#55 TEEN SERIES part 3: Teen burnout and rebellion with Joe Solowiejczyk

Join me today as I speak with Diabetes Nurse Educator and family therapist, Joe Solowiejczyk, as we discuss how to handle burnout and rebellion in teenagers living with type 1 diabetes. Joe has been working in the field of diabetes for over 40 years and has been living the type 1 life himself for over 60 years, diagnosed at age 7. Joe is a tough love, no nonsense kind of guy with a soft spot for crazy teens. You'll really enjoy hearing Joe's perspective and sage advice. Want to work with Joe? Find him on his website at A Mile in My Shoes. Have a question? You can email Joe at joe@amileinmyshoes.com Enjoy the show!

Joe's Book: A Type 1 Diabetes Guide to the Universe
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Transcript

Katie: 0:00

This is episode 55 of the sugar mamas podcast and the third installment of the 10 week series for parents of teens living with type one diabetes. Today, I have the pleasure of chatting with Joe Solowiejczyk about teen burnout and rebellion. Joe is a diabetes nurse educator and a family therapist. He has been working in the field of diabetes for over 40 years. Not only that, but he himself has been living with type one diabetes for over 60 years. Joe is also the author of an interactive ebook called a type one diabetes guide to the universe. I really enjoyed talking to Joe. We share a similar dry, sarcastic, and sometimes morbid sense of humor. Joe is a tough love, no nonsense kind of guy, but he does it in a way that is both loving and funny. I could say more, but I don't want to give it all away. So without further ado, let's get to. You're listening to the sugar mamas podcast, a show designed for moms and caregivers of type one diabetics here. You'll find a community of like-minded people who are striving daily to keep their kids safe, happy, and healthy in the ever-changing world of type one. I'm your host and fellow T one D mom, Katie Roseboro. Before we get started. I need you to know that nothing you hear on the sugar mamas podcast should be considered medical advice. Please be safe, be smart, and always consult your physician before making changes to the way you manage type one diabetes. Thanks.

Joe: 1:41

Hi Katie. It's an honor and a privilege to be here and especially about being able to talk about. Subject that is near and dear to my heart. You know, um, love working with teenagers as difficult as they can be. Um, I don't have any teenagers, but that's probably. Y I'm pretty good at working with them, um, is that I don't have to deal with them all the time. My heart goes out to the parents that do, um, Joseph, the white Jack diabetes nurse, family therapist. I've been, uh, working in the field of diabetes and coaching as a diabetes nurse and teaching. Um, for the past 40 something years, I got diabetes when I was, uh, seven years old. So this year will be 68. So

Katie: 2:28

years.

Joe: 2:29

Yeah, something like that. Yeah. When I first got diagnosed, uh, there were no blood sugar kits. There was urine testing. So you had to take four drops of urine, stick it into a test tube of Benedict solution and boil for five minutes.

Katie: 2:45

Really?

Joe: 2:46

Yeah, there were, the needles were three quarters of an inch long stainless steel hypodermics

Katie: 2:52

Oh my goodness. How often did you have to do that during the day?

Joe: 2:55

today. I was, I went to the, my parents were really great and they knew that if you get something and you need help, you go to the best. And they did a lot of research and they found out that the Joslin clinic in Boston was teaching patients how to self-manage. So there's really nothing. terms of my exposure to diabetes initially, in terms of how to manage it tight control versus loose control. we were taught that tight control was important. Elliot Joslin, the founder of the Joslin clinic and the first American doctor to administer insulin in 1922. believe that if people, without diabetes, don't spell sugar in there. And that's the Mo that's the clinical goal for people with diabetes, there's little sugar in the urine as possible. and so that was the goal. So carb counting, multiple daily injections, there were no pumps obviously then, all of that stuff was sort of did it if they knew. in the old days, there were just as, uh, on top of doing what you needed to do as they are today. You know, a lot of stuff has come about in funny ways that, um, in the sense that there's nothing new except for the technology, which is really pretty astounding. things haven't really changed from a long time ago. At the end of the day, it's still a pain in the ass.

Katie: 4:14

That is the truth. Yeah.

Joe: 4:15

If you don't take the technology out of the box, or if you don't code drive with the technology, you're not going to get the results that you're hoping for. There's just sort of plug and play kind of a thing. You it takes a lot of work and it takes a lot of courage and determination on a daily basis. So my specialty is helping people. Come to terms with the initial diagnosis and the daily challenges of living with a child who has one, particularly teenagers.

Katie: 4:47

Yeah. Do you feel like the majority of your clients. Parents of teenagers or teenagers themselves with type one.

Joe: 4:53

Yeah. Well, though, I work with everybody, you know, the full range from infants all the way up to not currently, I'm working with some kids who are. With a child who is God at, when he was diagnosed, when he was five months old which is pretty rare, but you can just imagine how difficult it was. And in terms of things being easier or better now, they are in a lot of ways. I mean, can you imagine what it must've been like for a parent to have, to get the urine from a diaper and then know that the urine is a half an hour to an hour and a half behind. What the blood sugar is, and then make insulin dose adjustments based on that. So today we have CGM and all this kind of stuff, and granted it's a hell of a lot easier, yet at the same time, it's still exhausting.

Katie: 5:41

Uh, absolutely. Yes. I agree with that for sure. I am curious about carb counting before we jump into the whole teen thing, you know, back when you were first diagnosed and when you're growing up and kind of the earlier years, because I feel like nutrition labels, those are a pretty new development, right? those there weren't nutrition labels on food.

