diabetes

[momofdiabetic]

Dear Dr. Bradley,

I had a couple of comments/questions:

1) I was interested and surprised to read in your book the thoughts of a diabetic teenager. Do you have any more experiences to share with us about raising teens with diabetes and other chronic illnesses? I’d be very interested.

2) Parenting books often make the distinction between how a parent should handle life-threatening activities and non-life-threatening issues. Do you think there are some important differences for parents to keep in mind when the teenager has an illness such as insulin-dependent diabetes?

For example, activities such as experimenting with alcohol or drugs can impair a diabetic’s hypoglycemia awareness. Simply not planning ahead and having a severe glucose low in a place where there is no one capable of helping the diabetic teenager could be life-threatening. A teen impulsively running away for the night (“don’t forget your meter and your juice boxes!”). A teen refusing to take their insulin or eat (“I’ll just wait until you pass out, then I’ll call the ambulance”).

I have, for the most part, concluded that I have to let my diabetic teen make mistakes, even if these mistakes might be fatal. I do discuss possible consequences of activities he is thinking of doing, but he brushes aside my concerns. He’s only had one crisis (involving alcohol), and he admitted it was a good lesson. We do discuss a lot of things, and overall he’s a pretty good kid and mostly on the right track. But the diabetes always adds extra risk to anything he does, even activities like going swimming, a hike in the wilderness, downhill skiing, driving, …. because of the chance of hypoglycemia. Preventing it takes planning ahead and stopping to test and eat. Not something a teen usually wants to do when he’s having fun or his peers are around to gawk.

[Mike Bradley]

Dear Mom,
What a great question! Yes, kids with serious chronic illness pose a whole bunch of added challenges through adolescence as you noted so well. In general, they grow to despise their illness as a controlling, intrusive force in their lives that they hate. Adolescence is the time when they try and separate themselves from controlling influences. The disease can mimic all the things they can hate in us as parents at times, and they start to rebel against the disease as they would against over-controlling parents---using denial, limit-testing, and outright defiance. That stuff usually won't kill a kid when it's directed at a mom, but it can when it's aimed at a disease. So what do you do?

Your answer was great as well. You recognized that there are limits to what you can do, even in the face of some life-threatening situations. You see that if you push too far, you can get a "diminishing return" where the more you push your kid to monitor his sugar, the less monitoring he'll do. You start to take some risks where your son gets sick but perhaps learns a lesson and takes more responsibility for his health. Finding that critical balance point of where you control him, and where you let him roll dice (learning versus dying) is why you get paid the big bucks for parenting. Each kid and each situation is different, and you, mom, get to toss and turn all night figuring out what your best response is. The fact is that with teens there rarely are "good" responses, only least risky ones.

My final thought is to take this kid out for a coffee, and talk from your heart about your dilemma, without looking for some perfect solution. Perhaps tell him you're not looking for an agreement, just an ear. That you want him to know what's in your heart about him and his illness, so he can make the best decisions he can.

Good luck and please keep us posted.
Attention other parents of kids with chronic diseases: Any thoughts?

Mike Bradley