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From Westland, Michigan, USA:

My 15-year-old daughter has had type 1 for a little over 12 years. Her A1c is the highest it's ever been, 10%. I know it is because she is forgetting to bolus a lot and she is grazing, eating something, then one-half hour later, deciding she is still hungry, eating again, then maybe doing that again. Her diabetes team says, "Oh, it's just because she is a teen," but I was hoping they would make her take responsibility for it. She and I have had many discussions on not forgetting to bolus. Is this "just a teenage thing"? Do all teens have some sort of rebellion against diabetes? She is a very moody person anyway and I'm not sure how much is diabetes/sugar related and how much is teen angst. How can I possibly make her see how bad forgetting to bolus and not eating right is? She says she knows. How can I help her?


Although it is quite common for adolescents to forget to bolus for meals, it does not mean that it’s OK. It’s also normal to feel overwhelmed and burned out by the never-ending daily responsibility for the diabetes regimen. Finally, it’s quite normal to feel frustrated by the fact that sometimes numbers make sense and sometimes they don’t, no matter what you did or did not do. When what you do is not directly related to your numbers, it can feel downright demoralizing.

So, what do you do to help your daughter? First, please let her know that diabetes is exhausting and that you recognize how hard she’s been working at it. Then, ask her what sorts of practical things you can do to make diabetes less burdensome. For example, many parents will bring their child’s blood sugar meter to them when it’s time to check (without saying anything, by the way), and, then, once their child pokes their finger, the best response is: “Thank you for checking” – no matter what the number actually is. After all, there’s nothing anyone can do to correct numbers if you don’t check them, so saying thank you for checking is very important. Another thing many parents do is offer to do the carbohydrate counting and the insulin dose calculations for their child whenever there’s a meal where the parent is with their child. That can also decrease the burden for your daughter and, at the same time, increase the chance that she’s bolusing at meals (the ones for which you’re around). For lunch, many parents will actually text their child: “Lunch Bolus” at about the time that lunch is scheduled so that there’s a reminder in place. Some parents and teens also find it helpful to download the pump and meter data once per week and then look at patterns together. That type of shared problem-solving is quite useful.


Additional comments from Dr. Stuart Brink:

While it's common for teenagers to "rebel" against the rules of diabetes, it's also pretty dangerous. Long-term complications, of course, are directly related to how high the blood sugar levels/A1c levels are and how long they stay high. You may want to have a separate conversation with your diabetes team and see if all of you, as adults, can strategize to try to improve the situation. Similarly, some teens respond to consequences, i.e., losing telephone, computer, video time if they don't take better self-care of their diabetes. Participating in adolescent chat rooms such as those on the web site, the ADA web site, the JDRF web site, and MyGlu can also be helpful. Most important is to have consistent goals and consistent consequences, but sometimes parents need to step in and say such-and-such behavior is not okay to continue - and then stick to the consequences quietly, but reliably. In many practices, our own included, when the A1c levels are above 8.4%, kids lose medical clearance to get a driving permit or to drive since such chronic hyperglycemia is really unsafe. That sometimes becomes the motivating factor for change, but sometimes phone time or computer time works just as well...


Original posting 18 Jun 2013
Posted to A1c, Glycohemoglobin, HgbA1c and Behavior


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Last Updated: Tuesday June 18, 2013 15:53:34
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