Joe: 5:59

No, it's a woman, but you could, you knew in portion sizes. So my parent, my mother and I worked hard and my aunt, my dad wasn't. In my diabetes management, he was at first, but then sort of left the reins to my mom most of the time. but we were taught at, in a certain portion of food. They knew the food value for stuff. We have to weigh food on a grand scale. So you knew that, 30 grams of a banana might be 15 grams of carbohydrate. You know, we're food value charts. They just weren't. On the packaging had to calculate for yourself how to do that.

Katie: 6:35

Okay. Yeah. I use a food scale now because I feel like it's, even when there isn't a label on something, just because it's so much more accurate to weigh it and then get the car value from that. So how, how has your type one diagnosis kind of paved the way for you to help, you know, families, caregivers of T1 DDS, then T1D's Like at what point in time in your life did you realize that's what you wanted to do?

Joe: 7:01

Yeah. Great question. Thanks. I think it's like, for me, it's like the St. Francis. It is in giving that we receive it is in loving that we are loved. It is in, um, healing that we are healed. That's a paraphrase. But, I feel like for me, that's what it's like. It is in the giving that I received. There is something about being able to work with others and help them deal with the trauma profound sense of powerlessness that comes with an, a diagnosis of a child with diabetes or living with it yourself. And so it came about when, my dad had a heart attack. I wasn't quite sure he had a heart surgery and, um, I wasn't quite sure which direction I was going to go. And I was in university law, maybe this, maybe that, but I couldn't really put my finger on it. And, So I took my time. I graduated with a degree in Southeast Asian studies and European history, Russian and Italian, and, uh, still, wasn't quite sure after graduating what I wanted to do, but it was standing over the bed of my father, watching the nurses, take care of him that I said oh click. Okay. Do this. And then the thing that really pushed me to do it was, watching two nurses in Indonesia tend to a wounded friend of mine. they were giving him a sponge bath and I just thought it felt like, and looked like these guys were in a state of grace, this sort of providing comfort to someone who was in a difficult situation. And it resonated for me personally. Sort of, viscerally clicked for me about, oh, this is what they mean by it. Isn't giving that we receive kindness and I realized then that that's what I want.

Katie: 8:31

that's great. I I'm in healthcare, I'm a physical therapist. I feel like we have similar stories in that. I, my major is actually in Spanish. I have a bachelor in Spanish and, uh, and then I went back to grad school for physical therapy, which, you know, is complete opposite of, a BA in Spanish. But Yeah. I kind of came to the same conclusion that I wanted to help people in some way, shape or form and healthcare. I mean, if you don't go into healthcare with the mindset of I'm here to serve others and help others, you will become very bitter and very cynical very, very quickly because it's a very, it's a hard field to be in. I mean, it's definitely a service service industry.

Joe: 9:10

Yeah, I agree. Yeah. Providers and clinicians don't understand that it's a service industry.

Katie: 9:18

No. I think a lot of people these days are like, oh, it's job security because healthcare is not going anywhere. And they don't realize, the emotion it's hard, it's draining, it's emotionally draining and you have to have some very thick skin to be in healthcare. For sure.

Joe: 9:31

I think that if you're in healthcare and you understand that it's a service industry, then you also understand that our mission is to delight the customer. Even with difficult circumstances, goal is to make the felt experience. And which is why I wrote my book. a type one diabetes guide to the universe. I wanted to make the feeling high touch and high tech, but I'm a really high touch guy. what I mean by that is, is that I want to make the situation such that people look forward to coming to work with me and visit. That was what I wanted to important. The book of felt sense of that kind of a thing. Like, well, this is miserable, but he's a nice guy, you know, or we'll have some fun or, you know, this kind of thing, you know, especially for the kids, you know, so using magic and smoke signals and just silly little games and being goofy and stuff like that is really important to me. And one of the ways that I can really connect with kids is to just acknowledge that this thing. So. There's not one part of it. That's fun. And if you like this thing, you're not saying you need medication.

Katie: 10:34

Yeah. no, that's very true. I tell my daughter that all the time. I mean, you know, cause every now and then we have like little breakdowns and I'm like, Yeah, it's really, really does suck. And you're allowed to cry about it. We can't stay stuck here, but please have your moment. And let's all acknowledge that it's really.

Joe: 10:50

it's in the falling apart and coming back together again, that there's a sort of death and rebirth death and rebirth death and rebirth. And I think that that's the pattern cycle living with a chronic illness is that you come to terms with it. It's not a one-shot deal. And then you graduate once you get it. And then you're off on your thing. It's a circle that you keep coming back to the same issues, but it layers in different levels depending on how old you are. The most important thing for parents to be able to give kids and particularly teenagers is to give them the message that you can hate this and take care of yourself simultaneously. are not mutually exclusive states. I believe a lot of providers and a lot of parents because of their own hurt. Watching a struggling teenager believe that the teenager has to have some kind of like. At one with the universe, um, kind of experience that they'll then get it. You know, I think that's how it goes. You get it and you lose it, you get it and you lose it, you get it and you lose it and you get it again and you lose it again. And it's a process. And, um, the most important gift that I think parents can give their kids, especially teenagers is the gift of understanding that you don't have to like this thing, but you do have to. we're not in charge of what cards we get dealt, but we do have a role in how we play the cards.

Katie: 12:10

So tell me a little bit about how you operate in your, in your job, how you counsel people, I'm assuming by the time they get to you, they're, they're in trouble, right. Um, either maybe physically with their medical care or emotionally or both.

