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My step-daughter has had a rough road with her diabetes. When she was 8 mo old she was originally diagnosed with epilepsy and given pills for it. At 2 with the seizures continuing, she was finally diagnosed with type 1 diabetes. When she was 4 my husband and her mom were divorced. She lived with her mother during the week and with my husband on the weekends. In 2011 we had noticed a very bad pattern with her blood sugar tests. We filed for custody and won. Since then my step-daughter's a1c has gone from 10.5 to 7.5 in a matter of 9 months. Unfortunately, my step-daughter was taught how to mistreat her diabetes by her mother. She taught her everything from bruising herself with the needles to not giving correct dosages of insulin so that she'll crash or her blood sugars would sky rocket. As of now there hasn't been any contact from my husband's ex-wife to the kids in almost a year and there has been a no contact order put into place. This is where I'm confused. My step-daughter has the pump, so that helps a lot. But she also suffers from PTSD (post traumatic stress disorder) due to life in her mother's house all those years. She has over come the bruising herself but even with the pump we cannot get her to stop over or under dossing herself with insulin or the problem with over eating or hiding food. I'm wondering if anyone has any advice on these problems or if anyone else has had to deal with things like this? We've tried to have her talk to a nurse or to her doctor and she does see a psychiatrist but it doesn't seem to help.
The damage her mother has done with medicating my step-daughter goes all the way back to when she was 8 mo old. She wasn't giving her the meds that were prescribed to her and when she was diagnosed with diabetes she (the ex-wife) wouldn't give her the shots she needed with no explanation on why not. As of now my step-daughter's A1C has improved and her 2 week average is 178 compared to 357 when she moved in with us almost 2 years ago. So my husband and I have it under control but my step-daughter cannot stop the bad behaviors with it when we aren't there like when she's in school
Although you have seen a psychiatrist, I recommend she also see a child psychologist or professional counselor that specializes in the treatment of children. Depending on how big of a city you live in, you may be able to find a counselor also certified in diabetes education. I'm a psychologist and routinely work with adults who have Posttraumatic Stress Disorder and although I used to treat children, that was nearly 10 years ago. Good news, a specialist with training in the treatment of PTSD can significantly reduce the symptoms of PTSD when working with most children, though treatment may be slower than when working with adults. Personally, I would attempt to find a therapist who used an "eclectic" approach in treating children, but did have formal training in a PTSD treatment--like "Cognitive Processing Therapy." I do not believe that this therapy has been tested on children, but many of the priniciples work really well. I would combine approaches of this therapy with "Cognitive Behavioral Therapy."
PTSD can often cause a lot of anger and volatile emotions in general. By getting some relief of her PTSD symptoms, her diabetes management will become easier. All psychologists have a lot of experience in helping patients with medication management and though they may not have a clue on how diabetes treatments work, with your help they likely will be able to assist here too. However, if your insurance will cover it, there is nothing like a diabetes educator who is good at working with pre-teens! Call you local hospital or ask your endo about Certified Diabeties Educators who are good with pre-teens.
Send me a message if you don't have insurance and need/want help finding a provider that will provide services at a low rate (or hopefully free)--that is if you live in the US
Thank you. I'll let my husband know. Right now we do have her seeing a psychologist but they keep persisting that she has ADHD. No one not even the schools see it so we don't bother with those meds. The thing with the PTSD is that my step-daughter doesn't have any problems with it until the topic of her mother is brought up. This psychologist is persisting on getting her to talk about her feelings on her mother and, to quote my step-daughter, "She don't want anything to do with me, I don't want anything to do with her". Once she said that things were going great. Then she went to an appointment with the psychologist and we went right back to it all. Yeah, it's time to find a new one.
You are really doing a great job with her! 7.5 is tremendous progress and good in and of itself! One reward that we use with our son is that he can earn money for taking the family out to eat. This is how I do it, but I try not use it very often so it doesn't lose its impact. When there is a new behavior I want him to learn, I set up a generous reward system. We then assign a dollar amount for each time he displays that behavior for a period of time. How much time you let pass is different for every kid, but it can't be too long or it won't be effective. For our 10 year-old we still reward daily. Since we would go out to eat anyway and depending on the quality of the restaurant he chooses, I may change things around. Anyway, if he chooses the Cheesecake Factory, I will make a big deal about how generous he is being to want to earn money to take the family out to the cheesecake factory. For this restaurant, I would probably make the total goal last 2 or 3 weeks, but set payouts to occur daily. At the end of every day I give him money to put in a jar. At the end of the 2 or 3 weeks, I let him get the money out and he pays for the entire meal! I usually try to make it so he has a few dollars left over as well. Depending on you child's favorite place to eat, this might be a useful option.
