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The following message appeared in a discussion on another diabetes website:

"A bit of healthy fear can motivate you to do your best to take good care of yourself and to exercise caution with your health so hopefully nothing this extreme will ever happen."

A friend of mine started a new discussion in reply to that message. Here is his post:

"I would have to disagree, I don't like when people use fear to try to motivate me to take care of myself. I realize it is necessary for a diabetic to understand the possibility of complications, but I wish there was a uniformed and less harsh/ scary way for doctors to inform diabetic children. The "fear" that some used to try to motivate or scare me when I was younger just made me feel hopeless and scared. I think children have a hard time understanding the fact that if they take care of themselves they greatly reduce their risk for complications, they just hear that "diabetics lose limbs" and assume it will happen to them.

I think endocrinologists and pediatricians should have special training on how to discuss diabetes with children, what to say, and what not to say. I think some doctors are too harsh or not careful enough to make sure the child understands that people that take care of themselves have a great chance to avoid or delay complications.

Changes I think need to be made in the relationship between Type 1 children and their doctors:

1. Doctors should never try to scare the child/ patient
2. Doctors should never make the child feel different from other non D children
3. Doctors should never make a child or parents feel guilty for high Bg numbers
4. Doctors should tell children about people who have had the disease for years and are perfectly healthy, that would be motivation and give hope
5. Doctors should put themselves in the childs shoes rather than judge and talk to the child like perfect management is easy
6. Doctors should put themselves in the parents shoes rather than judge and talk to the parent like perfect management is easy
7. Doctors who want to work with diabetic children should be required to go through special training concentrating on the emotional effects of type 1 diabetes to the child and the family of the child. Teaching the doctor how to communicate effectively and positively with the children and the parents, not to judge, scare, or guilt them."

I think my friend has written a wonderful message. He has received many thanks, mine included!!!

What do you think?
 

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I agree with you and your friend. Even my former doctor tried fear on me and not the positive things that can be accomplished. Fear never works with children. They need positives in their life and what can be accomplished if they pay attention. This gives them models to follow and helps them set goals. I know a local teenager, Type 1, that had fear of God put on him by his original doctor, but the parents changed doctors and the current doctor is very positive and he in turn is doing excellent.

Many teenagers rebel at some point and he admits to wanting to do this at times, but then remembers his current doctor with a positive attitude and the goals they have set together. He says that he wants to be an aerospace engineer and realizes that if he lets diabetes take control, he may not get reach his goal. His parents are proud of him and his management of diabetes, only one A1c over 7.0 in his six years of management and since diagnosis. No wonder he is looked up to by other teenagers with and without diabetes.
 

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I also agree that, especially for something like this, fear should NOT be used as a motivator.

I think that using fear in diabetes education, even "healthy fear" (whatever THAT is) associates diabetes with fear. And that's most certainly NOT healthy.

The more I research about diabetes, the more people I find that are living truly inspiring lives. I don't think they could do that if they really feared this condition...
 

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During my 2010 pneumonia hospital stays, I had one doctor who tried the scare tactic method on me. I was depressed for days and needed to talk to a hospital social worker before leaving the hospital. I am no longer a patient of that doctor. I truly do not believe that scaring children will move them in the right direction.
 

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I think there should be a happy medium to what doctors say. If a doctor lets things go to easily with the child, the child will never learn the importance of taking care of themselves. But, I dont think scaring them into a corner is right either. Be honest while being nurturing.
 

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I don't have a very high opinion of specialists at all...and that is all from direct experience.

Basic child development principles will tell anyone that punishment/fear is a negative approach as has been proven not to work...

I can't help but think there is always a 'blame' factor with specialists...I can remember one telling me 2 years ago I had Glaucoma (which I don't) and would lose my feet (which again was not true) to scare me into doing what he wanted me to do (I was doing fine on low carb but he didnt want me to do that)...for me he was plain lying to scare me...and Im an adult...he put me into over a year of deep depression...I refuse to see him again...

People...small or adult...respond much better with positive reinforcement...

The ego of some specialists is a massive barrier to patient education ... unfortunately I think that the more specialised they are they can become more narrow in their thinking...

My son is severely disabled and also diabetic...I am now only taking him to a local doctor for his diabetes...I won't allow Mr Negative (specialist) to talk his rubbish in front of my son...it's difficult enough getting him to eat as well as I can without being judged by someone who disregards the context some people have this disease live in...whereas my local doctor has a much more holistic approach...

I guess that's the point...we're people..not a sum of all our 'conditions'...

Doom and gloom does not help! How can anyone strive for any goal without hope?

So really we need paediatric endocrinologists...they need to focus FIRST on the child then the disease...

I have dealt with so many specialists for my son...I have yet to find one that has more than 2 minutes to blurt out what we SHOULD do...it's a pity they have not worked out that their approach to their patients has such a huge impact...
 