Joe: 12:24

We're talking about teenagers, So usually before people come to see me, they ended up. Sort of using a number of ways of trying to get the kid to take better care of themselves. So lectures and sermons, you're going to lose your toes. If you don't, you know, this kind of thing you're gonna, you're going to compromise your future health and you don't take care of yourself. One arm around the shoulder went up for the Gipper, all kinds of, sort of things, you know, and then providers do the worst thing that. You can think of doing is that they tell the parents leave the room. I'm here with Susie over Tommy, and we'll talk about, have a heart to heart about diabetes. The problem with that approach, the lectures and the sermons, and the more education. If you're not doing it, none of these kids who are not doing it, don't know what they're not doing. Never met any teenager in my life that needed more education. They're actually they know exactly what they're not. This is not about knowing this is about doing or not doing so when they get to me, they've already exhausted all of those sort of attempts at trying to make things better by the usual approaches, support groups, summer camps, what kinds of stuff like that? Do you know what I mean? For me, it's funny. There's like, why do most parents who, uh, bring their kids to, uh, if it were a summer camp, And it were a support group thing that that would be enough to get a kid to sort of have a spiritual epiphany. Oh, I need to take better care of myself and be mature. then it would have happened a lot of points before. And then why is it that when parents come to pick their kids up at summer camp, they asked the director, if there's not a longer session from August to July, no kids do well at camps because the counselors in the camp don't put up with silly. support groups are great. I have diabetes. I love talking to the people who have diabetes. It makes me feel better. It doesn't make me do better.

Katie: 14:13

Okay.

Joe: 14:13

There's a thing about feeling better and doing better. You have to ask yourself as a parent, what would you like your kid to do? Would you like them to do better or not? I'll give you a for instance. Okay. I'll tell you if you get the joke, you'll get the difference between my approach and the approach that many other clinicians have. Two guys are talking with each other. One guy says to the other year, I'm not a big problem. The other guy goes, what's your problem? He goes, well, my brother, he thinks he's a chicken. You know, the guy goes, your brother thinks he's a chicken today. That's not such a big problem. You take your brother and thinks he's a chicken. Send them to a psychiatrist, psychiatrist talk. So we get some pills. Doc pills sends him home and tells him to come back in five weeks. More, talk more pills in six months, your brothers cure. The other guy goes, you know, I'd love to do it, but I can't. He goes, what do you mean you can't? He goes, I can't. They need. It's easier to be the mother and father of the problem child, that it is to be husband and wife and intimate with each other. I don't mean sexually, I mean, around the diagnosis and I mean around the experience of falling apart

Katie: 15:09

Hm.

Joe: 15:10

time with the diagnosis and how you are as a couple will have everything to do with how your child's diabetes on. They did an interesting study at children's hospital in Philadelphia. About 40 years ago, we replicated this study at UC Davis Sacramento. We want it to see what things, what variables would contribute more significantly in statistical manner to a child's hemoglobin A1C a year after diagnosis. What do you think it was? Self-esteem quality of life by stress inventory. what do you think it was

Katie: 15:45

Well, based on what you said before, I feel like maybe like the family life in the home. What, what state? The family life.

Joe: 15:52

specifically even more astounding is the mother's subjective sense of how supportive she feels in the family as a wife, a woman, and a mother by the family members. How the mom feels about what's going on at home. And how in a two parent family, the couple react with each other and talk and communicate with each other about other stuff, not about diabetes stuff has everything to do with a child's metabolic control. So if we have a child who's out of control and we believe that our arm around the shoulder, or one of the gift world camp or support group is going to fix that we're delusional. The approach has to be a systemic approach. There are two ways of looking at it individually and systemically. It's not either, or though it's both I as a patient with diabetes, a person with diabetes, I get sad. I get depressed. I get angry. And I also live in the context of my family. My family is impacted by it as well. How we react and how we deal with trauma. We'll have everything to do with a child's metabolic control and hemoglobin A1C a year after diagnosis. So my understanding of systems allows me to help families restructure how they deal with diabetes. This approach is family approach to diabetes management is most effective for kids who are doing well in every other area of life, but falling apart in diabetes. So if I have a kid come to me, she's 16 years old and I'm Suzie and. She has a brother to me, 14 years old, mommy and daddy, they come in and, sit down and I say, how can I help you? The mother says to me, we'd like you to tell Susie how important it is to take care of herself. I say, that's not a problem. I turned to Susie and I say, Susie, it's very important to take care of yourself. Was there anything else that you wanted me to help you with today? You get where I'm coming from? Yeah.

Katie: 17:45

Yeah.

Joe: 17:47

This first approach of you tell her is we're exhausted. And we have we're desperate at this point, no matter what we say is not getting her to take care of herself, So I talked to Susie and I say, you know, Susie, what's the worst part about having diabetes, you know? And she gives me, uh, now teenagers are when they like you as me and I roll in a grunt.

Katie: 18:07

Those are signs that they, they enjoy your company.

