Go D-Parents! We love recognizing the near-superhero powers of parents who so bravely take on the role of manual pancreas along with the rest of their parenting responsibilities. In this week's edition of our weekly advice column, Ask D'Mine, longtime type 1, diabetes author and educator Wil Dubois explores how the D-World has changed in the past 20 years and what that's meant for parents of children with diabetes.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

 

Tom, type 1 from Kentucky, writes: I've been living with type 1 for decades now, after being diagnosed as a young kid. Back in those days, my parents hardly ever got up to check my blood sugars in the middle of the night. I would simply eat a piece of toast with peanut butter and a half a glass of milk if my readings were less than 100 at bedtime. That would get me through the night, most of the time. I know those were different times: two shots a day, meal exchanges, and home glucose meters weren't as mainstream as they are now. But I bring this all up because I read ALL these parents these days talking about never sleeping and getting up every-other-hour to monitor their kids' blood sugars. What brought about this change? Is it overkill on the part of the parents? I mean really, as someone who's been around the D-block personally and professionally, Wil, do you think modern CWDs are hovered over, and parents are creating more stress and worry for themselves than need be?

Wil@Ask D'Mine answers: A couple of disclaimers—I'm an adult-diagnosed type 1 myself, my kiddo (knock on wood) doesn't have T1, and I only work with a handful of kiddos and their parents professionally. That said, I do get a constant flow of emails from D-Moms and D-Dads, so I think I'm in touch with their feelings and their general modus operandi, and I'm appalled at the dedication these parents show their children! Talk about not having a life, I'm 100% convinced that it's 100 times better to have this bitch of a disease yourself than to have to be the co-pilot for someone else's diabetes.

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But you're right, there's been a sea-change over the last few-dozen years when it comes to the job description of the D-Parent. And I honestly don't know where it came from. It might have come from the endos or from the Pink Panther—although both actually recommend only "periodic" nocturnal testing, not daily nocturnal testing. It might have grown out of fear of the heavily publicized Dead in Bed Syndrome. Or maybe it just came from the protective parental instincts of our species accelerated by the new technologies.

We do what we can do to protect our children from harm, whether that means sleeping at the mouth of the cave with a spear to ward off prowling sabD-Superhero Logoer tooth tigers, or getting up at three in the frickin' morning to do a fingerstick test.

Dress it up as Superhero Pancreas Mimicking or doing what needs to be done... we're on the job, just taking care of business.

Another thing to consider is that the face of type 1 itself is changing, and that face is smaller with chubby cheeks. We are seeing type 1 onset at progressively younger and younger ages. So while a night-time hypo might be handled solo by a "competent teen," we can't really expect a 4-year-old to know what to do. So younger diagnosis requires more parental management, and that creates habits that are hard to let go of.

On top of all of that, this worry about night lows is no idle fear. Clinical research with CGMs over the last decade has shown us that nocturnal hypos in kids are far more common and far more dangerous than previously believed. And lastly, due to our interconnected world, we are all more keenly aware of the death of a D-Child than we were in the past. Today, every parent's worst nightmare is only one mouse click away.

There's a whole discussion about where the line is, and Mike wrote about this just the other day, showing that it's not always a black-and-white thing to recognize.

Of course, there are a few other things to consider as well when we look at the differences between now and then. Let's talk about gear. For at least three generations of "our kind" there were no glucometers. Really, all you could do in the old days was kiss your kid goodnight each night and pray it wasn't a goodbye kiss. As the meters came on the scene, that changed. Interestingly, however, the meters show up mainstream in the era of soccer moms and helicopter moms. I'm not saying there's a connection, just that the technology enabled an already-existing social trend of more intensive involvement in the lives of children.

And you are right, insulin itself has changed, too. On one hand, the flatter modern basal insulin profiles should be safer. The old NPH had quite a peak. It could kick like a mule, generally in the middle of the night. That said, some people maintain that the modern insulins cause more wicked, deeper, and more dangerous hypos than the old ones. I'm not convinced of that from either the research or my personal experience. I've been around just long enough to have started on NPH. Personally, I've had my ass kicked by both old-school insulin and modern insulin, and I don't see any difference. I've had some officially scary moments from both classes of insulin.

