Angela Oswalt Morelli , MSW, edited by C. E. Zupanick, Psy.D.
Middle Adolescence and Diabetes
As discussed in the adolescent development article, middle adolescence is a period of increased independence and decision-making. During this time, teens want to feel like they have control over the lives and this often includes an increased desire to independently manage their disease. Parents are naturally concerned about completely relinquishing their involvement with their youths' diabetes management because these very same teens test boundaries and inaccurately evaluate the risks they take. During middle adolescence youth often feel invincible and may make unwise decisions because they cannot readily consider the immediate and long-term consequences of their decisions. Therefore, teens that have lived with diabetes since childhood may now begin to experience denial about the dangers of improper management of Diabetes. When someone has a serious, life-long disease that requires daily care, the disease becomes a part of a person's identity. This is particularly relevant to teens during middle childhood when identity development is an important developmental milestone. Youth during this period often experiment with different identities. During middle adolescence, youth must develop a self-identity that includes an acceptance and recognition of their disease and all that it implies.
Late Adolescence and Diabetes
By late adolescents, teens no longer rebel against their disease and have learned to incorporate their disease into their daily lives with greater independence and responsibility. However, late adolescence poses its own set of developmental challenges for youth with diabetes. While youth have learned to manage their disease at home and school, they now need to learn to manage their disease in the work place, learning to discuss their needs with their supervisors and co-workers. Furthermore, career decisions may be influenced by Diabetes. For instance, it may be unwise and possibly life-threatening for a youth to become a steel worker on high-rise buildings. A single low-blood sugar episode on a high-rise could cost them their life. If older adolescents are living on their own, they have to make sure they order and purchase their supplies in a timely fashion, so they don't run out; they also may have to deal with insurance companies over the coverage of these supplies.
Suggestions for Parenting Teens with Diabetes
It can be a challenge for parents of diabetic adolescents to find the right balance between responsibility for their children's' health versus encouraging their children's independence and responsibility for managing their own disease. It can be tempting for parents to do everything for their children's diabetes management from fixing all meals and snacks, figuring out and counting carbs, ordering all supplies, and reminding them of all medications and insulin injections. However, if parents do this, youth will never learn the self-discipline to take care of these things. On the other hand, it can also be tempting for parents of teens to stop monitoring their children's diabetes all together, assuming that their children are grown up enough to take full responsibility, when they really haven't fully developed these necessary skills.
There are many ways parents and their teens with diabetes can find the right balance. While adolescence includes a period of rebellion against authority, it is important for teens to avoid viewing their care team as "authority figures" enforcing rules. Parents can limit this likelihood by encouraging youth to view their diabetes management team, not as authority figures, but as their advocates who work together with their teenage patients in a collaborative manner. Teens may prefer to attend some appointments on their own so that they can freely and honestly discuss their concerns and frustrations with their care team, without parental "meddling." Of course, this does not mean parents should not participate. Sometimes it is possible to split the appointment into a private consultation, followed by parents joining the care team. Another option is to alternate attendance at appointments, allowing the teen some private appointments, and some when parents join in.
When youth meet with their Diabetes care team, parents should gradually fade into the background allowing youth to take the lead in telling the doctor about their symptoms, eating habits, and medication/insulin adherence, and ask questions about any new medical directives. However, parents should still pay attention and ask a few of their own questions, so they can understand their children's medical needs. Parents and youth can request the care team help them to establish how much parental involvement is needed, and how much independence a youth should be expected to have for managing their own disease. This aligns youth with their parents in achieving the right balance, as the medical team serves as a neutral third party.
Day-to-day, parents should talk to their children about their symptoms and overall health and help youth make connections between their nutrition, monitoring, and medication and their overall health, without nagging or sounding judgmental. Parents can avoid power struggles by not confronting their children about every poor food choice they make, as that will only cause constant conflict and may actually increase the youth's rebellious health choices. However, if youth are making a series of poor choices that are truly starting to negatively impact their health, parents may have to provide immediate consequences or set firmer limits to prevent youth from sliding into serious health consequences.