Abandoning Responsibility

My son is 12 years old and lately he has not been taking care of his diabetes. The other day he left all his diabetes supplies in his gym locker after basketball practice. He is not treating his lows. I was watching at home on Nightscout and I was alerted he was going low and I texted him to see if he treated and he didn't answer so I called the school to see if he went to the nurse and he just completely ignored it like nothing was wrong. He keeps being really high when he comes home and he said that he must have forgot to bolus for lunch. He was diagnosed 3 1/2 years ago and we have never had a problem like this. Do you think its just a phase?? Does anyone have any suggestions as to how I can help this problem?

I responded to a post a while back about this; it's probably too much detail but I thought it might help you. You may want to go back and find that and see other people's comments as well. We had an extreme situation where my daughter was not taking care of her diabetes at all. Her A1C was repeatedly terrible and since she is very independent, she wanted to do it all on her own and any intervention by me caused great conflict or she just ignored what I said. She is also very social and diabetes interferes with that, and when she gets busy talking, checking social media, whatever, she just doesn't do what she's supposed to do. We still struggle.

She started this behavior about age 12 -- she's now 14. And was diagnosed at age 9 1/2 so it sounds very similar to your situation. One of the first things I did, by the way, was require that the nurse supervise my daughter's after lunch insulin dose. You might want to start there.

My daughter is 11, diagnosed 2 years ago. I'm a developmental psychologist, so that's how I deal with this stuff.

I don't think it's irresponsibility or a phase as much as growing up. Fitting in, managing school issues, becoming independent - as these things become more important, Dex alarms and bolusing get crowded out. But we need our kids to grow socially and become more independent. We need them to figure some of this out on their own.

To me, it's like a toddler saying "No!" It's frustrating and requires a thoughtful response -- even quite firm action if safety is involved - but also a sign of moving toward a greater sense of self and identity, so it can be appreciated in that way.

We became clearer about our bottom line. Faking BG numbers, for example, and how we would respond if that continued to happen. What we need in place for a sleepover to happen. We also were clearer about what is negotiable - bolusing off of the Dex, for example.

Just like the middle school teachers with the "did you remember your notebook" signs and homework coupon for late work, we don't like it but we expect it and try to build in a system that moves them toward good habits. For example, we check the Dex every day at school pick and just correct down as needed. We catch a missed lunch bolus and are back down by dinner. At home, we just bring the supplies to her rather than ask her to test. Much less conflict and an A1c that is higher than a year ago but still ok - around 7.

So 3 categories - bottom line, negotiable, and situations we try to work around for now. Makes it easier to choose our battles and communicate.

I feel like we go weeks with seemingly nothing but backsliding, and then out of the blue she packed all of her own supplies for a 4 day trip. Progress even if it doesn't seem that way most days!

I am just beginning this process my 13 year old was diagnosed 2 weeks ago. Since he is going back to school from break tomorrow i can tell you that going to the nurses office three times a day to have his bs checked, once mid morning, once at lunch to check and to get insulin and once before they will let him take the bus home, is an incentive to being on a pump and cgm.

I am wondering if you set firm guidelines if he does not follow the goals you have set together, then you let the school know. I know our school is very supportive of the kids being independent but they also do not want something going wrong on their watch, so if he is not able to care for himself there, they would probably step in. I wonder if just the thought of it happening may get him back in line, or if maybe on some level he would like that to happen.

Hi, Laura. I'm sorry you guys are going through this. Diabetes is so relentless, its easy to understand why anyone would like to ignore it and everything it requires you to do for any length of time, no matter how short and regardless of the consequence.

My son, Caleb is about to turn 12. He's been living with diabetes since the age of three. He has and continues to be compliant with his care. There was a period of time when he was in third grade when he ignored dexcom alerts. We negotiated- set the thresholds differently. Even let him go without DexCom for a while just to get a break. When asked why he was ignoring the alerts, he said he didn't like being interrupted from what he was doing at school. Who would? So we adjusted things so the interruptions would be fewer, but were still able to keep him safe.

Caleb has experienced several transitions in care as he's grown to match his level of responsibility. One of the things I did early on was require that all his care be done wherever he was. It was not required for him to see the nurse. The nurse came to him. As he grew, we eliminated the need for the nurse to see him - we communicated electronically. Everyone stayed informed of his care throughout the day, he even received guidance when he needed, but it took very little time and interruption bc he could do it where he was.

Structuring his day to be as much like his peers has always been a priority to me. It has at times taken effort to convince those around him at school that this makes sense because it's not the traditional approach. I always discuss Caleb's medical well being (blood sugar kept in range) as being as important as his emotional well being (being fully included as other students). It's not in Caleb's best interest to spend time in the nurse's office, and it's not necessary. I believe this has played a big part in Caleb's compliance bc it's as seamless as it can be. It's almost always a matter of seconds to complete a care "event".

When we meet with his 504 team, I talk about his medical devices as his insulin pump, cgm and his phone (and previously his iPod). His ability to be able to text is as important as the insulin he gets and the reporting of his blood sugar.

Could you talk to your son to understand a little more what may be behind his actions? Perhaps there is some room for negotiation. There are things that are non-negotiable - you can agree on what those are together - like bolusing for lunch. But perhaps there are some things that can be adjusted to make it easier - like having to go to the nurse, or maybe evaluate what supplies he carries and see if some things can be housed somewhere as opposed to carried all day. Or maybe these things are not the issue, but something else that can be compromised?