I have a theory about couples who manage their child’s diabetes together: that one parent worries more about the immediate consequences of a devastating blood sugar low (i.e., unconsciousness or death), and the other worries more about the long-term, down-the-road consequences of repeated highs (heart trouble, kidney failure, blindness, etc.). My only evidence for this is how the dynamic plays out in our family, and a comment from Bisi’s diabetes nurse educator, who sees 400 patients (!), so can speak to this on a larger scale: “I do tend to see a split. Usually one part of a couple tends to be more concerned about the lows, the other tends to be more concerned about the long-term complications caused by highs.”
In our family, I’m the person who worries about lows, Mark about the highs—though of course, really, we both worry about both things. This dynamic plays out in all kinds of ways, in all kinds of situations—when Bisi’s doing sports, before meals, during the night.
This morning, when Bisi woke up like a Grumpy Cat on steroids, after a night where her blood sugar was in the low-to-mid 200s and Mark got up to give her insulin twice (her target night time BG is 150), our conversation went something like this:
“She’s probably grumpy because her blood sugar was high, and it’s not good for her long-term. I think her night-time target should be 120; 150 is too high.” (The lower her target, the more insulin her pump calculates for when she’s high.)
“I worry about shooting for the low 100s at night. Sometimes when she’s in the low hundreds, she’ll start dropping quickly and ends up way lower than she should be.”
“But that’s why we have the CGM.”
“Yes, but the CGM isn’t always great about catching lows, and sometimes when she’s sleeping on her back it loses her altogether. It only takes one bad low.”
In this case, I think we’re going to raise her night-time basal rate a bit, because we think that her insulin needs have changed, and that the higher blood sugars we’ve seen the last couple of nights aren’t so much caused by the food she’s eating, as by her body’s growing need for insulin. (Even if people with T1D were to eat nothing, they would still need basal, or baseline, insulin to control their blood sugar; we make changes in her basal rate all the time.) But the high-low debate is a larger philosophical issue, maybe even one that’s inherent to our personalities and the types of things that set our own personal worry bells ringing. It’s also, maybe, a functional way to make sure that her care is balanced—that we’re not walking too close to the edge with lows, or too far from the edge toward highs. Our worries counterbalance each other. The truth is that if Bisi’s A1C is a guide, we’re doing a pretty good job (it’s significantly below the American Diabetes Association target for her age group of 7.5; though some argue that that target is too high).
I’m curious: if you are parents managing a child’s T1D together, do you have the same dynamic of one especially concerned about lows and the other about highs? If so, is it the same gender split as ours? (Part of my theory was that mothers tend to worry more about lows and fathers about highs, but Bisi’s nurse shot this supposition down. “No, it’s not a gender thing,” she told me.) Or do you both gravitate towards the middle of the T1D teeter-totter?