Joe: 18:11

Yeah. And, I say, oh, maybe I looked at her the wrong way or something like that. I'll ask her a different question. Did your parents tell you why you're coming here today? Because for me that's diagnostic. So, she gives me another eye-roll in the grind and I turned to her and I said, listen, let me just tell you something about how things work here in this whole. Uh, I'm not here to be your friend. You have a lot of friends. I have a lot of friends. I don't think you're looking for up another friend. also, the other thing is, is that there were rules of behavior. If somebody asks you a question in a nice way, no eye rolls, no grunts. I want to tell you this. I want to thank you for bringing your appearance here today for therapy. I need to let you know that we don't need you for the rest of the session. If you're not interested in Sydney. But I promised you this, we will be talking about what a juvenile delinquent you are in diabetes and what would be, we'll be talking about how to make your life miserable. That's my job is to how to help your parents make your life miserable. Not to be your friend. Would you like to stay or would you like to go? Wow. I said, that's great. What's the worst part about having diabetes? She goes, my mother she's always nagging me. That is so great. I'm so happy that you said that I thought you were going to tell me that you had organic lesions on your brain that made it difficult for you to understand how important it was to take care of yourself and bolus before you eat not two days after you eat and, you know, check your sugars and carb counting your mother's. The problem. We will hire a contract killer and ice her, and then three months from time of IC, your A1C should have. They go, I'm not the funniest job, but you get my point.

Katie: 19:56

Yeah

Joe: 19:57

Can I ask you something, Susie? She goes, yes. I say, what's your curfew. I have to be home by 11 o'clock if I'm with my boyfriend or friends. So what happens if you can't get home by 11? Well, I have to call my parents and tell them that I can't make it home. There's a plan. I said, okay. Let's say you go out on a Saturday night with your boyfriend and, Uh, 11 o'clock comes and goes and you're not home. And you haven't called 12 o'clock one, o'clock two o'clock at three o'clock in the morning. Your parents are beside themselves. They're standing on the front steps of the house and they see you and your boyfriend coming down the street in his car. He runs up the front lawn on the lawn, not the driveway. both engage in a real long kiss. Your parents are staring through the window. And they're like, can't believe what's going on. You roll out of the car. You can't walk. Cause you're drunk. Your boyfriend air's ass backwards. I said, how many more times in this century would that ever happen? And she goes, it would never happen. And if it did happen, it would never happen again. I said, why do you say that? She goes, because I'd beat. And I said that my heart goes out to your sweetheart because until your parents treat your misbehavior and diabetes, the same way that they treat your misbehavior in dating, you will never be able to take care of yourself. It is delusional to presume or think that a teenager at the age of 16 will be more responsible and responsive to a educational sermon than a 44 years. How many people smoke and they know that smoking is dangerous, knowing does not necessarily lead to doing when parents have a kid under their watch, they need to make sure that the kid does what they do. I asked, I said, do you have any kids who don't have diabetes? Yes. I say, let's say your nine-year-old is standing by the door who doesn't have diabetes. And the bus is coming in 30 seconds and she's in a posture of lollygagging. You say to her, sweetheart, would you. Got you, but to the corner because the bus is coming, she goes, well, my now's as good a time month to talk with you about what I really want to talk with you about last week, I went to school and I went to school for five days. And I have to tell you that it really crushed my spirit, that I've decided that I'm only going to school two days a week from that one. This is what we're talking about. Negotiating with kids about how many blood sugars you're going to do and how often you're going to bolus and we'll reward you. If you, you know, remember to boldness once a month and all this kind of stuff is desperate. Sets the bar very low parents have a job as parents. My job as a therapist and as a diabetes coach and educator to tell parents that whatever you use as parenting to get your kid to behave in all other areas of life, need to be applied to diabetes as well. This is not a special area that all of a sudden, only the diabetes educator or the doctor knows how to talk with your kid to do some kind of voodoo stuff. If you know about getting them to take better care of their. Something that's totally within your of influence, you know, so the father says, wow, that sounds great. You know, how, how should we deal with it? I said, I don't know. She's not my daughter. She's you have to put her, you know, I don't want to step into the role of doing it for. What's missing here is a conversation between the mother and father about how to approach this. Usually you have one parent who's over involved and sort of like a Shrek kind of a person. And you have the other parent who's like protecting the kid from the Shrek, you know, this guy thick, but they're not on the same page in terms of what constitutes right parenting. They're still. Blown away by the diagnosis and they haven't come to that nor have they gotten anybody that helped them do that. So I say, you know, if she were my kid, it would be the rack or flogging, you and I'd have one of those ankle parolee things on her ankle every time she thought about committing the dietary indiscretion, I would zap her mother goes, oh, Joe, you know, we thought you were a nice guy and a little funny, but now we think you're a fascist. Happy with punish her for having them BDS. I say, you're not punishing for having diabetes. God gave her that life gave her that you're punishing or disciplining or for misbehaving in the area of diabetes. And you'll think that well, if we punish her for that, we'll dramatize her. I would say the opposite. If you don't, you appoint a shirt, she needs to get the message that this is in the same realm as any other behavioral aspect of growth.

Katie: 24:41

Hmm.

Joe: 24:42

That's the magic and that's the trick. And it usually takes only about two or three sessions.

Katie: 24:46

So it, you start really with the parents, the mom and the dad, and they need to be on the same page. They need to get a game plan together. Hey, Hey, Hey, it's Katie jumping in for a quick sec to tell you about the product feature of the week. High key mini chocolate chip cookies. These little guys are keto friendly, low carb grain-free and gluten-free, but more importantly, they are so yummy. Look, I've been eyeing these cookies for a while. Every time I walk past them at Costco, but to be honest, We've tried some of the really popular, low carb, keto friendly brands out there. And we didn't like the taste of them so much. So I was pretty skeptical, but when they went on sale last week, I was like, okay, fine. I will try them. You guys, these are delicious. My whole family loves them. Plus they are so super easy. Sarah's blood sugars. I recently shared these in one of my Instagram stories and had multiple people reach out to me to tell me that not only are the chocolate chip variety amazing, but the mint chocolate mini cookies are to die for. So naturally I went on to Amazon and ordered a three pack. Want to do the same? I will leave a link in the show notes so you can try them too and see for yourself again. That is high key mini cookies. Okay. Now back to the. So it, you start really with the parents, the mom and the dad, and they need to be on the same page. They need to get a game plan together.

