Your child is in the midst of a temper tantrum, which a kid will do no matter what his age, and before you discipline him, you stop yourself with these questions: "Maybe it's his blood sugar. Maybe he's low again. Maybe his BG readings are high. Then again, maybe he's just plain acting out."
These questions plague most parents with children who have diabetes: How can you really know if a tantrum is just bad behavior or if it's diabetes?
Diabetes adds in a new level of complexity to parenting and specifically to reading and then managing a child's behavior. Before a diabetes diagnosis, an all-out temper tantrum may have meant a trip to the Time-Out Corner. Or, if you've an older child, a fast trip to his room with all privileges revoked (and don't forget to give me your phone and iPod on your way to room)
Now, with diabetes in the picture, parents need to consider whether or not BG levels are impacting their kids' behavior.
Low blood sugar, or hypoglycemia, is characterized by symptoms like mood changes, irritability, irrational behavior and even belligerence. Parents of Type 1 kids know these tell-tale signs all too well and often pull out the glucose tabs as their first line of defense.
On the other hand, high BG levels or hyperglycemia can impact behavior too. Symptoms are wide ranging, and include general malaise, difficulty concentrating, nausea and headaches. My son likens prolonged high blood sugars to being poisoned. Who's not going be a bit on the cantankerous side if he's feeling like that? The ADA conducted a study with feedback from 42 parents with Type 1 kids aged 5 to 10. For the study, researchers measured a child's BG levels twice during a 72-hour period and had his parents fill out a questionnaire with behavior-related questions during the corresponding period in time. The results, although qualitative, found that kids tended to act out more when BG levels were high as compared to normal levels.
Bottom line: your child's behavior certainly might be affected by BG levels, and significantly.
Put an action plan in place
So what do you do? What can you as a parent, with so many moving parts to keep track of, do? I recently sat in on a presentation by Ann Bartlett to parents at a Type 1 Friends meeting, a support group based in Northern Virginia. Ann, a fellow HealthCentral blogger and Type 1 for over 40 years, recommends that the child and parents have an action plan to turn to so that the child can go on autopilot when blood sugars are out of whack.
For the child, this plan can be as straightforward as sensing that something is not quite right, then testing his blood to see if he is high or low (and symptoms can be easy to mix up, one can feel like his blood's plummeting, but it is actually high). Once the BG is tested, then treat accordingly. If low, take glucose tabs or something else to bring up blood sugars and furthermore understand that this need is more immediate and the symptoms are short-lived.
On the other hand, if blood sugars are high, then take the needed actions that are usually done for your child, whether correcting with additional insulin, or drinking water, or exercising. Don't dwell on the high number, rather set out to do something about it and understand that high blood sugars can take time to come down.
If a child is younger, the parent or caregiver will need set in motion the action plan, while explaining to the child why this is happening and how the plan will make the child feel better.
Get the school on board
If your child is old enough to go to school, then teachers and administrators need to know about the behavioral signs that your child displays with either low or high blood sugars and what the subsequent action plan should be (often, these action plans have been incorporated in a child's diabetes management or care plan at school). A good rule of thumb is to institute a policy at school and daycare is that if a child is acting up -- whether out of character or not-- then the child ought to test, or have a caregiver test, his blood sugar. Next, disciplinary action should not be taken unless this is done and a patent is contacted or if blood sugars appear normal.
The older your child gets, the more time he will spend away from you and at school. By the time a kid hits elementary school, days often are about seven hours long. If you use before and after school care, then the days can be up to ten hours in length. That can mean a lot of people who are responsible for your child throughout the day, many of whom may not be in tune with the finer behavior nuances and signs of either your child's high or low blood sugars. This is why communicating to everyone who has contact with your child is critical.
A normal functioning adult?
At presentation I'd mentioned above, one parent had wondered if her child would grow up to be a normal adult. Ann assured parents that their children would grow up to very well adjusted if the children were encouraged to treat diabetes as simply a part of his or her life.
She recommended the group to test their kids BG levels to know what was going on with the child, but not to tolerate bad behavior. If BG levels are off-kilter, whether low or high, then correct the blood sugars and then attend to the behavior. If it continues, then discipline or address the behavior issues as you typically would without the diabetes.
Ann told the group that this is how her parents had raised her and she had turned out pretty well.
Quite well indeed, I'd say.
However, even with a light at the end of the tunnel, the childrearing road seems full of potholes, often caused by diabetes, many of which can ruin your alignment.