The SuperNanny Takes on a Diabetic Five-Year-Old

by Leighann on November 30, 2009

My thoughts on this subject are many and I have had a difficult time trying to organize them in a coherent manner. I thought it was important to present actual quotes from the show and my thoughts, opinions, and reactions. Bear with me.

I set my DVR to record the SuperNanny last Friday. I had reservations about watching the show since it was diabetes-centric. Sometimes seeing diabetes on the screen leaves me emotionally raw, whether from empathy or from being incensed.

The episode was described:
Bill and Tammy McGrath of Hamlin, New York, have three beautiful young children, and their middle son, Aiden, 5, was recently diagnosed with Type 1 diabetes. Managing his illness is very anxiety-provoking for Tammy, because she saw her father die of diabetes at just 46 years of age. She sees Aiden’s diagnosis as her worst fears realized, and mealtime has become a battlefield. Aiden makes power plays, refusing to eat, which not only threatens his own health and frightens Tammy, but causes problems for both parents in adjusting Aiden’s insulin levels. The other kids, Liam, 4, and Paige, 9, feel their parents’ distraction and are frustrated by it — Paige hides out in her bedroom and Liam acts out aggressively. Jo pinpoints Bill and Tammy’s problems communicating effectively and enforcing discipline — their versions of timeouts are useless. Can she help Bill and Tammy regain control of their family?

Tears came to my eyes in the opening segment as they showed this little boy, the same age as my own daughter, who has diabetes. I cry when I hear of yet another child’s diagnosis because I know what a hard road it is: both for the child and the parents.

The show began:

“It’s literally a question of life and death…”

“…and help this sick little boy.”

“It’s really all I ever feared as a mother is to have one of my children be diagnosed with diabetes.”

And that was just the 30 second intro!

I really hoped for the best and that this show would be educational for those not familiar with diabetes. But I immediately began shaking my head.

Introduction

(1) “It’s literally a question of life and death…”

Yes, diabetes is a question of life and death. But you cannot live your life as a patient or a parent thinking of this every second of every day. And you certainly cannot put that type of pressure on a child. I have never told my daughter that it is life and death. Rather, we tell her that her diabetes management keeps her healthy. (Notice the difference in the wording and my words show optimism.)

(2) “…and help this sick little boy.”

That
child is not sick. My child is not sick. Being diabetic does not mean you are sick. During our education classes after diagnosis, the nurses stressed to us that diabetes should not be considered a disease but rather a condition because disease implies being sick. You can be healthy and diabetic.

(3) “It’s really all I ever feared as a mother is to have one of my children be diagnosed with diabetes.”

There are far worse things in life than having your child diagnosed with diabetes. Diabetics can thrive. My daughter is thriving. But many of the children we encountered at the hospital had it far worse. Children whose immune systems were so compromised that they had to back away from our outgoing child because they could not be breathed on, let alone accept my daughter’s outreached hand. Children wearing bandanas, obviously suffering the effects of chemotherapy. Children who were in physical pain. Children who may never return to their normal lives. Children who may not live. There are far worse things than a diabetes diagnosis.

Facts and Figures

(4) “In America alone there are roughly 186,000 children under the age of 20 that have Type 1 diabetes.”

186,000 may seem like a large number, but given the total number of children in this age group in the US, it seems like a small percentage. I find it fascinating that we have met so many diabetic children locally.

(5) “Type 1 diabetes has rose over the past two years by 13.5%.”

This increase in the number of children diagnosed makes me question whether or not there is some new environmental trigger that had been unseen (or unrecognized) previously. The funny (or not so funny) thing is that we began eliminating many children’s products from our home that contain BPA when our second child was a baby. BPA is a known endocrine disruptor that is used in some plastics to harden them. My husband wondered if the bottles that we used for our daughter, which did contain BPA, could have been a trigger. Though there is no way to know and no way to prove it. (And we did our best with the knowledge we had at the time. When our daughter was born, the safety of BPA was not a well-known issue.)

