Ep. 11 - Type 1 Diabetes - Children, Adolescents & Young Adults

Type 1 Diabetes in childhood is HARD! What happens to glycaemic control through adolescence & young adulthood? Hayley & Jaimee talk about the evidence highlighting how diabetes management can become even more challenging through the teen & young adult years.

Does that first year after diagnosis impact on the future? In this episode, we use some evidence from the research to talk about our experiences and thoughts on the challenges of T1D from diagnosis, and through the younger years. We hope sharing some research & some personal experiences helps people feel less alone, & maybe even help prepare (as much as possible) for some of the possible hurdles.

Research articles:

• Children’s and young People’s diabetes services: What works well and what doesn’t? N. Kime, S. Zwolinsky, A. Pringle , F. Campbell (2022). Public Health in Practice 3
• Glycaemic Control in Youth and Young Adults: Challenges and Solutions,  Khadilkar, A. &  Oza, C. (2022). Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2022:15 121–129

Other useful resources:

• Moving on up to adult health care services – NDSS
• When and how psychologists can support people with diabetes fact sheet (ndss.com.au)

Transcript

Jaimee 0:16

Welcome back to another episode of Diabetes in the Roar. We've got Hailey and Jamie again. Hi Hailey.

Hayley 0:23

Hey, Jamie.

Jaimee 0:24

How's your last few weeks been in terms of diabetes? Because I've got a bit of a rant to go on, which will lead into our topic today of adolescents and young adulthood for type one diabetes. But let's start with how your boys are going.

Hayley 0:38

Um, yeah, probably a little bit up and down. I'd say we probably have got a few rants too. One in particular, we have had a review with the endocrinologist and diabetes education a couple of weeks ago. All fine, all very happy. Um, same as we've had previously with Master J. Just can't see patterns. Just, you just gotta roll with each day as it comes because every time you think there's a forming, it changes. Um, we have had a few pretty rough nights, some of them on sensor change days, and maybe just the sensor not. Quite up to par, which I think one night led to hubby getting up 11 times to deal with, alarms. And there were some loads I think in that too. And then maybe about a week ago we had a night where I think I was up seven times to treat the two of them with just repeated loads. And it's, um, it's quite a conundrum when, when you just wake up and you have to get into action and both pumps are alarming and you're like, Which one's gonna be lower? Which one do I go to first? so yeah, they were just, not sure what they were, whether it was a bit of over bolusing, a bit of excitement. Cause they've got a cousin over from England, who knows? Or just one of those things.

Jaimee 1:58

I know. And that's why we say someday he is thriving. Others just surviving. Because I feel like personally for the last few weeks I've been doing my best to thrive, but uh, just not winning. And my husband makes comments like, you need a good diabetes educator. And I'm like, yeah. Do you know what that that's true. I'm, it's funny, but. Also, you can't help what your body does, what hormones do, um, what stress, anxiety, excitement. So that's, we are gonna sort of jump into that today. And you mentioned when we weren't recording prior to recording, you mentioned that it's eight years today.

Hayley 2:33

Eight years today since Master B was diagnosed with, diabetes. So he's now Oh. Coming up 12 and a half. So he's lived three quarters of his life with diabetes. If my math is right there, three quarters, two thirds, whatever.

Jaimee 2:50

So just to give the listeners a bit of background, I've grabbed a few, recent research articles cuz we love to get some evidence-based, topics to talk about, but then, Put our personal experiences in. And of course none of this is medical advice. It's more just us sharing and hoping that people get something from it. Even just feel less alone. Like, like we've been for the last two weeks struggling, in silence, haven't we? Cuz I didn't know you were struggling and I mean, when don't you struggle? But some, some weeks and some

Hayley 3:21

can certainly, you can certainly feel alone when it's. Two o'clock in the morning and it's the fifth or sixth time you've got up and you feel like nobody else in the world is awake or doing anything and you are there trying to make decisions. And personally for me, as, as the parent, I find the knock on ears. I often don't go back to sleep. So, I think Sunday night is an example. We hadn't been up, but we had to get up to do a calibration and I set the alarm. And I woke up at 3:00 AM and said to Harvey, did you get up at two and calibrate? Oh no I didn't. I said, well, why hasn't the alarm gone off? Because I'd said it for 2:00 PM instead of 2:00 AM

Jaimee 4:02

so easy to do overnight.

