When Jessica and her parents came for her regular diabetes appointment, she sat sullenly in the doctor’s office with her arms folded across her chest. She had no comment when she was told that her HbA1c was now 10.5% and that she had ketones in her urine.
Chaz is a 17-year-old who was diagnosed with Type 1 diabetes when he was 11. His HbA1c was usually around 8.5%. Chaz had never been interested in his diabetes management and had been resistant to following any kind of meal plan or learning how to count carbohydrates. His parents felt as though they constantly nagged him about his diabetes care.
This year, as he moved toward high school graduation, the situation got worse as he allowed school pressures and senior activities to get in the way of his diabetes care. He admitted to being scattered, disorganized, and random in his approach to caring for his diabetes. He readily acknowledged that he skipped injections during the day when he “didn’t have time” to do them or couldn’t find his supplies, and he also often skipped his basal insulin at bedtime because he fell asleep before taking it. At his most recent medical appointment, his HbA1c was 11.7%.
At the root of the problem
Most parents of teens with diabetes will tell you that to one degree or another, they have seen similar behaviors. What happens to a well-intentioned, well-cared-for kid that causes him to quit caring about his diabetes? Maybe it isn’t that he has quit caring about it, but that he can’t make it the priority that it needs to be. There are probably as many reasons for lapses as there are teens, but there are some common issues that contribute to poor diabetes management during adolescence. Here are some of them:
We live in a sped-up world. People are busier than ever, and we encourage our children to be busy and involved. Most high school students not only have academics to think about but also sports, extracurricular activities, college entrance exams and applications to work on, and a job. They have little time for themselves, and most of the unscheduled time they do have is spent communicating online, text messaging, or phoning friends. Today’s teens are stressed, fatigued, and often have difficulty keeping up with the things they want to do, let alone the things (such as diabetes care) that they do not really want to do.
Teens are risk-takers. It has long been known among developmental experts that risk-taking behaviors are a big part of adolescent behavior. Part of adolescents’ make-up is that they don’t think bad things will happen to them, and they also have difficulty delaying gratification. Teens have a tough time doing something — or not doing something — today because it will have an effect on them in the future. Alcohol consumption, tobacco use, other drug use, unprotected sex, and other risky behaviors are common among teens. When it comes to diabetes care, skipping blood glucose monitoring or insulin injections may be a way of testing the limits, or it may reflect a teen’s inability to consider the potential consequences of these actions when he’s preoccupied by something else.
Independence struggles abound. One of the normal and universal tasks of adolescence is to separate from parents and to form one’s own identity. This includes not only pursuing individual interests and forming one’s own opinions and values, but also having more physical independence. However, parents remain legally and morally responsible for their teen’s safety and health, and when a teen has diabetes, parents need to supervise and stay involved to make sure that the diabetes tasks are getting done. Not surprisingly, staying involved in diabetes care while simultaneously loosening the reins in other areas can be difficult. Some teens resist parental involvement in their diabetes care to exert their independence generally. In addition, diabetes care issues can become a focal point for conflict, even if the real sources of conflict have little to do with diabetes.