May 26, 2004
Behavior, Hypoglycemia
Question from Lutherville, Maryland, USA:
My son was diagnosed on his second birthday, just under one year ago. I am trying to find a resource (book, article, advice) for dealing with discipline in a toddler with diabetes as related to low blood sugar. I have been told by other parents with children with diabetes that you simply just cannot discipline a behavior if it was done during an episode of low blood sugar because the child was not himself, they did not know what they were doing and that since they probably don’t have any memory of the incident, that discipline is useless. They excuse any behavior done during a low. I am concerned how handling behaviors this way will affect my child’s future behavior and I don’t want him to use his condition as an excuse to be able to do whatever he feels like and I am not sure how this will affect my other child and children at preschool next fall if he is given free reign to behave however he feel like and not be reprimanded while they must all obey the rules.
My child has a change of personality with low blood sugars where he acts more aggressive and has hit his younger brother, thrown toys across the room and other physically aggressive behaviors, which is a complete change from his normal personality, so, in my child it definitely can signal low blood sugars to me. I always test to make sure (and that is a signal given to other caregivers to test him) and have given time outs when he does not have a low blood sugar, but am not certain what to do when a low blood sugar is behind the scenes, besides treat the low of course, as related to discipline. We have also had issues with this same behavior as if he were having a low when he is having a fast drop in sugars even if they are in a normal range. He has, at times, dropped over 200 mg/dl [11.1 mmol/L] in less than an hour.
Do children know what they are doing when they are low? Can they control it? How should a parent or teacher handle a child whose misbehavior is when he/she is low? Can you and/or should you discipline, via a timeout, a child for doing something wrong when they are having a low blood sugar? Do you test them then decide or punish then test? Do you not want them to make an association between certain behaviors and blood sugar so that they will not try to use it as an excuse to get out of trouble? How do you deal with it as an example to siblings or other children at daycare if there are different rules for them versus the child with diabetes? Any resources you have would be helpful.
Answer:
A very good book is published through the American Diabetes Association. It is called The Ten Keys to Helping Your Child Grow Up With Diabetes by Timothy Wysocki.
When any person has a low blood sugar, less than 70 mg/dl [3.9 mmol/L], they are not in control of their emotional reactions, their learning, or their behavior. It may be helpful to you to contact your diabetes team and ask them to explain, in detail, what happens to a person when they are low. This additional education will help you better understand why everyone is telling you that people can not be disciplined for what they do when they are low.
Children do not remember what they have done when they are low, so they are not learning to use diabetes as an excuse for inappropriate behavior. If you are checking blood sugars when you see unusual behavior, and you are disciplining your son when his blood sugars are in a reasonable target-range, then you are handling discipline appropriately.
JWB