Hayley 4:04

That's right. So hurried off, up, checked, but then that was it. From three o'clock I was awake, couldn't sleep, and that's just a cycle I find. I go in, um, if we've had repeated nights of getting up, I will go through a run of, I don't go back to sleep. yeah. I And then other times I go back to sleep and barely remember that I got up. So yeah, it's just, it's just riding those cycles. And this week have actually tried doing a bit of self-care during the day and on Monday I did actually stop working down tools lay down and ended up having sleep, which is not I not ideal cuz you want your sleep pattern to regulate art. It's what you have to do.

Jaimee 4:44

And that's a good message for other parents listening out there, I think because it's so easy just to put what parent doesn't put your kid first, but you know, type one, you don't get a night off, you don't get a day off. So jumping back to so eight years, I wanna bring you back, and I know we're not gonna go over, diagnosis as such, but this research article. Is called glycemic controlling youth and young adults challenges and solutions. And I just wanna, I guess, highlight the importance of. Diabetes management in that first year post-diagnosis, cuz all the evidence suggests that how well the team works with you to get that glycemic control as close to those targets as possible. I think most centers in Australia these days tend to aim for under 7%, especially with these closed loop systems, with the pumps and CGMs. Um, but that's not taken away from anyone that gets a 7.4 or five. We, we all know how hard. You know, that is to achieve. So I guess I just wanted to chat a little bit in opening about, you know, that first year, how important it is and the education process. how did you find, can you remember back? And cuz I know a lot of it's a blur, you know, and it's hard sometimes to retain all that information.

Hayley 6:06

Um, no, I, I can remember quite clearly at those early days and just. Being meticulous. so we'd had been taught carb counting in hospital, and, you know, was sent home with our little book with the carbs in it and then quickly got used to, using Google or something to look up carbs and within, so we were, I think maybe a set dose of in, in, at mealtimes. And so that was a set number of carbs, but within. I am gonna say within the first couple of months we had gone back to, we had a private pediatrician at the time and went back to her and said, look, sometimes he just doesn't want to eat all that food and sometimes it can seem a lot of food. So we, I'm gonna say fairly quickly moved to, dosing for what he was eating and he only wanted 15 grams of car. That's what he got. And if he wanted 50 grams a game, so,

Jaimee 7:03

individualizing the education. I think most centers now teach carb counting at diagnosis. But you do have to pick your time cuz I find that's what most families. Find the most challenging and stressful in at, in that initial period after a diagnosis. It's, it's just, yeah.

Hayley 7:22

I don't think I did, but maybe that's from a lifetime of me always trying to lose weight. I'm fairly. I suppose with looking at labels and things there, certainly packaged foods, no issue. I did find very daunting in the, I'm gonna say probably the first six months doing a recipe from scratch and that, you know, remembering to weigh everything and look up the carb counts and, you know, others, within family, my dad being one of them. Surely there has to be an easier way and it's like, but sadly, there. There isn't an easier way, you've gotta work it out like, so that I did find quite daunting, but in terms of, uh, maybe reading labels and establishing carbs and working it out, the maths I didn't struggle with so, Fairly fortunate that that grasped that. But I do remember early days, hubby and I having slightly different ways of working things out, like getting the same end result. And one night just coming to log the heads over it because I'm like, this is how you have to do it. And he's like, I don't do it that way. And then we were like, well, we both get to the end result, same end result. So however, but I, I can see why it would be daunting and overwhelming and I think with that carb counting as well. The fear of getting it wrong, the

Jaimee 8:38

what I was gonna say.

Hayley 8:40

of what insulin can do.

Jaimee 8:43

And, and it's that, that not quite understanding. I mean, everywhere, everywhere's gonna be different, but most places, you know, if I've worked somewhere, it's usually that you have a doctor's phone number and every day for the first week at least, you're contacting the doctor to review the carb ratios and the correction factors. But, If you don't fully understand your thinking, if I get this wrong, that insulin dose is wrong, and then the consequences of that. So I think it's that as, as well as the actual carb county. Now, it's just that combination and that stress involved with, you know, if I don't get this right,

Hayley 9:19

that's right. The burden of the responsibility of it.

