Friday, January 31, 2020

Don't Let Insulin Prices Kill You

Originally published August 2019
Some people die every day because they don’t have access to something they need. Especially if you travel outside of the US. If you investigate, there is often a string of reasons contributing to their lack of access to something they need. So while none of us expects a fellow human to be perfect, survival and its first world, distant cousin we call “thriving” often demands a solid succession of wise decisions. We should be encouraging each other to make good decisions and I include the medical community when I say this.
The Diabetes Online Community often says that people die just because of a lack of access to insulin because of the prices of insulin. It’s a bit more complicated. This story has been oversimplified. Obviously, the prices of insulin are a huge contributing factor, but since prevention of more people ending up this way is of key importance, I think that talking about the other reasons which may have played a role is crucial. For example, these people who died because they couldn’t afford insulin, did they not have family or friends or a church community they could lean on? Did they have the latest smartphone or a nice car? Did they get in over their heads financially? Did they struggle to keep constant employment for some reason? Was it due to poorly managed blood sugars? Were those due to choosing to eat foods that make it really hard to manage blood sugars?
In other words, did their life choices help make them this vulnerable?
Some in the DOC will ask how these cases happen and often, community members shoot back saying that it does no good to question and that suggesting that their personal decisions played a role is just WRONG. Well, I beg to differ.
I think it could absolutely help someone to question this. Someone who could be next might be reading and may make a determined push in their life to make themselves less vulnerable. We should never minimize the power of wise personal decisions. They often make all the difference.
Of course, these stories are awfully tragic but I do question how each might have been preventable, too. Why? Because my daughter and I have type 1 and that makes us pretty vulnerable as a family unit with crappy health insurance and one income. So to best protect ourselves, my family has to think through possible safety nets and situations very carefully. We can’t afford certain things nor to engage in certain behavior or take certain risks. People tell me I should take a vacation because there is a bit of money in the bank. No. That money exists as a cushion to the realities of life–one with two type 1s in it.
Life is rife with consequences for everyone, especially those most vulnerable. One of the saddest things to me about type 1 diabetes is how vulnerable it can potentially make a person. No it’s not “fair” but life isn’t fair so what I would recommend any type 1 to do is strive to make careful decisions and to try to find ways to insulate themselves from further vulnerability, and simply do what is in their best interests, even if that means going without something else like a smartphone or a vacation or a nice car or cable TV or new clothes, etc. There are exceptions to everything but surely most of us can minimize the chances that we will end up like these sad cases?
Obviously, insulin prices are horrible (believe me I know, I pay twice over). However, each of us is probably responsible and smart enough to figure out how to survive if we focus and carefully prioritize while we work for improved affordability.
Here’s my plan against death and destruction from type 1 due to a lack of insulin under normal circumstances (not talking about a zombie apocalypse with a lack of electricity or a shortage of supplies or something–Lord help us all in that scenario):
My family already eats a very low carb diet which works best with R insulin for meals. On top of this my daughter and I also use a basal insulin and fast-acting for corrections. What if I can’t afford the basal and fast-acting? The plan is to use R and NPH for $50 a month to survive and be more disciplined than ever. It’s better than death and I’m also positive we can do it to achieve much better glucose control than most who have access to all the latest insulins plus a CGM and a pump. How to afford very low carb food? I would pretty much live off of tuna and sardine cans, I’m sure. It would suffice for a difficult period of time.
It also helps to keep friend and family ties, if possible. The more people to help you in a pinch, the better. Staying healthy usually saves money, so doing what one can now, today, to take great care of health and type 1 will pay off big time later on.
I’ll do all I can to prevent anything hurting me or my family. I suggest you do what you need to do to ensure your well-being, too. Don’t let excuses and a lack of priorities get in the way of your survival. After all, surviving and working to improve things is always the best way to honor those who didn’t make it.

