Diabetes care is not a priority. Adolescents with diabetes have trouble making their diabetes a priority in their lives. It is not that they don’t care about it, but they tend to care more about other things, such as fitting in with their friends, not being noticed for having diabetes, and not being different from their peers. They usually do not want parents, friends, and teachers to focus on their diabetes, and when there is focus on it they can be easily embarrassed. They care about their activities, sports, friendships, and, hopefully, class work. If diabetes care fits easily into the day, it might happen. If not, it might not happen.
Diabetes care is complicated. Today’s diabetes care regimens are more complicated than regimens in years gone by, when one, two, or three injections of insulin a day were the norm. Most teens are now encouraged to inject both a basal insulin once or twice a day and fast-acting insulin at meals or to use an insulin pump. They are asked to check their blood glucose level four or more times a day, count carbohydrates, eat healthy foods, exercise, carry supplies with them, maintain an insulin pump, and keep records of their blood glucose levels.
Although these therapies have the distinct advantage of providing a better match between insulin, food, and exercise, they require time and constant attention. And teens are notorious for not being able to attend constantly and consistently to anything! Most are not particularly good at it. How often do teens have to be reminded to pick up their laundry, take out the garbage, or do other chores? In many cases, a complicated, modern diabetes regimen is more than an adolescent can handle on a sustained basis.
Tips for helping your teen
The good news is that most teens who have periods of giving up on their diabetes care eventually mature and start to do better again. There is often a struggle around the transfer of responsibility that typically occurs between 13 and 17 years. Kids whose parents took full responsibility for their diabetes care when they were children are accustomed to having someone else do it for them. It takes some time and maturity for them to begin to consider themselves responsible for their diabetes. In the meantime, here are some suggestions that may be helpful while you wait for your teen to take hold.
Stay involved. Most teens (and adults, too) don’t do well with diabetes tasks unless someone is helping to encourage them and make them accountable. To help your teen take charge (without feeling abandoned to figure it all out on his own), ask your teen what is helpful for you to do and what is not. Make a point of repeating this conversation from time to time, even if things are going well. Your teen’s needs will change over time: He may need you to do more during stressful times such as final exams, or less, as he decides that taking more responsibility is worth the increased freedom he gets as a result. If you see that diabetes care tasks are not being done, let your teen know that you’ve noticed, and ask what’s going on. Then listen carefully so that you can help your teen work out a solution.
Find a health-care provider your teen likes. A strong relationship between your teen and his doctor, diabetes educator, or dietitian is critical, both to the health-care provider’s ability to evaluate and motivate your child, and to your child’s ability to communicate with the health-care provider. Do your best to choose health-care providers who listen to what your teen has to say and who are willing to offer alternatives based on your teen’s preferences. If you see your teen listening silently to a plan of care then failing to follow it once out of the office, it may be that your teen doesn’t feel safe objecting to the plan or asking for accommodations. He may need some help with speaking up, or he might do better with a different health-care provider. However, it may also be that he feels uncomfortable expressing his needs or concerns openly in front of you. So don’t hesitate to allow your teen some time alone with his health-care providers.