Jaimee 9:21

Yeah, and children are used to be unable to eat in like when they want what they want to a degree. Of course there's boundaries at home and things, but yeah, I think parents find it hard to say, well now you can't eat for two hours cuz we need an accurate glucose level and

Hayley 9:36

And I remember struggling that with Master B, he, whether it excuses that little bit older, different personalities don't remember that issue. But with Master J. I can remember in that first week coming home from hospital, virtually every day him and I would end up on the kitchen floor, both of us in in tears because he wants to eat. And I'm saying, no, not yet because that breakfast insulin shot isn't gonna cover you and giving you another one now is a bit too soon, and you know, whatever. And trying to explain that to a three year old. But I will say, On a plus site so we don't sound all doom and gloom looking now and looking compared, you know, to what you see generally in society. Our kids are fairly well regulated with food. I'm not saying they don't eat their fair share of junk and stuff that isn't as, preferable, but that ability to regulate and say, I won't have anymore. They might go, I can't have anymore, can I? And if you say, well, no, it's best not to, or That's not the best combination. They've got an understanding of that, which I think is great and will hopefully stand them in good stead as they come into adulthood.

Jaimee 10:57

Well, that's right. So you go from those difficulties for those who have had children diagnosed in those. Toddler younger children possibly. Okay. Now I've got a good understanding and, and it's a bit easier for the parents to manage things and control things and that's where this podcast is pretty much leading into that adolescent young adulthood where all the evidence suggests we lose that diabetes management and those H B A one Cs, and this is internationally, they go up, up, up. And there's a number of reasons for it. We're gonna go. in this podcast, but one of those challenges is going to be adherence, and I don't love that word, but it's basically, you know, the ability to. To do what needs to be done to get those glucose levels in range. And there's no judgment around that, but it's just, I guess, important that we kind of highlight some of those challenges, whether you come into it or not with your boys in the next few years. I don't know. Cuz one of the big factors is, um, You know, the fam, the family and, and the

Hayley 12:02

Mm.

Jaimee 12:04

and I guess it's that challenging behavior and everyone is gonna go through something different with an adolescent coming into young adulthood.

Hayley 12:11

Mm. Yep. And I, and I see some of the things that, that we might face and you wonder about how you deal with them. You know, one in particular, younger, one, very easily distracted. And you think, well, I just hope that as you get older, that improves because it, it would just be a pure and simple forgot bolus rather than necessarily a deliberate forgot bolus. But you know, the time in a week when we go, oh, you haven't calibrated, and you've, you've said, do your test calibrate, and you're like, surely this is what we do every morning when we get up. Surely it's just done. And minds just don't work the same way. So I have to tell myself, I just hope that that repeated each morning, Hey bud, just need to do your finger prick, be a calibration, pop a bolus in that, that repeated, it just gets, somehow becomes ingrained and they'll just keep doing it. I, I don't know,

Jaimee 13:15

Yeah, and I, and then you know, the adolescent brain changes and. The physiology of the body. So we, we start to come into those, those sex hormones and, and puberty and all of that, which in itself causes insulin resistance. So one of the big factors we need to consider is sleep patterns change. You've got actual insulin resistance coming from those hormones around puberty, which can. Double, if not more insulin requirements. And do we keep up with them if we are seeing the clinic, seeing someone every three months, sometimes six months. Because clinics don't allow for adolescents who are focused, whether they're focused on their sport, their friends, um, exams, clinic hours are between eight and four most centers. So it's all about, you know, that's where I guess we are going with this. All the evidence suggests that we need to individualize things, think about their lifestyles, try and make things flexible, but in reality, it's hard to do when those clinics don't run at hours. That would suit these adolescents and young

Hayley 14:24

That's true. I, I think the advent of the telehealth has helped. So we are now, we now do two face-to-face, two telehealth per year. Uh, and there's less impact there. So for us, location of where we live, time it takes to get to the appointment the boys would often miss and the timing of their appointments in the day would, would often miss a full day of school with a telehealth one. I pick them up 10 minutes before the appointment. They go back after. So again, that that minimizes impact on them.

