Empathetic parenting: Pros and Cons

Empathetic parenting has benefits but comes at a price...

empathy - noun em·pa·thy \ˈem-pə-thē\

1:  the imaginative projection of a subjective state into an object so that the object appears to be infused with it

2: the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner; also :  the capacity for this

Below are some excerpts from a Quartz article about the benefits and risks of empathy as it relates to parenting and caregiving. I thought we all would benefit from reading the findings. I pulled some interesting passages but encourage you to click over to Quartz and take in the entire article.

Best,

Scott

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from Quartz article by Corinne Purtill

“Caregivers of people with chronic illness develop chronic inflammation and elevated stress hormones over time”

— Quartz

Kids with empathetic parents have well-documented advantages: less depression, less aggression, more empathy themselves. Parents also report better self-esteem when they make the effort to understand their children’s feelings.

But inside, it’s tearing them up.

“It’s not selfish for parents to make time for those things—it’s actually critical for their own mental and physical health.”

— Erika M. Manczak

Empathy requires us to push our own feelings aside to focus on someone else’s, an effort linked to increased stress and higher inflammation. Empathetic parents may also be more willing to sacrifice their own health for their children’s sake, forgoing things like sleep, exercise, and other activities that could mitigate the stress of caregiving.

“In adolescents, parental empathy was significantly associated with both better emotion regulation and with less systemic inflammation.

For parents, being empathic was associated with greater self-esteem and purpose in life, but also with higher systemic inflammation.”

— American Psychological Association

Anatomy of a High Carb Breakfast

A step-by-step guide to how I managed a massive breakfast...

This image is here to help you to visualize what I am describing. Clicking on it will open a new page so you can refer back and forth.

Arden had a couple of friends sleep over last weekend and before they went to bed the girls asked if they could have french toast in the morning - I said, "sure!"

The meal consisted of:

• French toast with home made bread, eggs, milk & a sprinkle of powdered sugar
• Sliced Bananas
• Green Grapes
• Chocolate Milk
• No Carb Syrup
• Bacon

Let's start at the beginning...

Arden's BG was steady at 75-80 from midnight until three in the morning when I decided to do a thirty minute temp basal off (probably should have tried 50% decrease). I was woken at six in the morning when her Dexcom alarmed as it reached the high threshold of 160 (since changed to 130). I waited fifteen minutes before acting because I noticed that the line was beginning to trend down. Decided to do nothing (probably should have bolused). A little after seven I decided that this BG wasn't going to move (morning BGs are stubborn for Arden) on it's own and I began to try and nudge it down. I only used tiny boluses because I was trying to get her BG down, while also letting her sleep; all with an eye on being prepared to eat a high carb meal soon.

Ask yourself - Do I find morning BGs difficult to effect? Meaning, do they take more insulin and time then normal, to get moving?

Over the next hour and a half I used three small boluses (refer to image) to get Arden's BG moving, without it moving so fast that I may have to wake her prematurely. Her BG leveled off around 120 for a while. It began to drift down again as the girls appeared in the kitchen. It was time to get a portion of her pre-bolus going, but not too much. She was still dropping albeit slowly and I wasn't totally sure how long it would take for the meal to be completed. But French toast without a pre-bolus would not go well, so I started small (1 unit) with something that I could effect with the fresh fruit - if needed.

Food and Carb Counting - So I've got three girls to feed, a plate with a randomly sliced banana and a bowl of grapes as back-up (in case my pre-bolus gets wonky). Time to get cooking! I never specifically counted any of the carbs Arden would soon eat. I was sure that she would have some of the banana, probably a few grapes, lots of french toast - maybe with some powdered sugar. She was definitely going to drink the milk because we don't so chocolate milk very often, so that was looking like a treat. I made all of my insulin decisions based on my historical knowledge of how much Arden eats on average and what that amount generally requires in insulin. I was counting on her Dexcom CGM to tell me the rest of what I would need to know.

My definition of a successful Pre-Bolus - If Arden's BG is between 75 - 100 and falling when food consumption begins, I'm a happy pre-boluser. The girls threw a monkey wrench into my plans by asking for the fruit plate before I was planning to put it out - no matter, now I could bolus the balance of my intended initial insulin. I say initial because this meal was going to be a free-for-all and undoubtably require more insulin as it went on. The fruit and milk went on the table and I bolused again soon after, this time 4 units - again that amount was based on nothing but my feeling for what the meal, as it appeared so far, would require.
 

