A Doctor for Every Teen

A great doctor means everything in diabetes care.

Last week my son went to his first diabetes appointment without Mom.  As I said before, I had emailed the clinic. I had given them a heads up about a lot of things but I was not at the appointment. I was both surprised and impressed when a little while after the appointment I text my son, asked him how it went and he said “I will call you after.”  He was going to call and share the appointment with me? I was very pleased that he wanted to do this.

Later that evening we did talk. He told me that they had a lot to say, most of it he didn’t remember.  Again, my son is 16 and forgetting what adults say is a teen brain specialty. The nurse made a few changes.  His doctor commented on how much he had grown…and then his doctor talked, and talked, and talked to him for a full hour.  That was not unusual.  This doctor takes a lot of time with his patients and their families.  He gets to know you, shares with you and advises you.  He is wonderful.

My son was a little shocked by his high A1c (personally I was shocked that it wasn’t higher).  His doctor quickly told him that he didn’t care about that. It was just a number. (Yes you read that right! His DOCTOR said he wasn’t concerned about a high A1c!)  The doctor’s concern was with my son learning to handle HIS disease.  He wanted my child to know how to troubleshoot the issues himself.  He needed to know how much insulin to give himself, how to adjust a basal or bolus setting.  This was on him.  Now was his time to step up and learn.

I was beaming on the other end of the phone! This was what I had been aiming for as well but coming from his doctor was different from the “momma yammer”.  We do sit down and discuss strategies.  For the past few years, when making changes I would first ask him if he thought it was a bolus or basal issue.  He now had to develop the confidence to do it all on his own.  I was thrilled and reminded him that he was already doing a great job learning.

No one was suggesting that this complete transformation would happen overnight. This was his two-year plan and his doctor had told him that messing up and having a high A1c while he found his way was okay. This was a good reminder for Mom and a great message for my son.  Learn! Learn! and then when you have it figured out, go back and fix that A1c but for now learn about you, your body and your disease.

I still love this doctor and would gladly clone him for everyone else with diabetes to have as well.

d health

Watching The Stumbles from a Distance

My son has been living with his father now for two full months. I still walk into his room and hope to find him there. I still find used test strips in strange locations. I still wake at night thinking that I should get up and test him but it is getting easier. I am slowly learning to adapt.

I keep in touch with both of my boys on a daily basis. I still worry about both of them.  I worry about the troubles that can find young men. I worry about many things that a parent will concern themselves with but I don’t obsess over any of it. I focus on how strong and independent they are. I pray that they always remember that I always want the very best for them.

My youngest son has been great about uploading his pump and touching base with me once a week to discuss his readings.  I have worked very hard never to freak out at the lack of testing. I don’t scream at him when I see high readings.  I normally just ask for more data. We discuss how different meters are functioning and talk about how to handle bad sites.

Stepping back and letting him make the decisions is very difficult.  It’s not because I am a control freak (although that has had its challenges), it’s because I am a Mom.  I want to protect my children from all ills. I failed him once by allowing him to get this disease. It has therefore been my job to protect him from the ravages of it.  That’s how a parent thinks.

Yesterday my son and I talked about his readings.  Once again I did not scream. I did not cry–but boy did I want to! I looked at the very few readings (maybe two per day) and saw none of them in range.  All readings were incredibly high (a low reading was 14 mmol or 252 mgdl).  My mind’s eye saw nothing but kidneys breaking down and eyes being damaged.  I quickly reined in my imagination and remembered the concept of metabolic memory.  I had prepared for this day.  I had kept him in excellent control his entire life.  The theory was that it would protect him through this time as he stumbled and found his own stride.

Instead of showing my obvious distress, I reminded my son that he felt bad when he was high. I asked him a few questions about his readings–“how long before you tested did you eat? So you were probably high for at least four hours previous.”  I then set to work. I was nervous about making sweeping changes with so little data but I had to do something! I upped his rates almost across the board.  I suggested that he might want to try to test a bit more so we could get a better idea of where we stand and help him to feel more like himself. I left it there.

This would have to be his decision. He had to decide to look after himself and make testing a priority again.  We had met for dinner a month ago when I was near the town that he now lives in.  I watched as he began to eat without testing. When I questioned him, he quickly took out the pump remote, tested and stated that he had forgotten because he was just so hungry.  Perhaps that was the case but the data I have been seeing suggests that he just often doesn’t bother to take the time to test most of the time.  He remembers to bolus however so I will be grateful for the things he does do.

I praised him for giving me the truth about high numbers. He was not using the pump remote for most readings so he could easily have lied about the 20 and 30s (360-540+) that I was seeing on his upload.  I said that it was great that he was showing me these.  We would work together to bring the readings more in range.

I have no illusions that things will change after this latest talk.  We had a similar one a few weeks ago.  That reality is what sets me on the edge of tears.  He will see his diabetes team next week. I pray that they will help him see sense but again, I doubt it. He is 16.  He knows best. He will have to learn on his own.  One day he will hopefully realize that I was trying to keep him healthy.

I have spent the past 13.5 years teaching him how to take care of himself. He has the tools.  Watching him not use them is heart-wrenching.  Many adults with diabetes and parents with older children tell me that this will pass. One day he will remember all that he was taught and will get himself back on track.  I do believe that–I have to.  The hard part is waiting for that to happen and in the meantime standing on the side lines watching, guiding, and praying that the scrapes are no more than that.

My son is a good kid–both of my children are.  They have never brought any trouble to my door. They have never been involved in any serious and dangerous behaviors that I know of.  They have always been quite respectful of me and as I said, all around great children.  Diabetes just adds that extra layer. It’s like that best friend that you really don’t want your kids to hang around with but they think he is the best thing going.  You know the dangers that he can cause for your child and they think that they have him under control.  Daily you pray that they are right…but it is terribly difficult.

I will continue to monitor my son’s longtime friend called diabetes. I will work to prevent as many scrapes as I can. I will be on the sidelines encouraging him to find his own stride and remembering that no matter what I have done in the past, this is his disease to learn to manage.

Liam Oct 1998