From raging hormones to rebellious behavior, the teenage years can be a turbulent time for type 1 diabetics. Here, how parents can help ease the transition.
Kerri Morrone Sparling can still remember the cupcake in question.
The wrapper was in plain sight, and the frosting was still visible on her face when her mother asked if she had any idea why her blood sugar had shot up near the 400 mark. “I was 15, so of course I lied,” recalls Sparling, the author of “sixuntilme.com,” a widely read blog about living with type 1 diabetes. “I told her I had absolutely no idea what was going on.”
A roller coaster of hormonal changes combined with the rebelliousness of youth can make the teen years a turbulent period for diabetes control. But experts say with a little patience—and some of these tips—parents can help teens with type 1 make a safe and healthy transition into young adulthood.
Stay connected: “Years ago, we used to push teens to be more independent, but as the care has improved, it’s also become more complex, and it requires more parental involvement,” says Heather Lage, a certified diabetes educator at Children’s Hospitals of Minnesota. Though teens may try to push their parents away from their daily diabetes management, Lage encourages parents to “put up with some extra eye-rolling” to make sure teens really are taking care of themselves. Research shows that continued parental involvement is closely related to improved control of diabetes.
But don’t talk about it all the time: Parents of teens with type 1 are often in constant contact with each other, texting blood sugar readings, calculating boluses, and counting carbs. “But your relationship has to be about more than just diabetes,” says Sparling. Communicate your interest in every part of your teen’s life and celebrate all her successes—not just the ones you see in the doctor’s office.
Understand the teenage brain: Though type 1 diabetics benefit from having a community of caregivers, coaches, teachers, and friends familiar with the risks of this chronic disease, to a teenager, all of this support and supervision can feel intrusive. “The hard part about diabetes is that everyone wants to know what you’re eating and what you’re doing, and why your blood sugar was high or low, and there’s often feeling of being judged, “ says Lage. It’s not uncommon for teens to burn out on the daily demands of diabetes by lying about food intake, checking blood sugar less frequently, and even concealing their glucose readings by using control solution on test strips.
Outsmart the teenage brain: Though poor management can raise the risk of nerve damage and other complications from diabetes, threatening teens with what could happen in the future is a losing strategy, says Lage. “A teenager’s brain does not think long term. They’re only thinking, ‘How does this affect me today?’” If your teen isn’t keeping up with his care the way he should, short-term consequences—like taking away the iPod for a week—are a more effective way to get your point across.
Make them do their homework: Parents sometimes worry about coming down too hard on a teen with type 1, concerned that their child is already being punished by the demands of living with a chronic disease. “But if they’re not doing what they need to manage their diabetes, it’s the same problem you’d have if they weren’t doing their homework,” says Lage. “Your job is to teach good habits and set expectations, so that they have the skills to live with this in the real world.”
Don’t expect perfection: Lax blood sugar control isn’t always to blame for the volatile ups and downs parents may see on a teen’s glucose monitor. “With teenagers, you always have to take into account that puberty is going on, and that wrecks havoc with your blood sugars,” says Lage, noting that the teenage years are often marked by higher A1C levels. “Even teens who are doing everything well are going to struggle with it no matter what.”
Teach good nutrition: Teens with type 1 aren’t immune to peer pressure to be thin, but skipping insulin to lose weight (a dangerous dieting practice called “diabulimia”) can put them at terrible risk. Since correcting for low blood sugars with extra calories can make it easy to gain weight, Lage recommends that teens having trouble with weight control meet with a nutritionist who may be able to recommend eating strategies to maintain healthy weight while keeping blood sugars in balance.
Teach safe driving: For a diabetic, low blood sugar impairs your ability to drive safely, which is why Sparling’s parents insisted she check her blood sugar every time she got behind the wheel. Not only did having access to the family car become “a huge incentive” for keeping careful track of her blood sugars during her teen years, it started a healthy habit she still practices today.
Connect with other kids: Whether its going to diabetes camp for the summer, or chatting on an online message board, encourage your kid to find other teens who can share their experiences of living with type 1 diabetes. “Just having a place where you can say, ‘I’m so sick of being high all the time,’ and to have people who can commiserate with you is really important, and can make your burn-out phases shorter,” says Sparling. “It reminds you that you’re not the only one.”
Cupcake photo courtesy of Anne Field Photography
Written for myOptumHealth, March 2012