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As our children with diabetes age, we know that they will need to take over more and more of their care so that they develop a strong sense of independence, and more importantly from a parents' point of view, a positive self worth. We know that we don't want to be intrusive in our children's lives or demeaning, but we also fear that they will not take care of themselves properly. As adults we are cognizant of the ramifications of poor glucose control over time, while our teens tend to think in term of instant gratification, today, now, and this minute or next. There are differing philosophies about how to help our teens, but before giving over the reins of control, you will want to make sure that he/she has an excellent knowledge about diabetes and how it affects their body. This includes all facets of self-care including insulin types and mixing, glucose monitoring, food intake, illnesses, how to deal with high and low blood sugars, exercise, and more.
Dr.Tim Wysocki, Ph.D.'s book for the American Diabetes Association (ADA), The Ten Keys to Helping Your Child Grow Up with Diabetes has a list of questions and norms to help you make a safe judgement as you hand over more power to your child. If you don't have it, you can order it through the ADA.
Now, how do we help our teens to eat properly? Most teens go through their teen years with some storm and strife, but all of them do try on different hats to help form a cohesive personality, and we can expect them to degrade some of our thinking. It is very important that we give our adolescents safe ways to being different. Ever note how they dress, their hair styles, their language? For most teens these challenges can be pain for their parents, but for the diabetic teen some challenges can be of even more concern. How do we sleep at night?
- Family meetings at regular intervals can help keep the lines of truthful communications open. Don't forget that words are not the only way to communicate.
- Don't nag your teen. Listen to him or her, and you'll hear where they are "coming from." Ask them what they need, and tell them what you need in terms of their safety. Then allow them to be part of the solution.
- We all often say that teen years are as stressful as any we know. Raging hormones, school achievement, dating, separating, individuating, and social interactions make any child vulnerable. Talk to your child, but hold firm on the bottom line. Diabetes care is not negotiable.
- Don't forget to praise your child when he/she is doing something well.
- Try to separate diabetes from other aspects of your child-the-mind-body split. " I know that stopping after 1 piece of pizza is tough, but you have made wonderful friends who would like you even if your pancreas worked."
- Be prepared to be not too rigid when dealing with your teen. As parents we all know that one day a mature young person will arrive home from school, and the next day an immature one who is more needy may arrive. You can be honest about why you are intervening, and that you look forward to pulling back again.
- As a diabetic, I can attest to the fact that taking care of this disease can be intrusive and tiresome. And, I am an adult. Don't blame your teen. We all slip and teens tend to use denial, as do we all, to forget to monitor our glucose levels especially if you know that they are high. Sometimes it's nice to take a vacation, the problem being that with diabetes, this can be a disaster. If these vacations come too often, if your teen gets involved with drugs, is using insulin to control weight, or displays other destructive behavior, and you are at a loss, get help from a professional.
- When I worked in Virginia, there was a prominent pediatric endocrinologist who worked with many teens. His group set up contracts with these teens to keep in control all week, and then would help them get back into control very quickly if they cheated A LITTLE on Saturday night. For many teens this reward worked.
- Now with instant acting insulin and carbo-counting, make sure that your teen and his/her health team have discussed how to vary what they eat and still remain under control.
- Start your child early with a diabetes summer camp and a support group so that positive friendship will help through out their teen years and beyond, and our teens will gain camping skills that say "you can do it."
Now how do we help our teens to eat healthy?
- Remember, if the whole world ate the way our diabetic teen is supposed to, the incidence of heart disease and type 2 diabetes would be much lower. Therefore, everyone at the table should be eating the same healthy food.
- Try a variety of foods and styles. Tex-Mex may be in this year, and Greek, the next.
- Allow your teens to help plan menus and prepare the meal. Being part of the solution is preferable to being part of the problem for most of us.
- If your home is like ours was when both of our children were still home and everyone went in different directions some evenings, having frozen meals ready to zap in the microwave is a blessing. Also making one meal that can be recycled quickly is a good idea. See previous planned-over recipes from this magazine.
- Keep a stock pile of snacks in the house that are safe, as well as a supply of glucose tablets, power bars for diabetics, etc.
