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Parenting Success... Initial Stages of Diagnosis and Beyond

boundries and parenting with type 1 diabetes
This is part of the series Parenting Success: Seven Steps to Navigating the Initial Stages of Diabetes and Beyond (by Michael Watts, Assistant Professor at Mount Royal University
and former Medical Social Worker at the Alberta Children's Hospital).

If you have not done so already, we suggest reading the following as background information:

Introduction to the Seven Steps of Parenting Success
Step 1: Respect
Step 2: Structure
Step 3: Expectations

Step 4: Boundaries

Many of the families I work with struggle with boundaries – especially families with teenagers. In my experiences, the primary reason for this struggle is simply a lack of discussion about, creation of and agreement upon boundaries.  Boundary violations happen frequently in the families I serve, namely because they were never established.

Boundary violations include some of the following examples:
  • Before saying ‘good morning’, asking if the adolescent tested his blood sugar.
  • Texting, e-mailing, or phoning the child’s cell phone multiple times throughout the day to talk about diabetes.
  • Allowing your parental fears and insecurities to interfere with the adolescent’s independence, and with mental and emotional growth.
  • Not validating the adolescent’s thoughts, beliefs and perception regarding how she manages her diabetes.
  • Owning the child’s negative mood, taking it personally, and then chastising her.

A lack of boundaries can create a situation in which the adolescent perceives the parent as a perpetual ‘diabetes cop’, constantly nagging (or as we call it in diabetes clinic: ‘Loving’) and showing little to no interest in the adolescent’s life outside diabetes.

I’m of the view that parents are always in the 'action' stage of their child’s management. For example, many parents think about their child’s diabetes day after day; they think about safety, potential complications, what the next A1c level will be, etc, etc.  This thinking leads to a desire to take action to make things better. Being in the action stage often gets in the way of parents creating and adhering to age-appropriate, meaningful boundaries.  Boundaries are so important on multiple levels, and adhering to them helps to strengthen relationships, trust, responsibility and accountability. 

Here are a few points to consider when establishing boundaries:

  • Do we have an agreed upon time of the week to explore diabetes issues? I encourage families to meet for 15-20 minutes on Thursdays to get the adolescent prepared for the weekend, and on Sundays, to get prepared for the week. Furthermore, I encourage families to explore what the adolescent and parent(s) are doing well, and what they can all improve upon in the context of management.
  • Under what circumstances can we discuss diabetes outside of the established times? (e.g. ketones, flu, parents notice adolescent is skipping injections or finger pokes or engaging in any other behaviours which jeopardize the adolescents short and long-term health)
  • Does the adolescent understand that if she does not follow through with the expectations regarding boundaries, the parent will use parental ‘veto’ power to get the adolescent back on track? (See the next article on Discipline.)
  • Does the entire family agree to be accountable to the agreed upon terms of the boundaries? Are there consequences of not being accountable? Does everyone understand these consequences?
  • Is the parent aware that his parenting style will likely determine the success or the demise of establishing boundaries? For example, an over involved parenting style will likely create boundary violations if the parent is not aware and makes the necessary adjustments.


Steps 5-7

Any questions? Comments? Feel free to Contact Us.

The above information was written by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.

This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.

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