Joe: 26:19

Well, they need to get more than a game plan. They need to work together to set behavioral expectations and to have consequences. So lectures and the sermons don't cut it. Actually, the heart of the parents work, the less the kids have to the goal is to get the kids to do. In an age appropriate way. So parents have to sit down and say, these are the things that we expect you to do. These are the things that will happen to you. If you don't do that for every time that we catch you, not bolusing before you eat. And we lose a basketball practice for every time that you, um, committed dietary indiscretion without covering yourself with a bolus. And we know about it, you lose 30 minutes of cell phone. It has to be a consequence that has currently. It can't be in 20 years from now. You'll lose a toe.

Katie: 27:06

we haven't, hopefully we never will, but we also have not gotten to a stage in our diabetes management where we're met with just complete Nutter, you know, disobedience and rebellion and everything. but I know just in parenting in general, I know that when we have a problem, like a big problem and it needs to change. try as best we can unless somebody is out of town or whatever, to sit down as a couple together and be like, look, this is what's has happened in the past and it's not working. And this is what's going to happen in the future. And if this, you know, if you don't do this, or if this doesn't happen, then these will be your consequences. And I feel like sitting down together, you know, obviously this is a, not a diabetes example, but that definitely gives them the impression of, oh my gosh, this is a big deal. Like mommy and daddy. Sitting in front of me together.

Joe: 27:55

yeah. And if you don't do this and diabetes, then what the kid gets the message. Wow. This must be something really horrible. If they're so paralyzed in every other area of life, they have their act together as parents and they drew up a line step over it. There are consequences in diabetes. They're so terrified that there are no consequences and there were no lines. So I'm, you know, most kids, this is their way they're acting out. Is there a way of asking for help from their parents for structure and boundaries?

Katie: 28:26

What have you seen in terms of, know, coaching somebody through this

Joe: 28:31

yeah. What I've seen is that every kid that I had said, I'm not here to be your friend. I'm still friends with, that's what I see. And. Hopeless desperate cases turned around in two or three sessions. it doesn't work. The magic doesn't work every time cleaner. There are people who are not interested in the solution. And clearly there's the thing about, I can't fix everybody we'll work with, you know, like do well with everybody. It's like, it's a chemistry thing, but 90% of my clients. Do much better in two to three, five sessions at the most. And I'm still in touch with the kids.

Katie: 29:03

That's great about an, a single parent situation?

Joe: 29:06

Parents is another story. Single parents, the most statistically significant predicting variable in single parents is the support network that they have in place. At the time of diagnosis, the support you have as a single parent, the better your kids A1C will be a year after diagnosis. So my approach to working with single parents is to co-parent with them to lean a shoulder in, um, some people would call that codependent or doing too much work or this kind of thing. I have a funny field. Um, my, my sense is that in a lot of clinics around the country, in the world, that single parents are sort of prejudiced against in some way that sort of like they're not giving the right amount, this. And, um, they need support as parents. So usually what I'll do is I'll have a session with the kid and the parent and the parents are exhausted because the nice thing about being a single parent is that you don't have to co-parent your rules of the rules and you don't have the rule by committee.

Katie: 30:05

Yeah.

Joe: 30:06

The best part about being a single parent is that you don't have to, you know, exhausted. Right. So, um, So I see my role and our role as educators, because my work is about teaching the nurse educators, diabetes educators, how to do the family therapy. You're a client of mine. And I just see you meeting, you know, to go over diabetes. You won't even know that you're getting family therapy sort of. You know, it's a black ops operation. No, it's like you get, you feel something's changed and that kind of stuff. But anyway, so it's either appearance. I leaned her shoulder much more into it as we're going through this stuff. And I get the parent to the single parent to tell their story, having the kid listen, what was it like for you growing up? What things were traumatizing for you? What was it like for the divorce separation? Tell me a little bit about that because I have a, I have a clinical sense that the. Difficulty with dealing with the powerlessness related to the current diabetes, then thread of connection to the powerlessness that a kid experiences in the forced situation, when you're a kid and your parents divorce, you don't have any control. Nobody came to you and said, sweetheart, do you think we should divorce or separate or you know, this kind of thing. And so the powerlessness of having diabetes is coming from. Y the powerlessness of the force and that we need to process some of the divorce stuff and the powerlessness stuff connected to that. And so getting them single parent to tell a little bit of their story about what it was like for them to grow up. And this is about helping reestablish a connection between the teen and the. The powerless, this thing I think is really profound. And it's at the core of the diagnosis of any diabetes thing. What do I mean, I mean that as when your kid gets diagnosed, whether you're a single parent or two parent family disabused of the delusion, that you can protect your child for many things. And in terms of, job description for parent protecting your child, At the top of the list. And then if that experience of powerlessness, which is spiritual and psychological, emotional bad enough, the second most difficult powerlessness feeling is the realization that you can't fix it. You can't make this go away. I don't know, one parent on the planet who wouldn't take their kids diabetes from them, if they could.

