Tommy and James (made up names) are eighth graders. Both have T1, and live in Fairbanks. We’d been chatting at a restaurant for about an hour during dinner, when James’s arched eyebrows began to worry me. Did I have food on my chin? Tommy almost screamed, “What are you doing?” Tommy and James’s distress for me conveyed a sort of, “What kind of idiot are you?” question. Our busser was about to clear plates, and it turns out, I just tossed my $1000 “personal diabetes manager” [PDM/insulin controller] onto my dirty dish—casually throwing it away like a napkin. With their warning, I snatched my PDM in the nick of time, assuring them I’d never made a mistake like that before.
Although James and Tommy likely viewed me as an idiot, it did get them and the other teens to start talking about mistakes they’d made with their diabetes management. And then it got fun! They liked telling me about these “errors” and how they coped, and how parents or teachers reacted. I could tell you some of their “errors,” but I told them it was confidential, and I want to protect their secrets. I realized I assume I will make plenty of mistakes with diabetes. And I will say more about my mistakes later.
Carol Dweck and other research psychologists at Stanford University study differing beliefs and how these act as mental controllers and affect learning. She focuses on students’ mindsets. The first is a fixed mindset, or a student’s belief that their capabilities are set in stone, and not changeable. Dweck’s research found that fixed mindset students make less academic effort, and they defend their “smartness” by avoiding challenge. They think, “I do well, because I’m smart, and if I don’t do well, I’m not smart.” The second mindset is a growth mindset, or a student’s belief in their ability to alter their own capabilities with persistence, effort, and hard work. They think, “I do well because I work hard, and if I don’t do well, I did not put in the effort.” Growth mindset students take charge and activate their own successes.
A growth mindset promotes kids with “grit,” or the ability to sustain motivation when tackling long-term projects. Andrea Duckworth and psychological colleagues found that people high in grit maintain determination and motivation over extended periods of time even when they experience failure and adversity. Grittier people expect setbacks in the course of achieving their personal goals. And they remain committed to achieving their long-term goals and stay on course even with setbacks.
What does this have to do with T1 diabetes and mistakes, you might ask? Well, “What is T1 diabetes if not a long-term project?” “What is T1 diabetes if not opportunity to make errors?” Now, I know T1 is not an academic project. But handling setbacks, problems, and mistakes is something every T1 child, teen, or parent of a T1 encounters regularly.
Teaching kids and teems to handle mistakes in diabetes management is crucial. If we teach that a short-term outcome of a BG reading, or one HbA1c is an all-important target, we are informing them that there is only one fixed way to proceed. If we teach there are certain narrow and easily sustainable goals, we are telling them to think in one fixed way about diabetes self-management. When my BG numbers are “good,” a teen may think, meeting this BG goal makes me a smart diabetes manager. But when things are not going so well, they might think, “I am not good at this anymore,” and give up. My opinion is that it’s better to promote that mistake making is endemic to T1 life, and how we handle these errors is key, not that errors occurred.
As I said, I’ve made so mistakes with my diabetes management, probably there are too many to catalogue. Once I had an intense low while waiting for a flight—for a diabetes organization board meeting. I was sweating, and for some reason emptied my pockets, carefully placing my pump and sensor on a seat next to me. I treated the low with Lifesavers, but was still shaky and sweating as I found my seat on the plane. Next a very sweet flight attendant made an announcement. “Someone left a D-E-X-C-O-M 7 in the terminal. It has no name on it, and if it’s yours, ring your bell.” My thought was, “Wow, how odd someone else on this plane has T1 diabetes, and is wearing a sensor like mine! Who would leave their sensor?” I checked my jeans pocket to reassure myself I had mine tucked away. “Yikes, it isn’t there…then it dawned on me, “That is my sensor!” I got to my board meeting and this had become a good story. And I found out most people with sensors or pumps label them with their names and numbers.
In my view, one major goal of T1 diabetes treatment is not merely medically based, by numbers, but helping kids and parents build self-confidence in knowing they can handle T1 in trying situations. I once slept, ate, and ran for 36 hours in a 200-mile relay with 13 other T1s. I expected to be stiff, cramped, and tired. Of course I felt all of those things, along with astonishment and amazement, that other T1s have an incredible capacity to push themselves, and build exhaustion into fun and grit. We revel in what we overcome!
A core value of a group I admire is insulindependence is this: “People with diabetes should challenge routines to adapt individualized self-management strategies.” To me these words mean to challenge yourself, and put yourself in novel situations, to expand your diabetes horizons. It’s guaranteed you will make mistakes as you push into difficult unmapped territory, but will also grow grit. This doesn’t mean you have to get your kid to run a marathon, or go to an adventure camp for kids with diabetes. It might mean debriefing with them when they come back from the mall, and finding out how they handled (non-judgmentally) a difficult food court, or know how they got free of a taunting jerk in algebra class.
I know Tommy and James’s mom and dad’s worry about them. I know because we talked later. Tommy’s mom worries—even though he’s dealing pretty well with diabetes now—about his future, when he’s not living at home in a few years. James’s mom worries about him taking too much insulin before wrestling matches, and how “cutting weight” impacts his diabetes. Parents worry through millions of day-to-day diabetes worries, and looming formless worry for when teens become ready to launch.
For parents of teens or kids with T1, you already know that diabetes management in 2014 is a full-time job, with no time off for good behavior. And living with T1 forces kids in into making mistakes. If you’re a parent who believes managing diabetes is simple balancing of a few factors and voilà, all is well, then it might be you’re unwittingly teaching your child or teen that if they don’t succeed in that narrow definition, all is lost and they can’t change. What you say is what you believe, and feelings expressed to your child or teen when they make a “mistake” in diabetes management is important. I counsel parents to shy away from asking, “Why, or how” particular mistakes were made. Rather, I counsel them to ask, again in a non-judgmental way, “How did you solve the situation?”
Mistake-making with T1 is not “denial” or a refusal to address it, but oh so human, and like many other aspects of life, ways we can promote growth.