And of course, we now have insulin pumps -- able, in theory, to perfectly match the needs of the user's body. Hah! Oh, sorry. Most of us pumpers are far from seeing flat-lined blood sugars, and we're not dealing with the constantly changing environment of a child's body—a seething soup of hormones, growth-spurts, erratic eating, and even more erratic activity.

Now enter CGM, the seeing-eye dog of hypos. In theory, CGM should let parents sleep more, or at least better. And while that is true, from what I see, most parents still aren't ready to trust this technology (odd, as these same parents are the ones screaming loudest for an artificial pancreas). Still, CGM is only... What? Eight years old? I've been on that bandwagon since the beginning and CGMs have been, and are continuing, to improve at an exponential rate. But it takes time to build trust, especially when your child's life is on the line.

Well, so much for my thoughts about how and why D-parenting changed. I think it's a mix of changes in gear, meds, pathophysiology, and social trends that resulted in the D-Parents of today playing the game in a different way than those of yesteryear. Now on to your question about spoiling kids.

Yes, I think the new D-parenting style has created a generation of "spoiled brats."* To manage type 1, you really need to own it, and I think that too much parental interference can be a recipe for bad self-management skills.

One of the people I lie awake at night worrying about is a 17-year-old boy who was sent to me by his endo. His mother still does the 3 a.m. check thing, and way too many other management tasks, too. He's an OK kid, but when it comes to diabetes, he's like a spoiled royal prince. He expects everyone else to do the work for him. Why do I worry about him? Because college cometh. He's a nearly-adult bird, ready to leave the nest, but he's never been taught to fly. I actually worry about his mom, too. She's had no life of her own for 12 years. She's probably forgotten how to be a person. Her role, her identity, and her purpose, is about to be stripped from her. The whole thing could end badly.

I feel like I'm watching a train wreck in slow motion. I'm trying to chart a fast course for them—a course from total co-dependence to complete independence—but I don't have a lot of time, and there are all kinds of hidden reefs in these waters. (Oh dear, I'm going metaphor crazy again, aren't I? Co-pilots, cavemen, birds, and nautical misadventures... I have no excuse.)

But, bottom line: Is this new style of D-parenting necessary? Are modern D-Parents being over protective, or, paraphrasing your words: should they be diagnosed with Overkillitis and be given a prescription for a powerful sedative? And more globaParentinglly, are parents just creating more stress and worry for themselves? That could be. Sleep deprivation is slow, insidious, and has a host of long-range health effects that can be devastating.

On the other side of the coin, doing nothing when your child's life is potentially in jeopardy is stressful, too, and there's something to be said for doing something. Checking BGs at night provides the peace of mind that comes from taking action. And whether that peace of mind outweighs the damage from disturbed sleep is highly debatable.

But backing off from the subject even further, does checking in the middle of the night actually work? The 'Mine team had a lively post discussion on this last year, asking if it's really needed or actually reduces the risk of potentially fatal lows? There's a shocking lack of evidence for the effectiveness of nighttime fingersticks beyond anecdotal stories, and most clinical studies on nighttime lows in kiddos have focused on CGM. But just speculating, is a nocturnal check or two (or three) really an effective way of preventing the worst from happening? Frankly, I doubt it. Consider how fast a bad hypo hits. But it beats doing nothing. Maybe the saber tooth tiger jumps right over the spear-armed parent snoozing at the mouth of the cave, but that's no reason to make it easy for the beast to get in.

Final thought: Let's not forget that 30 years ago there wasn't an online diabetes memorial wall of little blue candles to mark each T1's passing. Some of our fallen are awfully young. It was probably happening back then, too, we just didn't know it. If it were my son with the diabetes, not me, would I trust the CGM to wake me in the night if the shit hit the fan? I don't know. Probably not.

I guess it only looks like overkill until it's your kid.

 

* CORRECTION: We'd like to note that the word "spoiled" was in the original question. It was edited out inadvertently, but unfortunately not Wil's reference to "spoiled" kids, where he was in fact reacting to the reader's wording. Apologies for any upset this may have caused.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.