Discipline for Type one teens?

Type 1 and LADA Parents of Children with Type 1 Diabetes
1

Help me here!! Kennedy is 13 now and taking over more and more of her diabetes duties. She's doing all her own diabetes care all day at school and not going to the nurse at all. Our endo said at our last visit give her one day a week to forget bolusing for lunch. If she misses two days then she needs to go back to nurse for reminder. She's mostly doing well with her school boluses, sometimes she boluses late, 40 minutes after eating. She's scared to bolus before because of the unpredictability of her school lunch. Sometimes there's nothing to eat at all. ( she has celiac) She doesn;t really want to bring lunch either. ( It s about doing anything to " stand out" or draw attention to herself, really)

Really its after school that 's more of a problem, grazing, not bolusing, or if she's at a ballgame, she will eat without bolusing. She told me " mom I'm just too busy.

Our endo suggested to get her afternoon snack all on one plate then bolus and be done with it rather than grazing.

Her aic usually is between 7.1 and 7.4, last visit was 7.5, so not terribly worse, but I dont want it to get any worse from there!

I still do her overnight stuff and respond to dex if it alarms, and remind her about upcoming pod changes, and dex changes, etc. But she does most of the changes actually herself. I might help her slap a tegaderm on but that's about it!

I'd like to hear what other dparents have found successful, what other adult t1's experienced as a teen, and what kind of discipline approaches work.

And then how do you seperate diabetes control issues from other teen discipline issues? Do you keep them completely seperate?

Do parents ever take away a privelege for poor diabetes habits? Like staying home on the weekend or taking away the phone? I just really think that seems cruel, but??? Is it for her own good?

2

When I was a teenager hanging out with friends, I would tend to not check my sugars or take shots when I ate. I HATED standing out, I HATED others thinking of me as weird. And I think that's just something that every teenager with this disease goes through. It's a part of nature, you don't want people staring at you or looking at you funny. I went through a couple of years doing that, and then I would go back to my normal routine when no one was around.

She will eventually learn that taking care of her diabetes is the MOST important thing that she can possibly do. And she will learn if she doesn't then their are consequences (Bad Feelings) when she doesn't. I say since her A1C is still in the fairly good range that even though she misses a bolus she's still handling it pretty well. Does she play at the ballgame? or is she just a spectator?

3

ok I was a teen d and had a daughter who was a teen d. let me say she will make mistakes but she has to live with it and she will do what is needed i'm sorry to be so blunt but it's the truth. now my daughter helps me take care of my d better than I can. just give her some room and she will do well
I don't think making punishment for not doing her d stuff will help it tends to make them even worse at doing it just saying

4

I agree with you. If you punish her for not doing her stuff with her diabetes she will just rebel and it will make things worse. Dealing with Diabetes is hard especially when your a teenager, she's having a hard time accepting her disease around her friends. And you pushing her will make things a lot worse because she will be resentful for having Diabetes.

5

Never was a teen with diabetes, but I just wanted to let you know that I am struggling with the same situations that it seems your daughter is. I'm often forgetting to bolus until after I eat and I'm at a loss of what to do when I'm out with friends. As I'm 26 and taking this very seriously, her behaviour might not be a sign of disobedience but just... being diabetic is hard. Maybe consider finding solutions to make it easier for her in these situations (like a predictable lunch, or supplying her with lots of no-carb foods to graze on).

I mean, if she was refusing to bolus, that's a disobedience. But... it sounds like she's trying but just isn't terribly good at it. It's the difference between a kid who is a genius at math, but gets a C, and a kid who is really horrible at math and worked hard and got a C. If the situation is tough, but she's just having a hard time, support and help could be better than a punishment.

6

Diabetes is a lifelong fight and can sometimes feel like having a job. It does have its benefits though as you get to learn about your body and you get the opportunity to take responsibility for something in your life. As a teenager you hate to stand out for bad reasons. Many people think diabetes is a bad thing for them to have to deal with in the face of other teens. I personally saw it as the opposite.

Diabetes gives you that opportunity to gain control of something and take responsibility for it. It is an opportunity to show yourself you can manage something like this. It shows your parents you can take responsibility for it and hopefully this carries over into other aspects of life and gives you some independence.

Taking care of your diabetes is also a great way to show friends that you are responsible and that they can depend on you. There are going to be those ignorant kids out there that might see you as defective and you need to think if those people are worth being around. Surround yourself with people who care about you regardless of your diabetes and with those that can see how tough you are for dealing with diabetes.

