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Luann
Luann, Psychologist
Category: Mental Health
Satisfied Customers: 158
Experience:  Licensed Psychologist, 24 years experience working with children, adolescents, families and adults.
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I have twin fraternal 16 year old girls that both have type 1 diabetes since 14 mont

Customer Question

I have twin fraternal 16 year old girls that both have type 1 diabetes since 14 months old. One of the girls, Kayla, is very defiant. She won't test her blood when she is suppose to, got her driving priviledges taken away because the rule is you must test your blood before getting behind the wheel and she got caught not testing and lies constantly about things about her diabetes and school. Right now it is 12:10 AM and I just checked her meter and the last time she did her blood was 5 PM, she is suppose to test before she goes to bed. We do go to counseling but rarely together. When we do go together the versions she tells is so totally different. I try to tell her things that can happen to her due to diabetes complications but she just blows me off. Please give me some ideas I am so concerned about her health not only now but in the future. I am a RN and I work at a rehab unit and I see the amputations and the kidney failures but she's like that won't happen to me. HELP!
Submitted: 3 years ago.
Category: Mental Health
Expert:  Dr. Mark replied 3 years ago.

Hi! I believe I can be of help with this issue.

First, let me say I can imagine how frustrating this situation must be for you. You know the self imposed dangers that Kayla is putting on herself. And this is probably part of the dynamic for her: she's mad at the world, mad at G-d, mad at her parents for her genes and so we'll show them! That this is hurting herself more than anyone else is not what adolescents see in their brains. So telling her these things will not help. But what will help?

I'm going to tell you something that has a good chance of helping in a short period of time. Therapy will be hit or miss at this stage because she is resistant and not every therapist can handle a resistant teenager. That you're a nurse will help with this:

You have to find some older people in the range of 30s through 70s who have diabetes 1. The sicker the better. People who have been to the ER multiple times are the best. People who've had amputations of lower limbs are the best for her. You're looking for people wit the goriest stories to tell. You need to take her to meet these people and talk with them. If you could take her to the morgue to see a diabetic who died, that would be important too. But not practical, I know.

You are not going to win the argument war with her. I have a feeling you might have dismissed my suggestion as being theatrical. That's right. You've got a daughter who's so angry at her plight, I'm meeting her on her own field of play. I've only treated one kid with diabetes 1. But I've treated lots of teens because I work with a boarding high school locally. This kid was not as angry. But I know from angry teens that if I don't play it in a language they can understand, whatever their problem is, the solution isn't going to get through. And Kayla is angry enough that this is pretty much what you have to do to get it through to her.

So please consider it seriously. It can change her life.

Please remember to click the green accept button. Feel free to continue the discussion; my goal is to get you the best answers possible. Bonuses are always appreciated! If I can be of further help with any issue, just put "for Dr. Mark" in the front of your new question, and I'll be the one to answer it. All the best, XXXXX XXXXX

Customer: replied 3 years ago.

Dr. Mark,

 

With my patient's permission I did introduce Kayla and her sister to a few patients of mine. One was a 61 year old, with a baby face, he had numerous heart attacks, by-pass, and they this past May went into fulll kidney failure and was put on dyalysis 3 times a week. He had type 1 since 15 years old and was a CEO of hospitals during his careers until he was forced into retirement due to disabilities. One night he was very confused and he was sent to the ER, he was dx'd with sepsis and the drs thought he had another heart attack. During the 2 weeks there he toes were turning black and his legs were getting harder and harder. He got transfered to Yale where a surgeon who has worked on him before practiced. Now he needed an amputation put if he has the surgery his heart may not make it and if he doesn't, well he may die anyway. He had the surgery on a Wed and the surgery took many hours more that predicted and he went right on a respirator and the following Monday he died. He always asked about my girls and always told me to tell them to take care of themselves. This is only one pt, there are more and if they didn't meet them they knew about the diabetic ones, still it seems as if there wasn't an impact on her. If I go to a morgue to see someone who has died from diabetes do I need the family's permission? Also about 10 years ago a neighbor's son, who was about 24 at the time dies during the night, google dead in bed related to diabetes. It's rare but it does happen. On a web site that I got to there were 3 teenagers who died the same way dduring 2010. Kayla reaction was, ok mom, right, sure.

Expert:  Luann replied 3 years ago.

