Remind your teen of the short-term benefits of good blood glucose control, too, such as feeling better generally, having more energy for school and other activities, and receiving more privileges when parents are confident that the teen’s diabetes will be taken care of. You might also choose to reward your teen in some way for performing certain tasks or maintaining certain behaviors over a set period.
Taking ownership of one’s diabetes means accepting it and making it a priority. It doesn’t mean dealing with it all alone; even adults with diabetes need help sometimes or with some tasks. But it does mean being ultimately responsible for making sure it gets taken care of.
Jake, who was diagnosed with diabetes at age seven, had never really taken charge of his diabetes because his parents had always done it for him. Now that he was 15, however, and spending more time away from his parents, it was time for him to take charge.
Here’s what I said to Jake: “You are now at the point where you have to own your diabetes. It is your diabetes, not your parents’. You have think about doing this for yourself because you want to stay healthy and have a long, healthy life, not because Mom or Dad wants it or because you want to please your doctor. You have to do it for you. We’re here to support you as you take charge and figure it out. It won’t happen overnight, but one step at a time.”
To get the process rolling, I ask Jake what level of effort he is currently putting into his diabetes care on a scale of 1 to 10 and how he might “kick it up a notch.”
To the first question, he says, “3 or 4.”
To the second, he says, “I dunno. I guess I can test more. I can remember my bolus insulin. Eat healthier.”
“That sounds good,” I say, “Let’s focus on one or two of them for now and talk about how you can start doing them every day.”
Jake sighs. “OK. If my Mom helps me with the carbs, I promise to put them in the pump. And I can set the alarm on my pump to remind me to test.” (All pumps have a feature that allows the user to enter the number of grams of carbohydrate to be eaten. The pump then suggests a bolus amount of insulin based on preprogrammed carbohydrate-to-insulin ratios and on the amount of insulin currently active in the user’s body.)
I then ask Jake if he can identify any personal benefits he might get from making more of an effort at diabetes care, such as improved athletic performance or feeling more confident about his diabetes when he’s away from his parents.
After giving it some thought, he says, “Well, here’s one. Whenever I go on a long bike trip with my friends, I just eat a lot so I don’t go low, and sometimes I cut my insulin, but I don’t test. Then I get dehydrated and thirsty and have to stop, then I’m high and take a whole bunch of insulin and end up getting low and holding everyone up. If I do a better job, maybe I can finish the bike rides without stopping or having everyone hover over me.”
“That’s a great goal. Anything else?”
Jake shakes his head no.
“Mom? Anything else?
“No, this has been good. This has been helpful. Jake, I want you to tell me and Dad what is helpful and what is not. Can you do that?” Jake nods yes again, although I’m not sure that he will do it without encouragement. Like most teens, he will probably take one step forward and two steps back as he works toward taking on these new responsibilities. With that in mind, I make one more suggestion, and that’s for Jake and his parents to have weekly meetings to go over his diabetes self-care.
It’s well known that kids of all ages do better with their diabetes self-care when their parents stay involved. For Jake’s family, I suggest the following, “What if Jake uploaded his pump information into the computer every week and you looked at the data together? Jake can tell you what changes he thinks should be made, and you can tell him what you think, so that he can take on the responsibility of doing his own management. Knowing that you’ll be going over his numbers every week will make him more accountable, and a weekly meeting is also a chance for him to let you know how he’s doing and where he needs help. However, you, Mom, have to promise not to freak out if he isn’t doing a great job, because that might happen. What we are looking for is progress! Jake, is that OK?”