Ask The Expert
Children

I understand your concern-- and anguish. In fact, I can assure you that the title of this question will likely prompt many parents to click on it hoping for a solution. You will see from all the resources listed below that the problems you are describing are unfortunately very common, and not rare by any means. Growing up is hard enough without diabetes-and I'm sure you realize that the teen years can be a time for rebellion-so when you add diabetes into that formula, it is understandable that perhaps your son may be resentful, and he may perceive the tasks required for intensive diabetes management as too daunting to consider.

Some Analogies:

• Teens are asserting their independence, and perhaps may be a little "negligent" when it comes to cleaning their rooms, or remembering to do requested errands, for example; so it comes as no surprise that they find it difficult if not impossible to keep up with the many demands imposed on them when they have diabetes.
• When I taught teenagers about the potential complications of diabetes, I would tell them that I suspected their concern about future complications was about as great as their interest in planning for retirement-i.e. at their age, they can barely comprehend worrying about their future financial security, let alone their health, because at their young age, they often feel invincible.
• Another analogy I use when discussing diabetes complications is that I compare having diabetes to being given a free credit card, in which you don't receive a bill for 20 years. In this scenario, you would perhaps spend freely, and travel carefree around the world. After 20 years of this, if the credit card bill arrived at your door and you learned that you owed $5 million dollars, you would probably say: "I can't pay that back; I can't return all the items I bought-I wish I could undo all this." Diabetes can seem very similar to this scenario, especially to a teen, when the teen may feel perfectly fine despite having widely fluctuating blood glucose levels. But if the poor control persists for many years, it may be too late to "undo" the damage that was done. I don't mean to imply that this analogy will help your son change his attitude, but I provide it purely to help you understand how your son may view his diabetes - i.e. he is not intentionally trying to cause problems, but he simply cannot fully comprehend the future ramifications to his current behavior.

Living Successfully With Your Teenager:

Diabetes Self-Management, Nov/Dec 2001 featured an excellent article called "Living Successfully With Your Teenager," by Margaret Grey, Dr.P.H., C.N.P. She discussed in detail the issues surrounding teens with diabetes. Here are some of her key points:

• Changing body and body image, and increased self consciousness: The rapid growth during teen years is not only disconcerting but also it is associated with insulin resistance. This decrease in response to insulin resolves after your son stops growing, but meanwhile, it can cause erratic blood glucose control. He will need increased insulin during this time, which naturally means that glucose monitoring and phone contact with the diabetes team are necessary-although I know not always easy to accomplish.
• Abstract thought: You wonder how your son can skip testing his glucose or taking his shot-i.e. "Doesn't he know this could cause problems?" Yes, he knows; as teens learn to think abstractly, they know that an action can cause a certain consequence-but they don't comprehend that it could happen to them. Ms. Grey gave the example of driving: most teens know that driving with a low glucose is not safe, but translating that knowledge into checking a glucose every time they drive would mean accepting that bad things could happen to them-and developmentally they are incapable of that thought. She suggested helping work out a reasonable diabetes management plan with a clear expectation that your son will check his blood glucose every time before driving. She further recommended that when you don't understand a choice or action your son has made, ask him about it; he may have a very valid reason for his action, and listening to your son's reasons will help you know how to help him.
• Developing identity/independence: It is challenging for any teen to understand his own social role/public image, when he is faced with peer pressure-as well as diabetes. Teens want to be independent although they aren't quite ready to be totally on their own. Studies support what I often witnessed: teens do better when parents stay involved. The authoritarian approach (where you set all the rules and your teen has no input) has proven to be disastrous; yet equally ineffective is the opposite approach of leaving your son alone to totally be responsible for his diabetes, with no oversight from you. So the goal is to find that balance of being supportive and setting some limits without being overbearing. Ms. Grey suggested:
  • Accept the challenge of erratic control: Don't assume your son is cheating but help him figure out what is going on.
  • Think like a teen: Make the tasks relevant to today-not 10 years from now. Rather than warning your son about complications, talk about feeling better today and avoiding low blood glucose-and keeping driving privileges.
  • Give positive reinforcement: Praise and reward the good actions, rather than criticize the negative behavior, so your son gets attention for what you want him to do.
  • Be available: Be a good listener and reassure your son you are there for him. When he has a problem, rather than jump in to give the answer, help him find his own answer. The more you understand what he thinks, the better you will be able to communicate with him.
  • Listen to yourself: Listen to the tone of your voice-guard against criticism and lecturing-and be sure you are allowing your son the chance to speak up.
  • Remember your teen is a person first, who also has diabetes. Ms. Grey concluded that too often parents become so focused on diabetes management that they miss recognizing the bright young person who does many other things well.