- Don't punish siblings for eating what the diabetic can't. The truth is the truth, but consideration and not being an emotional bully are important lessons for all siblings to learn.
- No one is on time all the time. Cramming for a test or dressing to impress the boy or girl of your dreams for the day, can take extra time. Have frozen power muffins in the freezer, know how to make a quick breakfast drink with the right number of carbos, or have boxes of cold cereal and fruit ready to grab. It's important to feel like one of the guys or gals sometimes.
- Don't be upset if your children want to eat the same thing day in and day out as long as you know they are eating the vegetables and fruits they need. Fighting over food is a mistake. Wait until they grow up and eat you out of the house and home, and ask for fillet or lobster when they come home from college.
- Do what you say. You can not sneak around your teen and eat junk food whenever you can, nor can you bribe them. How they will respond will be too expensive in terms of their health. To tell the truth, they need to understand the reasons why eating healthy meals is important to them, not you.
- Do fortify sauces and gravies with vegetables such as bell peppers, mushrooms, carrots, celery, onions, etc. Spinach or grated squash can be added to ricotta in lasagna and other pasta meals. We all know that zucchini makes good muffins and breads as do other squashes and root vegetables.
- Beware of eating disorders in especially girls. Teens are often overly concerned about clothes and how they look. Once you understand the relationship between insulin and weight, your teen may also figure out how to skip insulin shots, fudge on his/her blood monitoring by adding water to blood or getting someone else to prick a finger, or just fabricate his/her log, becoming self-destructive to keep weight off. It is true that some teens are pleased that the "diet" they were on before they were diagnosed with diabetes even though it came with unpleasant side effects. This is denial working here, but it is true that they liked being thin. Using insulin properly can add pounds, so be aware. Eating disorders can be difficult to treat in an otherwise healthy young woman, but think about the ramifications in your diabetic daughter. If you suspect an eating disorder, contact your child's health care team.
- There is another type of child with a chronic disease like diabetes and that is the child who is afraid to become independent. With this child, you as the parent have to show the way and separate yourself step by step, praising as you go. Make sure to enlist the family and health team in this one. They can be of great help.
- Adolescence covers many years with changes in weight, muscle tone, hormones, sexual traits, and your son or daughter's insulin needs will change. Make sure that they continue to meet with the health team regularly so that carbohydrate and calorie needs can be matched with insulin intake.
- Mistakes happen. It's what we do to rectify them that counts and helps build character and a sense of "can do." This applies to eating healthy as well as everything else.
- What to do when your teen announces he/she's going to become a vegetarian? Take a deep breath and realize that this is when you call in the health care team. Together you can discuss the various kinds of vegetarian diets, and work up a vegetarian meal plan that is based on your teen's likes. The experts at Joslin Diabetes Center point out, "vegetarian eating provides two basic health benefits. First, the increased consumption of fiber may help improve the management of diabetes. Secondly, the decreased use of animal products will help lower the fat and cholesterol intake, and thus help reduce the risk of heart disease."
Since a vegetarian diet is more than broccoli and lentils, you will want to invest in a couple of cookbooks that can guide your teen to healthy eating. We have some excellent vegetarian recipes in our Joslin Diabetes Gourmet Cookbook (Bantam Books) which you can buy in our book store or borrow from most any library. We also have lots more vegetarian recipes in our new cookbook Joslin Quick & Easy Cookbook which will be available in November (more on this later). In the meantime, we can also recommend Vegetarian Cooking For Everyone by Deborah Madison (Broadway Books). We've followed Deborah's writings since her first very successful The Greens Cookbook (Bantam Books) and we agree with the critics -- this new book is her best! We've put the book in our book store under "other books" for easily ordering, along with our review and a sample recipe. She does not give nutritional analysis so you'll need to help your teen count the carbos. Also remember to further reduce the fat in her recipes by substituting low-fat or skim dairy products and limiting egg consumption to 2 to 3 egg yolks per week. As the recipes in all of these books are quite delicious, this would be a good time to introduce the meat-eaters in the family to some healthy vegetarian dishes.
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