The teenage years are a time of physical, mental, and emotional growth. Like all times of transition and change, the going can get rough at times. For teens with diabetes, diabetes and its care can be one of the rough spots. Just as the changes happening in their bodies make maintaining blood glucose control more challenging, teens are often expected to take more responsibility for managing their diabetes. At the same time, the increasing demands of school, the possibility of holding a job, and the opportunities for a wider social life can make diabetes care seem relatively unimportant in the teenage mind. With all of these competing demands and pressures, some teens quit taking care of themselves.
When this happens, what is a parent to do? Understanding the global issues facing teenagers, as well as those particular to the teen in question, will help to address the problem. Here’s what happened to two teenagers as they hit their mid- to late teens.
Jessica is 15 and has had diabetes for 9 years. When she was much younger, her parents monitored her blood glucose levels, recorded the numbers, measured and supervised her food intake, and made frequent adjustments to her insulin doses. Her blood glucose levels were reasonable, and her HbA1c test results were usually under 8.0%. (The American Diabetes Association recommended goal for HbA1c, a measure of blood glucose control, is less than 7% for most people with diabetes.)
Jessica never had a severe hypoglycemic episode that required treatment with glucagon (a hormone that raises blood glucose levels and that must be injected), and she only ever had ketones in her blood or urine when she was sick. (Ketones are acidic by-products of fat metabolism. Their appearance in measurable amounts can indicate that a person doesn’t have enough insulin in his system to use glucose for fuel effectively.)
As a child and preadolescent, Jessica seemed to accept her diabetes. She told her friends about it, was interested in carrying out her diabetes care tasks properly, and could be trusted to take care of herself when her parents weren’t around. When she turned 12, her medical team and family decided to start her on insulin pump therapy. Jessica was thrilled with her new pump and the freedom that it brought her. Her parents were pleased that Jessica was capable and responsible about caring for herself, and although they knew the teen years could be rough, they fully expected that Jessica would be able to handle her diabetes and her pump.
However, as Jessica moved into her teens, her behavior around her diabetes care changed. She became increasingly secretive about it, often had to be reminded to take her bolus insulin at mealtimes, and stopped keeping track of her blood glucose levels. When her parents asked about her insulin regimen or blood glucose levels, she became angry. In addition, Jessica’s activities often kept her away from family meals, and when she didn’t eat regular meals, her parents noticed that she grabbed food and snacks on the fly.