Jaimee 14:56

and you know, some, some kids want to. School and are happy to take a hold of and go to clinic and then go out for lunch with mom or dad and, you know, make a day of it. And then others, yeah, they're focused on their studies. They don't wanna miss school, and then you wait for an hour in the waiting room and then the appointment takes two hours and, you know, it's, it's just not always focused on them. And so it's just another challenge plus the actual,

Hayley 15:23

another

Jaimee 15:24

yeah. Yeah. And interestingly, you know, you were talking about the boys and their pumps and things like that. So this, one of these studies reports that, approximately 65% of patients using an insulin pump miss one bolus of insulin per week. Well, one bolus. I reckon that's pretty awesome personally. And, but then it also goes on to say that if doses are frequently missed two or more in a week, that it can change the H B A one C. 0.5%, you know, so you might be looking at a, an 8% instead of a 7.5, which is, you know, important in regards to long-term management. If we are talking

Hayley 16:01

definitely. Definitely. I think maybe one of them that struck me in reading that article was, and it's repeated a few times, talking about it as a chronic illness or a chronic disease, and I think that is very easily overlooked. So particularly for those who may have been diagnosed at quite a young age and then come into adolescents, I've heard it said many times and reference to my boys, oh, but they'll be fine because they've had it so long, they're used to.

Jaimee 16:28

Oh yeah.

Hayley 16:29

Whereas I see a flip side to that of yes, they have had it a long time and that's what they do, but I think the burden can weigh heavier because, they have been dealing with it for so long and they, they don't remember, neither of them remember life without it. So that natural curiosity of what would it be like if I didn't have it? And you know, it, it does. They're again, coming into adolescence and trying to strike that balance of, oh, how have levels been today? How have you been today? Any highs, any lows? Particularly with Master B because he is self-managing at school. it's remembering to have a look at the pump, have a look at his download and seeing could we maybe tweak some things that, that, that might help, might improve. But not wanting to be the nag and just, just more background white mum noise.

Jaimee 17:22

And you know what, I'm gonna jump in and I was No,

Hayley 17:25

mum white noise. Not white mum noise.

Jaimee 17:28

mum. White noise. Yeah. And, I think one of our next episodes in the next couple, we are going to actually jump deeper into that with the diabetes etiquette for parents, which is actually an amazing message I feel for parents and Hailey, and I'll talk about it in another episode. But in regards to what you were saying with. You know, taking over that management. If they were diagnosed, the children were diagnosed at a younger age, they also may not have the education and the knowledge to fully understand what's going on, and possibly parents. Who had children diagnosed at a younger age might sort of go, oh yeah, I know they need more insulin as they get older and they grow. But the extent to which those hormonal changes in puberty impact on glucose levels. So you miss one or two clinics in that timeframe of puberty, your insulin requirements will have probably gone up a, you know, quite a lot. So now we've got an H B A one C of 10% instead of 8%, where it was six months ago. So it's not just. You know, the adolescents not adhering. And then it comes back to the complexity of, of the management. Maybe we need to simplify things and change it from when they were 12. Now that they're 14.

Hayley 18:44

Mm. And look that I, I think we've seen some early puberty with Master B. So as I said, nearly 12 and a half now, I think he had some fairly early, changes and his body, you know, underwent right. And I believe puberties, you know, sort of been in stages and I think we did see a time looking back now. Uh, at what was happening with his levels, and it was that insulin resistance and could only put it down for hormones. And I believe that that is now what we're seeing with Master J. So he was only 10 in January, but there are signs there of starting early puberty and we've had that conversation of their environmental factors now that are triggering that, uh, uh, that is it. You know, in foods we eat, whatever. They're certainly things we are seeing. And I would say in the past three months, we had days. Of just ridiculously stubborn hides where the amount of insulin that we're actually giving has scared me. And one of them, we were on holiday, and I think we had two and a half to three days in the end, we took him out of manual mode because you were just constantly going to the pump. With alarms, we would run him on 200%

Jaimee 20:03

auto mode.

