My 14 year old daughter has Type 1 Diabetes. She has recently started writing the wrong blood sugar down in her log book. I found out by accident when I checked the memory in her meter for some missing numbers. How to I broach the subject with her? Is this normal or common?

Many teenagers experiment with their diabetes care in a variety of ways. Writing down blood sugar numbers that look “better” than the numbers on the machine is one of the most common. Usually, this means that the teenager is feeling burned-out by their diabetes care regimen. When I talk with teenagers about the reasons for writing down “better” numbers on their log-book, they usually tell me that their parents get very upset when higher or “worse” numbers appear. This leads to questions like “well, what did you eat?” or other comments about long-term control and complications. Teens then feel so distressed, that they would rather just show their parents a “better” number so that they do not have to face a barrage of questions or feel guilty about their choices around food. It is important to keep in mind that the adolescent years are the most difficult for stable blood sugar control. This is true for a variety of reasons, not the least of which is rapid growth spurts and hormonal changes (both growth hormone and the sex hormones all reduce the effectiveness of insulin). So, if your teenager feels that fluctuations in blood sugars are not acceptable to you, then they may be more likely to give you numbers that will make you happy, even if they are not the accurate ones.

Of course, in addition to the issues of honesty and trust, your diabetes care-providers also will not know about the higher numbers, so when you go to them for a clinic visit, they will not be making any insulin dose changes even when those changes might be necessary. This then leads to a significant decline in diabetes control, since the teen is then typically not getting the right insulin doses. Then their A1c’s will not match the log-book and accusations about falsifying numbers, skipping shots, etc. can get made and soon everyone is overwhelmed and miserable.

To prevent such a vicious cycle, it is important to sit down with your teenager and gently let them know about what you have found. Be sure you do this at a time when you are in a good mood, and when there are not a lot of other demands that need your attention. Tell them that it is common for teenagers to feel overwhelmed by the demands of the diabetes regimen. Acknowledge that many teens are afraid to let their parents know about the food choices they have made or the shots they may have missed, but that honesty will lead to more trust, more independence, and more help from all the members of the diabetes team (professionals and the family) in figuring out ways to reduce the burden of the daily regimen. Ask them if they were afraid of your reaction to higher numbers. Talk with your teen about things you can do to help them feel less burdened by their diabetes care. Perhaps a parent needs to take responsibility for the shots and tests for a few days or weeks. Perhaps a parent needs to be the one to down-load the numbers into the log book. Perhaps a parent just needs to sit with the teen while he is testing blood sugars and giving shots, just to be supportive and let them know what a good job they are doing. An open, calm discussion about the burden of living with diabetes that includes your commitment to help, no matter what it takes is vital. The more the entire family shares the responsibilities for the diabetes care, and the more the family is willing to accept the difficult times with the easy times, the better adjusted your teenager will be.

JWB