I can remember a number of teenaged patients vividly. One girl had developed an eating disorder, another teen drank and used drugs, and others developed antisocial, anxious, and depressed behavior. All tried to ignore their diabetes, which meant they met me in a hospital setting. Psychiatric illness has been shown to be more common in children with diabetes, most especially depression and anxiety disorders, both of which affect metabolic control. Certainly, coping by acquiring an eating disorder, as some teenaged girls with diabetes do, plays havoc with blood glucose levels. We all know that is difficult to care for ourselves when we feel hopeless or helpless about our medical condition or health. Research has shown the cycle of trying to cope with these conditions as a teen moving through the developmental milestones of adolescence, can make both his or her life difficult and can put a great deal of pressure on members of the family.
Time is an important concept in human growth and development. Children and teens notoriously think in terms of now and present, not the future, although planning for the future is an expected milestone that we look for as teens pass into late adolescence. They begin to plan for their futures and see the importance of grades, health, friends-you know, more mature thinking. They have graduated to abstract thinking, and scientific reasoning becomes second nature. For our children with diabetes, time may be very different. It is precise and rigidly enforced into schedules of blood glucose monitoring, injections, or programming or changing a pump; counting carbohydrates; secrets from peers; fears of hypo- or hyperglycemic events; and more. It means disappointing yourself and others, and having a built-in lack of just that flexibility that peers enjoy. Children with a chronic disease often have a sense of anticipation, not of something fun or exciting that is coming, but apprehension of which medical shoe will fall next, either at home, school or with friends. Research has shown us that teens with diabetes, even those who control it well as measured by HbA1c, feel that diabetes has a negative impact on their lives and is difficult to control. The results of this study, done at Yale University, were that health care teams should give equal attention to the quiet, non-rebellious, controlled teen from a supportive family, as they do to the rebellious adolescent with poorly controlled diabetes. Having said all of this, it is important to note that families of children who are diagnosed with a chronic disease may also go through a rough period emotionally. Some researchers have noted Post Traumatic Stress Syndrome in the parents of children diagnosed.
Now for the better news. These psychiatric disorders do not automatically accompany a disease diagnosis. This is not the first article we have written on the subject of helping our children with diabetes. Why not go back and read them on the site? There are certainly things we can do as parents and support personnel to take the edge off for our children. The first thing to do is to never bury your head in the sand when you see a change in your child's behavior. No one wants to take their child for psychiatric help, but sometimes sessions can help your teen let go of some thoughts that are not compatible with good self care. You can imagine that if you felt guilty, blamed yourself for your condition, or felt that you were out of control, your ability to make decisions would be impaired. Here, we do not just mean decisions about insulin or oral agents, but decisions about alcohol, drugs, driving with low or high blood glucose levels, monitoring those levels, school grades, or friends. In a large study in the UK, teens with diabetes were likely to be hospitalized often for complications. In an 8-year follow-up, one quarter of the boys and over a third of the girls had serious health problems. Some teens were smoking and drinking alcohol regularly; they also had high blood glucose levels and many had weight gains.
This is the time that children graduate from pediatricians to internists, some of whom do not have the inclination to deal with a teen's sensitivity to control issues. It is no surprise that it is also the time that teens stop going to see a physician and, when they do come back in their early 30's, they have most likely developed a complication of diabetes that demands immediate treatment. Remember how important your grades were in school? Well, those blood glucose levels are often seen as grades that a teen just cannot attain. The tightrope of showing trust and allowing our teens the ability to fail and retry and at the same time not demand so much from them that they know they will fail, is the one off of which we may fall, but if we do, our children may too.
Margaret Gray, Dr PhD, an associate dean at the Yale University of Nursing has been studying this issue for years. She shares 4 rules that can help parents aid their teenagers with diabetes. You can certainly use these when you speak to your child about what will happen at a party.
