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Re: [IP] Michael's DCCT stats as evidence

On Tue, 17 Nov 1998, LBE (Lennox) wrote:

> Just one question in the scare 'em into good control approach.  I'll use
> your numbers as it's been a few months since I reread the stats.  What will
> you then say if your daughter ends up one of the "unlucky" 30 - 40% who
> maintained tight control and still have the complications.

I think it depends entirely on how the information is presented. I've 
never been and advocate of trying to scare anyone, and I don't believe 
being informed and aware constitutes being scared or scare tactics. 
The earlier thread was  aimed at an adult who wished to bury their 
head in the sand and ignore control because it was too difficult. 
Specifically in the case of my daughter, based on family history 
of eye problems - macular degeneration in our older aunts, uncles, 
parents, etc... she probably will be one of the unlucky ones right 
along with me if the continuing deterioration of my vision follows the 
pattern of my father's. That does not mean we should not try to 
mitigate these changes by the best possible bg control. 
I've never tried to scare Lily, she did a quite good enought job by 
herself. She was quite impressed (or perhaps un-impressed) 
with her 20 year old diabetes camp counseler and the dual eye surgery 
story (Lily was 12 when she heard that straight from the 
horses mouth the week before the girl was scheduled to have it done). 
We have discussed the improvements that come with tight 
control, but not in great detail and not to the extent that has been 
gone into on this mail list. Lily is highly self motivated toward good 
control because of the positive effects it brings her in the short term. 
Aside from the privilege she regains like sleeping in, eating ice cream 
sundaes, etc.....
she feels better! She does not like to be high because it makes her eyes 
feel 'funny' in her own words. Her leg muscles hurt when she is high and 
she feels 'heavy'.  And... no one likes to be low, her included. She 
is 'into' sports in a big way and bg's that are not on target visibly 
screw up her performance which she 'really' doesn't like. It is not 
difficult to motivate her to do a good job, rather it is a matter of 
providing her the tools to do it. Her mom and I have done this primarily 
by teaching her to carbo count and do the math necessary to make accurate 
projections of what her blood sugar will be based on rate of change of bg 
measurements, unused insulin, undigested carbo, etc.... she knows how to 
profile her own basal requirements and make small adjustments to improve 
her overall control. Her carbo estimates are much better than mine or her 
mom's, blows me away how she can look at a plate of food and tell the 
carb content by 'inspection'. She usually uses her scale, but in a pinch 
she's pretty good without it. We have tried to 'round out' her education 
by making her aware of the positive effects of good control which include 
a reduction in the possibility of diabetic complications. Does that 
somehow make us 'bad' parents?

> your numbers as it's been a few months since I reread the stats.  What will 
> you then say if your daughter ends up one of the "unlucky" 30 - 40% who
> maintained tight control and still have the complications.

I won't be very happy I hope she does not have them, but I'm certainly 
not going around with a "can't happen to me" attitude and neither is 
Lily. This is not a topic of continued conversation. We hear 
far more complaints from her about not liking her numbers than she ever 
hears from us. Her attitude is simply that she wants to be as normal as 
possible and she is not going to let diabetes get in her way.

> you then say if your daughter ends up one of the "unlucky" 30 - 40% who
> maintained tight control and still have the complications.  Personally, I'm
> questioning whether the lows, the hassles, and the berations will still seem
> worth it.  

Sorry to hear you are berated. Perhaps you should tell who ever it is to 
shove off.

> What do you then say - oh you must have somehow lied and you are
> a rotten person because you have the complication?  Think about it now.  30
> to 40 percent is not a small fraction.  I don't think that threats work in

As I mentioned before, Lily is her own master (make that mistress). We 
counsel her (as parents should) about things to avoid or things that help 
her with control. With the advice from her endo, we have raised her 
bg targets to avoid lows (which are fairly infrequent). Her 
control is not easy due to her peculiar basal 'leap' at bed time and she 
frequently has bg's over 200 at night, but that's better than the 
alternative. It is my observation that Lily is more concerned about that 
than mom, dad, or doc. Our collective objective is simply to keep 
her hbA1c between 6 and 7 (lower would be nice) without the risk of lows and 
without making life unplesant due to a strict regimen. 6.5 isn't bad, at 
least not in my book, I was happy when she was in the low 7's.

> the long run.  I know that I've fired every doc that tried to be a dictator
> even when he knew little about my diabetes as compared to the person who was
> living it.  
> I'd hate to have that sort of relationship with a parent.   

Yeah, so would I and I don't think my kids would like us if we wer 
dictatorial  either, but then again that's not what they have:-) 
I have to admit, they take out the trash, fold the laundry and they 
aren't allowed to stay up late and watch TV. Thet even have to do their 
home work! I don't think any of that makes us 'dictators' although our 
kids may disagree at chore time. I'd call it 'good parenting'. I "expect" 
them to grow up to be responsible citizens, Lily included without 
regard to her diabetes.


> Of course most of us have rebelled in some way as kids, so I guess as 
> parents you have to make your choices.
> Take care,
> Lori
Insulin-Pumpers website http://www.insulin-pumpers.org/