Feeding frenzy: Soon after the french toast hit Arden's fork her BG leveled off around 100, I knew then that an increased temp basal was in order. Why, you wonder? Five units is a good amount of insulin for Arden and the fact that it wasn't causing a fall in BG at this juncture indicated to me that the food was now pulling in the other direction and would soon overtake the bolus. I mean this is a lot of carbs. A combination of a heavy dose of simple sugars and more complex carbs. 

So I increased the temp basal, 95% for one hour. Not long after that Arden asked for seconds of french toast (it is good!), I bolused for what I believed the seconds would require, 2 units. That bolus brought the total to 7 units of bolus insulin and an .60 of additional basal. I was happy with where we were and ready to see what would happen next. Oh wait... the girls want one more banana sliced up. Would Arden take two slices of it? Would she have four? I couldn't be sure but as I was deciding, I saw her put a fork full of powdered sugar on her french toast and so a bolused 1 more unit.... based on nothing but my gut feeling. Arden's BG began to drift up past 120 about an hour after I set the first increased temp basal so I extended it for another thirty minutes.

The girls finished eating and went back upstairs to do what ever little girls do during a sleepover. Three hours after the meal began... Arden's BG was 97 mg/dl by finger stick.

I wish that I could tell you that I was a great carb counter or that we have a perfect insulin to carb ratio figured out. I could lie and tell you that we do a lot of basal testing, but that's not true (I've actually never done that once). It certainly wasn't a low carb approach that got us to 97 three hours after this breakfast.

So I'm assuming that you want to know how I did this?

• Pre-Bolus
• Proper Insulin use; timing and amounts
• I trusted myself and what I've learned from past experiences
• I relied on the Dexcom G5 to tell me where I went wrong
• I bumped and nudge BGs instead of over-reacting and climbing on the diabetes roller coaster
• I was bold with insulin!!!
• I made my decisions based on the singular idea that I would rather (because it is far easier) stop a falling BG with a juice box, then spend five hours fighting with a high BG

I want you to remember a few things. First, this isn't medical advice, second the amounts of insulin and it's timing is different for everyone so you can't copy what I did and think it work. Third, I didn't do anything special, I don't have some super diabetes secret that you don't have. Anyone can do this. I mean it. It takes a little bit of practice and some trial and error - of course, the Dexcom sure does make the entire process simpler. But I promise that you can do this too and just imagine how easy regular meals and snacks will be if you can do this with a high carb, sugar infested meal like the one I described here. Right?!

Last bit. You may be inclined to think that what I described was a lot of work or that it was insanely time consuming... it was not. It just seems like it when it's written out and explained in detail. This blog post is representative of a few minutes of my focus during this morning. Trust me, it's far simpler than it seems and incredibly less stressful than watching, chasing and feeling the guilt that a high BG could bring after food. 

You can do this too, I know that you can! Believing that is most of the battle!

If you are interested in following these thoughts further, I recommend listening to my podcast to hear these themes spoken about in real-life situations with people just like you. Best, Scott

You many also like:
Blog post: You Too Can Bolus for Chinese Take Out

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Forgotten Wallet Buys a BG of 25

Perhaps you saw the picture that I posted yesterday of Arden making a play during her weekend long softball tournament? It was accompanied by a caption that read, "Tournament champions! Five games in two days, not one low BG. OmniPod & DexCom perfect together. #diabetes #softball #undefeated".

Tournament champions! Five games in two days, not one low BG. OmniPod & DexCom... perfect together.#diabetes #softball #undefeated

I probably could have written a blog post about the experience but I was still plenty exhausted from the weekend - so I went with a simple photo to not only celebrate, but to let you all know that it can be done. Long hot days, travel, little sleep and a lot of exertion can be managed with a few diabetes tools and a little extra focus. 

Do you know what a CGM and insulin pump can't help you with? They are not designed to remind a person that they put their wallet into the glove compartment of their wife's car - if they did, yesterday would have gone much better.

This is the story of a blood glucose reading of 25, that happened in a restaurant - it was an old school low, no working CGM and enough rookie mistakes to fill sharps container. Ready?

As previously mentioned, Arden had a softball tournament that lasted all weekend and required us to stay in a hotel on both Friday and Saturday night. In the fine tradition of baseball/softball lunacy, we scampered from the field Sunday afternoon moments after Arden received her championship trophy, to make the ninety minute drive home... so our son Cole could pitch in a 4:30 pm game (Five innings, no runs btw). Anyway, during that drive I put my wallet into the glove compartment of my wife's car and never removed it. This was no big deal, until I found myself in the parking lot of a restaurant the next day - with no money.