Katie: 32:30

Yeah,

Joe: 32:31

You get to, if you could.

Katie: 32:32

Oh, absolutely. I would definitely in a heartbeat. Take it away from my daughter. Yeah, I think you're probably Right. I'm I can't imagine a parent that wouldn't.

Joe: 32:40

Right So this is what it's at the core of, and my experience clinically of parents and families who are doing well, versus those who are not. Well, the families, the families who are doing well have come to terms with this powerlessness thing, eyes wide open. I don't mean in terms of fixing it. I don't think there's a fix for it, but there's a need for validation of having gone, going through it, coming to terms with it and falling apart before being reborn families who are not doing well, I've chosen for whatever reason to not deal with this. Maybe the pain's too great. Maybe they perceive that there's not available help around healthcare. Providers need to understand that our job is not only to fix, but it's to help heal. It's not our responsibility to make somebody feel better. It's our responsibility to help them get through the situation so that they can draw on whatever internal resources they have to help fix themselves. It's to give them the tools to get to a better place, not to do it for them.

Katie: 33:40

What's your. Advice for somebody who has a teen in the, in the 10% of what you're talking about, you know, th the, the team that just flat out refuses to take their insulin and, is just, belligerent and just,

Joe: 33:56

Okay. So let me ask you this, After talking with me for a while, what would you suggest? That would be my question to you. say this parent? What do you think they need to do for.

Katie: 34:07

I mean, I feel like what I would do as a parent is. Try to get them into, into counseling. I mean just knowing my family dynamic and knowing that we're, as far as I perceive, we act as a team and we're supportive and we're encouraging. And so I feel like if the wheels were falling off in my house, I would seek help from someone else other than me, because I feel like they wouldn't want to hear it from me.

Joe: 34:32

Yeah, exactly. But they would need to hear it from you because at the end of the day, it's not the therapist that does the work, but it's a therapist or the coach who gives you the tools that you need to do to be more effective in the parenting thing, they would need to find the person, a clinician who understands that it's a family thing that it has to do with parenting and not so much with getting the kid to feel. that would be number one, which is a rare

Katie: 34:55

Yeah,

Joe: 34:55

a lot of clinicians are still bought into the sort of a paradigm that we need to make the kids feel better and understand more in the bill do better. I think like that example that I gave you about the kid who says I went to school five days and had my spirit crushed. You know, what kind of conversation are you getting? Is it like sweetheart, get your ticket, but that did a quarter. And then we'll go to the psychiatrist when you get home from school, who do your thing, and then we'll talk about it. was most disheartening about seeing teams that are acting out and talking through their bodies? that. They have a sense of diminished self efficacy, meaning that there's, I think every kid that I've ever worked with when they know what they're not doing, they go to bed at night and they say, I messed up today. Tomorrow. I'll do better than tomorrow. Comes in later on. That's important for parents, to understand step-by-step how they need to get this thing going in such a way as to get their kids to do what they're supposed to do. So three rules about diabetes management, rule, number one, taking care of yourself as non-negotiable rule. Number two, you don't have to like it. You just have to do it. If you like it. You're not saying you need medication. And then rule number three. noncompliance, nonadherence and mismanagement as any other active misbehavior. Now, the reason you would need a therapist to help you with this is that if in fact you need the eggs as a family, that the area of fixing lies more in the area of helping the parents come to terms with how they're not communicating effect. I don't think kids have problems. I think they have parents and they bring their parents in for therapy.

Katie: 36:35

do you, do you encourage entire families to come together? I mean like parents and kids, moms and dads, and Yeah.

Joe: 36:42

Yeah. It's the only way. And I talk about everything that I talked about. I say up front in front of the kids, the kids knows what's going on. I'll ask the parents. How do you feel? How did you feel as a mother when your kid got diagnosed? The parents are a little reluctant to answer that question because they think that it's not cool for the kid to see them crying. In fact, it's quite the opposite. There are many instances where it's important for the kid to see you fall apart. Actually the kid acting out. There's a way of protecting the parents from having to deal with the extreme pain of a diagnosis. If you look at it that way, then you see how important it is for us to have a conversation with everybody putting all of their stuff on the table. This is not something that anybody can do, our skill and training and that kind of stuff. But this is important. And it's essential for every family who gets diagnosed, have the opportunity to have some kind of session with their educator and provider about what it's like, how you felt processing it, because what we need to do, the biggest gift that you can give it. W w co-packed at the beginning to your kid is to give them the tools about how to manage. You're not going to be able to take it away until there's a. Up until that time feelings and managing feelings and dealing with feelings are as important as adjusting insulin doses. You need to give them the tools to be able to understand that they can fall apart and piss and moan and check at the same time But Robin acting out teenager, I'd like you as a clinician to think that it does not have to do with learning how to carb count.

Katie: 38:16

That's probably not at the heart of the issue.

Joe: 38:19

more to do with the way that parents communicate with each other. But here's the problem. A lot of diabetes educators, and a lot of doctors don't get trained in family. So, if it is in fact, the family issue, then, you know, every diabetes clinic needs to have at least some resource that can deal with the family issues of diabetes. I've trained a lot of clinicians over my lifetime and the workshops and presentations on printing doctors and clinicians on how to do this.

