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September 24, 2001

Behavior

Question from Redlands, California, USA:

Our 14 year old daughter was diagnosed with type 1 diabetes about six months ago, and after the initial diagnosis, she was very interested and careful about all aspects of her disease and how best to manage it. However, she is now displaying a moderate reluctance in sharing her daily blood sugar numbers with us, reading about ways to improve glucose levels, etc. She is a responsible teen for her age, but has recently rushed out of the house a few times without her supplies, forgot to count fruit and milk as a carb, and insists that 170 mg/dl [9.4 mmol/L] before meal is okay. We try to limit our short "diabetes conversations" to once a day. Should we back off and not discuss it for days at a time? We want to give her as much independence as we can, but are nervous about her recent decisions regarding her health.

Answer:

I personally feel that you should get more involved and show your interest while at the same time trying not to be judgmental. Oftentimes as a young person progresses through the honeymoon, they discover that they have not followed their meal plan optimally or have given an incorrect insulin dose or two, but, surprisingly gratifying, they find that their glucose values remain acceptable. This leads then to a degree of on-going laxity. Then the honeymoon is over and the individual sees that they are “not doing anything different” yet the glucose readings are high. Believe it or not, this is a blow to one’s self-esteem and confidence. People begin to see the readings as a “report card” that you get four times or more a day that reinforces that one is “failing.” The solution they find? They don’t check — they can’t see the values.

Talk with your daughter’s diabetes team about getting back into a degree of control. Maybe it’s time to change the insulin regimen to a flexible one, such as multiple daily injections or an insulin pump, or perhaps she need a less obtrusive meter.

This may be a prime time to get proactive and have your daughter get together with a group of teens with diabetes. Her diabetes team may have a network for you, often through a social worker or psychologist. Show your trying-to-be-independent teen that you want to help. You don’t want to nag, but also let her know that you know that a pre-meal glucose reading of 170 mg/dl [9.4 mmol/L] is not ideal.

DS