Triggers and Regression

[Wendy]

I had always promised my daughter that when she was an adult and able to handle it, I would help her locate and establish contact with her birth family.  This spring she expressed the desire, and her therapist and I agreed it was time.  She wanted to meet birth mom and the younger of her two brothers.  She had no desire to see either birth father or the older of the brothers, as they were the primary abusers.  She exchanged a couple of letters with b-mom, and then called her one afternoon.  Hearing b-mom's voice was a trigger that sent her into a downward spiral, complete with voices commanding to smother me and then commit suicide and what she termed as "head jams," when she couldn't think or process any information.  She was no longer able to communicate what was going on in words, and regressed to drawing very graphic pictures to express her pain.  Her psychiatrist died in the midst of the letter exchange, and the only way to get her in quickly with a new psychiatrist (the waiting lists were several months long) was through an emergency hospitalization. 

The first hospitalization made things worse, as if her b-mom's voice wasn't enough of a trigger, her last night there she awoke at 3:00 in the morning to find a male patient stroking and kissing her arm, triggering memories of the sexual abuse, which happened prior to her 3rd birthday.  I then had to find yet a different psych unit and psychiatrist, as within three days of discharge the voices were back and she was unable to sleep. 

The result of all of this:  the new psychiatrist places her emotional age at 5-8.  We knew she was delayed, but both her therapist and I had placed her emotional age in the early teens.  Then it all began to click for me:  her last contact with b-mom came at age 7, so she has regressed to that age.  She is much more clingy and needy.  She is 5 inches taller than I am, but she will come kneel in front of my chair and wrap her arms around me, seeking comfort.  She is back to having night terrors, and tends to wake up at around 3:00 in the morning.  I can no longer leave her alone for even short periods of time.  I'm having trouble getting her to shower, which was a struggle for years (her brothers were in charge of bathing her and molested her in the tub).  In short, I have a young child in a 20 year old body right now. 

Now that I know what's going on, I'm going to return to some of the techniques that soothed her as a young child.  We will return to the bedtime routine of her early days with me, which included singing a hymn to her and reassuring her of her safety each night at bedtime.  She has already pulled out a CD of lullabies that she sets on continuous play in her bedroom at night.  I will schedule cuddle time each afternoon when she gets home from the sheltered workshop for her to reconnect with me and talk about her day.  I will make sure she gets similar time each morning before she gets on the bus to go to the workshop. 

Her psychiatrist has ordered that there be no further contact with birth family until she has been stable for at least a year.  If she does decide to pursue contact with birth family in the future, I will do much more in terms of preparing her and making her take it very slowly. 

She was removed from her birth family and placed with me just prior to her third birthday, so she has no verbal memories of any of this.  When we talk about it, I simply say that she wasn't safe in her birth family.  Obviously the events of those early years still have a very powerful influence on her.  I am so grateful that I actually have her history and know what happened, because it does help me understand what happens when a trigger causes a regression like this. 

Now if I could just figure out what's causing her blood sugars to drop so low....

Peace,
Wendy

[karleen]

Oh, Wendy, I am so sorry these bad memories have been triggered for your daughter.  She is so lucky to have a mom like you to help her through this.  Please know that my thoughts and prayers are with your family.

I have an idea for you on the blood sugar thing.  I have hypoglycemia.  If I don't eat correctly, my body will produce extra insulin, causing my blood sugar to drop too low.  I'm sure I don't have all the details right, but my understanding of this problem is this, as food is digested, sugars are put into the bloodstream.  The body works to keep the blood sugar level stable.  To much sugar, and more insulin is produced.  So what I eat (or don't eat) really affects it.  A few summers ago, I was working in the yard in the morning.  I went in to shower and meet dh for lunch.  I almost couldn't get out of the shower.  When I did crawl out, I called a neighbor, and she insisted on driving me to the dr.  She said to be sure to tell them my speech was slurred when I told them what had happened and how I felt.  That was my first major 'episode' of low sugar levels.  The wierd thing is that just the day before, I had exactly the same breakfast, did the same yard work, had the same morning and lunch routine, and I was fine.  The point is that it doesn't happen all the time.  The dr pointed me to a low glycemic (sp?) diet.  It is basically this:

To relieve reactive hypoglycemia, some health professionals recommend taking the following steps:
eat small meals and snacks about every 3 hours
exercise regularly
eat a variety of foods, including meat, poultry, fish, or nonmeat sources of protein; starchy foods such as whole-grain bread, rice, and potatoes; fruits; vegetables; and dairy products
choose high-fiber foods
avoid or limit foods high in sugar, especially on an empty stomach

I'm certainly not saying she has this condition.  But until you figure out something, following these ideas might help.

Take care.

[Wendy]

Karleen,

Thanks.  I wish it were as easy as a low glycemic diet.  Lena has diabetes, so I know her lows are connected with too much insulin and/or too little food.  The challenge is that she's eating the same as always, and I've been cutting her insulin, and she's still having lows.  Yesterday she'd had several lows, so at bedtime we drove to a local ice cream store.  I told her I'd buy her some ice cream so she wouldn't go low over night (ice cream, which has protein and milk fats, will usually carry her through the night).  I then cut her insulin in half.  I checked her at midnight, 1:30, and 3:22. Her blood sugar was nice and steady between 101 and 122 (normal blood sugar is 70-120, her target range is 80-150)-- right in her target zone.  When I finally decided she was safe, and I could sleep until the alarm went off at 6:15, she apparently went low and rebounded (liver dumps glucose in response to an untreated low), because her blood sugar was 233 this morning (normally I'd think she'd been up and into food, but she's got a broken ankle, so she's not going very far.) 

