Topic Overview

The teen years may be the most difficult time for a young person with diabetes and his or her parents. The normal cycle of rapid growth spurts and periods of slow growth along with the normal teenager behaviors of going to bed late, sleeping late, and eating meals at varying times makes it hard to keep a teenager's blood sugar level consistently within his or her target range.

Eating "fast foods" often also makes following a balanced diet and weight management difficult for a teen.

Your teenager may be very mature and assume appropriate responsibility for his or her diabetes care. If so, your job as a parent of providing appropriate supervision will be relatively easy. On the other hand, teenager rebellion is normal. Your teen who has diabetes may rebel by lashing out at you for the ups and downs of the disease. Try to be empathetic, and imagine the feelings of fear, sadness, anger, and even guilt your teen may be feeling.

Your teenager with diabetes may rebel by:

• Skipping insulin doses or, if he or she has type 2 diabetes, skipping his or her oral medicine.
• Eating high-fat, high-calorie meals or eating whenever and whatever he or she wants, ignoring the daily meal plan.
• Falsifying or lying about blood sugar test results.
• Hiding or denying the disease when around his or her friends in an effort to "fit in."

These behaviors may lead to a serious problem with high blood sugar and even diabetic ketoacidosis.

Teenagers, especially girls, may try to control their weight by going on fad diets, vomiting after meals, or eating very little food. Because insulin can cause a person to gain weight, a teen also may skip doses in an effort to lose weight. This can be dangerous and may lead to high or low blood sugar emergencies or to an eating disorder.

You can do some things that may be helpful and may reduce your tendency to nag your teenager:

• Keep the disease in perspective—as only one part of a person's life. Encourage your teen to be as active as he or she would like to be in sports and other healthy activities.
• Don't back off completely, but do require that your teenager assume total responsibility for his or her diabetes care. Accept the fact that ultimately it is up to your teen to take control of his or her care. Be there to support and guide. If you have encouraged your teen to assume more and more responsibility in the past and have given appropriate guidance and supervision, this transition of responsibility will be much smoother.
• Allow your teenager to meet with his or her diabetes health professional alone. This will encourage your teen to be highly involved in his or her care. A registered dietitian can help your teenager build a healthy meal plan.
• Don't overreact to high blood sugar levels. Everyone with diabetes has them from time to time. Praise your teenager for checking his or her blood sugar level and problem-solve ways to handle it effectively.
• Use a flexible insulin dosing schedule with a combination of long-acting and rapid-acting insulins. This allows greater flexibility for those times when he or she sleeps late, attends parties, or alters the meal schedule.
• Use an insulin pump instead of multiple injections. Some young people really like using the insulin pump because it is a less obvious way of giving their insulin injections. If rapid-acting insulin is used with meals, the pump makes it convenient to give an extra dose if needed.
• Identify a safety support system. Because low blood sugar levels are likely to occur, especially if your teenager is keeping blood sugar levels tightly within a target range, he or she needs to have at least one friend who knows what to do in case of an emergency. Help your teenager identify friends who can be a backup for safety. Discuss who else needs to know and what they need to know.

Talk with a doctor if you have serious concerns about your teenager who has diabetes.