The Wrong Perspective

(6) Mom: “I knew diabetes was a death sentence. It meant death to me because I watched my father die.”
SN: “Diabetes doesn’t need to be seen as a death sentence. Aiden is five years old and he’s got his whole life ahead of him.”

During our education we were told that current statistics are that people with diabetes have a life expectancy approximately 10 years shorter than non-diabetic people. I look at this in two ways. First, older diabetic people currently contributing to this statistic weren’t given the benefit of current care standards. Second, treatment and care will likely change dramatically during our child’s lifetime and who knows, maybe predicted lifespan will be similar to the general population for children who are presently diagnosed. There is not, and never has been, a reason not to think that our daughter wouldn’t live a long, healthy life.

(7) SN: “If he hasn’t eaten his dinner then he has to consume the amount of carb necessary?”
Mom: “We’d have to make him something that he’ll eat.”
SN: “Aiden has recognized that when his mom and dad panic about him eating food that really he has an enormous amount of power and control over them.”

I had serious issues with the parents force feeding this child.

First of all, he is five years old and common protocol at this age is for the child to eat first and be given an insulin bolus based on the food (and number of carbohydrates) actually consumed. This is what we do.

From what I witnessed on the show, the parents calculated his bolus and administered his injection after the meal. If they are following this protocol, then there is absolutely no reason to force this child to finish his plate.

Young children’s appetites vary widely from meal to meal and day to day. This is exactly the reason why most providers allow for post-meal bolusing.

“Do you want to get sick? You need to eat.” The child will not get sick if he is given the appropriate amount of insulin for the food actually consumed. Assinine!

At one point they wanted him to finish his meat. Meat has no carbs and would not have made a bit of difference in his bolus calculations. Instead of making it an issue, he could have been done with his meal right then. Jo said, “We must have sat there for an hour.”

Are you kidding me?

It is not healthy to make any child sit there for an hour until he is made to finish his plate. And I always think that diabetics will have enough issues surrounding food without being force fed.

I know the goal is to give insulin before eating (something that we are working toward), but force feeding a 5-year-old diabetic is just going to create more control issues.

I really have to question this protocol. If you are bolusing after the meal, you can bolus for what he actually ate. It’s hard not to make food an issue, but force feeding just creates control issues.

(8) Obviously parents of diabetic children need to be in control. But these parents I think were approaching it from the wrong angle and making it worse for the child. And in a lot of ways they let him have the control.

We were taught to give control where it can be given (e.g., which finger to check or one of several food choices at snack time) but be matter of fact about other aspects.

Q was very compliant by the time we left the hospital as far as acceptance of getting finger checks and injections. At about a month out we had issues for all of 3 days. We used Rufus to allow her to give him an injection first. Then I would say, “Q, you have a choice to get your injection in the kitchen or the living room. But not getting your injection is not one of the choices. Let’s do this quick and easy and be done with it.”

I completely understand that a child may feel frustration about not having choices. But parents need to provide a strong framework, routine, and set of expectations. Children need structure and you shouldn’t let that go by the wayside just because your child has been diagnosed with diabetes.

Celebrities with Diabetes

(9) Since the show always ends on a high note, they had a special message from a diabetic athlete.

SN: “Before I leave this family I want to shed some information that allows them to accept that diabetes is a medical condition that they will live along side and that it never has to restrict Aiden on what he chooses to do in his life.”

Jo listed these celebs with Type 1 diabetes:
Halle Berry
Mary Tyler Moore
Nick Jonas (singer and actor, Nick’s Simple Wins)
Jay Cutler (Chicago Bears quarterback, Touchdowns for Diabetes)
Sean Busby (professional snowboarder, Riding on Insulin)

Mom: “I think Aiden absolutely got the message that it’s okay that he has diabetes.”

Great message, however it misses the mark a little. I have a five-year-old. She could care less about most of these celebs. Why not do a little research and come up with some people that children could actually relate to. People closer to her own age. My daughter doesn’t know who most of these older people are.

