The Emotional Side of Nighttime Testing
By Dr. Wendy Rapaport, Clinical Psychologist
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Nighttime testing is probably one of the most sensitive and emotional issues for parents of children with diabetes.
Panic, resentment, guilt, worry, anger, dread and disgust are all very difficult feelings that might arise at times about this responsibility and the decision on how to handle it. But guess what? These feelings are in the normal range! And, they are important because we are all human.
The goal is to create a positive-enlightened attitude for the long-term. No easy task! This is important for you in carrying out your responsibility and getting an effective outcome, not only with the numbers, but also one that bolsters your "diabetes self-esteem" and reduces difficult emotions. For example:
- “I appreciate the hard work and love that I put into keeping my child safe.”
- “I know that lows can happen at any time; I treat the lows with calmness and gratitude, knowing that I can take care of my child well, not perfectly.”
Your attitude as a parent will affect the way your child internalizes her/his view of lows. If you originally felt fear as the driving force for nighttime checks, change your mind set to: Nighttime checks are a good habit.
How you feel about the lows – and accepting them when they happen as a routine part of normalizing diabetes control – is as important as attempting to prevent them. Deleting words such as "panic" and "crisis" is a good goal to strive for.
Creating an effective attitude IS possible…with a little help from your friends. Talk to other families affected by diabetes. Don’t have any near you? Find more than 2,000 parents on the DRI Foundation’s PEP Squad closed group page on Facebook. Approach your health care professionals, and in particular, the mental health professional on your team. It is important to be open about your anxieties, challenge your health care professional’s advice, and create an individualized prescription that may change over time…one that fits you and your family.
Making sure you share the tasks with your spouse or partner – even if you think they do it “less well” than you – is necessary for self-care and for letting the child know each parent is capable and interested. Your quality of life as a family and your diabetes management choices depend on a healthy, emotional stance. Excessive anxiety and obsessive or avoidant management must be addressed without shame.
Have you heard of the Hypoglycemia Fear Survey (HFS)? It implies that experts know that a fear of hypoglycemia exists. There can be two ends of the spectrum: avoidance by keeping blood sugars too high or obsession in tracking blood sugars. Either way, this can interfere with quality of life.
To avoid the pressure of being fearful, parents and kids need to be taught how to safeguard their thinking. The field of CBT, cognitive behavioral therapy, which identifies our thoughts that don't serve us well: overgeneralizing, magnifying negatives, catastrophizing, forgetting the positives, offers ways to react differently and effectively to thoughts, emotions, or behaviors that don't serve us well.
These feelings and strategies need to be revisited periodically; your needs and habits can change. You have a lot on your plate…handling your child's diabetes, your stress, and possibly dealing with reduced sleep. Everyone needs to kvetch (complain legitimately) about the pressures of taking care of diabetes, including siblings who are awakened at night or left out of the "complaining camaraderie."
Some additional tips:
- If you do nighttime test, consider "noise" machines or meditation tapes in your room to help you fall back to sleep more easily.
- Keep your internal conversation (self-talk) positive.
- Continue searching for information rather than judging.
- Think of a social worker or psychologist as a preventive, proactive part of your healthcare team.
- If there is alcohol involved, make sure she/he has a buddy system, a CGM or a diabetes alert dog trained to identify hypoglycemia. Again, rather than judging, try partnering. For example, many parents text their college-aged kids in the morning on weekends. (Make sure you have agreed upon permission ahead of time.) If alcohol is excessive, that's another conversation.
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SOURCE: Wendy Satin Rapaport, L.S.C.W., Psy.D., licensed clinical psychologist, is Adjunct Professor of Medicine at the Diabetes Research Institute, University of Miami, and has specialized in individual, marital, family and group therapy for patients with diabetes for more than 30 years. A professional writer, Dr. Rapaport has published more than 30 articles and book chapters on this subject and frequently lectures around the country.
[Rooney, N.J. Morant, S.Guest,C.(2013,) Investigation into the value of trained glycemia alert dogs to clients with type 1 diabetes, vol8, iss 8.(www.plosone.org)]