By Shideh Majidi, MD:

The teenage years are an exciting, nerve-wracking, and sometimes frustrating time for families. Teenagers spend these years trying to develop their own identity and figure out who they want to be, which often means they question everything, challenge authority, and push against the status quo.

Biologically, we also know that the frontal lobe—the area important for problem solving, judgement, planning, organization, and controlling emotions—is still developing during the teenage years and won’t be fully formed until their mid-twenties! This is why when we try to tell them about the long-term consequences of their current actions, it doesn’t change their behavior.

So why can type 1 diabetes management be more difficult in the teenage years? We know a teen’s brain isn’t completely developed yet, that they have different priorities, and they can’t assess long term consequences the way adults do. But when they have type 1 diabetes, they are expected to make diabetes a top priority, for their brains to be able to effectively and efficiently plan and problem solve daily diabetes tasks, and to understand what poor diabetes management now will mean for them in the future. This runs counter to where they are developmentally and can result in frustration, defiance, and conflict during these years.

Here are some tips to keep in mind as you and your teen manage diabetes during adolescence:

• Transitioning diabetes care to your teen takes time: We don’t expect teens to suddenly know how to drive when they turn 16 and we can’t expect them to suddenly know how to manage their diabetes at a certain age either. Transitioning diabetes care to your child occurs over many years and with a lot of continued parental support. Every family will transition care differently, but a step-wise approach typically yields the best results. Start talking with your provider about the transition process early to help transition as smoothly as possible.
• Focus on behaviors, not outcomes: We often focus on the blood sugar number and whether it is low or high, which can only partially be controlled by those with type 1 diabetes (biologic factors such as the effect of stress, exercise, and puberty often play a role as well). This often leads to tension and conflict between parent and child. Instead, focus on controllable behaviors that will ultimately lead to the results you want. For example, focus on checking blood sugars, giving insulin, counting carbs, changing insulin pump sets, etc. Work together to make goals focusing on controllable changes and allow them to help make and decide the goal.
• Avoid using “good” and “bad” to describe diabetes: Think of blood sugars simply as what they are, a number that may need to be acted on. When describing blood sugars as “good” or “bad,” it can implant the idea that when someone has a high blood sugar, they themselves are “bad”. This can lead to teens lying about their blood sugars in order to avoid conflict. Instead, set up a time weekly to review pump downloads (or blood sugar logs) together and discuss patterns and problem-solve changes together and in an objective manner.
• Puberty affects blood sugars: When teens tell you they don’t know why their blood sugar is high, they may be telling you the truth! Puberty is a time of significant insulin resistance, requiring increasing doses of insulin. This is another reason to review downloads or logs together because insulin dose changes are needed up to every two weeks during puberty to keep blood sugars in range.
• You are a doing a good job! It is easy to get frustrated with our teens when they don’t do something we know is good for them. You may feel guilty or feel like giving up sometimes. Know that you are doing a good job and you are not alone. You have a team at the BDC to help guide your family through the teenage years and into adulthood.