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March 6, 2006

Behavior, Hyperglycemia and DKA

Question from Taylorsville, Mississippi, USA:

My daughter is getting really bad about sneaking candy. At first, she would lie and say she didn't sneak candy, but now she just admits to sneaking it. On Valentine's Day, when we checked her blood sugar, it was 530 mg/dl [29.4 mmol/L]. I really didn't panic because she told me that she had eaten some candy from school. After a few hours, her sugar was back to normal. She does not understand the danger of her sugar going so high. We are rewarding her for keeping good sugar levels and punishing her for sneaking candy and having high sugar levels. Nothing is really working. Please let me know if you have any suggestions as to what my husband and I can do to help her.

Answer:

Keep in mind that small amounts of sweets can be worked into a diabetes meal plan nowadays, with the emphasis on small amounts and in moderation. Sometimes, kids feel pressured to enjoy sweets on special occasions, like Valentine’s Day, just like everyone else. If you talk with your child and come up with a plan ahead of time about a possible way to incorporate special treats into her meal plan, the problems with blood sugars going high won’t be as much of a concern. Hopefully, she will not feel like she has to sneak treats and it won’t become a ” food battle” between parent and child.

JMS
Additional comments from Dr. Jill Weissberg-Benchell:

Because blood sugars can be out of range for many reasons, and since many of those reasons are out of our control, I recommend against rewarding a child for numbers that are in-range or punishing a child for numbers that are out of range. If the specific issue you are concerned about is sneaking foods (whether they are sweets or other kinds of foods), I’d recommend you talk with your daughter about the importance of honesty and open communication. Some children are so worried about their parents’ reactions if they do eat something that was not in their meal plan, that they do not openly let their parents know what they eat or when they eat it. For children who fear their parents reactions, it may be helpful to have a note-book someplace that is easily accessible to both the child and the parent. Then, whenever the child eats anything that is not during a scheduled meal or snack, the child quietly writes it down in that book. Then, if the parent is ever concerned about an out of range number, they can first look in the book to see if the child ate something that may have contributed to that number. This strategy will not work if the parent comments on what the child ate or when the child ate. It will only work if the parent says something to the child like: “Thank you for writing down that you ate some extra sweets this afternoon. Now I know why your numbers were higher than I expected. I am very proud of you for being honest.” After a month or so of praising the child for being honest, parents can move to the next step, which is encouraging the child to ask parents to work the craved foods/sweets into the already scheduled meals and snacks for the day.

JWB