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That was very good!

Yes, some doctors can be very negative. My endocrinologist was so mean to me. He told me several times that I am lazy. If he could only see all the things I try to do in a day he would not say that. My friends tell me they don't know how I do it all. He also told me, "In a year when you come to see me and you have not lost any weight because of your laissez faire way of doing things, you will then have to go to the weight loss classes." that sure made me feel good, huh?!

Needless to say, I refuse to go back to him.

I cannot imagine being a kid and having a doctor say things like that to me. Just awful.
 

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I think fear can be good if it'll help a child from being diagnosed with diabetes. They should understand how serious it is, and because it's so serious, you should approach it with fear.
 

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It's a given... Here the patient (the child if he/she is old enough to understand or a parent if he/she isn't) is informed on how to treat diabetes properly, how to adapt to situations without running to the doctor for every bit and the possible complications, chances if you take care of yourself and chances if you don't. And that is how it should be everywhere else. A doctor is meant to give you the information in a simple way. Kind of like a financial adviser would give you advice with numbers and not with some philosophy...
 

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Agree

I don't have a very high opinion of specialists at all...and that is all from direct experience.

Basic child development principles will tell anyone that punishment/fear is a negative approach as has been proven not to work...

I can't help but think there is always a 'blame' factor with specialists...I can remember one telling me 2 years ago I had Glaucoma (which I don't) and would lose my feet (which again was not true) to scare me into doing what he wanted me to do (I was doing fine on low carb but he didnt want me to do that)...for me he was plain lying to scare me...and Im an adult...he put me into over a year of deep depression...I refuse to see him again...

People...small or adult...respond much better with positive reinforcement...

The ego of some specialists is a massive barrier to patient education ... unfortunately I think that the more specialised they are they can become more narrow in their thinking...

My son is severely disabled and also diabetic...I am now only taking him to a local doctor for his diabetes...I won't allow Mr Negative (specialist) to talk his rubbish in front of my son...it's difficult enough getting him to eat as well as I can without being judged by someone who disregards the context some people have this disease live in...whereas my local doctor has a much more holistic approach...

I guess that's the point...we're people..not a sum of all our 'conditions'...

Doom and gloom does not help! How can anyone strive for any goal without hope?

So really we need paediatric endocrinologists...they need to focus FIRST on the child then the disease...

I have dealt with so many specialists for my son...I have yet to find one that has more than 2 minutes to blurt out what we SHOULD do...it's a pity they have not worked out that their approach to their patients has such a huge impact...
Pity you never got to Meet Dr John Court he was my endocronoligist when I was a child and he was great this is before glucometers and 100 unit insulin and we relied on urine tests only and the blood glucose machine to test our blood was half the size of an average room!!! As long as you are seeing a Dr regularly and Diabetic educator and he has his HBA1c done then I see no issue to subject him to a imbecile of a specialist. Put a glucometer in the lab coat top pocket and they become God!!!! I have met a few in my life time.
 

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I agree that children need positive role models and positive input. Children do so much better when the positive is put first. Scare tactics never work and neither does putting the child down so they feel like they are incapable of doing anything. Children need to be built up and built up with love.
The same can be said of adults. We also need encouragement and praise for taking care of our diabetes even for trying to. I look at people like Richard157 and know that I can do this as well. He inspires hope to all of us. There are others with diabetes who also inspire me. Whether we be children or adults with diabetes we all need encouragement and hope and praise to do the right thing and to take care of ourselves. Thank you so much Richard for posting this.
 

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*SARCASM* I hear beating children works wonders too. *SARCASM*

Anyone who has every owned a dog, let alone raised a child, should know better. Fear is the enemy of confidence, happines and self reliance. You're more likely to end up with a self destructive or rebelious child than a healthy one. Make them afraid enough and they won't see life as worth living.

I think a child with diabetes needs to mature more quickly if they're to take care of themself. That's more than enough of a burden.
 

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I am learnng so much from reading about sports psychology, with kids! It is a terrific topic to apply to diabetes coaching of a kid. One insight that helps, "A little push is good, a lot is not." A little concern -- NOT FEAR -- would help.

I am also learning to ask the same vital questions of my kids, after a race: "How do you think you did? Better or worse than last time? What could you have improved? DID YOU ENJOY RACING? If you emphasize "winning," in seither sports or in D, too much, you end up with burnout and rebellion.
 

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Even apart from the psychological damage done by instilling fear in sick children, typically this fear is directed to the wrong concerns. The NIH reports that the leading cause of death for type 1 diabetics under the age of 40 is hypoglycemia, which accounts for 4% to 6% of all mortality in this group. Terrifying young children about the risk of long-term complications of hyperglycemia may induce them to press too far toward low blood sugar and court the mortality risk which is most dangerous to them at this stage of the disease.
 
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