Hayley 20:03

Yet took him out, sorry. Took him out of auto mode into manual mode so we could run those temp basils at 200% and override the pump in giving bolus. I mean, normally for us, swimming would just rock them, but he would get in the pool with, could be between six and eight units active on board and he'd still rides. And, you know, we kept thinking he's, he's gonna crash, he's gonna crash. And it wouldn't be until early hours of the morning when we'd been up three or four times just pouring more insulin into him, the amount he went. Like, it, it does, it scared me because you know what can happen when it's too much. But it was just like his body was saying, that's nothing. What's

Jaimee 20:51

Yeah, and I think that's one of the barriers to, to. Knows those hormones so for the women out there premenstrual, you know, the insulin requirements can change dramatically. But you know, personally, I've got a different basal pattern set on my pump for that, for that week before this, this month, it has not touched, like I've been looking at my total daily dose going, that's more than I've ever

Hayley 21:16

Mm mm.

Jaimee 21:17

less? Am I stressed? Have I gained? What, what is going on? I don't have an answer other than hormones.

Hayley 21:25

Mm. And it, it's hidden. It's, you can't see it and there are times you will not get an answer to it. And I actually find some comfort when we sat in the endocrinologist, endocrinologist office and the endocrinologist and the diabetes educator are looking at the downloads and asking these questions and going through and going, no, I can't see. I can. The outcome, the what is happening can't help you with why. And I actually sort of take some comfort from that because I go, you know what? I don't always have to have the answer as to why. So long as we're trying to keep on top and doing all we can.

Jaimee 22:05

That's right. And, and seeking help, I guess, if you need it. because yeah, you can have all the knowledge in the world, but you can't measure what's going on with hormones unless you go get blood tests all the time, which

Hayley 22:16

Yeah, that's right.

Jaimee 22:17

yeah, a hundred percent.

Hayley 22:21

That was just a little interruption for my husband there to let me know that master's tooth has just fallen out.

Jaimee 22:26

Oh, not diabetes related.

Hayley 22:29

notated. Although, can we put his steadily rising levels today down to a wobbly tooth? Never heard that, but there's always a

Jaimee 22:36

Who knows if there's pain involved. I, I'll, I'll look up some articles on that.

Hayley 22:41

true.

Jaimee 22:42

Yeah. and, another part of this research article is talking about, um, that transition from adolescents to young adulthood. So some diabetes centers might keep. Adolescents to age 18, a lot would be only 16. And it would depend on are they still at school? Do they live at home? You know, are they living more as a child or, or an adult? I think some centers can sort of individualize that. but this sadly says that it has been noted that the odds of poor glycemic control. I also don't like those terms. Were 2.5 times higher among youth with type one transition into adult care compared to those who remained in pediatric. So there's a. Difference in how care's delivered. I know from the, from the clinics and centers. I know. and a lot of it comes down to funding in the public health service. And if people frequently fail to attend, you can't just keep them on your books and, but you just don't get that same, okay, give the parents a call. You haven't come to clinic for six months. What's going on? Can we do a virtual, you know, virtual appointment? It's sort of like, you didn't turn up, oh, well, you're out and.

Hayley 23:50

and how do you get those people back once they've been lost to the system like that? How do you encourage them back? It's,

Jaimee 23:58

Yeah, that's the thing. They've gotta actively go to a gp, get a referral, and they're probably off at uni or doing some sort of, you know, work or travel to not high on their priority list. and there's been studies where they've had transition coordinators and things like this, and. You know, it's helpful, but again, very rare that the position is ongoing to support people. so the evidence is all there as to why glycemic control becomes more difficult through adolescents and young adulthood. I guess all we're saying is be aware of it and I, I dunno, just try and keep your young person involved, you know, with an endocrinologist and a diabetes educator and dietician at some level.

Hayley 24:44

Yes, I agree. I agree. But yeah, that, I mean, in, in a private system, I wonder if there's a little more done to keep you as in.

Jaimee 24:57

Yeah, I would say

Hayley 24:57

You know, it's, it's, it's an individual choice, uh, as to what age you choose to keep a patient or whether, you know, you say that's at 16, you, you move on out. And perhaps not the same constraints as, as publicly, funded. I, I think our endocrinologist say she would keep the boys on her books until they'd finish education, which, and it was implied through university, which, if that is the case that is. Amazing cuz you'd hope that if they go on to higher education, by the time they finish that they be at a point where they, you know, they are really fully transitioning to adult life and would hopefully accept the responsibilities, with it. I have to say there, there is a part of me going out on a limit limb saying this. There is a part of me that goes, but hang on, this is a life-threatening convict. So how can you not just get on and do what you have to do? But again, that's easy to say.