Keep the lines of communication open with your teen. It will not help if you loose your cool if your teen tells you that their blood glucose level was very high the last few times it was taken. It will not help if you do the same when you see your child eating foods that they shouldn't, or when you get a report of an elevated HbA1c. Stop and think for a second. If your teen tells you about high blood glucose levels, he or she may well be asking for help. Of course, they could be testing you, but hey, your response still matters. We can't tell you exactly what your response should be. That will depend on your child, his or her maturity level and capacity for independence and working through issues as well as personality style, but the end result needs to be a win-win experience. Your teen needs to figure out what to do to get back into control and you need to be able to breathe again. I know I shared that when we lived in Richmond; I worked with a Pediatric Endocrinologist who had developed a program to help teens cope with teen pressures on weekends. The teens were taught how to cheat one night a week if their blood glucose levels were controlled during the week. They were also taught how to get them back under control quickly.
Try to avoid talking about ten years in the future in terms of complications of diabetes. Teens understand the relationship between high blood glucose levels and poor outcomes, but talking about 10 years from now is meaningless to them. I can still remember at age 16, thinking that 20 was old age. It's developmental. Nagging about the future will cause many things but not change in thinking. So what do you do? Talk about needing to have blood glucose levels in control so that your teen can play his/her favorite sport, or whatever they want to do today, not some vague time in the future. This can work for going to that party on Saturday night. If your blood glucose levels are controlled you can go with your friends, but you need to make certain assurances like no smoking anything, no drunkenness, no dangerous behavior.
Give your teen an outlet for being different than you. All children rebel to some extent. I'll never forget the day our daughter cut off her long hair and got a very short, rather ugly haircut that mirrored that of her friends at school. Would you believe, she got it cut the day before she was to have her portrait painted? Of course you would. We all know that if our teen with diabetes messes up that we will pay attention to them. Why not give your child a safe way to rebel that we can attend to? These have to be safe, but hairstyles, a bright green streak, pierced ears, etc., may do. Here's something to remember before you say, "Not my kid." Our children may be so busy getting back at us that they do not think about the harm they are doing to themselves. Teen years are a time of trying on looks, styles, etc., i.e., different hats. It may embarrass you to see you son with spiked hair, but if his HbA1c is still 6%, let it go. If you wait long enough, he'll change hats. It could be worse; he might start a hard rock group that practices in your living room.
Her last suggestion is one that we taught also and which works well if you start it early on in the process. That is to help your child to handle social situations, aka peer pressure, in a smart way. Before you start, put yourself in your teen's shoes. They may well think that they have a metaphoric D on their sleeve at all times, so that when they are offered drugs, hard booze, or even something as simple as a Krispy Crème, they have to give a long embarrassing reason why they will not be part of the group in this instance. The response to practice is straightforward, short and simple. "I have diabetes. That will mess me up" I once had a teen girl who was embarrassed that she would not be drinking a lot at a frat party when she was going on a first date with her "dream boat". She decided to tell him that she wanted to stay for the whole party and not miss one minute with him. Short and sweet. She later shared that he asked why and in one sentence she answered. "I have diabetes and would get sick if I over drank, and miss our time together" When I went off to college, my father taught me how to drink, knowing that college students have been known to party. It saved me many times. Teach your child how to drink reasonably. One glass of wine will not make you feel bad, but two and you may be on the floor as your blood glucose levels drop. Give them the information they need. Explain the insidious nature of drugs and alcohol in the present. How it may affect them that night. Then with their words they will have a better chance of knowing how to handle the situation.
Your teen is growing up. Parties call. But total independence is thought by many experts to be a myth. As a person with type 1 diabetes, I can tell you that others, friends and family have come to my aid more times than I can count, and thank goodness I had spoken to them about how and when to help. You have shared the information they need. You have discussed the rules for going to a party and the results of over drinking. You have talked about not selling yourself short when it comes to relationships, and respecting yourself. You know the people who are going to be there. You know who will be driving and you have spoken to your child about what precautions they have made to make sure they are safe, just in case. Wave good-by and take a deep breath.
BSP
