At what age would you promote self management for a teen?

So it seems my sweet, cooperative son is developing some teen characteristics. We have always co managed his diabeties so to speak, with my attitude being he has years to do this on his own i would rather him be a kid than have to count all his carbs or worry about prebolusing ect. so now that he has entered high school he has been wanting to be more independent and seems annoyed with me helping him with his D. I am all about encouraging independence and am resonably confident with his skills. i have never been restrictive with his diet within reason of course and i wouldnt say i've shown to him to much worry over him or been overly controlling, however i dont think as of yet he truly thinks outside of the box when dealing with his D and mainly does what ever his pump recomends which isnt always the best decision. just when i thought i had worked through alot of issues with his D here comes a new one. even if i hand over control to him i will always be available for input and will be checking his numbers in his pump. it is just frustrating to see him go through this although i know it is developmentally normal i still hate to let go completely. my plan had been to gradually let go and have him mostly self manage in his senior year not his freshman year. i sense some tense years coming and hate to just throw up my hands and say ok you do it, especially with the inevitable bs highs with hormones and growth coming. we always have had a close relationship i think he is the type of kid that actually needs alot of attention, praise but now feels the need to disconnect which could be giving him a little identity crisis? he had one of his i hate D nights this week saying i make everything worse not better and cried himself to sleep. he has alway had some gloominess at night when he is extra tired where i just need to let him sleep and in the morning he is his same happy self but it still breaks my heart. any suggestions? amy

I pretty much ran my own show from when I was dx'ed @ 16. I didn't ever sit down and talk about it with my parents or anything but they seemed to think I could do it and I did it. They were there to help me but like many teens, I was like "I'm fine!" Of course, when I had my first hypo and was alone, I lit a carton of ice cream on fire defrosting it with the broiler so I could eat it faster, as I got hung up on the "wait, the microwave heats inside out...that's not gonna work conundrum...".

I don't think boy hormones play as much havoc as girl hormones so I wouldn't worry as much about that.

If the pump recommendations don't "work", I would think the settings may be off. I think I try to run my pump "hot" and deal with cleaning up post-correction lows as a matter of course. My plan is eat light all day and chillax at night, eat and drink more to cover the post big dinner "tail" of insulin. It works ok for me and, since I hardly do much at night, it doesn't really get in the way of anything to run down to the 60s and have a couple beers to nudge it up. Maybe you're running it off for some reason, on purpose but may need to get it set more precisely?

Our teenager flips out when she is tired too. It may be that he understands enough about diabetes to take care of himself. Unless she needs a ride somewhere, junior affects haughty aloofness and hides in the utter crap blaring out of her iPod. Every now and then, something erupts that we can help her with but, even though she's a bit younger than your son, she does a very good job taking care of things, although D isn't one of them. Your son is older and probably has societal "be a man" pressure totally unrelated to diabetes but is probably chafing to take care of things.

You may feel a bit terrified at the thought of your son having to cope with D along with everything else teenage life throws at them. Just think though, you are there for him, he has a great base, you've done the ground work. Now he wants a little independence and it is scary. I went through a serious rebellious teenage phase, I don't think it was my being angry at being D, just a personality thing. Your son seems to have a good head on his shoulders and there is no harm in giving plenty of praise. His crying about his D is just a bit of frustration that we all feel at times. I don't believe for one minute that he thinks you are making things worse. You are the closest person to him in the whole world, you are the one he'll take his frustrations out on. Stay strong and keep the communication lines open. He will make mistakes, but we all do, it's the only way to learn. I wonder are there any other teenagers with D he could meet up with to talk to, it may help. You can get plenty of support here from mothers also.

This is a difficult issue with many factors at play. I was diagnosed at 9 and of course by the time I was 12 or 13 I thought I could do it better than mom! I think you have to look at how long the child has been T1, how responsible the child is, how much the child wants more control and other factors…

Inevitably, he will want to (now or soon) go out with friends more, eat out without you, etc. and needs to know how to take care of himself. My mom had a pretty good solution you may want to consider. She scheduled seperate meetings where I met with a dietician, CDE and endo. They re-discussed all the standard of care, procedures etc. for 1990s T1 treatment. I found this completely boring (as I knew everything, of course), but my mom explained that now I knew how to take care of myself and she would be slowly handing over the reigns. She also said that in the not too distant future I would be going off to college and I needed to know how to take care of myself by then. It worked pretty well.

I agree with AR. I was in charge from the age of 10. Mom would help me make decisions when things needed adjustment, but she let me go.I made mistakes, no doubt about it, but I learned. That was 50 years ago and it was very different. Now he has ools. He will be a lot better off in life, in my opinion, if he takes the reigns now. He will go away to college and should start preparing now.

thanks all for your valuable input it is no nice to share and be heard and supported here on tu! amy

Hi Amy, I think if Jacob is asking for more independence regarding his D management he probably is getting to that age where he's ready. I agree with many of the other responses. Perhaps at first having him tell u what his plan is regarding his blood sugar, what he's about to eat, what he plans on taking to cover everything, and his rationale is a great idea. And I also agree there are a LOT Of kids out there who manage their D beautifuly and a lot of adults who don't. It all boils down to the individual. Good luck, let us know how it goes.

