohol is important. If they want to get drunk, the important safety issues are not to disconnect their pump. I’ve seen kids do that in order to avoid the low readings, but they can wake up eight hours later in DKA. Another thing is that they need a buddy who knows them and their T1D and how to interpret the Dexcom numbers. At a party, if someone is passed out in a corner, everyone assumes they are drunk and won’t think about their blood sugar being low; that’s where a buddy comes in who knows what’s going on. The issue can become that a T1D kid needs IV glucose, but no one wants to call EMS for that and get in trouble. To keep your T1D kid safe while drinking, there is a lot of prep work that needs to happen before the drinking starts. I encourage parents when talking to their kids, to make their intention clear about keeping them safe above all else.”

• Sarah’s Third Question: “How do we coach our son regarding practical advice on buddy training?”
• Dr. Justin’s Answer: “Even outside the T1D realm, parents need to have conversations with their kids about drinking and driving. I think of this conversation in a similar way to parents wanting to give their kids the freedom to go out and do things with the confidence that they are safe. Part of their safety plan should be to be with someone who can look at their dexcom, check their numbers, and know what to do. It’s as simple as the buddy knowing that if the number drops below 100-150 that they need to make the T1D person eat something. They should know not to assume that any strange behavior means that they are drunk, but that low blood sugar means they need to eat something right away. These conversations aren’t a one-time thing, but should start with young teens and be part of what they learn and discuss within their families.”

• Sarah’s Fourth Question: “Is there much known about T1D and marijuana use? Are there things we should advise T1D kids to do differently around smoking weed or taking gummies?”
• Dr. Justin’s Answer: “The physiology around marijuana use is different from alcohol and glucose metabolism. The concerns around alcohol use with kids not being able to accurately count carbs and read their numbers are still true with marijuana use. I tend to err on the conservative side of wanting them to be on the hyperglycemic side rather than the hypoglycemic side, but it’s not quite as scary in terms of glucose metabolism. The perception that ‘if it’s legal, it must be OK’ is dangerous; we know that early exposure to marijuana is not good for developing brains. The concern is that doing this at age 16 is different than doing it later in your 20s. The marijuana products on the market today are much more potent than over the last few years, and that difference is tremendous in the effect on young, developing brains. In talking to kids about substance use, it’s important to think about the underlying context in why kids are drawn to it. I think of it as a ‘push and pull’ of why they don’t like being sober and how the chemical makes them feel. T1D kids using these substances as an escape valve is something I worry about in the long term.”

• Dr. Justin’s General Takeaways: “These conversations around substances don’t take place one time but should be occurring over and over with your kids. It’s important to acknowledge that parents can’t control this with their kids, and the locus of control lies within the child’s decision-making. Adolescents and young adults have to take ownership of these decisions, and that requires that they have all the information to make informed decisions. As a parent, surrendering control and actually trusting your kid helps paradoxically and lays the groundwork for their own choices. That attitude takes substance use out of the realm of ‘rebelling against mom and dad’ and gives them the chance to make good choices in a much more helpful framework. Adolescents view risk-taking and novelty-seeking behaviors differently because their brains are different; we have to help them walk through concrete steps to take so they can make good decisions when those times come.” 

Resources:

Connect with Dr. Justin: Website and Newsletter

Visit my website for available resources and upcoming courses/webinars: www.diabetessweettalk.com

*Visit my website to get my Self-Care Kit to bring more ease and balance into your diabetes management routine!

*For help with the emotional and parenting challenges of facing T1D management, join one of our live recording sessions by clicking the banner at the top of the website homepage.

*For help in diabetes management, check out Sweet Talk’s Put Diabetes In Its Place coaching course. 

*For a more hopeful future for you and your T1D child, consider the After Diagnosis coaching course. 

Mentioned in this episode:

Get Help After Diagnosis!

Get back to being the calm and sturdy parent you were before your child's diagnosis with the After Diagnosis Course to help ease your mind and return you to calm parenting. Go to https://diabetessweettalk.com/courses.

Welcome to another episode! Today’s question comes from a listener who wrote to me, and I have a friend and fellow T1D mom, Annie, to join the discussion and offer her perspective on this difficult situation. Join us!

Show Highlights:

• Question from “Feeling Powerless”: “I need help in supporting my T1D daughter, who is in 3rd grade and was diagnosed almost a year ago. Her best friend since forever has begun to reject her around her diabetes. Most recently, she said that she doesn’t want to come to the anniversary celebration of her diagnosis, but the problem extends to not wanting to be around her at school or our house. I am friends with the girl’s mother, but I don’t know how to talk to her about it. My daughter is so sad, and I don’t know how to help, even though I’ve tried telling her to focus on other friends who are willing to help out.”
• JoAnne’s Answer (with input from Annie): “Friendship shifts are not uncommon for 3rd graders, but this is a hard thing. Kids often feel uncomfortable around their friends getting all the attention, and we see this often at school or with siblings at home. It’s also possible that this friend is afraid of needles and the responsibility of walking her friend to the school nurse because it feels scary. Since we don’t know the child’s reasons, we are focusing on how this mom can support her T1D daughter, and whether there is room to have a conversation with the friend’s mom. “Powerless” can validate that it feels bad for her daughter and speculate that this is a rough patch that may change for the better with the friendship over time. The friendship doesn’t have to be over because this girl is struggling with diabetes right now. Since there is a relationship with the girl’s mom, I think “Powerless” should go to the mom and discuss the problem with curiosity around how she might be feeling. It might be helpful for the moms to have the discussion first, and it’s important for the moms not to catastrophize the situation for the girls. These are eight- or nine-year-old girls, and there can be all kinds of ups and downs in friendships. I think the validation piece is about how diabetes is causing the shift in the friendship, which is painful, but there are other allies who can be supportive and helpful. As far as the Dia-versary celebration (See Resources for a blog post on the topic), there isn’t a right or wrong way to do it, but this may be another situation in which the friend may not be comfortable with all the attention around diabetes. It might be better to keep those celebrations within the family and not invite others to participate. It is not a birthday party, and sometimes it’s harder for people outside the family to understand the context of the celebration. It might be an easier pill to swallow for this friend for the special-ness of the occasion to be kept for the family members. This is an opportunity for “Powerless” to teach her daughter to state her needs in a situation that seems almost adversarial. It would be great for her daughter to acknowledge to her friend that diabetes is hard, but she still wants her to be a friend. That’s a big ask for a 3rd grader, I know. It’s important to realize that sometimes friends are good at showing up in some ways but not so much in others. Parents have to exercise caution about getting caught up in the kids’ drama. It’s always better to hold it lightly.”

Resources:

Blog post mentioned in this episode about Celebrating Dia-versaries: https://www.diabetessweettalk.com/blog/pe968a6ocp7vomgcos4rw2i0jdif8z  

Visit my website for available resources and upcoming courses/webinars: www.diabetessweettalk.com

*Visit my website to get my Self-Care Kit to bring more ease and balance into your diabetes management routine! 

*For help with the emotional and parenting challenges of facing T1D management, join one of our live recording sessions by clicking the banner at the top of the website homepage.

*For help in diabetes management, check out Sweet Talk’s Put Diabetes In Its Place coaching course. 

*For a more hopeful future for you and your T1D child, consider the After Diagnosis coaching course.

Mentioned in this episode:

Get Help After Diagnosis!

Get back to being the calm and sturdy parent you were before your child's diagnosis with the After Diagnosis Course to help ease your mind and return you to calm parenting. Go to https://diabetessweettalk.com/courses.