What is normal for a teen with diabetes?

by Doctor D, MD

A teacher asks Doctor D about a diabetic teenager in his class: “His sugar readings are often over 400. His mom says this is normal. Can this be normal?”

What is normal?

a) A state of harmony within the body and mind that leads to health and well-being.
b) The typical or status quo for a person; the way things usually are.
c) WTF? There is no such thing as “normal” for a teenager in the clutches of puberty.

I’m guessing that mom meant something between B and C.

The trials and tribulations of puberty

The teen years are some of the toughest in a life. You suddenly realize that you are no longer a child and find yourself drowning in a sea of raging hormones. You don’t want to hear your parents advice or follow their rules, you are desperate to fit in with your peers, you feel invincible, and you can’t wait to take risks (especially the ones adults tell you not to). The only people more stressed than teenagers are their parents.

Now add to a chronic illness to all the “normal” teen drama and you have a really volatile mix! If having a chronic illness and being dependent on doctors, tests, and treatments can push even a stable, well-adjusted adult to the limit, just think of the havoc it can wreck when you are 13!

Type I diabetes is a perfect example of this

Patients are often diagnosed as small children. They often don’t remember a time they weren’t constantly counting carbs and taking insulin under their parents direction. Doctor D has seen it again and again: a diabetic kid does fine until about 13 when they suddenly decide they have to live a “normal” life. The teen acts as if there is no illness and begins ignoring all the rules that keep them alive. In my experience chronically ill teens have difficult identity issues and can be in dangerous denial about the seriousness of their illness.

Parent during these times get frustrated and burnt out. The harder they try to manage their teen’s illness the more the child resists.

These power struggles between parents and teens happen in most homes, but when the teen has a serious chronic illness the tension can rise astronomically!

So why did Mom say everything’s okay?

Parents of chronically ill teens often feel helpless and very guilty that they cannot protect their kid’s health the way they used too.

A teacher asking about his illness could be a very sensitive issue for the the teen and the parent. I can understand the mother just answering “oh that’s normal for him” to avoid discussing the extreme stress and difficulty of the situation.

Sometimes when everything’s going to hell in a handbasket it’s easier just to pretend we’re all fine.

So you really want to help?

But if you know things really aren’t fine, and you’re someone like a relative, teacher, doctor, counselor, friend, etc. you really should try to help the frustrated family.

Here’s how you offer assistance without making things worse:

  1. You must be sensitive to what the teen and the parents are going through. If you act like you are just going to ride in on your white horse and save everybody you will get shut out by the parents and teen pretty quick. (Doctor D has learned that one the hard way!) Start by acknowledging how difficult the situation is to both the teen and the parent.
  2. Make it clear that you will protect their privacy. The teen should know you won’t embarrass them in front of their peer by exposing their illness against their will. The parents should know you won’t shame them as bad parents because their teen’s care isn’t working.
  3. Talk to them like they are normal. Even sympathy can be irritating and isolating for a family dealing with chronic disease. Talk to the teen and the parents like you are talking to normal people dealing with normal problems.
  4. Use your strategic position. Parents and teens often struggle to a stalemate. Being neither the parent nor the teen offers you a huge tactical advantage for breaking the deadlock. Let’s say you’re an adult such as a teacher or doctor. Sure you’re authority figure, but you aren’t the parent therefore the teen is much more likely to listen to your advice about sticking with treatment. So many of the stresses in a teen’s life are social so if you are in or around the social environment you may be in a unique position to explain the stresses the kid is going through to the parents. If you are a peer then you can help the teen “normalize” their chronic illness and see that it’s not something to be ashamed of. Being a semi-independent semi-adult is a weird state that strains the therapeutic partnership with the parents that previously worked so well for the chronically ill child. As an outsider you can help both parties create the new strategy that will help the young person manage their disease for years to come.
  5. Be patient. Unhealthy patterns usually don’t straighten out overnight. Nor do strained relationships between chronically ill teens and their caregivers. Often breakthroughs are followed with setbacks. Take the long view and remember the tumultuous teen years don’t last forever.

“Doctor D” is a physician who blogs at Ask An MD.

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