My son has Type 1 diabetes and I am having more and more trouble managing his condition as he gets older. He skips checking his blood sugar levels, and when he does so his blood sugar has been dangerously high. Despite my questioning and explaining the importance of checking blood sugar levels, he won’t listen. What should I do?

The developmental goal of a teenager is to separate from parents and fit in with peers. During this transition, they will often make risky decisions. Unfortunately, these decisions can create problems managing conditions such as diabetes.

It is important to understand that your teen may know how to manage his diabetes, but he will often have other priorities. He may feel “tired” of diabetes or uncomfortable injecting insulin in front of friends.

How can parents make sure their child remains safe?

  1. Setting limits

A common parental response is to scold and lecture the child. Remember to try not to nag! However, set clear guidelines for your teenager and establish clear expectations for him and intervene if limits are not met. It’s important to emphasize that there will be negative consequences for their behavior and that the set limits will be consistently enforced.

One strategy is to set up a check-in system that is scheduled by your teen two or more times a week. For example, this meeting might be scheduled twice a week to discuss diabetes management and to review blood sugars. It is important not to judge the actual value of the blood sugar or the teen will not be truthful – rather, evaluate the data and respond with appropriate suggestions. If your child demonstrates responsible actions, you can become less involved in the process. However, if your teen is unable to provide self-care, it is essential that you become more involved in their self-care behavior.

  1. Work with your child

Another method for limit setting is to create a contract agreement with your teen. When designing the contract, ensure that there is mutual agreement between both parties. Set concrete and measurable behaviors with your teen, such as checking sugars at certain number of times throughout the day or using a continuous glucose monitoring (CGM) system appropriately.

Incentives also work as a reward system for desirable and safe behavior. Younger children may enjoy small rewards such as stickers, Legos or small toys. Teens appreciate more independence such as permission for sleepovers, movies with friends or obtaining a driver’s license.

  1. Positive reinforcement

As a general rule, punishment and fear are not effective strategies for asking your child to be more responsible. In general, teenagers have a difficult time visualizing future consequences. They are more likely to change their behavior with short-term rewards and immediate consequences.

By discussing the long-term consequences of diabetes, your teen will most likely say that “these things happen to really old people” and that it does not apply to him. Therefore, note immediate consequences of poor diabetes management such as, “no car keys,” no sleepovers, etc. and incorporate small and instant rewards in your contract like earning small amounts of cash or an iTunes gift card for good behavior.

To be sure, the psychological and social components are essential in the management of chronic illnesses such as diabetes. Parents and teens may also benefit from professional therapists to discuss important concerns, but as a parent, you can make a difference by working together with your teen to develop proper guidelines to help improve their health.

ABOUT THE AUTHOR

Fran R. Cogen Fran R. Cogen, MD, CDE, is the director of the Childhood and Adolescent Diabetes Program at Children’s National. Her clinical interest includes intensive insulin therapy and its effect on quality of life. She is dedicated to advocating for the needs of patients and their families in managing diabetes, and in 2007 was named as one of the “Best Doctors in America."

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