(And there was an uproar among the DOC that Halle Berry was mentioned. Berry supposedly weaned herself off of insulin, becoming a Type 2 diabetic. If you are a Type 1 diabetic, you need insulin or you will die. Nothing like disseminating information to the masses!)

In Closing

They ended the show with a screenshot directing people to the ADA.

“If you or someone you love has diabetes, the American Diabetes Association can help.”

Since it was a show based on a Type 1 child, they should have also directed viewers to the JDRF.

I guess the good thing is that the family reached out for help. Hopefully the show made a difference for them. For me I was in awe that they had not gained control and figured things out at the eight month mark.

What did you think of the episode, whether or not you are effected by diabetes.

You can watch the episode in it’s entirety on ABC.

Other Reactions to the Episode

Lee Ann Thill of The Butter Compartment: Superninny (Love that post title!)

Rachel Thursby of What Life Has Become: My impressions of the SuperNanny diabetes episode

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{ 8 comments… read them below or add one }

1 Rachel December 2, 2009 at 8:40 am

I agree with everything that you said! After 8 months, they definitely should have a better handle.

Let's just hope that they find this wonderful online D-community! It's been so helpful to me! 🙂

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2 Shamae December 2, 2009 at 9:03 am

I watched the show after another T1 mom directed me to the episode. I was pleased with some things but displeased with others…you mentioned what bothered me. My husband said the same thing…why force him to eat? They bolus after meals so just bolus for what he ate. PLUS, I think he had a lot of food on his plate for a 5 year old. My 6 year old daughter Syd was diagnosed when she was 4. It just seemed like a lot of food. Anyway great post!

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3 Zita December 2, 2009 at 2:47 pm

Thank goodness we have a "total care" approach for our son including a CDE and a dietician. I remember one of the first things our endo said was "do not get into battles over food." While we haven't always been successful, I've always remembered it and tried to live by it.

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4 Lee Ann Thill December 2, 2009 at 8:56 pm

Lots to say about that episode, for sure! I totally forgot to mention some of the stuff you did, but I went from memory instead of going back and watching again. I could barely tolerate sitting through it the one time, LOL! Probably better though because my post was super lengthy already, even for me.

My hope is that the family at least found some help and support to prevent them from reverting to their old behavioral patterns. Some decent D education setting them straight about the force-feeding would be high on my to-do list for them too…

Great review of the show 🙂

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5 Sarah April 14, 2010 at 4:18 am

You mentioned bisphenol A… I recently made a website summarizing the scientific research on the possible environmental factors that could contribute to type 1 diabetes (and type 2), including a section on bisphenol A. BPA can affect the insulin-producing cells, and has been associated with diabetes in general. I also include information on the rising rates of disease; type 1 is rising at about 3% per year in kids, which is alarming. Please take a look: http://www.diabetesandenvironment.org. I’m looking for others interested in the possiblity of toxins contributing to this disease!

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6 catjacarol September 17, 2011 at 8:18 am

I think the main thing is there was little discipline or focus *before* the diabetes and this new diagnosis brought things to a head. I know many children with diabetes (I am a physisician) and their families and their experiences are far more like that of the author than of that of the people on this show. Thank you Leighann for this posting, and best of wishes to you and your daughter as you manage her diabetes. It sounds like you are on a good footing and that you have a full and happy life ahead of you.

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7 type1mom October 11, 2011 at 2:20 pm

Alot of this depends on how you were taught at the time of your child’s diagnosis. At our children’s hospital we were taught – and only given the option – of using Lantus and Novolog. We were told that once we mastered this, we could graduate to a pump (at some time in the future). We were not given the option of choosing any other brands or types of long-acting or short-acting insulins – only Lantus and Novolog.