Use diabetes as an opportunity to practice for life ahead. If you don't plan ahead things are likely going to end up bad for you. If you can't manage diabetes then how are you going to mange school, a job and eventually kids and a family. Diabetes can teach you about persistence and sticking with something. Along the way you may need to resort to punishment or a reward system to help motivate your daughter but in the end you just care about them. You need to express your concern for them in order to help prevent the backlash. Alot of times they need to find out the hard way but you can't let them fail though.

Also keep in mind there are certain things that are just unexpected and can't be explained with diabetes. Missing a bolus or not testing is something that needs addressed where as a random high does not warrant a punishment. In the end keep a positive attitude, be prepared and always learn from your highs and lows.

7

Having had surprising after-meal hypos from bolusing before meals, I understand her desire to delay bolus until after meal.

Forgetting to bolus, well I've done that too, but hardly ever. Tends to happen when I start off hypo, eat, but then never bolus until hours later when I'm feeling like crud and check and find a high bg.

8

just watching... boyfriend plays! That's such a good point, as a human being it is just not good to have people looking at you funny, staring, etc... What advice would you have for her if she were here right now?

I am not real heavy on " diabetes consequences talks" she has done such a good job, handled everything so well, and she knows everything about that. She just really doesn't care right now...

So It makes me wonder if a simple reward system for good diabetes behaviors and withdrawal of priveledges for poor diabetes behaviors would be better?

like a positive rewards system..

9

what do you think about positive rewards system, rather than negative punishment, lecturing, taking away phone, etc..

what might motivate her?

several things come to mind... like...

money? special trip? for a certain a1c or average glucose on her dex?

10

thanks! I know I feel bad about punishing for bad diabetes behaviors, it just makes my heart sink

11

wow thanks! that is such an awesome perspective!! Diabetes as a test for the perseverance that life requires!

12

After I got tired of feeling bad while I was out with friends, when I would take bathroom breaks or had to wash my hands I would take that opportunity to check my blood sugars or bolus if I needed (I know NOT the cleanest place in the world but it was better than me not doing it at all).

It was a lot more different with me as a teenager as I didn't have a pump when I needed to take a shot for a meal I would actually had to pull out a syringe load up the insulin then inject myself and I would definitely get a lot of weird looks there. But later in life I realized that if they were truly my friends or cared about me like they said they did, they wouldn't have given me a weird look or talked about me because they would be there helping me and making sure I was doing what needed to be done. That's what true friends are for.

When I would get home my parents would check my machine to see if I had been doing what I needed to keep me healthy. And if not they would fuss and give me a lecture about how I wasn't ruining anyone's life but my own. And that got so old BUT so did Diabetes. And I know for me, it would only make things worse. She's a teenager and to the age where she's going to do what she wants to do (she's got to learn somewhere).

I really don't believe in withdrawal of privileges for Diabetes related problems. Diabetes is a hard disease to deal with, and it down right sucks at times. I know your trying to be a good parent and keep her healthy but do you really understand what she's going through (not trying to sound rude) but no one really understands diabetes unless you've lived with it. You have your ups, you have your downs, you have your days when you want to do the best you can do and then there is days where you just want to FORGET you have it. You want to be NORMAL like others. Maybe we slip up occasionally but honestly her A1C's are good for a 13 year old girl considering her not staying on top of it plus the hormones that her body at 13 is starting to receive. The best thing you can do is when she's having a day where she doesn't want to have it, just remind her when she's around you to stay on top of it.

13

And I forgot to mention, I'm 25 years old and I was diagnosed at the age of 2 with Type One Diabetes. So I've lived with this for 23 years, and honestly I still have days where I don't check my blood sugar like I'm suppose too. Some day's i'll only check it twice and others i check it six or eight times! Just depending on how I'm feeling that day. I'm suppose to check it 6-8 everyday. But it's hard sticking yourself that many times!

14

I did 17/ day right before I got my black belt. I was running 2-3 miles and lifting weights @ lunch and then working out at the dojang for several hours/ night, including teaching people so I didn't want to screw the pooch! Since then, I've acquired a CGM and am not quite a gonzo so maybe 10-12x. I've posted this before but I've saved it because it sort of lays out what seems to me to be a reasonable # of tests:

• wake up, test bg
2) before eating test BG
3) before driving to work test bg
4) 2 hours after eating test bg
5) lunch test BG
6) 2 hours post lunch test bg
7) drive home test BG
8) get home, run 3 miles...oh wait, don't forget to test your bg!
9) post-exercise maybe, maybe not, maybe eat dinner and, you guessed it, test BG
10) 2 hours post dinner, test BG ****AGAIN****
12) stay up late? Maybe squeeze in another one, what if you have errands to run, what if you want to exercise more (when it's nicer out, I'll run 6-7 miles during the week, more on the weekends...a lot of times, I'll run a long run on Saturday and then a 20ish mile bike ride for fun, speed and recovery on Sunday...there's several extra strips in there...).