Jaimee 26:00

Uh,

Hayley 26:01

to say that when you are not one having to live it,

Jaimee 26:05

And your priorities as an adolescent and a young adult are not the same as someone in their thirties and forties. So there's another article here just talking about children and young people's diabetes services. What works and what doesn't, what works well and what doesn't. Uh, and we've touched on a lot of it already. You know, the two articles integrate well, but one of them is the psychology. and it has been increasingly involved in general diabetes care, I think, and there's a lot more around mental health and the understanding of increased risks of. Things like eating disorders or disordered eating as well as depression, anxiety. you know, the social side of diabetes I think is completely underestimated, which I could talk about personally. You know, it, it absolutely impacts on relationships and, you know, in adolescents and young adulthood going to parties. And as you were mentioned, Higher education possibly. And then you think of going off to physical jobs and so psychology is a huge part of it. I dunno if your boys have had any involvement or not. But I don't think we should be waiting to see some sort of need for it before the psychologist potentially gets involved.

Hayley 27:17

No. And look, I, I'm all for that multidisciplinary approach. and we did discuss it at our most recent, endocrinologist appointment is, The benefit and advantage of, uh, earlier, perhaps psychologist input more as prevention and to normalize talking to a psychologist so that by the time if an issue occurred, they are comfortable in discussing their thoughts, their feelings, how, how things are going. That it doesn't add an extra barrier to getting help with whatever, whatever the issue may be. But I would certainly be all for it. that if, Yeah, if, if, if somebody was, recommend it, but I think part of the issue is as well with the much younger ones, finding perhaps psychologists who, uh, one take on the young patients and two, have an understanding of, of type one.

Jaimee 28:20

And that's probably, I've probably been a bit negative about the public health services. Um, And that's not intentional. It, the barriers are real there. You know, that's why the, the research shows what's needed and it's not always possible. But one thing that I find they do well is have a psychologist and or social worker available and normalize that from the beginning. So you're a hundred percent right, so it's not that, oh, you are sad or angry, it's time to go see the psychologist. It's checking in with them every clinic or every second clinic, and just seeing how things are going. And as you said, have a chat.

Hayley 28:54

And I think teaching them that, if you wanna just put your hand up and say, Hey, I think I need to go and talk to someone,

Jaimee 29:00

Yeah, it's

Hayley 29:00

then you know it's there. You know? Yeah, that's right. It's just normalizing it. And I think for, um, family support too, to help, just help helping, to, helping to guide you so that you can assist them better.

Jaimee 29:15

Yep. Cuz family functioning is a big part of diabetes management. We can't pretend that it only impacts on the person with diabetes or you know, the mom and the person with diabetes or the, or the dad. You know, it's a whole family affair. A hundred percent.

Hayley 29:30

mm

Jaimee 29:30

So,

Hayley 29:31

Yeah. It is. It is. And, and look, transitioning to that, I think we've touched on this briefly, another podcast, but that transitioning with our kids moving into the older ages, and we're wanting some independence and to go and do things, it's. You've got your normal parental anxieties around that, but then adding diabetes into the mix, it's always adding that extra layer and it's always there. You can't just go, yeah, not today. It's, and it's always there. And that, trying to have your crystal ball and predict what's, what's gonna happen when you, you can't do.

Jaimee 30:09

No, and it's navigating those boundaries. And you know that that parental etiquette that we are gonna talk more about is, um, the language, the tone, everything can impact on how that

Hayley 30:21

that's

Jaimee 30:22

that relationship works.

Hayley 30:24

one thing that that strikes me is we still go into our boys' rooms as we go to bed, and we normally do a calibration then just so that the pump isn't alarming at like six o'clock in the morning for calibrating an hour or something. But there might come a time where the light. Don't come into my room, don't want you coming in, and But yeah, you know those boundaries. And you touched on earlier with that, you know, the going through puberty and sleep patterns changing. We already have some of that. And if they're sleeping in later, I can't help. I do have a reflex of. Are they sleeping or are they just really low?

Jaimee 31:00

Yeah.

