Seek counseling. Depression is often the reason that a teen quits caring for himself. A teen who is depressed may or may not have other symptoms of depression such as crying, anger, and changes in appetite or sleep habits, but a teen who quits taking insulin and quits caring for his diabetes is sending a clear message that he needs help. It may not be diabetes causing his depression, but diabetes care suffers because of it.
Some adolescents, especially girls, omit insulin doses as a way to control their weight. This is a very dangerous practice that can lead to serious health problems. Like girls who have eating disorders, however, teens who are omitting insulin are often reluctant to admit it.
Back to Jessica and Chaz
As it turned out, Jessica was not doing well with her diabetes because of her overpacked schedule and her desire to lose weight. However, when she skipped regular meals to cut calories, she got hungry and started snacking. Then she didn’t know how much insulin to take, and she also didn’t want to develop low blood glucose. Her “solution” was to omit her insulin. When she did, she discovered that she could eat more than ever and not gain weight, which encouraged the behavior. But her high HbA1c result and ketones showed that there were serious consequences to what she was doing.
After a long discussion with her doctor, Jessica agreed to give up her pump for a while and also to eat regular meals. She agreed to drop her involvement in drama club, which was the activity that caused the most disruption in her schedule. She and her family worked out a meal schedule that accommodated her other activities most of the time. She also saw a dietitian for suggestions on appropriate amounts of food. Although psychological counseling was suggested, she wanted to see how things would go without it, and her parents agreed to oversee the plan. Jessica was relieved to know that she had help in her self-care and that she, her health-care team, and her parents could all come up with a plan that could work for her.
Chaz started doing better after he agreed to carry a small meter and an insulin pen in one of the pockets in his cargo pants. With his doctor’s advice, he also moved his basal insulin injection from bedtime to morning, when he would be more reliable about taking it. He also asked his girlfriend to help him be accountable about monitoring and, as it turned out, she was more effective than his parents were in this role. Chaz also was maturing as he prepared for high school graduation, and he started to realize that his life and health were dependent on him.
Being there for your teen
The physical and developmental turmoil of adolescence is almost universally a rough time for parents and teens. Teens with diabetes are at additional risks during this period. If you see that your teen is skipping diabetes care tasks, delivering a lecture or policing his activities is unlikely to be helpful. Instead, one of the best things you can do is to try to engage your child in a conversation about it and attempt to understand his feelings, thoughts, and frustrations. Sometimes, just knowing that there is an interested parent or other team member available to support and encourage him is all that is needed.