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July 20, 2010

Ask Joe, Behavior

Question from Minneapolis, Minnesota, USA:

About a year ago, my 18-year-old daughter, diagnosed at age 12, pretty much took over her diabetes care. She wants to be independent, now sees an adult endocrinologist and has an A1c of about 12. She's still living at home, but obviously not taking the kind of care she should be. Do I try to take back some control (i.e., insisting on blood sugar checks and seeing results weekly and handing out consequences--which would be difficult and another strain as we've been struggling with her rebellious and independent spirit) or what? She says she wants to do better, but doesn't want me "in her business." How do you transition these young adults?


In one way, there�s not much you can do now. Your daughter is 18 years old and able to vote and is a legal adult “entity.” That�s why it�s so important to get younger children to be responsible about their management early on, in age-appropriate manners. Nevertheless, there are some things you could do to help facilitate a “conversation” about diabetes at home, especially since she�s living with you.

You’re right about not being able to insist on a certain behaviors and handing out consequences! It’s too late for that. BUT, you could try the following and see what happens:

Your job will be tough here because, as a parent, it hurts to see your child not do the right thing, especially here in diabetes. The first thing you’ll need to do is to be prepared to “let go” with respect and integrity, for the fact that your daughter is almost a grown-up. You’ll have to try to figure out a way to be able to “allow” her her space while not going crazy from fear yourself. My favorite approach in this regard is to say, and try and believe, the Serenity Prayer: “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can and the wisdom to know the difference.” It�s important for you to get centered/balanced internally before talking and interacting with her, more for your sake than for her sake. I believe the more centered and “clean” you are, the easier it will be to have a conversation and an on-going dialogue with your daughter, now and over time.

If possible, you AND her father should have a sit-down conversation where you share with her your concerns regarding her behavior around her diabetes. This is NOT to tell her what you expect of her, but to share with her both of your concerns regarding her not being responsible and on top of her diabetes care: from a parent�s perspective, e.g., how it hurts you to watch her hurt herself, how you both care about her growing up and having a full life, unfolding into whatever it is she wants to become, and that you want her to know that despite the fact that she�s not doing it “your way,” you’ll always be there for her in whatever way she’ll need–to talk with, to listen, to help out, etc. Try to set this conversation up as a “clearing up” of feelings and postures–for now and the future. Reassure her that you realize that she understands how important it is to care for herself in a responsible manner and that you realize how difficult it is actually to manage diabetes on a daily basis.

You could then ask her, after sharing your thoughts and feelings, to share with you about how she�s thinking and feeling about it. No pressure here, just a legitimate request. If you’ve set up the conversation with the intent that everyone�s feelings and attitudes will be respected, then it should flow naturally. But please don’t feel disappointed if she doesn’t give you the answer you were hoping for. Try to be satisfied with finding out where SHE�s coming from, even if it�s not the hope for response! This will ensure that you guys will have an opening for future and on-going conversations and she’ll get the feeling that it�s not useless talking with you, and that you’re really open to hearing her perspective on things. That�s the most important part here–making it genuine and real, even as I mentioned, it wasn’t exactly what you wanted to hear. Her perception of you will be that you’re truly open and available, not playing any guilt trips on her and pressuring her to come around to your way of handling it.

Give it time and be real. Make sure to let her know that the door is open. If you can let her know the extent to which you’ll be available to her, go to the doctor with her, visit a therapist together to discuss the impact of diabetes on the family, etc. She may not be interested in taking you up on anything you offer, but the important piece here is that you offer it honestly, without any conditions.

Try and talk to someone else about how you’re feeling. It is extremely difficult watching a child harm herself. It won’t be productive to harp on her or nag her, but it will help you and her, if you take care of yourself by sharing with a therapist or friends or sympathetic clergy member how you’re feeling. You are entitled to your feelings; you just don’t want them to get in the way of your relationship with your daughter.

The transition here is for everybody to respect where each is coming from and to allow people to unfold into their lives as they will. Offer help, try not to express your hurt if it is rejected. I’m reluctant to say that you should give her a “bottom line” regarding behavior/consequences because, at this point, I don’t really think that would be effective–only disruptive.

Additional comments from Dr. Jill Weissberg-Benchell:
I would not recommend that you take control of your daughter’s diabetes regimen. This will result in more conflict between the two of you. It’s likely she’ll view your taking over as a sign of that you do not trust her and as “infantalizing” her instead of your attempts to help her manage a difficult and frustrating disease. Instead, I would recommend that you find a mutually agreeable time for the two of you to talk. Let her know you are concerned, and you know she’s struggling with diabetes care at the same time she’s dealing with everything else in her life. Ask her if there’s anything you can do for her that she’d find helpful (you can even offer a few possibilities that you think may be useful). Then, listen to her carefully, and if she says “no thanks,” respect her wishes, but let her know that if she changes her mind, you’d be delighted to help in any way.