Diabetes, the Great Provocateur, Can Make You Better

Originally published July 2019
One of the reasons I look at a diabetes diagnosis as tragic is that it’s going to immediately prod at and expose all your weaknesses. You’ll suffer more than another person who lacks as much discipline as you, who also doesn’t have supportive family or friends, and you’ll particularly suffer if you are short on agency (and many of us raised in the last 30 years are, in my opinion). This is precisely the same reason diabetes can make you better at all you do because by knowing your weaknesses and having very clear motivations, you can actually improve yourself considerably.
A diabetes diagnosis is a great opportunity which is hoisted upon you forcefully and not meeting it head-on spells out a certain kind of doom. It’s undoubtedly harsh.
If you’re not organized, your diabetes management skills will constantly be undermined by your lack of preparedness and routine structure involving your supplies, medications, and activities.
If you don’t have peaceful relationships, you’ll be distracted from a big priority you have–your immediate and longterm wellbeing via blood sugar management.
If you lack financial resources, you’re going to be extremely challenged by a diabetes diagnosis and will have even greater financial strain. You’ll feel resentful towards your diagnosis because instead of affording x you now have to use that money for diabetes a-z.
If you lack agency, you will struggle to take responsibility for your life and may feel like a victim of diabetes and in many cases avoid doing all within your power to stay very healthy and manage diabetes successfully.
If you lack supportive people in your life, you’re going to feel lonelier than ever by living with a condition that makes you do unnatural things like give injections, draw blood with a lancing device, or save your own life with a substance you otherwise try to avoid or limit and/or carefully cover with insulin.
If you can’t defer gratification and have some self-discipline, your blood sugars are most likely going to be all over the place. Then you’ll feel bad, suffer at work and in your relationships, acquire anxiety and depression, and start a spiraling descent. Others will have the same character flaws as you but won’t be plummeting and you’ll be very tempted to blame everything on your diabetes.
If you are already depressed or anxious, a diabetes diagnosis is going to put a bucket of salt on your wound and make it that much harder to get out of bed in the morning.
I could go on but you understand. That’s because none of us is perfect and we all have something we’d like to improve about ourselves. And we all know how that something hurts our diabetes management. If we have too many of these challenges, then diabetes becomes unbearable to deal with. Your challenges were steep before? Now try surmounting them with this severe agitator compounding each and every struggle.
No, it’s not fair.
But it’s the reality and you’ve not got time to dwell on how unfair it is. We get nowhere unless we face reality and so I think that if you can manage to embrace a diabetes diagnosis and look at it as the beginning arc of your hero’s journey, you stand a very good chance of using diabetes as a trigger to finally tend to some bad habits or things you’ve been neglecting about yourself. Rise up to meet the new reality. Is it time to actually lose the weight? Use diabetes as one of your motivators. Have you lacked self-responsibility and maturity? Now you’re going to grow up. Diabetes can serve as a catalyst. It’s so bad that you’re going to act and propel yourself forward and up, up, up.
Even if you were diagnosed 20 years ago, you can still decide to one day make diabetes be ruled by you instead of the other way around. You’re going to use discipline, you’re not going to make any more excuses, you’re going to be in control of your actions and thoughts, you’re going to work hard, you’re going to be determined, you’re going to dig deep and show yourself what you’re made of. Diabetes may provoke your weaknesses, but that means you get the chance to face and conquer them. You stand to lose if you don’t but don’t focus on that–you stand to gain so much! Jot down exposed weaknesses and tackle them one by one.
One day you’ll look back and see that what you can do actually surpasses the actions of those who haven’t been challenged by one of the most silently gruesome and exhausting chronic illnesses out there.
To be successful with this condition, those weaknesses must be addressed and dealt with. You’ve been chosen to stop at a fork in the road and either fall into some guaranteed level of misery or live really healthy and be amazing in terms of what you can get yourself to accomplish. Not a lot of grey area may exist for you or me but great things lie ahead if we let type 1 diabetes change us for the better.

