Quick Summary: I will offer two super easy techniques that I use in family therapy to assist a family in structuring itself to best meet the diabetes
management needs of a teen. My wife is a senior research coordinator for diabetes and because of such I chose to specialize in assisting families who have a diabetic teen.
The teenage years are a time of identity growth, and to facilitate such growth teenagers want more control over their choices and less input from their parents. This relatively normal phenomenon can be extraordinarily difficult to parents who have a teen with diabetes as the teen will often no longer accept ‘input’ concerning diabetes management.
People unfamiliar with diabetes can unintentionally oversimplify this issue and label the actively involved parent as a “Helicopter parent,” which is essentially synonymous with being a control freak.
To give an example, a parent who is overly involved with their 17 year old’s tooth brushing care would often be given such a label. The Idea is that if a parent is exerting control over such a simple task then they are enabling the teen to not take personal responsibility for the simple behavior. You change the dynamic by increasing the responsibility of the teen and decreasing the parental control over such activities.
This seems like an applicable solution to a family with a diabetic teen, but it neglects to take into consideration the severity of the consequence involved in poor diabetes management.
Parents of diabetic teens are trained over many years to know that their child’s life depends on them being exceedingly aware and in control of the child diabetes management.
You cannot recommend that the parent simply relinquish control to the teenager because if the teenager fails once, they could die. Additionally it is the parents legal responsibility to appropriately attend to (and not neglect) the medical needs of a child.
The problem is further exaggerated by many of the realities of being a teenager:
1.) Desire to be ‘normal’ and to be accepted by the group can create feelings of embarrassment surrounding management = this can lead a teen to knowingly mismanaging so other won’t “find out” and can potentially lead to consuming alcohol which can lead to high levels and diminished executive functioning.
2.) Denial of conflict or trauma (true for all ages) = can lead to a teen avoiding the reality of their condition.
3.) Incomplete brain development related to cause and effect = this can lead to teens being indifferent to the ‘potential’ long-term consequences of mismanagement (note: when an adult asks a teen,” did you even think about the consequence of____________.” The developmentally appropriate answer for many teens is, “no, I can’t really think about the future the way that you believe that I can”.
4.) Increased need for sleep = this makes it difficult as the teen needs to interrupt their sleep cycle to properly manage their diabetes.
5.) Irrational desire for independence = this can lead to a teen not managing their diabetes because some authority figure “told them to.”
6.) Tunnel vision or present focus (often a good thing) = this can lead teens to become so absorbed in an activity that they truthfully ‘forgot’ to check their levels (I see this all the time with video games).
7.) Extraordinary debilitating stress from unrealistic expectations and a demand to always think about the future = Our push for teens to constantly live in the future as opposed to the present and for them to be engaging in an excessive amount of rout meaningless tasks can create a stress cycle or depression = this leads to compete indifference or hopelessness concerning proper management. (Adults – this is our issue to solve – we are demanding that our teens engage in the very same behaviors which are the source of this country’s unbelievably high rates of depression and anxiety. Often we are telling teens to do as we do even though what we are doing is not generally resulting in happiness).
What do you do?
These two solutions can feel so simple that is may be hard to accept, but I have seen these two solutions create incredibly positive ripple effects through an entire family.
I will preface here that often a family therapist is helpful in getting the ball rolling – teens have an easier time using these solutions when it comes from the therapist or when the therapist encourages a space in which it comes from the teen.
Solution 1: Create a dynamic in which the teen verbalizes to the parent regular updates concerning management. In exchange the parents do not ask for updates or demand management behaviors until the teen has been given reasonable time to offer updates without a prompt.
Example: “hey dad I checked twice today at school and I was all good… I estimated a little wrong on that pasta, but I was able to have a little juice and that evened things out.” In Exchange the father would refrain from something like, “are you going to check before dinner tonight?”
This solution empowers the teen to take control (which is inherently rewarding) and removes the “overseer” dynamic (which the teen finds inherently negative).
Additionally the parent is not left to live within a space of crippling anxiety as they are still given information necessary to deduce safety.
Solution 2: Modeling… walking the talk… create a family culture in which everyone takes responsibility for dedicating themselves to a health goal which is of equal difficulty to managing diabetes. Family systems operate on value systems – what is the value or expectation (often this value is not openly talked about) placed on family members in relation to being dedicated to health practices?
Example: If a teen watches an overweight family member dedicate themselves to a routine exercise schedule while avoiding all fast food, the teen will feel as though health management is a family value = this creates a collaborative environment that is more free from hypocrisy.
Teen are excellent at spotting what they label as “hypocrisy or inconsistency” = this solution removes their ammunition.
This solution creates a “we” family culture as opposed to an “us and them” culture. The collaborative nature of ‘we’ cultures naturally reduces defensiveness in a system as we have an expectation of us as opposed to I have an expectation of you (which can be labeled as oppressive by a teen).
To properly manage diabetes teens are educated to: be exceptionally mindful of the nutrition and the composition of their food (namely the amount of carbs), to avoid alcohol and cigarettes, to get proper exercise, and to be listen to their body and to take appropriate action based on the information. When the entire family system is holding itself to the same standard, it makes the task significantly easier for the teen. Additionally, the family is able to share insight concerning solutions that are working for them… this supports a dynamic in which reasonable solutions are being offered (for example: if the parent is able to come up with a solution for not eating all the candy found in most public space, that solution is going to be more helpful than an arbitrary solution that hasn’t ever been tested for efficacy).