I guess that I felt pretty silly having driven ten minutes to the restaurant with my kids and one of Arden's friends in the car only to find that I didn't have any money. I couldn't believe that I forgot my wallet. Then I recalled that it wasn't just abandoned at home, but was in Kelly's car. I thought for a second, asked my son if he had some cash that I could borrow and we drove home to get it from his room.

Ten minutes to the restaurant, a few minutes sitting in the parking lot figuring out what to do, ten minutes home, a few minutes to gather the cash and ten minutes back - then we got our seats, read the menu and ordered.

Lots of confusion, lots of running around - lots of opportunity to forget that I pre-bolused Arden for the meal, when we initially left to go out to eat, you know - almost an hour ago!

My brain snapped back into diabetes mode when Arden said, "Dad, I feel dizzy". I asked her to test. It took a few moments then suddenly the math came to me, Ten minutes + five + ten + five + ten + ten x I bloused for a meal / the CGM is still calibrating = JUST DRINK A JUICE!

I stayed calm not only because we were in a restaurant but because one of Arden's friends and teammates was sitting in the booth right next to her. I prioritized; stop seizure, try not to panic, juice, test, stay focused. Arden's BG was 50 when we tested but I could tell, even without her CGM that she was dropping fast. Not because I knew how long it had been since we bloused, not because a could see it in her face - I could tell because of what she said when I asked her to keep drinking.

Arden took a few sips and then put her head on the table. In my opinion, one of the most frightening and nauseating side-effects of low blood sugar is the inability to care about your own life. "Arden keep drinking, I really need you to keep drinking". She didn't move, I knew she heard me but she could make herself care. Arden understands what will happen if she doesn't drink the juice and she couldn't, because her blood didn't contain enough glucose, make herself care about her own life. 

I instructed my son to stand up and then I picked up Arden and moved her to my side of the booth. "Cole, go get apple juice from the waitress, walk right up to her - be fast". I got Arden to finish the juice that we carried and tested again, her BG was now twenty-five. With no CGM arrows to rely on, I just wanted her to keep drinking. Cole returned with the apple juice (Arden doesn't like apple juice) and I had to beg her to drink it - I whispered in her ear, "Arden, please drink this, I think you're about to have a seizure", she responded without hesitation, "I don't care".

Before I knew about diabetes, if you would have told me that a reduction in the amount of sugar in a person's blood would make them cease to care about preserving their own life, I would not have believed you. Continuing to exist is perhaps our most basic and natural instinct, it has kept humans alive and thriving for untold millennia and yet, too much insulin can make you lay down and die without a fight - even when the fight is something as simple as drinking a juice.

I kept talking until she would drink, soon the waitress brought bread and other foods, Arden began to eat and a few minutes later her BG was above fifty. She took a few more minutes to pull herself together and then asked to go back to her original seat, with her friend. 

My heart wanted to race but I stopped it from doing so, my eyes wanted to cry but I did not let them. I couldn't breath and I couldn't stop thinking about all of the avenues that I should be considering. Where is more sugar if I need it, when do I let others know how close we are to a real medical emergency, "don't you dare panic", and how the hell did you leave your wallet in Kelly's car? A swirl of thoughts and emotions but they were no longer needed, it was over as fast as it had begun. Now all I had to do was try to put my thoughts all back where they belong. Then the waitress put Arden's meal in front of her and I had to, and this almost seems unthinkable, had to count the carbs that I used to stop the low because I was going to have to bolus again for the meal. Only brave blousing can stop a rebound high. Time to be brave.

I must have looked terrible by this time because my son asked me if I was alright. I only responded, "It sucks being an adult sometimes" - and then we ate lunch.

From Friday night until Monday at noon, I made hundreds of decisions about Arden's diabetes. Some how I was able to manage her through five softball games, swimming, at times - less than healthy food choices, exposure to the hot sun and then I left my wallet in my wife's car -  a simple mistake made on Sunday night that took us up to the brink of Arden having a seizure on Monday afternoon. Had Arden not felt dizzy, I don't know what would have happened. 

UPDATE: I probably should have included in the original writing that Arden's BG, at the time of the pre-bolus, was 230. It was a restaurant that we frequent, knew what she was going to order and how many carbs it contained.

The Boy in the Red Hoodie

Every spring the parents of our town's Little League baseball and softball players get together to clean up the fields that the children play on. I normally bring my backpack blower and help with the leaves that are leftover from the fall.

A few people bring their children, but for the most part kids are usually left at home. 

My blower is crazy loud and so I wear noise-cancelling headphones while I operate it. The headphones, combined with the music they play, have a way of mixing with the vibration of the blower to create my very own sensory deprivation chamber. I can't hear anything but the music and so no one ever tries to speak to me, it's as if I'm invisible.