Parents Suffer but Children With Diabetes Suffer More

Originally published July 2019

I’ve been active in the Diabetes Online Community for an entire decade, literally since my twins were born. I’ve noticed that parents suffer a lot due to having children with diabetes. I’ve always had compassion for this because I could empathize and did empathize with my own parents growing up–it is gut-wrenching to see your child develop and live with an incurable, life-threatening illness. I know what it feels like to grow up with diabetes as a little girl so when my little girl was diagnosed, I felt strong emotional and physical pain. Type 1 diabetes in a child IS hard on parents.
However, something I’ve long wanted to say that has more weight now that I’m also a parent of a child with diabetes is that parents do well to remember that no matter how much suffering you’re experiencing, it’s worse for your kid.
Since I was 10 years old, when my sister was diagnosed, I’ve heard the following from type 1 parents (I never heard my parents say these things, thank goodness):
“Kids are resilient, it’s so much harder for the parents”.
“I’m glad my child got it early, they don’t know life with type 1 so this is much easier.”
“Children are different, high blood sugar doesn’t bother them much.”
“It’s so tough for adults who are diagnosed because they didn’t grow up with diabetes and get used to the needles and everything.”
These comments, while they might be someone’s valid opinion, for which I’ve never received an explanation that makes enough sense to me, indicate a lack of empathy and ignorance on the part of the parent, towards the type 1 child.
Parents are adults (or ought to be) and so they have much more in the way of resources with which to cope with difficult situations. I’ve been the kid with diabetes and I’ve been the parent of a kid with diabetes and I think it’s harder to be the kid. You still have worry, fear, and increasing awareness about how diabetes affects your life and you have to deal with it without completed brain development and before you master many other tasks.
We look at children and they play, they smile, they laugh, and we tend to forget that deep down they think and feel very deeply. Often, we talk to others about how they’re doing and we’re only giving out our perception versus the reality according to that child. So we have to be aware that in the midst of our suffering, it is our child who lives with this disease. It will move out of your home one day, but not your child’s body. Your child knows that and so while you’ll get a break one day, they know they won’t. You’ll likely worry for them their entire lives, but it won’t be the same. In my case, I’ll live with it forever alongside my daughter but I can’t carry it for her so she’ll have to bear all her own burden and I have to respect that reality.
Amidst your suffering, don’t give your child the impression you’re suffering more than they are.
As a kid, it was annoying for me to hear adults tell each other about how their job was the hardest and the diabetic kids were just living it up as normal kids. I did the teenager eye-roll, which was invented precisely so that kids would have a way of physically coping with the desire to throw something across a room when adults showed they forgot what being very young was ever like. Kids don’t have an absence of suffering, they just show it differently.
If diabetes is bad, then more time with it can’t be good. Impossible. So, that’s my thinking on the topic of it ever being a good thing that someone gets it sooner versus later. Damage adds up over time. It’s simple arithmetic and statistics. Damage is bad and who knows what someone’s personal threshold is for damage turning into a complication.
High blood sugar still affects kids, even if they say they can’t feel it and even if they can still be good at sports like I was, despite running high numbers. Children struggle to pinpoint their symptoms, this is why pediatricians get trained in the specific ways children describe certain sensations. They also have acquired less potential for neuroticism in their short lives so you’ll not hear so much complaining from them the way you will from an adult. Deep down, the symptoms they feel affect them. And at a cellular level, they’re absolutely being affected, the effects of which may not be very noticeable until they’re adults who must now take on this huge burden of accumulated damage.
I’m constantly wowed by the things my kids say, evidence that I too can forget their capacity for nuanced and complicated thoughts and feelings at their tender age. What children with diabetes need (speaking as a former child with diabetes) is to be asked about how they feel and what they think. You might discover they don’t care if someone tells a diabetes joke (that outrage might just belong to you) and they might feel profoundly sad or tired. Try not to speak for them. Don’t tell others that your child is empowered and handling this well. They might feel that you’re misrepresenting their experience and that makes it hard for them to tell you if they’re having a particularly hard time–they don’t want to make you out to be a liar. Listening to them talk about their diabetes from their perspective is probably one of the most helpful things you could do.

The Challenges of Managing Two Diabetics

Originally published June 2019
It’s been tricky managing my daughter’s diabetes alongside my own. Here are some things I’ve found particularly challenging:

There’s Only So Much Room Up There

There’s only so much space in my head and I’ve always hated taking notes and logging information. I have lower conscientiousness–in the form of organization skills than I’d like so I have struggled with laziness regarding doing these things.
But when managing my diabetes and my daughter’s, there just isn’t enough that I can reliably commit to memory. One thing that helps is that I’ve synchronized our schedules. We give insulin at the same time and eat at the same time (I homeschool so this works well). I also teach her what I’m doing as I do it and that helps me when I’m trying to keep things straight.

Double the Emotions

My daughter’s blood sugars are stellar but every so often when there’s a high or low and she feels awful, it doesn’t matter if I’m 80, I feel awful, too. And that’s been tricky to cope with because too much feeling awful is a recipe for a disaster. So I’ve been trying to just breathe and not get too caught up in those moments, as they are temporary. There are moments of despair though, like if I’m high and she’s low and our allergies are flaring and I’m trying to figure out if we can afford stuff and if I have the energy to pack more than one Frio with all the supplies and pre-cooked low carb food in a large backpack for a park on a hot day. Sigh.

Who Did I Just Inject?

