One key to being supportive with diabetes is remembering that sugary temptations for children and adults are ever-present, and often it may be okay to take an occasional break and enjoy a small treat. This is a personal decision when it comes to managing diabetes as an adult (self-care) and an even more difficult decision as a parent of an insulin dependent child. What does type 1 diabetes parenting require? Blood-testing, overnight checking, record keeping, careful food preparation and injections/insulin administration, the fears related to the loss of control of a child’s well-being, health and future… Part of being a parent of a type 1 child is being tough, but what are the psychological implications of this for a child? Does tough work? How about zero-tolerance restrictions?
With this in mind, I began to think about Amy Chua and the notorious WSJ promo excerpt – Why Chinese Mothers are Superior? which disarmed the parenting elite everywhere. Op-eds too numerous to count either supported or criticized the techniques described in her memoir, The Battle Hymn of the Tiger Mother. Western mothers (and many Chinese mothers) were outraged by her tough tactics and her strategy to eliminate all distractions from studies – no playdates, no TV and no sleepovers. I wondered what Amy Chua might do if one of her daughters had type 1 diabetes? Would her Tiger Mother-ness continue to reign or would she begin to buckle at the knees knowing her daughter had an incurable illness, and lighten up her demands? How would a mother like Amy Chua help her daughter manage blood sugar control? Like a Tiger?
I am not a mother of a diabetic child, but I was a type 1 daughter. When I was diagnosed my mother took the practical route (no time for tears), and was exceptionally tough when it came to dietary guidelines and activity. In thinking it over, I can see how she was a kind of tiger mother in overseeing my diabetes care. This was in 1975, a period I like to call the Middle Ages for diabetes. Insulin had been discovered 50 years earlier, but it was before the development of home blood glucose meters and fast-acting insulin. Modern insulin analogues hadn’t yet been developed. The insulin pump didn’t exist. I took two shots of NPH insulin a day, and peed on test strips for my “general” all-around sugar level. My mother weighed every portion of my food, and I wasn’t allowed any saturated fats, sugars (honey included), ‘sweet’ fruits (grapes were out), or junk food. Looking back, I can see how my mother was ahead of her time, but back then I began to hate food. I felt punished when it came to comparing what I could eat (pretty bland stuff) versus what my brother could eat (anything).
As I began to grow (develop hormones), I had cravings that I was just too afraid to tell my mother about. I would have given my left arm for a piece of chocolate or pizza, but she had a lot of trouble discussing the emotional distresses behind my illness and emotionally, she was incapable of giving me the attention I so desperately needed. The few times I tried, I could see that it was too painful; her voice would shake and she would have some trouble swallowing. I knew the signs. Admitting diabetes was a problem was something she would not let me express and I began to feel that diabetes, on top of three other demanding children and a difficult marriage, was the proverbial last straw.
To be fair, her tough love and stick to the rules approach back in the 1970s and early 80s was the greater part of what diabetes care was all about. It was rudimentary. Insulin was basic, and testing imprecise. I have no idea what my pediatric doctor may have told her in private. He wasn’t someone who smiled a whole lot. Perhaps she was doing as she was told, and feared modifying my diet. There weren’t any other children with diabetes that we knew well and often my parents compared diabetes to other hard to manage illnesses back then like epilepsy or hemophilia. Moreover, I was terrified of disappointing my mother. I was her smart, “beautiful,” last born – so nearly perfect, if only it wasn’t for diabetes. Slowly, I began to resent the burden as much as her.
The summer before I entered the University of Virginia, I lived with six other female graduating seniors at the beach and worked in a seafood restaurant on the local boardwalk. A part of my elation in leaving home was getting away from my mother’s complete devotion and awareness to every single piece of food I put in my mouth. One of the first things I did was to sneak over to Baskin-Robbins and order the largest sundae with three scoops of full fat ice-cream, heaps of butterscotch sauce and chocolate sauce, whipped cream, and sprinkles. I sat in a vinyl booth at the back of the parlor and ate the entire thing alone, watching the world go by through the plate glass windows. I assumed all my friends were either at the beach or working and I had convinced myself that no one had seen me. I was wrong; word had gotten around, and one of my closest friends confronted me. With embarrassment, shame and guilt, I exploded into tears, reliving the same emotions I’d experienced when I ate the sundae. My friend and I sat on the edge of the jetty with our feet hanging over the water until the sun set. I think years of repression, loss and denial came bursting out in one afternoon. While my blood sugar normalized within a few hours that summer day in 1983, it took a lot more time to work through the conflicting diabetes emotions of my late teens and early twenties.
I won’t deny there were positives that came out of my mother’s approach too, including: self-discipline when it came to routine and order, problem-solving capabilities, and knowing instinctively how to prioritize. Although she focused on food in the home, I was in charge of testing and insulin injections. I credit my can-do attitude and fearlessness for early independence and accountability. Indeed, the survival skills I learned then have carried me through the decades. However, I was unable to manage the emotional loss tied to my diabetes, with rage connected to the issue of restrictions and the unpredictable nature of the disease. I pretended to be a perfect diabetic as a young adult. I suffered in silence and was too ashamed to speak-out.
What Kind of Type 1 Parenting Works?
Here I have focused only on the dietary aspect of diabetes, but there are many other aspects that require some thought: testing routines, insulin injections/pump therapy and socializing are also matters to consider. It is as much of a loss for a parent to have a child diagnosed with diabetes as it is for the child, and parenting is a personal thing, so no judging here. I wonder, though, with all the technological devices that allow more freedom in diabetes meal planning and routines if parents are going the opposite way of my mother and becoming more lenient. Some might say yes, go ahead and have that treat, while others say restrictive tight control is the only way. Below are a few questions to consider when thinking about parental guidance, support and care:
Do you get upset at the prospect of your type 1 child eating something sugary or do you feel pretty relaxed about the occasional treat? Is middle ground best with occasional compromise or is a firm no better when it comes to sugar? (I never associate fun with hypoglycemia whether I am eating tablespoons of sugar or a piece of hard candy. I don’t really consider this a treat; I consider this a treatment for a terrible symptom.)
What motivates you either way?
If you allow treats, reasons may include:
Teaching moderation, fear of child rebellion (sneaking treats), sympathy, doctor’s approval, your ability to bolus and correct if sugar goes up, worries about “loss of childhood” (enjoyment)?
If you don’t allow treats, reasons may include:
Fear of complications, fear of sugar/carbohydrate addiction, teaching discipline, worry what other parents might say, worry that the freedom to have an occasional treat will be misunderstood by the child, doctor says no way.
Sometimes one approach or the other is dictated by a parent’s intuition and the personality of the child. Certainly, there is no-one-size-fits-all. What has been successful for you?
Originally posted on Diabetes-24-7.com and republished with author’s permission.