Hello,

I have a different approach for you to consider. You need all the approaches you can get because this is a very difficult and dangerous situation. As a psychologist and a mother of now 25 year old type 1 diabetic this is what I would recommend - find a medical team that she loves. She may like who she works with now, but maybe they seem like parents to her because she has worked with them ever since she can remember. Engage her in picking new providers, find a couple that you trust and give her a choice. I am sure she already sees a team, practitioner, diabetes educator, dietitian . . A team approach is the best for this disease but ultimately, the patient calls the shots. So empowering her in the right way may be the ticket. This will be her greatest asset her entire life. Staying her healthiest will mean her being in charge of her care not you. You are going to have to work on stepping out of this role, even though it is terrifying, because having her practice now while she still lives at home and has a safety net, is very important. See if there are support groups for parents in your area, you are going to need a lot of support to shift your role. You could also see if there are any "jobs" she could do through your local ADA. Another way to empower her. Let her find the facts, let other "experts" tell her the reality of her disease. You work on being a mom and being support to her. You may have to act helpless, I don't know what you should do about that . . . why don't you call . . . or why don't you ask . . . When you step out of the fight, it will take some wind out of her sails. My daughter went through some rough patches too, but in college, 650 miles away! Fortunately, she had a good pediatric team and found a great team near her college. She continues to see her provider there and now calls me with her A1C results! Hang in there, be a mom first and a nurse second.

Expert:  Luann replied 3 years ago.

Hello,

I have a different approach for you to consider. You need all the approaches you can get because this is a very difficult and dangerous situation. As a psychologist and a mother of now 25 year old type 1 diabetic this is what I would recommend - find a medical team that she loves. She may like who she works with now, but maybe they seem like parents to her because she has worked with them ever since she can remember. Engage her in picking new providers, find a couple that you trust and give her a choice. I am sure she already sees a team, practitioner, diabetes educator, dietitian . . A team approach is the best for this disease but ultimately, the patient calls the shots. So empowering her in the right way may be the ticket. This will be her greatest asset her entire life. Staying her healthiest will mean her being in charge of her care not you. You are going to have to work on stepping out of this role, even though it is terrifying, because having her practice now while she still lives at home and has a safety net, is very important. See if there are support groups for parents in your area, you are going to need a lot of support to shift your role. You could also see if there are any "jobs" she could do through your local ADA. Another way to empower her. Let her find the facts, let other "experts" tell her the reality of her disease. You work on being a mom and being support to her. You may have to act helpless, I don't know what you should do about that . . . why don't you call . . . or why don't you ask . . . When you step out of the fight, it will take some wind out of her sails. My daughter went through some rough patches too, but in college, 650 miles away! Fortunately, she had a good pediatric team and found a great team near her college. She continues to see her provider there and now calls me with her A1C results! Hang in there, be a mom first and a nurse second.

Customer: replied 3 years ago.

Luann,

 

We have been extremely involved with ADA for the 15 years she has had diabetes. They are also very involved and love Clara Barton Camp which is a diabetes camp for girls which is 5 minutes away from the Joslin Camp for boys. I am the support person through ADA. I am the person people call when they have newly diagnosed children and their diabetes team now is the one they picked even though it is further away it's ok. How do I get her to be in charge if she doesn't care about her health because I don't know anything and that doesn't happen or that won't happen to me. Many times when I test her during the night she'll be 30 - 40's. One morning I was getting ready to go to an ADA seminar and Kelsey is yelling, Kayla was starting to seize. We gave her glucagon, she stayed home from school and slept and my plans were cancelled. BUT she still doesn't think anything of it! During Christmas break I drove 3 1/2 hours one way to pick up a friend in MA who also had diabetes and is a positive role model. When this girl would test Kayla would watch her, when she'd pre-bolus Kayla would continue what she was doing. I would say Kay do your blood and I wwould get some dumb answer. I wouldn't say this right away, most of the time we were already eating. Then her friend started saying pre-bolus so you won't have spikes in your numbers but she still wouldn't. This girl is her BFF! I have stepped out of the fight before and she'd test 1 -2 a WEEK!! I can't wait for her to come around. Maybe I should tell her that we are going back to Joslin, 3 1/2 hours away, we went there when they were babies but the distance was too much with babies. I no longer say anything about work because she has told me she doesn't care about work, if she starts fighting with me and if I say anything back it's that I 'm mad because I'm not at work. We bought a car for them with the understanding that you must test your blood before getting behind the wheel, caught her on that so her priviledges were taken away. I used to run the support group but that was when the kids were young and the interest dwindled as the children aged. We do have Family Link through ADA, I am the Chairman, and we do have get togethers but my girls are the oldest, they like to go to see the younger children. Any other ideas??? FYI I am even being honored in April's edition of Diabetes Forcast. HELP!

Expert:  Luann replied 3 years ago.
Talk to her team, ask them how far you can let things go. Tell them you want to step out and want them to step it up. You have been her safety net so things don't go too far because you have the nursing skills to intervene. Maybe you need to call the ambulance when she is having a severe low, let them handle it and her, while you go to work. If she is not going to take it seriously why should you take on all the responsibility. Do what you need to do to keep her safe, but think, what would a friend or unskilled family member do in this situation? It is sort of that tough love approach.
Luann, Psychologist
Category: Mental Health
Satisfied Customers: 158
Experience: Licensed Psychologist, 24 years experience working with children, adolescents, families and adults.
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