It can be hard to remember who I just gave an insulin shot to. Especially around dinner time when I’m busy finishing a hot meal and setting the table and timing it all with my husband’s arrival from work. I’ve asked my daughter, “Did I just give you a shot or was that me?” Scary, right? I’ve had to nearly slap myself on some early mornings to make sure I’m fully alert and mindful.
Mindfulness is crucial. I have to make sure I don’t switch our doses. I can’t give her my basal or bolus dose without turning things into a life-threatening situation. So I’ve learned to inject only once I’m fully present. If I am not or if I’m rushing, I stop myself and wait until I can inject safely. If someone is talking to me I ask them to stop. If there is a lot of commotion, I remove ourselves to another room.
The same thing happens with checking blood sugar. “Were you 104 or was that me?” It’s easier to keep track of whose blood sugar is whose now that she checks her own blood sugar, though.
We have different doses, different insulin correction factors, different glucose needs to correct lows, and I have to remember my diabetes is very different from hers right now. I’ll go higher and lower much more easily so I can’t mimic her schedule completely. I have to remember to check more often and still remember to check her at the right times. She still makes some of her own insulin and I probably don’t.

Exhaustion

Sometimes I just get purely exhausted. This is mostly due to the physical hit I take from waking up in the middle of the night for our blood sugars. Now, in most cases like ours, I’d say the other parent should be getting up to check the diabetic child and that way everyone shares the “burden”. In my family’s case, my husband works 12 hour days doing hard, outdoor physical labor in construction with dangerous equipment, sometimes on high scaffolds–my point is that he needs to not be sleepy during the day so that he doesn’t make a critical error and lose life or limb (he’s already lost a tooth and his wedding band and almost lost an eye and a finger). You understand.
Some nights, I get up twice for my daughter and twice for myself and that kind of interruption to sleep is brutal if repeated too often within a week. My lymph nodes swell and I start feeling like I have a cold.

Master Mind I Am Not

Forgive me, the kids are really into Star Wars, lately.
Due to being the diabetes expert and stay-at-home parent, all the diabetes stuff automatically falls on my shoulders. My husband and I have a plan for using the weekends as training times for him because he needs to be able to do and know all I do and know. It’s intimidating for him because he sees that I get intimidated sometimes, and I’m an expert in living with type 1 and this is our dear little girl. But if we get a habit of synchronizing our giving insulin and stuff, him taking over on weekends seems like it can cause me to get out of my routine and screw up my flow, so there is a lot of creative trouble-shooting we’ll have to do to work things out. Mainly, I have to work hard to remember my own diabetes. You’d think this wouldn’t be an issue after so many years, yet here we are.
It’s hard to know exactly what it’s like unless one lives with type 1 and also manages it in someone else. If you’re like me, your mind is constantly analyzing and accounting for various factors like food, illness, stress, exercise, insulin doses, and more and when you’re doing that all the time for two people, it can be overwhelming and one person’s diabetes may suffer as a result. In our case, it’s been mine because that’s what parents do.

The Cost of Two Diabetics

The toughest part of everything is something I won’t go into too much because people paying for one case of type 1 diabetes can already imagine–the cost of two diabetics in one household. I grew up with a type 1 sister and these days, it’s a completely different ballgame to pay for two type 1s. We’re talking tens of thousands of dollars. Geez, makes an incredibly tough medical condition almost pale in comparison.

Pity Me Do Not

I like being understood but please don’t pity me. I’m so glad to have a wonderful family and to know how to keep my daughter and I well-managed. This hard work leads to focus, dignity, and gratitude. And in a blink of an eye she’ll grow up and I’ll only be managing my diabetes, once again. Though If I could magically manage both forever, so she wouldn’t have to, darn it, I would lol.
Due to writing this post, I can see what we need. To adopt a strict write-it-all-down habit where our every detail is responsibly tracked. Forcing out my own stubbornness (I hate logging!) won’t be easy but as is evident from all I’ve shared: necessary, it is!
(Sorry, again.)

