My 13 year old daughter, who has had type 1 diabetes for two years, doesn’t feel the need to take care of herself if I’m not standing over her telling her what to do. When we go to the doctor, she listens and agrees to what he’s saying, but then, 10 seconds after we leave, she blows off what he has said.

She wants to be normal again and that’s just not going to happen. I’ve shown her pictures of what this disease can do to her and told her of the long term effects, but nothing is fazing her. Until she loses a limb or foot, I just don’t know what I can do for her to make her understand. She knows what she feels like when her blood sugars are normal and she hates it when she feels crappy when her sugars are high so one would think she would like to feel good all the time. What can I do with her?

It certainly sounds frustrating for you to watch your daughter ignore her diabetes. My hunch is that she is afraid and angry, and her behavior is covering up those feelings. She may be acting out in defiance of the reality of diabetes. Do you have access to a therapist experienced with diabetes? If not, then I strongly suggest linking up with other parents of kids with diabetes to get some support for yourself. Your daughter might listen to a peer more than a physician or a parent. Your local American Diabetes Association or Juvenile Diabetes Research Foundation could be of assistance also. In addition, the teen years are the absolute worst for kids with diabetes. The last thing they want is to be different from other children. Trying to “scare” her into control will not work!

CMB

[Editor’s comment: Even though it is normal for teenagers to feel invulnerable and having diabetes is the “pits”, your daughter is in serious need of counselling to explore the reasons she is unwilling to take care of herself. Education alone at this point will not do much to solve the problem. Often, the problem is really the fault of health care providers and parents who place value judgements on high numbers (blood sugar levels and hemoglobin A1c results), then the patient may be “blamed” and/or “chastised” for poor control.

Your daughter is normal, she just happens to have diabetes which seems to be controlling her instead of her controlling it. Her difficulty might be the result of the treatment plan itself. Her regimen needs to be individualized to fit her lifestyle, including her appetite. It is important for her to be able to discuss her management difficulties in a non-threatening environment and to work with a team which specializes in the care of teens with diabetes, in order to develop a treatment plan that not only improves control, but self-esteem as well. Perhaps it might help to set up a meeting with her diabetes team to explore some of these issues and devise a treatment she can live with. If your local team is not helpful, I would suggest taking her somewhere else to “get a fresh start”.

In the meantime, you and your daughter can discuss whether you should take on the responsibility for blood sugar checks and injections to temporarily alleviate your daughter of this burden.

SS]