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December 28, 2011

Behavior, Hyperglycemia and DKA

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Question from Tallahassee, Florida, USA:

My daughter was diagnosed with type 1 two years ago at age 4. She now uses an insulin pump. She tends to have behavioral issues when she gets above 200 mg/dl [11.1 mmol/L]. She gets very angry and unreasonable, says hateful things to her little sister and to my husband and me. Obviously, this behavior can occur without the presence of diabetes, but it is an indicator to us that something is off. Nine times out of ten, her sugar is high. We are struggling figuring out how to discipline her. At the moment, I make her sit in time out, however, this is not a very effective way of calming her down. Our four-year-old is always watching and trying to do whatever her big sister does and we have noticed her acting out in some of the same ways big sister does during highs and/or lows. That being said, we feel that we need to have some level of discipline for the moment that does not have lasting consequences, such as grounding. I also do not know how much of her behavior she can control and cannot always determine if her behavior is that of a normal six-year-old or a result of her glucose levels. We test her sugar, but there are times when she is dropping or climbing at a rapid pace and we can’t see that. She has a CGM, but finds it painful to wear. Our daughter has barely any body fat and doesn’t have a lot of “real estate” as our doctor calls it. I would like to get a different brand, but our insurance will not cover another CGM. Do you have any suggestions for discipline when dealing with highs? How do you suggest we handle her younger sister watching her older sister not get in trouble for things she herself is not allowed to get away with? Any suggestions for a more comfortable CGM unit? Right now we have the Medtronic version.

Answer:

From: DTeam Staff

First and foremost, diabetes is annoying and frustrating and blood sugars can be unpredictable sometimes. So, let�s give your daughter some credit for being a trooper and handling this disease every single day. Lots of kudos to you guys as parents and to her sister as well, as diabetes affects everyone in the family.

With respect to misbehavior when her numbers are in the higher ranges: She likely feels grumpy and irritable because she is not feeling her best. However, with numbers in the 200s mg/dl {11.1 to 16.7 mmol/L], she is in control of her behaviors even if she does not feel particularly great. Therefore it is important to respond to her mean words and unacceptable behaviors just as you would at any other time (and also make corrections with her insulin). Whatever discipline techniques you used before she had diabetes, and whatever techniques you use with her sister should also be used with her (this does not apply if her numbers are under 80 mg/dl [4.5 mmol./L]).

As far as the CGM, please contact your diabetes team members and also the representatives from each of the CGM vendors to see what they current have available and what they expect will be coming out on the market soon. That will help you get the information regarding comfort at the insertion site.

JWB