MEDICAL DIRECTORS CORNER: MYSTERY BOLUSES As we have seen for many years (see the link to my 2007 post) there WERE some of these events discovered at camp. We addressed them by quietly and privately talking to the camper and asking them to stop. First a warning. Next if this continued we would have to call the parents and ask perhaps even them to take off the pump until they went home. Had the consequences been dramatic (like a low BG seizure) the family would have been called immediately, but that did not happen. But the larger question is this: if the child/teen feels free to dose insulin indiscriminately at camp, what do they do at home when not supervised by parents? They are behind the firewall of trust that family provides. This could also be called a blind spot to parents, depending on your point of view on this matter. How many of those unexplained lows at home MIGHT have been due to a random mystery bolus and change in pump settings? I dont know, but its illogical to assume it does not happen. This bespeaks the 90% of what diabetes self care is all about: the psychology of this disease. Many kids might privately say (and they do) that a low BG equal sweets and snacks. And on the operational level of a youngster that is sound logic. Sometimes its a cry for help (like...perhaps I dont really want to be on this pump you got for me and expected me to wear) to the family. It can even be a getting even method, like Ill show them. This is where a pump can descend into the realm of a weapon, but only a weapon of self-destruction. A pump is not a rite of diabetes passage. Its a responsibility. And as a wise person once said you can delegate authority, but you cant delegate RESPONSIBILITY. I have seen many campers who have little to no assistance from their parents as far as critical diabetes decisions are concerned. So, what have you delegated to your d-kids lately? And what is your tolerance for missed boluses (shots) or mystery boluses (surreptitious). At least in the latter, you (the family) rarely knows its happening (or the child has a rational explanation) or you simply think your child would never engage in such a behavior (ostrich-like behavior?). But I have earned my grey hairs on this topic and I can assure you: IT DOES. Not in every child, but the smart ones or the bored ones may start to experiment and see what they can get away with. Its actually a normal part of their adolescent and childhood development, only empowered and magnified by a $6,000-7,000 device. Your role is not easy. Its NOT to be the diabetes police, but more of a trusted sidekick and colleague. This is a very difficult role for many parents to take, especially if they have borne all the responsibility for their son or daughters diabetes for many years before reaching the age of shared responsibility, as our good friend Dr. Barbara Anderson in Houston describes it. As parents, we have watched our kids go through many of the physical trials and errors of life: learning to walk, ride a bicycle, etc... As they stumble, we pick them up and keep on encouraging them. I encourage you to rekindle that attitude in working with your d-kids as they struggle with all the choices they must make to navigate this condition. They NEED you to advise them, NOT always to do it for them. Think about that this week while we are caring for your sons and daughters. Just think about that. Please share any experiences you have with mystery boluses. This is not a behavior limited just to the camp setting. diabetech.net/challengediabetes.diabetech.net/2007/11/12/the-mystery-bolus/
Posted on: Thu, 07 Aug 2014 04:15:44 +0000
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