Signs and Symptoms
Let's just say this first: Parents never expect their child to burn out. They've seen the kids who have—teens who balk at daily care or younger children who flat-out give up on taking active control of their diabetes. Deep down, most parents let their egos say, “That will never be me.” Well, it's time to check the ego because while some children fly through a life with diabetes without worry or care (and here's hoping yours is one of those), most children struggle at some point. You have to be understanding about this struggle: Think of how hard it is for you to keep on a diet, or to maintain a regular exercise routine. Almost all people vary from the norm (or even take a few days off) from time to time. But children with diabetes don't have that luxury. There is no break from diabetes, not even for a day, and over the years, that's bound to take its toll.
The First Hints of Burnout
Your child has been cruising along for a few years or more, checking when needed, bolusing on time, discussing food options, and even talking openly about her diabetes for her friends and her world to hear. You live by the clock, from blood check to insulin dose to food to blood check again. You settle into thinking, “Yes, we've got this beat.” And then, something starts to change.
Often, the first signs are hard for a caregiver to spot. Children are afraid, for the most part, to let their parents down. Think about it: Most parents have raved about and applauded a low A1c or a good food and bolus choice, and your children know how much you have put into helping them with this disease. Sometimes admitting she cannot “hold up her end” can be too much for a child to face.
So, kids will start to practice avoidance. They go to play across the block and “forget” the meter. You understand; you've forgotten it, too. They eat a granola bar and “forget” to bolus. You know what it's like snacking; it's easy to just gobble something down and forget you ever did.
A surprising elevation in an A1c reading can be a sign of burnout. Because kids will avoid talking about their burnout, this higher number is often the first true message a parent gets that his child is struggling.
And so, children tend to slip into burnout right under their caring and loving parents' noses. What's a parent to do? Check your ego at the door and be vigilant in looking for signs. Most parents have their egos attached to caring for their child, and with good reason. This life with diabetes takes brains and brawn, and all parents like to think they can rise to the challenge (maybe even a little better than everyone else). You see other kids who have fallen off course and cluck your tongue in disapproval. You assume your child is cruising along for one main reason:
Keeping a logbook is more important than ever at this time of struggle. By forcing yourself and your child to keep one together, you'll force both of you to look honestly at the day each day. Sick of it as you may be, it works.
So, you begin to see the cracks. Missed boluses (all with excellent excuses; kids are masters at this). Forgotten blood checks. If your child used to speak openly about his disease, he may begin to keep it private.
The “I Can Do It Myself” Sign
Often, a good sign of early burnout is, ironically, something parents celebrate as a victory: a child's request to handle her diabetes on her own. This is a tricky thing. Most parents encourage their children (rightfully) to be responsible and take on duties. Life with diabetes is no different. You cheer when she does her own finger stick the first time; you call all the relatives when she gives her own shot or changes out her own pump site. But a child asking to be completely on her own—even in the teen years—is often a putting out a mayday that parents need to pick up on.
At what age is my child ready to do this all alone?
The long answer is he's ready once he heads to college or moves out of the house. Until then, children of all ages need their parent's support and, often, their intervention. The short answer is she'll never be ready. You'll always be your child's parent.
Another first hint is erratic blood sugar readings that your child claims not to understand or repeatedly comes up with the same “answer.” If you see this, take notice. Suddenly, you notice he needed to change out sites or do shot corrections more than once a day. This is a real sign that trouble may be on the horizon, or smack in the middle of your life.