Bad Behavior

[school nurse]

I have a student with type 1 juvenile diabetes.  He is in first grade and is seven years old.  He was diagnosed a little over a year ago.  Lately, he has had several problems with behavior here at school.  Some is aggressiveness: hitting, pulling on people's arms, pushing, etc.  He also has disregarded rules on the playground like climbing the fence and not lining up to go inside.  He has been caught lying to me about symptoms of being ill, and lying to his teacher about hitting another student.  When asked if he has been in trouble at home for the problems at school, he says that his mom and dad don't care.
     Mom and dad are semi-educated people. Dad happens to be trying to get into medical school.  Their response to this problem with behavior is that he has done nothing wrong, that his sugar fluctuates and when he is high he will have behavior problems. It makes sense to me that if he's too high or too low that he may need to take a test at a different time.  But I have never heard of blood sugar affecting behaviors like these.  Can you please tell me about this? How should we handle this?

[JDRF-Team-sgg]

I am a type 1 diabetic who was diagnosed at age 12, 35 years ago. My answer to you is going to be a mixed response, so please read carefully.

First, I want to let you know that low or high glucose levels CAN affect emotions, and many parents of type 1 children notice and comment that their children are more irritable, hard to control, or emotional when glucose levels are not in good balance. The balance of chemicals in the body and brain do affect emotions. I have babysat toddlers with type 1 diabetes who would become rather wild and loud or would withdraw and seem depressed or sad when glucose levels were off-kilter. So this is true.

HOWEVER, BEHAVIOR does not have to follow emotional upheaval. Many type 1 kids, myself included when I was young, do not choose to act out inappropriately when their emotions are in upheaval, and many of us also do not behave inappropriately because we feel bad. Yes, the child can be taught to express himself if he feels bad and he also can be taught to make a distinction between appropriate and inappropriate behavior. I think my parents would agree that I was a well-behaved child, even years ago when glucose control was really hard to acheive with older insulin regimens.

Personally, I believe that it would be wise to have the child check his glucose levels if his behavior seems "off", but if the numbers are off, he should not expect people to just put up with inappropriate behavior. If he is taught that it is OK for him to express himself any way he chooses because he is diabetic, he may grow up never learning to maintain control over his behavior. If anything, excusing him this way may do more to make him feel helpless and depressed (a very common complaint among type 1 people who write in to us at the Juvenile Diabetes Research Foundation) than working to teach him to take charge of his behavior, which is something HE can control no matter how he feels.

So I do not agree with his parents that his behavior should be ignored, but I do think you need to be aware that his glucose levels may play a part in the emotions he feels. Both high and low glucose levels tend to make people edgy and irritable and sometimes irrationally depressed. So it may be necessary to not only attempt to teach him how to channel his emotions into constructive behavior, but also to adjust the glucose levels with either more insulin or quickly-digested carbohydrates in order to help him feel better.

[JDRF-Team-LRS]

School Nurse,
First I want to thank you for your work and your going these extra miles to figure out what's right for this youngster.  I'm not a physician, but a long-time diabetic.

From what you've written, my best guess is that he acts out quite simply because "My parents don't care."  His words and your experience seems to indicate that that's at least partly true.

As I'm sure you've seen, kids with or without health issues YEARN for parental attention and if they don't get it on a regular basis for normal kid-life things, they can escalate bad behaviors in search of it.

There do seem to be plenty of parents too busy <sigh> to be parents.  My best recommendation is to continue to report all bad behaviors to the parents, and if needed, involve the teachers & principal in a meeting with them.  There is something wrong with his behavior.  It might be due "simply" to parental non-involvement and/or there could be underlying issues. If his behavior is escalating, it's good to intervene soon.

In my opinion, diabetes complicates behavior issues, but it doesn't cause the things you describe.

[Kristy Mari]

Hi - my daughter got diabetes when she was 6 yr old (she's now 30)-and- one of the most difficult things for me to cope with & for her to deal w/was when she got the Diabetes, it took "her" away...   she was a very different little girl personality wise...   It was like I had lost my little girl...   and for her it was extremely frustrating not feeling well/her old self & being terribly frustrated because of it all.   As the years went by - each real bad instance that had sufaced - I sat her down & asked her to help me understand how she's feeling & when she didn't feel good and/or was frustrated by TALKING/Communicating it by conversation when it was happening and why...   Not so easy to do while a child is at school - but in time, a Nurse's and/or teacher's gentle/positive efforts to communicate with the child - will eventually help that child to know what they're living with is being understood the more they talk things thru/think things out before acting in not acceptable school required behavior.  With the deliberate/constant/sincere effort from the School Nurse and/or the Teacher's involved - the child will eventually learn that he or she can work THRU/WITH their illness's sometimes not so great side effects...   It also helps them to deal with just plain LIFE itself...   GOD bless you all for your great hearts & compassion for all children dealing with Diabetes and other illnesses

[Rachelsmom]

My daughter was diagnosed with type 1 diabetes almost 1 year ago, when she had just turned 7.  One of the first things we noticed was that her personality had changed radically.  She was very clingy, and irritable, and easily frustrated.  Over time I realized that two things were going on.  First, she was responding to an overwhelmingly frightening event that changed everything about her life.  Eventually, she settled down, even though she is still more clingy and easily upset than she used to be.  Secondly, I have found a direct correlation between her behavior and her blood glucose level.  When her levels are low, she gets irritable and irrational.  When her levels are high, she gets obstinant and weepy and depressed.  In no way, however, do we allow her glucose levels to excuse her behavior.  We are working with her to help her recognise when her levels are off and 1. check her sugar 2. tell me  3. adjust her sugar and 4. find an acceptable means to deal with her emotions until her levels normalize.  We have given her permission to remove herself from a situation so she can regain her composure, and we try to gently lead her toward resolving her issues.  The most effective thing we have found is to delay dealing with an issue until she is less emotional.  One thing I found helpful for myself is to remember when I, or a friend, has had PMS or dealt with menopause.  It seems to be a similar type of affect - irrationality and irritability that is difficult for the person herself to recognise.   Insulin is a hormone after all.  God bless you for caring enough for your student to seek an answer.  One thing that might help the boy is to join a group of similarly-aged children dealing with diabetes.  His parents can check with his medical team.  I know it may seem like the parents are coddling the boy ~ they probably are, but please remember that they are dealing with a severe shock to their lives as well - their child has a life-threatening, life-altering disease that will never go away.  Their medical team can also help them to deal with their fears and desire to protect their son.