15

I wouldn't reward for "results". If you want to reward your daughter reward her for good behaviors like going a full week without missing a bolus or testing x times per day,

16

Natalie just my opinion but I think that if u try and make it a big thing she will revolt on u..........................just let her learn SHE is the one goning to have to live with the bad feelings she gets from going hi to going low not u I had to learn this on my own and so did my daughter. I know it hurts when u know that u would do better for her but like I say SHE is the one who has to live with this. I know it's hard to do but she will learn her lesson soon and she will do much better. Kids surprise u they will get it after awhile.

17

Ok I like that. Maybe going a full week without missing a bolus, doing her calibrations and testing, we'll do some kind of reward, ??

18

So there is an approach out there that deals with mental health in the face of medical conditions. It is referred to as the Flourish approach and it focuses more on the positives and how to maintain mental health rather than dealing with fixing mental illness or in the case of diabetes fixing the whole burnout thing you see as kids age.

The Flourishing approach starts by building on what is already working. I am sure your daughter already understands the challenge of diabetes but the next thing is believing that there are resources available and things out there that can help. This can help motivate her and give her diabetes a meaning to her so that she can make it who she is. You need to stay positive and continue to try and prevent problems, not fix them.

I would first sit down and figure out what she is doing right or doing well. At the same time identify areas that need improvement. Since your daughter will need to take ownership of it, you will then need to have her set goals to maintain what she is doing well and to improve what she needs to work on. The key is moving towards what she wants to do. Make sure you put focus on what she is doing well and how it can help her do other things in her life better. Once she know what she needs to fix, where she wants to end up and the direction she want to take she needs to integrate this into her life so that the whole process bestows some benefit upon her. You can definitely integrate rewards into this system but overall you need to keep it positive.

Good luck and I hope this helps. In the end you need to be on her team and make her feel like she is in control and that you are there for her and care that she does well.

19

Difficult but intersting question...

How do you play such games without stating either SHE is INCOMPETANT or you do not trust her as if she was three years old again??? Play either card and (IMHV) she'll clamp down like a submarine about to dive being charged by enemy destroyers.

There is a third path btw... but its subtle and Psyc-Ops 101, black-bag parenting.... sneaky, diabolical stuff.

You will have a much easier time IMV if, if you do something so unimaginable, so RADICAL that she'll go WTF.... WHAT DID MOM/DAD JUST SAY...

We sing the same song, day after day, for years, if we radically change the tune we use, they sometimes hear very clearly... because its such a radical departure from the blah-blah-blah norm.

Only say/do the same thing, and it becomes worthless. Do something unique, you get the target bulls-eye, something sticks.

20

-Sad Grim Look-

A game of power, by definition requires both parties to have power to affect one another. As her mom, as parents you come to this game UNARMED. If Kennedy digs in her heels, turns the launch keys and presses the proverbial launch button....i.e. MY body, MY disease not yours game... the beating heart of the issue is she is dead-right.

At the end of the "book", it is her disease alone. It is a dangerous field of land mines to be sure.

I believe a good approach is "Parental Acting 303". Your role is to set aside the emotions and reach her AS A WOMAN. The detached, un-emotional woman she has literally never met before! Treat the dumb choices as that, dumb. But when they happen, you treat them with no mercy, as you might her very first (sic. wicked) hangover????

Acknowledge and bring up her "suffering", but give her no rainbows and kittens, no little girl snuggling. Let her struggle and acknowledge them. Offer her tea... and talk one woman to another (One of them teachable moments and you can add a side oder of sex, alcohol, whatever your need/preference (non diabetic topics btw); )

Once she has struggled, then you "dance".

Experience is a wicked teacher.

Bolus, eating lunch sound like they need a dose of basic logic to break. IMHE, IMV remove the hidden-terror (many parents hold) and only deal with the sparks right in front of you. Enitrely possible she may need her phone clipped/internet grounded (AND YOU THOUGHT A HYPO SEIZURE WAS SCARY -GGG-)

Please remember diabetes does not start every breath, every sentence. Sometimes Kennedy is just a teen, who also HAPPENS to be diabetic too. Two creatures in one body...

In my humble opinion

[P.S. Were you aware you can turn on PARENTAL CONTROLS on most phones, and TURN OFF her ability to text or email during or past certain times??? My kids can ONLY receive incoming calls/emails during school from 6 people if we turn texting on. After 10pm from mom & I only, etc... ]