The Challenges of the Teenage Years with Type 1 Diabetes
The teen years are a time when young people waver between wanting to be an independent adult and wanting to stay a dependent child. It is not surprising that they go back and forth when it comes to taking over the diabetes responsibilities. Many research studies now show that when parents stay involved in diabetes management, the diabetes will be in better control.
The Challenges
The teenage years are often the most difficult for having optimal sugar control (including an HbA1c value below 7.5 percent [58 mmol/mol]). And yet, they are important years in relation to an increased risk for diabetes complications. If the number of blood sugar checks per day is reduced, or high CGM glucose levels are ignored, the HbA1c level will rise. At least 60 minutes of physical activity daily is important, both for diabetes control and for a sense of well-being.
- Growth and Hormones: Growth and sex hormones are at high levels and interfere with insulin activity. Insulin pumps, more frequent insulin shots or boluses, or use of the basal insulins, Lantus (Basaglar), Levemir or Tresiba (Degludec), rather than NPH insulin can help some teens. However, if meal and snack shots (or boluses for pumpers) are missed, the HbA1c value will increase.
- Driving Safety: Driving a car safely is very important beginning in the teen years. It is important to always check a blood/CGM glucose level before driving. Driving with a low blood sugar can result in altered judgment and reactions that can be just as severe as if driving while drunk.
- Teenage Priorities: Diabetes is often not a priority to the teenager. Teenagers have special issues, including:
- Struggle for independence
- Growth and body changes
- Self-identity
- Sports activities
- Peer relationships
- Substance abuse (tobacco, alcohol, drugs, etc.)
- Sexuality (including anticipatory guidance for birth control and safe sex)
- Driving a car
- College
- Emotional changes
Consistency
Consistency is a key word in diabetes management. This may relate to food intake, exercise, stress, monitoring of blood/CGM glucose levels and timing of insulin shots/boluses. It is often hard for teens to be consistent.
Tips for Parents
- Stay Involved: Find ways to stay involved in diabetes management. You can be helpful in keeping the log book, downloading meters, pumps or CGMs and in talking about insulin dosage.
- Set Expectations: Set and enforce reasonable expectations.
- Be Supportive: Be available to help, but try not to be overbearing or constantly nagging. A supportive adult can be helpful for a person with diabetes, no matter the person’s age.
- Communication: Help with communication to the diabetes care providers. This may involve sending meter, pump or CGM data by email, fax or the cloud.
It is not surprising that diabetes is often referred to as a “disease of compromise.” Balancing independence with the necessary support can help teenagers successfully manage their diabetes during these challenging years.