The D-Teen Conundrum

Diabetes and the teen years mix like oil and water. As their bodies change and their mindsets shift, teens with diabetes often place their self-care priorities somewhere on a dusty shelf in the back of their expanding minds.

Parents find this d-boredom or d-resistance as one of the most challenging periods in their d-child's life. The attentive, invested and cordial child morphs in to the surly, moody, argumentative adolescent who seeks to thwart every proactive diabetes move the parent or physician suggests. The phrase “leave me alone” aptly sums up what many teens are going through. Ironically, early teens want nothing more than to expand their social network with others their same age. Or at least not at an age close to their parents. It’s all an expression of the innate need for the teen to establish an identity apart from the family they have been a part of since birth. It’s also quite natural. Diabetes, or another chronic condition, sours this process.

What used to be important no longer seems worthy of some d-teens attention. Priorities shift to becoming part of the peer group. That means fitting in with their besties, distancing themselves from the nest (home and parents), and pushing the behavioral limits to find weak spots in their parent's disciplinary armor.

The goal of diabetes care (at least to me) is the attainment of a sense of normalcy. Adolescence doesn’t change this. But what many parents might overlook is that while the goals of managing diabetes are unchanged, a new set of skills and tactics are needed.

Parents may become very comfortable, maybe complacent, with a compliant pre-teen d-child who does what is asked with minimal pushback, deception, or deviation. While this adherent demeanor might persist through adolescence and into adulthood, chances are there will be obstacles and new challenges ahead.

The early teen might continue their adherent behavior only to start experimenting with their care (and not sharing this with parents) with deleterious consequences on their BG control. I often note that many of these actions are spawned by curiosity and an intellectual questioning which indicates a high level of intelligence. Some of the best overall managed adults with type 1 diabetes I have known, lived on the glycemic rollercoaster as teens.

The parent is the other side of this behavioral equation. Depending on age of diabetes onset, the parent normally takes full custody (ownership) of the child's diabetes. The younger the child, the longer the parent investment in full managerial control. Consequently, these parents may see their child's metabolic and other test results as a reflection of their abilities as a parent. It also becomes the parent’s diabetes more than it does the child’s. This symbiotic d-life relationship may last a decade or longer before the emerging teen begins to start wrestling away some autonomy for themselves. They do this by challenging parental authority either directly or passively. The classic passive approach is omission or going rogue with their eating (in either direction: too much or too little).

The d-teen knows exactly how to push the highly invested parent’s buttons. They know how invested the parent is and what sets them off. Sometimes as a form of attention seeking behavior, they will sabotage their care. Teen reasoning to some is an oxymoron, but I think most d-teens are incredibly smart. Acts of omission, lying or hiding actions are always part of the teen's job description. Finding a way to separate diabetes from this natural process of emotional growth is our d-teen conundrum.

So as the d-teen attempts to assume more diabetes self-control, the inevitable mistakes, omissions and inconsistencies build up. The parent often attempts to step in and rescue them. This is the parent’s job. The consequence is that this starts a cycle of conflict as to who's diabetes is this after all? Often, it's verbal comments or criticisms by the parent or the child which sets off a volley of back and forth barbs which may result in tension and conflict within the family. I often see teens in such a Glycemic “Cold War” with their families.

The parents might emotionally view the teen as unraveling all the hard work and attention they poured into the child's diabetes for years. The teen, lacking a long-term view of life, is more focused on the here and now. To a teen, the 'future' is a just a week from now, not months or years. This entire topic is the subject of decades of research, so let me stop here and make some suggestions on how to approach it.

START EARLY

Developing a strategy to make the child-to-teen transition easier and less traumatic should begin years before it's needed. Plan.

Start by taking the judgment out of diabetes numbers as soon as possible. I addressed that topic earlier in the no “good or bad” numbers. Laying a foundation of non-judgmental diabetes self-care which is not based on rating people by numbers (BG’s or A1C) is the best first step.

Next, negotiate. Behavioral contracts are powerful tools if used judiciously. These require open and clear communication. These too can be implemented in pre-teen children. But make them focused and with clear objectives. Usually one is all that is needed. Remember, this is a marathon, not a sprint.

Finally, accept that failure is a powerful teacher. Reviewing blood sugar data with an eye on cause and effect is superior to using the sugar logbook as a ‘gotcha’ tool or a springboard for a third-degree interrogation about what they did wrong in your view. Check your judgment at the door. This will be the hardest thing for any invested parent to do: let teens make their own mistakes. Sitting down to discuss results in a nonjudgmental fashion is truly a challenge.

Praise them for the effort, not the results. You only set the bar higher and higher by rejoicing about their lowest A1C ever or a week of “perfect numbers”. That will inevitably come to end, leaving them to scramble to find ways to stay in your good graces. Check your facial expressions and word carefully. Approach numbers as dispassionately as possible. They are not value judgments.

IT’S NOT THE END OF THE WORLD

And are you hurting them by allowing their BG to be less tightly controlled? In the long run, I say no. In my opinion, more harm is done by engaging in a long-term struggle of glycemic tug of war. These kids need to develop their own relationship with their diabetes, not adopt yours. The parent must become comfortable moving from the driver’s seat to the front passenger seat. Eventually the back seat, then ultimately out of the vehicle altogether.

But don’t move over too soon. The research on this is crystal clear. Staying engaged and sharing self-care duties (NOT telling, reminding or lecturing) results in overall improved measures of diabetes control, fewer visits to the hospital, and just better well-rounded adult with type 1 diabetes. The d-teen best needs a partner, not a policeman. Shedding to role of boss and becoming more of the d-buddy is hard for some parents to do.

D-TEENS ARE NOT IMMUNE TO MENTAL HEALTH ISSUES AND OTHER SOCIETAL ILLS

Our children today are bombarded by the effects of divorce and feelings of guilt, worthlessness and uncertainty of the future due to the fears of diabetes being constantly dangled in front of them. Plus, they possess no special immunity to the epidemics of substance use, bullying, teen pregnancy, abuse of all kinds and even human trafficking. These fears and misconceptions about them are further amplified by social media. D-teens are at higher risk for depression and other mental health conditions.

Getting a teen with poor control to seek counseling is a good first step. But it’s best that the family be part of the initial assessment, not just the teen. The teen might be suffering from the burnout of one or more of the parents who themselves need help but refuse to consider it. Overall, the stigma of mental health conditions as a driver of poor d-teen diabetes control is often the last thing considered and then only after waiting too long to seek help.

If your d-teen is spending lots of time in hospital for diabetes control problems, consider the non-medical aspects of this matter, not just how many more adjustments to their management routine they need.

Adolescence is rough. Diabetes and adolescence can be much rougher. Take the journey together, side by side. It’s the best way to travel through that tortuous valley.