Katie: 38:50

can you give, parents listening some practical. Tips, do you kind of lay out like the steps of, okay, obviously we're here and there's no reason why we're here. So this is how we're gonna move forward. Do you kind of walk them through a series of steps

Joe: 39:05

Yeah. So the first step is for the parents to have the conversation about what their behavioral expectations are until the parents have that there's no movement forward. So one parent may say, I think that Suzy. Looking at her CGM before she boluses and bolus correctly, the other parent says, no, I think that's putting too much on her. She should come to us to ask about how much the ball is available. You know what I'm saying? It works in the family. So the parents have to have the conversation. Then they have to have an agree upon the consequences for what happens if you don't do this, you know that no lectures. No, sir. You know, Susie comes down for breakfast every morning and her parents go, did you check? And, as opposed to asking her, sweetheart, did you have any nice dreams last night? Or how can we be with you? Or it's always about diabetes, diabetes, diabetes. It becomes nauseated. the parents have to back off on the sermonizing and the lectures and the harping, because I said to you before the harder they work, the less the kid has. Right. Parents are doing all the work and the worrying. Then you don't have any problems. Then the parents have to come to an agreement about what the consequences are. Then they have to sit down with the kid and say, your dad. And I have decided that it's high time that you start taking better care of yourself. This is what we consider a constituting responsible behavior around your diabetes. You'll need to do this. And if you don't do this, this happens, you'll need to do this. And if you don't do this, that happens, you know, and we will not lecture you or remind you anymore. We are here as your super consultants. You need, you can come through us at any time. No. If we see that you're having a hard blood sugar number that has as a result of not bolusing, then you lose blah-blah-blah, you know, this kind of thing, right. If it's a number and you miscalculated, but we see that you tried your best, then we'll work with, you and then that's it. And then you meet once a week, like a weekly report card, five minutes, no lectures. No. Yep. And you say, Hey sweetheart, look, it looks like you didn't do three checks or it looks like you didn't bowl us four times. You lose two hours of cell phone this week, or computer or social media, blah, blah, blah. And the kid goes, no, I hate you. Look here, look, look at my meter, look at my CGM. I might did I say, oh, you did, but you didn't write it down. As we said, you will need to write it down because I believe that kids need to write this stuff down every so often, like at least a week, every three months. Yeah. So you put that into a black hole and the number's not yours, you know what I mean? And then it's up, it's good for the clinician, but it's not good for the kit. You're not, you need to see and wrestle with the patterns, right? You need to own the numbers. So you did it, but you didn't write it down. You lose a half an hour of cell phone privileges. I hate you. You're stupid. No parents go listen to. Where are your parents and we love you. And you'll realize that when you're a parent, you'll be doing this. If you're a parent, then you end up having to say that you lost. What I tell parents society, the kids, when they get into this existential thing about, I hate you and you don't understand is I tell the parents to tell the kids, listen, sweetheart, it's clear that your father and I hate you, and that we hated you before you got born. That's why we gave you diabetes and not your brother Timmy for this week. You've lost these privileges. If you've liked to not lose privileges for the week to come, please consult us. We're here for you. Thank you. And as I say in California, have a nice.

Katie: 42:30

I have a nice. day. I always tell my kids, my kids haven't haven't yet told me they hated me. I hope they never do, but it's probably bound to happen at some point. But, uh, they have told me I'm very mean. And I, I learned this from John Roseman. Who's a pretty no-nonsense parenting. guy. And he, he says when they, if they tell you you're mean, you say, I am mean, thank you so much for saying that. I mean, what I say and I say what I mean.

Joe: 42:56

Yeah.

Katie: 42:56

Yeah, I

Joe: 42:57

that's the way it goes. Yeah.

Katie: 42:58

Yeah.

Joe: 42:59

if I have a pro, if I see you not doing something all the time and I'm telling you do better, do better, do better, do better without giving you the tools to correct it. I would consider that nagging, you know, but the nagging doesn't get reduced as the kids do better. Nick, what I asked the kids. A lot of times I say, what would be the easiest way to get your mom off your back? You know? And the kids say, if I did better with my diabetes, I say, okay, so now we're not dealing with a cognitive deficit. All right. That's important for me to know that what happens is, is that once you put this plate into place, the parents have to back off from their, again, the nagging is what sets the dysfunctional dance cycle into place. stopped the game and watch what happens. That's how that goes. Yeah. It's not that the kid starts doing better. And then you, Nick, less nagging has to do with overworked parents. This is what happens when a kid's sort of victim not doing well helpless and you know, They don't have to do anything because their parents are so worried and so upset and doing it all for them that then there's no space for them to do it. What this plan does is it helps the parents back off, put them in an appropriate role for parenting and gives the kid enough space to hang themselves by the rope or to get praise. Parents say, well, what about incentivizing them? Why say incentivizing them? You mean like for every blood sugar that you do for every. Time that you bolus before you went, you give five bucks like that. That's like training, Al-Qaeda terrorists. You know what? I'm just like, you do not want them to be doing it for the carrot. You want them to be doing it because it feels good to take care of yourself.

Katie: 44:49

Yeah

Joe: 44:50

You don't incentivize them to go to school. Do you like, if you, if you go to school, I'll give you$10. Never heard of anything like that.

Katie: 44:59

I'd be real broke real quick. That's for sure.

Joe: 45:03

Okay. Cool. Yeah. So that's, that's the point. So it's really an important distinction. Yeah.

Katie: 45:07

Yeah. I've just, again, I at the moment have nothing to really relate it to in terms of diabetes. But I know my daughter right now is like really struggling with math and, you know, she comes home and like, did you do your homework? And she's like, yes. And I'm like, need to see it. And, and she, a lot of times hasn't done it all or has done it and all, you know, mostly. The questions are

Joe: 45:29

Yeah.

