Teens with Diabetes. Michael A. Harris

diabetes, and restricting what types of food they can or should eat will contribute to a backlash, with the teens eating more of the foods we would encourage them to limit and/or not telling anyone what they are really eating.

      Many health care providers, as well as parents of teens with diabetes, say that teens don’t care about their diabetes. As with many of the other things that are said about teens with diabetes, this statement is factually inaccurate. Not caring about one’s diabetes would translate into not doing anything to care for one’s diabetes, such as not taking any insulin, never checking blood glucose levels, eating whatever and whenever, and never obtaining medical care for diabetes. This just doesn’t happen in diabetes. What does happen is that teens don’t adhere at the level that medical providers and parents would like them to. Instead of five or seven blood glucose checks per day, a teen may be checking his or her blood glucose five or seven times per week or per month. This reflects less-than-optimal self-care, but it also reflects an effort on the teen’s part to care for his or her diabetes. This may seem insignificant to most health care professionals working with this population; however, any self-care effort represents an opportunity to reinforce a teen for doing the right thing. Most interactions between health care professionals and teens with diabetes are void of anything positive unless the teen’s metabolic control is in the 7% range, which is unlikely.

      Reinforcing a teen for even showing up to clinic represents a move in the right direction and provides leverage for improvements in health behaviors. As one of our beloved colleagues (Dr. Richard R. Rubin) often said, there is only one acceptable response when a person checks blood glucose (regardless of the number on the meter at the time): “Thank you for checking.” It is the behavior of checking that we want to reinforce, as such acknowledgement increases the chance of that person checking again.

      Having a patient take sole responsibility for diabetes should not be a goal of any diabetes clinic, regardless of the age of the patient. Yet providers and parents often talk about the need for teens to “take responsibility” for their diabetes. What does this mean? In most cases, it means that teens should do all that is necessary for optimal diabetes care completely by themselves without anyone reminding them of what they need to do. Because teens are sensitive to the words we use, the need to “take responsibility for diabetes” is heard as “You are irresponsible.” Teens lose their house keys, forget homework assignments, oversleep, etc. Why would anyone expect them to treat diabetes-related tasks differently than other tasks?