Have you considered having a contract in which the parts of control are listed by the CDE, and as each area is revisited, the areas are checked off. Also, like teenage driving is now viewed with certain restrictions and allowances, so can carb counting in the evening out with friends and the I:C ratios for evening be enabled with assistance. Menu availability online is a plus. Introduction to calorie king and other tech assistives can be done. He doesn't have to deal with alcohol for many years, or does he?

I don't like iea of the contract involving the CDE unless you are *really* confident that the CDE is 1) excellent and 2) credible to junior. If the pump settings are "off", or there's some kind of gap between the pump and Jacob's Mom's plan which seems implied in the initial's not inherently "bad" to deviate from the pump but the doctor/ CDE will very likely feel that the pump *is* the plan because they assume that we do what they tell us to do. I deviate from my pump's suggestions all the time too, and I think that it's a good idea but I am pretty loose about "plans" and anyone telling me what to do, perhaps because I've always been in charge.

Another thought (which has been alluded to by other posters), your son is nearly old enough to go out on his own. Isn't it better to have four years experience self managing with you to go to as a resource that lives in the same house, rather than having him scramble in his senior to feel confident in his diabetes management. A senior year is complicated enough--full of new beginnings and endings.

You guys have a good relationship. Tell him that he can make the decisions, but if he has any questions to consult you. His numbers may not be steady right at the first, but the learning curve is really steep. He'll get to know what to do before you know it.

It may actually be easier to get him started with self management now, before the hormones really hit--so that he'll be confident with his decisions when they do.

About the gloomy night--I promise that this happens to everyone. Diabetes or not. I'm thirty-five, and I still have occasional crying jags and times when I lash out at my mother. I had them when I was a teen--and when I came back home before the diabetes. He might not even know why he lashes out. Part of it is that he trusts you. He knows you love him and aren't going to go away, even if he does push.

I remember--when I was a child, all my life centered around home--yes, I went out to school, but it was going out. All the real stuff that I remember happened at home. Around the time that I started high school, that changed. All of a sudden, my life happened outside--with friends, at school. Home was a base for me to eat and sleep. An anchor of sorts--like a kite string that gave me the stability to let me soar.

You've done a good job--he feels it's his time to head out to conquer the world. Trust him--and trust yourself to let him soar for a while. The last thing you want is for him to feel that the only way he'll be independent is by pushing you out of his life.

hi christy! things are going well, i really think his angst is mostly fatigue and hormone related. over the weekend he did most of his managment, which he really is quite capable of, but didnt get upset if i brought him his PDM ( he has on omnipod) or did his calcs for him while he was otherwise occupied, it is dance we play and i think there will be bumps like all teens but we trust and understand each other so that is a plus. he has been out solo with friends over the years and more at the end of last school year and he handled himself pretty well, if he is in a crowd and he has recently tested at home so we have an idea where he is we 'let' him bolus occasionally without testing ( it is a compromise he knows this is a once in a while practice) so he has earned my trust with that although i am hoping he meets some new friends that he will be comfortable sharing with and testing in public on the sly of course! he is way to young to drink alcohol be we have discussed the implications with D. he is pretty young for his age and is usually a rule follower, so i am hoping for the best! thanks for sharing, hope all is well with you. amy

Hi AR, i think the societal be a man thing is surely modeled for him by his dad, so there is something to that. i think boys are less hormonal for sure( sorry for you!) but testosterone can add to moodiness too along with his bs's being affected by growth! he seems to have settled out for now, you here alot of horror stories about all that but we'll see. that is what i mean about not always doing what the pump says he seemed to be going through a growth spurt during the summer and i just always had to overshoot but better now. and here is a pump question i can ask you, if you dont mind. jacob has an omnipod and the insulin on board feature just represents correction, so say he is high at dinner and has a big correction, 2 -1/2 hours later he tests for bed time snack and it says he still has like 1.5 units on board ( his insulin action is set for 4 hours) i really dont think to much of that insulin is active at that time esp over 3 hours so i tend to overestimate that bolus if i dont by experience it is not enough. so this is one instance that he needs to think outside the box and doesn't usually think of that factor. i'm going to bring this up at his next visit to his endo in nov. we have a good relationship at his new endo but we dont rely on them in between visits unless i'm stumped. i was thinking of asking about changing his insulin action to 3 hours i checked with omnipod and they said too risky, no big surprise there, not a biggie just wondering what you thought of insulin action he uses novolog. anyways thanks for responding. enjoy the fall, i'm sure you love it for running it was a hot one in IL, my big sis lives in Lockport. best, amy

I use 4 hours for insulin action. I still think there's an invisible "tail" out there past that but it's not too significant and I cut it off by turning down basal stuff. I think setting the pump at 3 hours would make the IOB issue perhaps worse, as there'd be the same amount of insulin floating around, it just wouldn't be displayed?

