Adolescence and Diabetes

This week’s entry is about the challenges of moving through adolescence with diabetes, and for the people (parents, grandparents, or others) tasked with caring for Diabetian adolescents. It’s a preemptive family therapy session (you’re welcome). You see, there are a number of perfectly normal personal developments that take place at this stage of life that become more complex and more severe when diabetes is in the mix. And because the stakes are raised, the tensions, fights, and resentments can become more frequent and more intense, creating a self-sustaining cycle that does no good for anyone involved.

A time for testing limits (without the safety net)
Adolescence is a time to question the world and push boundaries. Adolescence is the era when a personal identity and path forward that is independent of your caregiver starts to take form. Little kids will yell at parents, throw tantrums, break the rules, and cause trouble, but the basic premise of “parents are in charge” is seldom questioned. The issue is not liking the rule, while in adolescence the validity of the rule itself can start to be questioned. And that is a good thing! We all need to do that, or we never become self-sufficient enough to make decisions for ourselves.


But what about the rules governing diabetes care? That can be a different story! Because while questioning the world is something I believe should be encouraged for adolescents, questioning the validity of controlling blood sugar should not. So the question for caregivers is: How do I allow my child to grow into her adulthood, to question her world, to question who she is and who she wants to become, without lapsing in her diabetes care?

The answer, I believe, is to let go — partially. Obviously, no responsible caregiver is going to just abandon all involvement in diabetes care the minute her child turns 13. But you can pull back, and provide support rather than directives. And yes, for a time this might mean more high blood sugars, and more low blood sugars. And on occasion you might have to step in and put a foot down. But what I’ve seen on more than one occasion is this: An adolescent starts to question things, and expresses an interest in more autonomy with regard to their medical care. Of course, this is an adolescent — it’s often not worded as a polite “request for more autonomy.” The wording might be something I can’t print here. Nevertheless, the desire for more freedom is apparent. And what do the parents do? They panic, assuming their child is pushing to act irresponsibly, and they respond by “putting their foot down” and doubling down on the directives. You can imagine the results.

What is needed from the caregiver is space, with support. You need to give up some of YOUR control (and I know this is scary — it was scary for my own mom, but she did it and the transition worked), and explicitly tell your child that YOU are no longer the pilot — he is, and you are here for guidance and support. Your child needs to know that he will have the freedom to make choices — and it’s helpful for him to know that you WILL still be there for support or emergency intervention.

As for you adolescents, here are just a few tips from someone who went through adolescence with diabetes himself and lived to tell about it. First, understand that your parent is giving up control over something that has the power to cause real damage and handing it over to you. That’s a scary, scary thing and you need to have some patience. And before you flip out over getting too many directives, remember that those directives have been keeping you healthy for many years. Remember this, and negotiate with your parents about what you need. Express your needs calmly, and be grateful for the help they’ve given you for so many years.

Finally, don’t be embarrassed to still need some help. You’re testing limits, living into who you will become, taking your place in the world. That’s wonderful, and it’s an exciting time. But that doesn’t mean you need to feel bad about seeking some shelter in the loving stewardship of your parents. It doesn’t mean you’re weak, or unable to care for yourself, or you’ve failed. Remember, the transition into adulthood is a process, and the transition into taking full control of your diabetes is a process, too.

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