Get your teen’s perspective
“OK, OK,” I say. “I’m getting the picture. Let’s step back for a minute. Jake, how do you respond to that?”
Being willing to hear your teen’s perspective — without judgment or interruption — is an important step toward working as partners in his diabetes care. He may be having problems you don’t know about: Maybe he’s depressed, doesn’t want to (or know how to) share his diabetes with a girlfriend, or is afraid of becoming hypoglycemic when he’s active. Maybe he’s just had enough of diabetes and needs a less complicated diabetes-care regimen for a while. (His health-care team should be able to help with that.) Some kids cannot verbalize why they are not taking care of themselves, but others are surprisingly self-aware.
Given the opportunity to speak, Jake begins, “It’s not like that!”
“What is it like, Jake?” I ask.
“I don’t know; I mean to do it. I think I’ll do it, but I forget.”
I say, “But I’ll bet you do remember to do the things that are important to you. Am I right?”
Mom says, “Oh, yes!” Jake nods in affirmation.
“So that tells me that you don’t really believe this is that important right now?” I say.
Jake is silent.
“So,” I say, “Let’s see if we can figure out some ways to make this more important so that you will take better care of yourself.”
Note what your teen does well
You may not like what your teen has to say, or you may feel that it doesn’t get you any closer to a solution. Now what do you do?
Before voicing your disappointment or disapproval, find something positive to say. When I ask Jake’s mother whether there is anything that Jake is doing well, she reflects for a minute then smiles and says, “He’s really a good kid. Never gets in trouble, is a good student, practices his drums and trumpet, and doesn’t do anything wild.”
“What about with his diabetes?” I ask. “Can you think of anything he does well there?”
“Well, he’s good about changing his pump site regularly and knows how to work the buttons and pump better than me. He doesn’t sleep until noon, like most of his friends, but gets up, takes insulin, and eats early without much urging every day.”
Hearing what he does well is much more motivating to a teen (or an adult) than hearing what he does not do well. It may help him to say more about why he’s not carrying out his diabetes care plan, and it may encourage him to try to do better at some of the tasks he is not currently doing well.
Acknowledge that diabetes is a big job
In addition to stating what your teen does well, acknowledge that caring for diabetes involves a lot of work.
As I say to Jake and his mother, “There are so many areas of diabetes to consider — carbohydrate counting, eating well, monitoring blood glucose, monitoring ketones, preventing or treating lows, keeping records, taking insulin or maintaining a pump, getting in for appointments, and a lot more. It’s rare for kids and even adults, too, to do all aspects well. In fact, I don’t know anyone who does everything perfectly.”
It’s important for parents to remember that diabetes management can get tougher in the teenage years. The hormones that cause teens to grow and develop also cause insulin not to work as well, so the diabetes regimen that has worked well for years may need to be adjusted just as the teen is taking over more of his own care.
In addition, going through puberty involves more than just physical changes; it’s an emotional time, too, and many kids have difficulty doing what they need to do at this time of life. It’s pretty common for kids with diabetes to slack off in their self-care efforts when they reach adolescence.