It has been ok weatherwise as, during the first part of the summer, I was running in the AM. Since the long runs started, I've cut back a shade during the week and not pushing myself.

Hi Amy. It must be in the air, because my son is asserting his independence more since he started high school a few weeks ago, too. My son has been pretty independent with his diabetes from the very beginning, but these days he gets very annoyed if I ask if his homework is done, has he studied for that test, etc. It’s hard to let all of that go, but our job is to turn these little creatures into independent, self-sufficient men ready to face the world. Them wanting to handle things on their own means we are succeeding!

Specifically regarding the diabetes management … Since my son has always been fairly independent (with me as a sounding board or to take over when he’s sick or just needs a break), I am confident that he knows what he is doing and makes good (mostly) decisions. Since he has started high school, he is not testing as much during the day as I would like. We compromised and came up with some absolute times he has to test (and I will check his meter periodically to be sure he is doing it), but other than that, I agreed to back off and let him use his judgement. He doesn’t like the way he feels when he is out of range, so he is incentivized to keep things pretty steady and continue to make good decisions.

I am trying really hard (not always successfully) to let the natural consequences of his decisions and actions guide him rather than me nagging or lecturing. For instance, when he ate a large pizza while out to lunch with friends a few weeks ago and had crazy blood sugars and felt crummy all afternoon and evening, that feeling was a much better deterrent to doing that again than my nagging or lecturing would have been.

You are doing a great job. I am a big believer in listening to your gut. If you have evidence that Jacob is ready to take things on, let him, but be there as back up or to help pick up the pieces when he messes it up. Best wishes to you and Jacob!

I've always felt we were kind of on the same page marie! It sounds like Zac is doing well. it is not easy to let go of control, i like how you let him deal with the natural consequences sometimes, unfortunately for me in some regard jacob has to be really high to feel poorly. somedays are harder than others but i think we are all doing the best we can! i just sometimes feel it is doubly hard being a mom of a teen and a teen with diabetes. it is good to have others to share and relate to! best of luck with young man! amy

I couldn't have said it better.

I (like acidrock) was dx'ed as a teen, my parents were not involved in my diabetes care and management; I was left to find doctors, etc. on my own.

I have never pumped, only ever been on MDI, which worked for me, but as I understand is not as complicated as pumping.

I am mom to a toddler, so I have yet to hit the swings of teenagerdom, however, I stand firm in the school of thought that parents know their own kids. If (when) you believe he is ready to self-manage he probably is (even with a little hidden parental guidance), especially if he is feeling claustrophobic about his diabetes and others involvement (he is probably trying to assert himself and find where he stands with his diabetes).

I cannot speak for all diabetics, but I imagine at some time (and for some people it may be more frequent) we all feel a little down in the dumps about it, all part of this rollercoaster ride, I guess.

Is your son on TuD? If yes, maybe he should see what other teenagers in his situation are doing and if he isn't, maybe he should join and that might bring him some of the independence he is seeking.

Do you have an endo/nurse he sees regularly? Perhaps, an idea is to sit down with them, yourself and your son and come up with a group plan for diabetes independence.

I am sure it will all work out; if your son only knew how lucky he is to have involved parentals (I have no contact with any of my parents or siblings because of their denial and disregard of my diabetes), because he is very lucky to have a mom like you!

Bests to all :)

thanks aimee! you are right things are always better in the morning, and he always bounces back. jacobs decision making skills are getting better, stepping back is hard but knowing i am "hurting" him more by not letting go is probably worse in the the long and short term with him. as long as i am keeping tabs i can already see he feels more in control and better about himself by being a more active participant. i hope vivian is having a good school year so far, talk soon! amy

thanks for your support bec, things are going better already with jacob, there will be ups and downs but i think he feels better with me backing off a bit. he unfortunately is not interested in joining tu, i guess he just wants to treat his D and forget it, i understand that, although being part of this community has helped me so much. i am hoping someday he will meet an empathetic girl who is interested in him and learning about his D, then maybe he will realize it is ok to share and most will be concerned or curious but not judgmental. i hope things are going well for you bec, you are an inspiration to me after all you have been through, i hope you are stronger and greatful for the people in your life that get you, support you, and truly recognize you for all that you are. I can see that you are special just from your posts, so thanks again for sharing and enjoy your little one, such precious times. amy

good to know, i'll check his pump to see if we can program 3.5 especially when jacob is not at school he eats every few hours also, at least now he knows to watch for this and adds in a bit! thanks for the input!