Eventually my blower ran out of gas and the illusion of being alone was lifted. I looked up and saw a little boy in a red hoodie playing by himself in the grass of the outfield; he must have been all of four years old. I watched him play for a few moments; he appeared to be off in his own world. He spun in circles and was talking out loud to what seemed like imaginary playmates - his parents off somewhere helping with the clean up. The site of him was heart-warming and yet, I was also crushed by the carefree nature of his joyful abandon.

I couldn't stop myself from wondering if his parents knew how fortunate they were to be able to let him run on his own, without worry. I tried to remember what it was like to not feel that pressure in the back of my head - do you know where I mean - it's the point where my skull and my spine connect. That pressure of concern and vigilance, the feeling that you are always guarding against something that may or may not be coming. It's the omnipresent tension of readiness to act, coupled with the intensity of constantly having to assess and reassess your surroundings and situation, so you can be ready at a moments notice - for anything. An ever-present and exhausting state of fight or flight.

In an instant I felt ashamed for wanting the boy's parents to know how I feel. It was a mad rush of conflicting emotions that left me confused. There was a part of me that wanted to tell his parents how lucky they are, I wanted to beg them to cherish this small, yet wonderful moment. I wished I could convey to them just how jealous I was so that they could know how fortunate they are. My shame deepened when I recognized that my jealousy was a despicable conflict of the love and admiration that I have for my daughter and the intense way that I want type I diabetes to not exist. I watched the boy for a second longer as I wondered if my daughter will ever get to feel life so simply ever again, then I lifelessly mumbled 'fuck' under my breath and walked away to refuel my blower.

When I returned to the leaves my moment of jealousy had passed and I began to think about all of the dozens of people on the field. What challenges did their lives hold that I am not aware of? In just a few minutes of consideration, I realized that each of the people at the park likely had countless life issues. As I tried to imagine what those challenges were, I recognized that they could be marital, health, financial, family, and on and on. The more I thought, the more I could imagine - and the less feeling jealous about the boy in the red hoodie seemed reasonable.

You Look Terrible!

It was Sunday night at 8 pm and I was looking for a place for Arden and I to sit down while we were waiting for my son Cole to finish at his baseball practice. 

"Arden, what does your CGM say?"

Turns out Arden would have no idea what her CGM was reading, because I din't pick it up from our kitchen counter as I promised I would. We were too far from home to go back, and just close enough that I wasn't scared to not have any of Arden's supplies - well, except for an emergency juice box that lives in the door of my car. I asked Arden how she felt, she said, "Fine", and then I went to my car to get the juice - just in case. 

When I walked back through the door I was met by three people, one after the other, neither privileged to the conversation that I had with the previous. I got two, "You look terrible!" and one, "Are you okay?" comments I responded to each by saying, "I haven't been getting enough sleep" - the rest of that sentence, that words that I didn't share??? ...since Arden was diagnosed  almost eight years ago. What I wanted to say was, "I haven't been getting enough sleep since Arden was diagnosed almost eight years ago". --

You see, Arden went to a sleepover the evening before and I lost my confidence (Through absolutely NO fault of their own) in the adult that was overseeing the party. Honestly, this person was well informed by me, knew what they were doing and completely onboard with the steps that the evening was going to present - I just got scared. 

Arden and I managed her snack and bedtime BGs, all via text messages, and all was fine with the exception of an elevated blood sugar that we were able to easily reduce. Around midnight I realized that she was not going to sleep anytime soon and so I told her that I would help her ensure a stable BG for bed. Arden fell to sleep a bit after 2 in the morning and I was comfortable that her BG would hold up overnight. Still, I couldn't go to sleep. I finally was able to relax around 4:30 and I slept until, wait for it, 7:30 - when Arden called to say that the hot tub they went into the night before caused her OmniPod to peel just enough for her canula to come out - something that has nearly never happened in our over five years of using the insulin pump. So, it's 7:30 in the morning, I've had three hours of sleep and I'm driving across town to change an insulin pump. The good news? I was able to watch an entire season of 'Breaking Bad' the night before, but the bad news is that I'm still having trouble bouncing back from the lack of sleep, many days later.

I snapped a photo of myself earlier today after getting my haircut (I have a meeting with my publisher tomorrow), I wanted to share the picture with my wife who is away on business, we set up private photo sharing site when one of us travels so everyone can see what's happening on the 'other side'. The kids and I post pics and so does Kelly, it's a great way to not feel to far from home - but man, do I look tired and old in these photos. 

I need a month long nap, and apparently... I look terrible.