Katie: 45:30

And, and anyway, I mean, I have to stay on top of her and I feel like she hates every second of it, but you know, that's my job as a parent is, Hey, this you're in fourth grade and this is the foundation of your academic career. So if we don't get long division, right, you're not going to be set up for success. So it's kind of the same idea of one day. You're not going to be living in my house. And my job is not to be your best friend or hold your hand, but

Joe: 45:55

into that you have to do things that you don't like. it air for kids with diabetes? Now, the thing about kids with diabetes is that some of their naivete has been, been disabused of some of their childhood naivete. They understand things that their peers who don't have a chronic illness don't have to deal with. And that is at this time, given those set of calls, There are certain things that you have to do that are non-negotiable.

Katie: 46:21

Absolutely. Well, before we sign off, I mean, people are, you're like available to work with families. Right? Do you work virtually?

Joe: 46:28

Yeah, I worked virtually, I see and families from all around the world, Canada, Australia, England, the United States.

Katie: 46:36

Okay. How, where can people find you?

Joe: 46:38

At, with the go to my website, a mile in my shoes.com. There's a race where they can send an email to me and I'll get it.

Katie: 46:45

Alright. And your book too. Is that available? Where is that available? Okay, so it's an e-book.

Joe: 46:54

Yep. It's like a book out of Harry Potter world.

Katie: 46:56

Oh, okay.

Joe: 46:56

Yeah. It's got moving pictures and parents talking kids talking from all around the world. It's both in millimoles and milligram per deciliter. So for England and, Australia United States. You can look at that. It teaches you. If you didn't know anything about diabetes and I stuck you on a desert island and gave you the book, you'd see videos of me talking to you through it as if you were in my office, plus videos of kids and parents, brothers sisters, and how to deal with that kind of stuff, as well, and sort of give you with feeling as close as possible that you were in my office.

Katie: 47:30

I love that. Okay. Very good. All right. Before we leave any words of encouragement for parents out there that are just totally fed up with their type one, teen

Joe: 47:38

you know, if you're having trouble with a team. It means that your kids, a team and that the devil will have taken your teenager until about the age of 18 and then 18, the devil will give you your child back

Katie: 47:51

Yeah.

Joe: 47:52

and that until then, may the force be with you and give me a call if you need help.

Katie: 47:57

Yeah, that was good advice. I've heard that from a few people. Like if, if we could just give them away from like 13 to 18, that'd be ideal.

Joe: 48:05

But here's the deal. This is the most critical period

Katie: 48:08

Yeah.

Joe: 48:09

of time for a kid with diabetes because they get away with not taking care of themselves and being a responsible, that will be what they take with them when they leave.

Katie: 48:18

Mm.

Joe: 48:19

We'll be another 10 years until they come around to perhaps a spiritual epiphany about I'm messing up,

Katie: 48:26

Yeah.

Joe: 48:26

I'm going to tall. My eyes are going my heart and my nerds are this kind of thing. So it's our job at this time to teach them the right behavior. I don't care so much if they know or understand as much as if they do the right, doing, we'll get them to the right.

Katie: 48:43

And I, and I feel like if nothing else, like in the 10% of cases that you mentioned if nothing else, those kids are gonna grow up and they're going to be adults and they're going to look back and they, at least they're going to be able to say, you know, my mom or dad, or both parents tried to, to help me and to, you know, they'll have the respect of knowing that you at least attempted

Joe: 49:05

Well, they'll have a lot more than that and the messages is that you can support people by challenging them. You don't have to buy everything that they're selling. You can, a teenager will feel supported. And I think what I talked about speaks to the fact that if I'm friends with all of the kids that I've worked with on some level, it was sort of like that old men in skin brace or commercial, you know, I was like, thanks. I needed that. You know what I mean? Thank you for challenging me. No, I needed to be disabused of my delusions and that's what the parents are doing. You know, we can support you sweetheart, by challenging your craziness,

Katie: 49:42

Yeah. I like that. I'm going to, I'm here to challenge your craziness kid. Let's go.

Joe: 49:46

Yeah.

Katie: 49:47

I love it. I like your tough love. Demeanor and your way of, tackling these rebellious teenagers. So I'll be keeping your email address in my back pocket for the future. Hopefully, hopefully I won't need it, but we'll see. Yeah. Thank you so much. And I know Joe is going to come back on and talk about a couple other things related to. T one D teen, uh, and diabetes management in general. So he will be back. But for today, thank you so much. I think we covered quite a bit and I appreciate your time.

Joe: 50:16

Thanks. Katie was really wonderful being with you.

Katie: 50:18

Yeah, it was. Thanks, Joe. I'll see you soon. Bye. That's it for our show today. I hope you enjoyed hearing Joe's perspective and advice. I will leave a link to where you can find him and his book on the worldwide web. Of course, if anyone out there is interested in working with Joe, he does work virtually and in the show notes, I can leave instructions on how you. In touch with him. Plus Joe will be back later in the series to talk about diabetes and eating disorders. If you'd like to follow along with the show on social media, you can find me on Instagram and Facebook at sugar mommas podcast. Last, if you're an awesome person and would like to support the show so I can keep bringing you guys awesome content every week, you can head on over to buy me a coffee.com forward slash SugarMomma to donate today. Check out the links in the show notes for more information. All right, you guys have a fabulous week. Keep calm and bolus on bye.