How to Stop Fearing Discomfort

Originally published June 2019

To stop fearing discomfort we can arrange for it and face it head-on. This is easier than being thrown into the deep end against your will and will result in a better grasp of what we’re made of.
To put this in context and why I write about it on a diabetes blog, let me give an example:
Many people recognize that lowering their carbohydrate intake is beneficial to their diabetes management and overall health. However, they are caught by the fear of discomfort that will arise from giving up favorite foods, spending energy on reworking recipes and grocery lists, and sticking out like a sore thumb in social scenarios involving food.
As someone who has gone through all the above and come out happier and objectively better off, as a result, I can confidently say that the thought of doing something uncomfortable is actually more uncomfortable and challenging than it is in practice. Why? Because our fear of discomfort is very real. We, humans, are hardwired to avoid inconvenience, deviation from social norms, and hard work, even as we discover that confronting all these can be immensely rewarding. We’re funny creatures like that. Some of these characteristics are at the root of all discoveries and inventions that have come about but other aspects of our nature are dangerous in terms of hindering potential growth. So we need to constantly seek to create the right balance.
Marcus Aurelius, one of the great stoics, would sleep on the floor to remind himself that the fear of discomfort is greater than the actual experience of it.
You could try it. Or you could try something similar.
Choose something uncomfortable such as:
  • skipping TV for a few days
  • turning off your phone for a few hours every day
  • getting up at 4 am for a week
  • saying “hi” to everyone you meet
  • eating two simple meals a day for a week
  • sleeping on the floor or couch for two nights a week
Why do we derive value from activities like camping and fitness challenges? These activities are largely uncomfortable, yet many are called back to them year after year. Do they help connect us with our inner strength and give us confidence about our ability to do without certain comforts? There is a peace in knowing that one can “do without” and that we can survive pain and extreme fatigue and inconvenience.
Women who have never given birth are generally more afraid of the pain of birth than women who have been there before. The latter have survived the experience and are comforted by that fact.
It’s uniquely trying to be a person with diabetes who relies on insulin. We cannot stop taking it without dire consequences and should never attempt to. And I believe that for many, this reality leads to a destructive kind of vulnerability. I find that too many people with insulin-dependent diabetes often feel quite helpless, overly reliant on others, and almost in a state of panic over their permanent situation.
As a result, I think we could really benefit from the practice of stoicism. Combatting feelings of vulnerability can fuel our strength and resolve for our challenging way of life. Instead of mere victims of a disease, we can face up to the realities by being creative about ways to protect ourselves in certain scenarios, turn our energy to joining or supporting those trying to figure out how to survive tricky circumstances or cope with potential challenges, and we can accept our reality and let it make us better. Adversity can be a great teacher if we embrace the lesson. I’m all for not learning the hard way, except if you look all around us, it seems that too many aren’t learning the easy or hard way and maybe a more self-directed and intentional route to wisdom would help.
Recently, I carried out a carnivore diet experiment for 3 months. I realized I could be happy despite giving up so many pleasurable foods. I learned that I could have the discipline that I previously thought I could not have. I found that indeed, less could be more. And when I stopped the food experiment with the diagnosis of my daughter’s type 1 diabetes, I found that those 3 months helped to prepare me for the great emotional, financial, physical, and mental challenges ahead.
I wake up every night at 2:30 am to check my daughter’s blood sugar. I spend most of my free time cooking so that my entire family eats nutritionally rich and delicious homemade food for every meal. My family spends way over $10,000 on medical costs per year. There are no vacations. Clothes and shoes are bought used. But let me tell you what: I am happy and I don’t fear discomfort like I used to. Most days, I fear things worth fearing, which feels healthier and motivates me in the right direction. Then acting in the right direction actually leads to improvements and fuels more happiness so I know it’s a better way of functioning for me.
I strongly believe it can help people with diabetes to get comfortable being uncomfortable. Do it for a while and you’ll notice that when the lights go out and everyone is in an ugly state of despair, you’re ok, in fact, you’re lighting a candle and having a great time.

Two Reason Why I Split My Basal Insulin Dose

Originally published May 2019

More Even Coverage

The first reason is obvious and common–it helps provide better “coverage”. However, I take Tresiba and most providers do not encourage splitting the dose of that insulin due to its approximate 42-hour action profile. When I took one dose, I had an extreme drop in blood sugar at one point of the day and didn’t like that.
So, I was splitting it like this at first: 6-8 units in the morning and 3-5 at night. I check at random times, often at night and things seemed to be working very well. Then I discovered through trial use of two different CGM systems that I was dropping in the early morning hours while I was sleeping. Sometimes I would stay around 30 for an hour before waking up. Other times the graph simply indicated that I dropped to the 30s or 40s and then rose on my own (thanks lifesaving liver!) to about 60 or 70 by the time I got up.
Is this why I’ve been waking up really tired and groggy and with a headache for such a long time? Sheesh. Maybe I should just be grateful I’m alive…
Anyway, after that, I tried flipping the dose around giving the larger one at night and the smaller in the morning. This makes the drop happen around dinner for me–and it’s also a more moderate drop, I guess I need a bit more insulin in the afternoon as opposed to the middle of the night. It’s certainly safer than a blood sugar dip while I’m asleep and not plugged up to a CGM of any kind.
Not surprisingly, I’m much more chipper in the morning since I figured this out.
I share this extra bit in case anyone out there splits their dose and isn’t aware of nighttime lows–beware and check at different times during the night to make sure there are no consistent lows happening without your knowledge!

