November 18, 2008
Question from Toronto, Canada:
On Sunday, our son, who is 15 years old and was diagnosed at 18 months, woke up convulsing and trembling with inaudible, loud, animal-like growls. We called 911, but in a brief moment of alertness about to get the glucagon kit, we got some juice into him avoiding the use of glucagon. The paramedics came anyway and forced me to make him pancakes as they watched him eat it to ensure he was okay. When he woke, he was 3.2 mmol/L [58 mg/dl]. After two juices and pancakes, he dropped to 2.7 mmol/L [49 mg/dl] but eventually got to 4.4 mmol/L [79 mg/dl] before the paramedics left. He only ever had one episode like that before and we did use the glucagon. Anyway, it got me to thinking that he is almost 16 years old and I'm wondering what would happen if this happens when he's on his own, whether at University or just an independent adult. Can there ever be a time where he is alone or should we make sure that if he doesn't have a roommate/girlfriend, etc. that we should make sure he comes home or one of us goes there? I'm also kicking myself a bit. I was up to 2:30 a.m. with him as his numbers were low. He was 3.8 mmol/L [68 mg/dl] when I checked him at 2:00. At 2:30, he was 4.0 mmol/L [72 mg/dl], so I figured he was good as he was going up. My husband and I take turns checking. Imagine the horror when around 7 a.m. that morning I heard my husband yelling our son's name" and then, "Quick, call 911." I thought I killed my child by being lazy - i.e. not staying up longer until he was higher, but I really don't know what's a comfortable level that you can go to sleep. Is a continuous glucose monitor a good idea? I'd ask my son's endocrinologist but he is very reluctant to discuss anything that isn't "by the book" and he says he doesn't talk about life after 18.
This is a big question for families. You have to let them grow up. Roommates are clearly a great idea. The issue of transition plagues parents and doctors. I worry a lot with adolescents about education…jobs. Here, in the U.S., insurance is tied to work and kids with diabetes cannot get insurances without a job and lose parental coverage at some young age! It’s a lot more than hypoglycemia. Maybe by the time your child is grown, the continuous monitoring systems will be good enough to be mainstreamed. It does require lots of education and training for the emerging adult.
I always honor the love and devotion of parents with diabetes….the nights of worry. I get some of it at diabetes camp, a couple of weeks with a lot of kids in a strange situation. I know the worry, but mine is short lived.
You just have to plan.
[Editor’s comment: During her teen years, I found that I checked our daughter, now 21, more frequently during the night. I didn’t always know her activity level and the food/insulin involved. I, too, worried about what would happen when she was going to leave for college. For me, fate intervened and I broke my wrist, the one with which I would write, check blood sugars, etc. so I had to reduce the amount of checks I was doing (can’t read what I tried to write during those 3 a.m. checks). After a few weeks, I decided that it was time to let our daughter take over those checks. Of course, at almost 18, she would stay up late, go out with friends, etc., so she would check at her bedtime and we’d check at our waking (hers, of course, being that of a teen–after 10 a.m. or so). This worked well, as it was the summer before college. When she moved to college, we stressed how she needed to check during the night by herself and literally taped a glucagon kit to the headboard and explained to her roommates how to use it. She (and we) survived that first year, then she moved, had different roommates, etc., but she usually tests during the night, I believe. She does wear a continuous sensor sometimes because she doesn’t want to go low, nor does she want to be high. Unfortunately, I think there are teens/young adults who aren’t as conscientious and we parents cannot force our children to behave this way. So, before your son is ready to move on, encourage him to become more involved in those nighttime checks, maybe just on weekends or holidays when he doesn’t have to get up early for school. And, when he does go off to University, ask if he’d like you to telephone him at 2 a.m. or so. He may surprise you and say “sure” or maybe he will be embarrassed and handle it himself. Only time will tell. By the way, when she is home, I offer to check our daughter during the night because I know this is something she lives with and does many, many times, so I try to give her a break. This is my choice because I am lucky enough that I don’t have to live with diabetes myself.
By the way, if paramedics ask you to make your son pancakes, please inform them that there are other options for treating low blood sugars. Your diabetes team should be able to advise you. A small glass of milk and a piece of bread would usually suffice. Personally, I would not have wanted to cook since my hands probably would have been shaking from the experience!
Finally, try not to be too hard on yourself. There are many factors that affect blood sugars and you cannot spend all your hours worrying or you will drive yourself crazy and maybe get sick from not spending time doing things for yourself, like sleeping.