The broken ankle also makes the lows more of a mystery.  Her blood sugars should be running high, because she's not as active as normal.  She is stressed, and yesterday she was tremoring quite a bit (possibly related to the psychiatrist stopping her risperdal), so I suppose that could make her low.  When her blood sugars are jumping around like this, she just doesn't feel good.  Today I dropped her insulin some more, and by 2:00 her blood sugar was back in range....  She said she slept most of the morning at the workshop-- she just wasn't feeling right because of the blood sugar, which has been steadily dropping all day.   

She's obviously dragging right now, and is in the kitchen getting her afternoon snack (and again reducing her insulin)....

Peace,
Wendy

[karleen]

Oh, brother!!  Just when I thought I might actually have some useful input.   

Now I have a dumb question.  Just as hypoglycemia and diabetes can and often do begin later in life, is it possible they can stop, or switch?

[Wendy]

Karleen,

I appreciated your response, and am always willing to clarify what's going on with Lena-- her tremors yesterday could have been caused by her blood sugars, her psychiatric drugs, her epilepsy, or who knows what else.  She has always been complex.  Diabetes is a progressive disease, and since she has type 1, her pancreas shouldn't be producing any insulin at this point.  I may have to do some intense record keeping and fax things to her endocrinologist next week to see what she suggests.  I'm certainly stumped right now, and am not comfortable cutting much more insulin without guidance.   

Lena had her snack, and I cut her insulin 25%.  We had our conversation on my bed (with the old cat jealously demanding attention), and she dozed off.  She came downstairs to wait while I fix supper, and was once again low, though she caught it at 65, yesterday she was in the 40's before she caught it.  She just ate a peach, and hopefully that will carry her until dinner is ready in 20 minutes. 

Important items from our conversation: 

I explained a little about triggers and her body remembering bad things (I don't tell her what they are, just that she wasn't safe). 

She has asked me to sit in the bathroom tonight while she takes her shower to help her feel safe. 

While I think the problem is her long acting insulin, which I draw up so I know she's getting the right amount, she has asked me to check the fast acting insulin dose she dials up on her pen, to help her feel safe. 

She is convinced she had a low and rebound last night, so even knowing I'll be grumpy tomorrow from lack of sleep, she's asked me to check her blood sugar through the night so she'll feel safe.

We'll go back to the old bedtime routine to help her feel safe. 

She actually was able to giggle a little as we talked, which is a good sign.  She has been very tense and withdrawn lately. 

Obviously, we're back to safety being her highest need, and I will do all I can to help her feel safe.  I've always told her it's my job to keep her safe while she's learning to keep herself safe.  I explain that the reason she was removed from her b-family was that she wasn't safe, and that b-mom wasn 't able to keep her safe because she had problems.  I tell her that her safety is my #1 priority.  I'd wondered if she was taking extra insulin to show me she needed help keeping herself safe right now, but after our conversation, I'm fairly certain that isn't the case....

Unfortunately, it's hard to figure all of this out in the midst of the stress.  Her first hospitalization was in June, and I'm only beginning to put everything together and formulate a plan....

Peace,
Wendy

[adsglinda]

Wendy,

the extra stress will make her sugars go wild!!  Stress attacks the body.  Sounds like she is still in the middle of a trauma reaction and her stress level is continually off the scale.  Stress like that attacks the body. 

keep her eating a little more often.  high carb snacks.  maybe even have her eat a few crackers or take a couple of those high carb flavored pills around midnight or 2am. 

It is the stress that is attacking her and the diabetes.

maybe have her sleep with you for awhile (could take 6 mos of sleeping with you to help her calm).  Slow everything down that she does and get in the habit of reminding her that she is now safe.  Do things everyday to calm stress.. even if she looks like she is having a good day.  Give her lots of extra love and compassion.  Your goal is to slowly work her stress back down and let her mind/body know she is safe.  The fear level she is having is extreme and it takes a long time to get out of that high level of fear.  and she will go months where she seems calm.. but you know her mind/body has not gone through it all and settled down until she is back full time as a teenager and her blood sugars are managed easier. 

So just keep doing extra to make her feel safe.. and verbalize safety in everything you do and everything she does.  u can make comments out of the blue too like "wow.. I am just so glad you are safe now."  "we are so lucky that we are safe now.  It's horrible when a person isn't safe! Glad we are safe!"  etc etc.

[luvmyboy]

Wendy--

Linda, as usual, is right on target.  The stress can sure mess up the sugar levels.

How long has your daughter had diabetes?  Do you know her A1c level? 

My 29-yr-old d. has Type 1, which she got at age 7.  She did fairly well, and is now living alone, but has had a couple of lows and her roommate, who was a nurse, had to take her to the hospital.  I know the swings are scary to deal with. 

Has anyone talked to you about a pump?  The insulin used is different, and it is infused at a steady rate, which can be supplemented as needed.

Hope you get the sugar swings under control.

Dottie

[Wendy]

Linda,

The time we spent together this afternoon really seemed to help her.  I've been feeding her everything in sight, so now I'm reducing insulin.  Her blood sugars were in range all evening, and I promised to check her through the night.  Sleep is highly over rated. 

Dottie,

We've talked about the pump-- there are two issues:   her developmental handicap limits her math skills significantly, and she has been known to manipulate food and insulin when she's under stress.  We don't want her hooked up to a source of insulin.  I'm hoping that the closed loop system of pump linked to continuous glucose monitor will be available soon, and she can get that.  I think her last A1C was 6.9.  Not as low as I would like, but decent, all things considered. 

Peace,
Wendy

[Wendy]

Dottie-- I forgot to answer you other question.  She was diagnosed 7 years ago at age 13.  We were blessed by a very long honeymoon. 

Peace,
Wendy