Hayley 31:01

Um, and you get porn between, do I go and Tess, do I not? One thing I do really like, so Master B got his first phone at Christmas time and he has the, Medtronic app on there. And we actually find that if we leave the phone in the kitchen, it still picked up from his pump when he's in the bedroom. So it's great. We don't need to have the follow up cuz we can hear it, but it also means of a morning. I can go, oh yeah, his levels are fine. I don't need to worry about him sleeping in because his levels are fine. And for us, a benefit is not being on the, we were previously on liver mirror, a morning and night one, and we are not having to put any of that out of whack or adjust it. So yeah, it's, the pump has made that a little easier for us.

Jaimee 31:48

Yeah, a hundred percent. Technology is a game changer, actually. Absolute game changer.

Hayley 31:53

One. One thing I was surprised at Jamie in this article saying that a lot of adolescents reportedly in this article not using the technology, not using C D M I found that quite surprising,

Jaimee 32:05

Yeah. And I think some of that is control around saying what I will and won't wear on my body, understandably. and I think another part of it is they're annoying. They get knocked, they come off, people see them. Yes, you can put them in spots you don't wanna see them. They alarm teachers say, what's that alarm? Why have you got a phone? There's so many barriers. probably another whole podcast episode on that. And it'd be great to get. You know, some adolescents perspective, but there'll be lots of research on it. I just, I feel this, this quote here in this article, sort of as we start to wrap up says we have, we have to be, quite careful in that we don't hold all the responsibility for diabetes management and that we support families for them to hold it, and that we will always be there for that support and advice, but to help them build the skills that they are the ones managing their condition confidently now coming into adolescence and that independence, that's making sure the parents. But then the adolescents and the young adults have that knowledge, confidence, understanding, and I was thinking of you as you, I was thinking as you mentioned, your, your boys staying up later sleeping in that we don't look at these pump downloads and go. You were up until midnight and you were eating there, instead of sort of questioning why were you up till midnight? And sometimes it might be warranted if it's every night of the week and but it might be more around, oh, that's good that you gave a bolus when you ate at midnight, instead of being all judgy. And you know, because that's black big brother watching and

Hayley 33:34

that's right. But, and I think that transition, I think that also comes from our experience as a parent in those early days of, you said in the quote that, you know, the, the professional shouldn't hold all the responsibility and it's about teaching, the parent and then the child, whatever, to manage the. Certainly in those early days, I was very much of the mindset. Who am I to determine what is right, what is wrong? Gotta go to the professionals they know best, and it's only over a period of time and a fairly lengthy period of time that you become comfortable with, well actually I kind of do know what is happening here, and I do know the theory of what you need to do, so I'm gonna make this change and all I.

Jaimee 34:18

know.

Hayley 34:19

As I do when we go, I go, oh yeah, I did make a few changes a few weeks back, Ladi blah. So I can see how with adolescents and young adults, that is gonna be a time progression. They're not gonna instantly get it and have the confidence. And same token, you don't want them being overconfident and a bit blase about what they do. So it's patience. Patience and, and calmness, I think is what is needed. Support that, um, transition to fully self-managing

Jaimee 34:49

Yep. And educate, empower, and it might be give some control over. Nope. Bring some back. Finding that happy medium. So there's, there's no rule book. Diabetes is not an exact science. it's literally some, some days thriving. Others just surviving and. That's why we are sharing our stories, not to bore people to death, but just to say, Hey, I've lived this over 25 years. I've been working in this well over 10 years. Um, I still don't get it right every day, every week, and I don't have all the answers. And there's technology changing all the time that I can't even keep up with. so there's always gonna be room for education

Hayley 35:30

education improvement.

Jaimee 35:31

Yep. Well, my bubs crying at nine o'clock at night, so I'd best head off. Thanks for listening, everyone. love to hear what you think, and if there's any other topics that you would like covered. Hailey, anything you wanna say to wrap up?

Hayley 35:47

No, I, I think I've enjoyed tonight, I've enjoyed the chit

Jaimee 35:51

It's therapeutic for us too. So guys, so thanks for that.

Hayley 35:54

Very therapeutic. Thanks for listening. Do share any thoughts or anything you wanna hear? Let's talk about Always open to suggestions.

Jaimee 36:02

Perfect. Alright, thanks for listening and our next episode is an exciting one. We have advertised it but held off, so we are gonna be putting up the End India study, so stay tuned for that.,