CAUTION: How You Discuss “Bad” Blood Sugars in Children with Diabetes

There is a commercial on the air that shows when a woman receives a report from her doctor and her cholesterol (the LDL “bad kind”) has dropped; she is ecstatic. She high-fives the world … and goes bowling; she is very happy.

When it comes to diabetes and numbers, I have always thought it better to take a different approach. When my daughter Kaitlyn was younger, each time she checked her blood sugar, we tried our hardest to show no reaction and always just thanked her for taking care of herself … it served us well.

Here is my cautionary tale to all parents…

In as much as good numbers seem worthy to shout from a mountain top and posting pictures of your child holding a meter with a number like 92 seems encouraging—my question has always been, what happens when your child is 18.9 mmol/L341 mg/dL? When you don’t shout about those numbers … what else can your child think but that they failed.

Now hear me out. I’m all for 100 percent positive reinforcement for any child. Lord knows how much I love kids and would do anything to make their lives easier. I’m not asking this question to you, from your point of view … I want you to think of it from their point of view.

If you tout a great number or a great A1C number, undoubtedly there will be times when a less than optimum number will be present; if you build one up, it is only natural that your child will feel like they failed when that not-so-good-number shows up. It is not their fault. There is nothing they could do to prevent this disease.

So if given the choice, if they are trying (I leave that to you to define) their best; the number should not matter in relation to doing well or not. The number is a gauge that allows them to adjust. The number is a means to correct something going on inside their body. I cannot warn strong enough, to be very careful how you reflect that number on your child — good or bad. Because if you highlight the good, the bad will be taken to heart.

Think about it.

“Great number, honey.”

“Wow, one hundred — way to go.”

“What a great day of numbers you are having.”

“GREAT! Second number in a row below 6.7 mmol/L120 mg/dL… good job, honey.”

And what happens when the numbers do not reflect so good?

(We … say … nothing.)

What is your child to think? However if you think of something to say, for the simple reason they are checking their blood sugar to make sure they are staying healthy (over simplified, I know) as a positive reinforcement—fabulous.

My dear friend, Dr. Richard Rubin, (and truly the world’s best at the psyche of children with diabetes), told me once that after we check Kaitlyn’s blood, to ask her why she thought the number was what it was: 5.5 mmol/L100 mg/dL or 15.6 mmol/L280 mg/dL? Of course, depending on how high or how low that number is matters as to when to ask that question, but his point was clear—do whatever we could, so that the number had no direct reflection on our child. Even if “they were bad all morning,” eating what they were not supposed to eat (geared to the teen years) — it’s still not their fault they have to eat a certain way.

Now I never stated this would be easy. We have all gone through the teen years and it is very difficult when they are not doing what they’re supposed to be doing. But when it comes to diabetes, it is not the same as “clean up your room.” If your child “shuts you out” because you have made their  diabetes your mission, correcting them at every turn—your voice will be “muted” as they get older.

Be creative.

Dr. Rubin (Lord, how I miss this man) stated to always make it about choices. As fast as possible, change out the focus on the number with asking them what they should do about it?  “You are 18.0 mmol/L325, should you take insulin or just a glass of water?” (And ask them why.) The younger they are, the simpler you make it … but make it about choices. “You are 5.5 mmol/L100, do we need to do anything?” After a while, these questions will become their questions which they can, and will, address themselves.

When it comes to diabetes, I always tell people numbers are a gauge … make sure your child is not taking them as their reason for failure. The more you celebrate those “good numbers”, they will most assuredly take the “bad numbers” in a way that they are doing something wrong. Easy? No. In the long run it will serve them much better though. Leave reflections to the mirror.

I am a Diabetes Dad.

WRITTEN BY Tom Karlya "Diabetes Dad", POSTED 11/06/15, UPDATED 08/04/23

Tom Karlya, vice president of the Diabetes Research Institute Foundation, is commonly known throughout the diabetes community as Diabetes Dad, where he writes a daily column. His monthly column can be found at dLife. He's been a diabetes advocate since his daughter, Kaitlyn, was diagnosed in 1992 at the age of two. In 2009, his son Rob was also diagnosed, at age 13. Tom has been introduced to the NY State Capitol, testified in Washington, D.C., appeared at diabetes-related events at the United Nations and has lectured across the US about being a Diabetes Dad. He received numerous commendations for his work in the Katrina efforts where he was instrumental in organizing aid to over 10,000 people with diabetes. Tom was awarded The Jeff Hitchcock Distinguished Service Award from CWD, The Diabetes Advocate of the Year from the Metro-NY Chapter of the American Association of Diabetes Educators, and was also recognized by LIONs International for his work in diabetes among many other awards from groups and organizations.