So we went home and did what we were taught. My daughter was so sensitive to the Lantus that she could only tolerate one injection of it in the morning (never, ever more than one small injection per 24 hour period) and the amount she received was very low. Outside of this, we would give Novolog injections after she ate, and were very careful to give appropriate doses in an effort to avoid hypo episodes.

In spite of all this, we fought off low blood sugar episodes if she went too long without eating. And let me repeat – this was on a very, very low dose of Lantus. It’s just the way my daughters body reacted to the Lantus – it was like a force moving through her body, and it would not stop unless it was intercepted with food. I have talked to many other families who have had this same experience. Some call it “chasing Lantus”. In a nutshell -you’re chasing your kid around all day and saying “Please eat a few crackers for me!” so that you can outrun the effect of the Lantus. So yes, it became an absolute nightmare for us when she didn’t want to eat! And believe me when I say – I am the type of mom who, under any other circumstance, would never ever think it was right to force a child to eat. It goes against what I believe. But while my daughter was using Lantus – I found myself going against my better judgement just to keep her from passing out.

Of course we tried lowering the Lantus dose – we weren’t born yesterday. But guess what? When we tried lowering it – even by a smidge – then we were fighting off highs all day. It sounds so illogical, yet this was our experience. In addition, if we gave lower doses of Novolog after a meal – then we had too many highs. So the best we could do was keep the Lantus at a reasonable dose – then make sure she ate when her blood sugar started to get low. And this was no fun when she didn’t want to eat.

As I stated previously, at the time of my daughters diagnosis, we were given no other options. Though we were told she could go on the pump at a later date, we were not given any other choices in regards to other injectable insulins or management routines. Further, every Pediatric Endocrinologist in our city worked at this particular childrens hospital, and they all followed the same protocal – so unless we wanted to drive out of town, this was our only option. Thankfully – my daughter is now on a pump – so we no longer chase lows all day. But I can totally understand those who do, since that’s where we once were. As they say: YDMV (Your Diabetes My Vary!!!!!)

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8 Beulah March 22, 2012 at 11:16 am

As a type1 diabetic since 1969 my views are old fashioned. Help people see that we are what we eat, weather diabetic or not. My life is far from “normal” yet I do not have a death sentence due to decades of injections, high & low blood glucose levels, or uncertainty how emotions, trauma, or excess activities will affect my diabetic control.

My parents explained to me that I would be diabetic forever, hence it was my actions and education that were important to my well-being.
Fruit is dessert, vegetables are a staple, and all carbohydrates are carefully counted to influence my boluses. Proteins and fats DO affect my blood glucose by delaying metabolism of all carbohydrates eaten with these slowly digested food types. Learning exactly how many hours later the piece of meat will elevate my blood glucose level tells me when an additional food inspired bolus will be needed.

Insulin reactions are the problem family and friends of type 1 diabetics need to be knowledgeable about, no matter how old the diabetic. A mere 10 grams of carbohydrates helps bring me up to a safe level usually within 40-50 minutes without causing an unwanted high blood glucose later. For others 12 or 15 grams of simple sugar may be called for. This is only a couple ounces of sugarful cola or juice. Know that swallowing, something we learned as infants, is far easier for a body than chewing, especially when a diabetic has a low blood glucose level. When the diabetic’s insulin level is too high this hormone seeks blood sugar to utilize, nothing else will move insulin from my bloodstream. Once the bloodstream is empty of sugar or glucose, excess insulin steals the glucose muscles use as fuel. This is why a diabetic having an insulin reaction has trouble standing and then cannot talk legibly. Leg muscles have no energy to keep them functioning, and our tongues too are muscles that cannot work. Once insulin has stripped all available glucose from the blood stream and muscles, it goes to the reservoirs the kidneys and brain hold. This stealing makes the diabetic loose contril of balance, body temperature, and more things I will not detail. Hence this paragraph is intended to educate family & friends on insulin reactions.

Living with diabetes is a live and learn process.
Trial and error are part of life.
Knowledge is useless unless shared.
It is a wise man who learns from the experience of others. B

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