That's a great idea! I'll bring that up to my husband
The problem with over eating and hiding food may stem from restricting certain high carb, sugary or high fat foods because the are harder to manage. You may not do this now but her mother may have done this when she was younger.
Our Endo and CDE do not restrict any foods for their teen age patients because it leads to teens having the forbidden food anyway, not loggin it and usually not doing the proper insulin to hide the fact. They try instead to show how to properly have a cupcake, donut or pizza with friends or at school occasionally and the importance of re-testing and correcting a few hours after having these foods.
I also had an ADD nephew that hoarded food. During middle school, his desk drawers would be full of candy that he bought on the way home from school. Counselors thought that he was using the candy to self medicate and relieve the stress of not doing well at school or socially.
The only time my son has under bolussed insulin was when he started going out with friends who did not know he had diabetes. He was bolusing after they left the fast food place when he returned to his car. Way too late! He actually never wanted to go low at school and call attention to himself by having to go to the nurses office. It sounds like your daughter may like the "attention" that the highs and lows afford her. I hope you can figure it out soon.
Her mother didn't give her snacks or even half of the time dinner. So she started hiding food then. We have a regular meal schedule here along with snacks. We don't tell her she can't have anything. We just constantly remind her about putting carbs in her pump. It's almost like she's a food-aholic. Her mother has done so much damage to her mind it's horrible. I thank you all for the advice. Being a step-parent and loving her as though she was one of my own it makes it real hard for me to see her do this stuff to herself without fully knowing what she went threw for 7 years living at her mothers and also knowing the other stuff that went on in her home. It's nice to know that she's not the only one that has done this kind of stuff. I thought that she was just "special" with these actions. She has done very well, but it's just the over and under dosing she does that bothers me still. We'll go a week or 2 that she's doing good with it and then we'll go a week where she wont do so well.
this is a tough one, i'm not sure how many there are out there but i would seek out a counselor with experience treating children with diabetes, with this complex of a problem i would say professional help is definitely necessary. at home i would go with lots of positive reinforcements for anything positive around the house not just D related and minimal punishment and kudos for handling anything responsibly. best of luck this mother should be put in jail!
i tend to obsess a bit about others problems..... i had another thought, i think working towards independence is very important in children with D esp.moving foward into her teen years but...... in this situation, maybe pulling control away for say like 6 months with the rationale to her that you just want her to be a kid, feel safe and cared for, she has her whole life to handle her D maybe for now you all and the school nurse run the show, unless she is low and needs to treat have someone else handle the bolusing. this may be so the wrong thing just an idea to have her seperate from her life as a diabetic to just a kid????? just thinking, best of luck you are a great step mom. unconditional love should go a long way in healing her wounds, i am with her sometimes therapist want to dig dig dig into the past, she lived it! how about teaching her to move foward with her life helping her cope with her current situation, learning healthier coping and a better way to feel at ease in her own skin! blessing to you all. amy
I have to tell you that even with a huge amount of family support and none of the issues that your step daughter has lived through, our son's usual reaction from the point that he started to self manage around age 12 was to panic in response to a high BG or a low BG, which then would cause a one to three hour roller coaster of up and down. It took a good couple years to get him to treat once, and then keep patient to hold off retesting for an appropriate amount of time, so that he would not dose too much insulin waiting for his body to respond to a high or overdose too much juice waiting for his body to respond to a low. I would just focus on making sure that she has as much psychological support as you can get.
Thank you for that. Makes me feel better to know that it isn't an odd thing for her to panic about the highs or lows. Cause she does. But at the same time there are times she does it to herself. Just for the attention. We never let her start monitoring her own insulin until she got the pump a year ago. It's on her and she should know she can ask if somethings not right. She doesn't though. She waits until she has to check for keytones before she says anything. We've actually gotten to the point of downloading her pump weekly to make sure on when she's giving herself a bolus dose at school. We had to start making sure it wasn't during class and only at snack time or lunch time. For a couple months we caught her doing it during class just to be able to leave class to go to the nurse. Basically to get out of class