For Safety

As for the second reason I split my dose, it has to do with safety. Before I took Tresiba I took Lantus and I before I split the dose, I didn’t, and you know what happened to me, twice? I accidentally gave about 20 units of Humalog in place of Lantus. Both of these instances were awful and involved a ridiculous amount of grape juice. I can’t even smell grape juice today without gagging. The fear though, that was the worst part.
After that, when I started splitting Lantus, if I were to ever draw up Humalog to the dose of Lantus, I would be giving half that amount and I’d manage the emergency where I was instead of finding myself being rushed to the I’m-going-to-bankrupt-you-ER.
Tresiba requires less in terms of daily units of insulin for equal strength so if I ever goof up with Humalog again (I don’t plan to) then I will be giving at most, out of habit, about 6-8 units of Humalog or R insulin and I can handle either of those doses with glucose tablets that I always carry on me.

My Thoughts on Diabetes Scare Tactics

Originally published May 2019

We should first define the scare tactic. I think that a scare tactic is the use of a lie or deception with the intent to provoke fear of a negative outcome in order to motivate or manipulate behavior.
Many diabetes “scare tactics” aren’t scare tactics, at all.
If one shares a truth, however vague and incomplete, the negative feelings felt by a recipient is not the sharer’s responsibility. If we share a lie, we’re complicit but still not entirely responsible. The burden of responsibility to fall for a lie should still lay at the feet of adult individuals. You can be lied to but you don’t have to accept a lie.
 
A scare tactic is, in my opinion, something that works best on those who are still mentally developing (children) as well as the naive and gullible who don’t do their own research or lack confidence, and the mentally compromised (whether by retardation or mental illness). 
 
What happens to most people is the information they know of or fear may be true is prodded at and they become emotionally stimulated. Many people lack agency. This includes the ability to take full responsibility for what one chooses to believe and how one reacts to incoming information. If you think you lack agency I suggest taking steps to increase that very adult quality. (I’ve had to do this as an adult so if this is you, you’re not alone).
 
Just because something is shared with a representative image that lacks context doesn’t mean it is saying what people interpret it to say. That’s one of those logical fallacies people commit all the time. Don’t read further into an image and assign it more meaning than it can possibly provide. You can guess, but how can you be sure if something is too vague? Your interpretation is only giving all of us a window into your perspective. It may be an oversimplification or a symbolic message that leads to more exploration into a topic or idea. Because an image lacks so much context and explanation as opposed to an essay, many interpretations can come out and I think responsible adults need to not make assumptions but instead educate themselves and their children on what is real and true. Simple images can help spur awareness that leads to important discussions and revelations on a topic, that’s why they’re used. You don’t have to like them but saying they’re inherently harmful is totally false.
 
Every time I see something that scares me, I try to take responsibility for my reaction to it and find out if there is any truth to it and if fear is warranted. This is the only way to really protect ourselves. If I find that fear is a reasonable response, then I figure out what changes I need to consider to benefit myself and my family. I teach my vulnerable young children that they’re not to take anything as truth until they have properly looked into it and spoken to a trustworthy adult about it, first. And I try to act like a trustworthy person so that they’ll always come to me. I also don’t let them run wild on the internet by themselves so that they’re not exposed to words and images they cannot fully comprehend, yet. It’s not your job to take care of my kids or me, it’s my job. 
 
As for those suffering from “scare tactics”, make yourself less vulnerable by educating yourself, toughening up, and then doing what you know you should do to serve yourself well. It seems to me that images that provoke fear due to some underlying truth are most frightening and upsetting to those who know deep down that their actions are not serving them. There is such a thing as well-deserved guilt. It doesn’t have to be detrimental if you use it as a guiding light. I’ve felt guilty plenty of times and used that feeling to guide me towards wiser behavior that improved my health, relationships, and life overall.
Protect those who are truly vulnerable from these images you think are potentially harmful by communicating with them and being someone worth trusting. Protect yourself by owning all that is yours: your thoughts, feelings, and actions. You’re in control and only you decide if you’re a victim or not.