Growing Up With Diabetes: Adolescence
D-Mom, M.S. (Psychology)
If you have ever thought “I wish I knew then what I know now” when it comes to your kids, perhaps this guide to typical psycho-social development of adolescents will help you deal with the current challenges, as well as prepare you for the ones to come.
The following section describes the normal developmental patterns, goals for diabetes care, challenges to diabetes care, and suggested coping strategies for teenagers and young adults.
Ages: 13-18 years old (and beyond)
Normal Developmental Patterns for Adolescence:
- Early Adolescence (age 12-14)… Young people in this age group:
- Tend to be intensely self-absorbed.
- Body image is important.
- Begin moving towards peers and away from family.
- Seek reassurance from peers more (and from parents less).
- Mid-adolescence (age 14-17)… Young people in this age group:
- Struggle for autonomy.
- Teen-parent conflict is more common, centering on relatively trivial issues.
- More often engage in risk-taking behavior (alcohol, drugs, fast cars, for example) than at younger or older ages.
- Late-adolescence (age 18-21)… Young people in this age group:
- Become increasingly stable.
- Start to shape long-term plans such as career and personal goals.
Goal for Diabetes Care for Adolescence:
Transitioning diabetes care to your child; preparing for adulthood.
Challenges to Diabetes Care for Adolescence:
- This is a period of rapid biological, cognitive and emotional changes – it can be a challenge to “keep up”.
- Limit-testing, peer conformity, and potential experimentation with drugs, alcohol, smoking and sexual activity can all impact diabetes self-care.
- Increasing independence from parents brings the possibility of insulin omission, inattention to food and lack of blood glucose monitoring.
- Changing self-image may create resistance to diabetes self-care tasks.
- Acquisition of abstract thinking skills does not always guarantee a more mature understanding of diabetes, though we often expect it to; this may have future implications of mismanagement.
Suggested Coping Strategies for Adolescence:
(see also Suggested Coping Strategies for All Age Groups.)
- Remain involved. Continue to provide love and emotional support. Teens still need structure and boundaries.
- Let go gradually. Transition diabetes-related tasks and routines over to your teen systematically.
(See Diabetes Self-Care: What Does My Child Need to Know? for an outline of possible tasks to transition and skills to teach.)
- Be prepared to get re-involved as necessary.
Tips from the Trenches
At 13, Paul has been doing his own infusion set changes consistently for the past year. There are times though when I will step in and change his infusion set for him. It’s usually when he’s having a hard time coping with challenging circumstances that I will do so (ie. has had a very bad day at school, is ill, etc). On the other hand, it’s about knowing when to get re-involved. Sometimes he just doesn’t feel like doing the set change and he would much rather I do it for him but I let him firmly know that he needs to do it, not I. ~Danielle
- Remember that the harder you work, the less your teen has to do.
- Break the nagging cycle. Instead be clear about what your teen’s responsibilities are: ex. he needs to check his blood glucose and record the result in the log book. Then instead of nagging him with “don’t forget to check your sugar”, simply look to the written record to see if he has done it. Use consequences for missed log entries (whether the blood glucose check was missed entirely, or whether he checked but didn’t write it down).
- Avoid the lecture – he has likely already heard it all and already “knows” the contents of your lecture. For example, your child with diabetes likely already knows about potential health complications from chronic high blood sugar. Lecturing him on how he’s headed for complications is not likely to make him follow-through on that pre-lunch blood glucose check. Instead, make the consequences clear and follow through when his actions don’t meet your expectations.
Tips from the Trenches
My son packs his own lunch, and already knows what healthy food choices are (and are not); he also already knows that I expect him to choose a balanced and nutritious meal from the food choices I’ve provided in the house. I have some treats in the house that the kids are allowed to choose from to put in their lunches, like wagon wheels, granola bars, Rice Krispy bars, etc. I noticed that Paul was taking one of every treat (with minimal healthy choices) just to get his lunch-making task completed quickly, so we needed to renew a discussion about healthy food choices. Rather than continuing to bring this discussion up again and again and lecturing him to make better food choices, I will let him have the freedom to make his own choices but there will also be consequences to his actions. He knows that if he overfills his lunchbox with all these treats that I will choose not to purchase them in the future. ~Danielle
- Work towards everyone (parents, diabetes team, and adolescent) having the same expectations and goals. TALK about these goals together, as well as the obstacles to achieving those goals. Develop solutions together that meet your teen’s social/emotional needs as well as his medical needs. For example, the goal is to check blood glucose before every meal; going to the pizza place next to his school with all his friends at lunchtime doesn’t allow enough time to check his blood glucose. Discuss possible solutions that allow him to go out with his friends without missing the blood glucose check.
- Teens should be encouraged to develop their own relationships with members of their diabetes team. Ask the team to provide education on: smoking, alcohol, drugs, and diabetes and pregnancy.
- When you truly have no control over your (older) teen or young adult’s refusal to take care of himself, it may come to a point when you’re only option is to stop fighting and pray for acceptance and letting go. You could tell him something like: “As your mom/dad I love you and I’m concerned about you. But I understand I can’t make you do anything you choose not to do. Whenever you’re interested, I’m here to talk about it and walk with you, if you want.” And then leave it at that. Not because you want to, but because nothing else you do will impact his behaviour, and continuing to push the issue is only fracturing your relationship.
Tips from the Trenches
If you find it impossible to do nothing, you could do something “behind the scenes”. Joe Solowiejczyk suggests putting away some money for your grown child, when he’s ready, to access a therapist to work through his issues with diabetes.
As with any challenges, if your family is facing serious obstacles to good mental health and social functioning, please contact a professional who can help you sort it all out. Many pediatric diabetes teams include a psychologist and/or social worker, so contacting your child’s diabetes health care team is a good place to start. Also, you could arrange a consultation with a mental health professional that you seek out on your own – you could check the registry for licensed psychologists or social workers in your province, or reach out to a diabetes expert who is also trained in your family’s area of need (teenagers, behaviour change, eating disorders, anxiety, etcetera).
This article was compiled from the following sources:
- Presentation by Dr. Carol Huang (Assistant Professor, U of C Dept of Pediatrics) at JDRF Outreach Event, March 19, 2011
- Parenting workshop by Michael Watts (Medical Social Worker) at the Alberta Children’s Hospital, March 26, 2011
- Presentation by Joe Solowiejczyk (Diabetes Nurse Educator and Family Therapist) at the Alberta Children’s Hospital, February 10, 2011
- Alberta Children’s Hospital Handouts “Tips for Toddlers with Diabetes” and “Pointers for Preschoolers with Diabetes”
- Presentation by Dr. Tracy Vaillancourt (Associate Professor, Educational Psychology) for the Alberta Centre for Child, Family & Community Well-Being, November 3, 2008
The above information was reviewed for content accuracy by clinical staff of the Alberta Children’s Hospital Diabetes Clinic.