Parents Must 'Draw the Line' With Diabetes Control

Jan. 25, 2008— -- In matters ranging from curfews to car privileges, teens and their parents throughout history have been natural enemies. But for families managing a chronic disease like diabetes, the expected challenge of raising a teenager can be even harder to prepare for.

Children begin to crave more independence and privacy during adolescence. During this period, parents generally pull away and allow their teens additional freedom. But for parents with diabetic kids, pulling away too quickly may present a potentially hazardous situation.

"We need to protect [teens with] diabetes from this general parent pull out, [because] parent involvement is essential for an adolescent to do well with diabetes," said Barbara Anderson, co-author of a 2002 study titled Family Conflict and Diabetes Management in Youth.

Especially as children enter high school, "their schedule is a little more erratic, they have more freedom ... and there happens to be a lot of bake sales," said Deb Okell, whose 15-year-old daughter, Amy, is an insulin-dependent diabetic.

But often, for kids who have lived with diabetes for many years, parental control can be particularly frustrating. "I'm not stupid!" or "I've had this for years ... I got it!" are common retorts.

Just ask Aaron Hoffman, a 15-year-old type 1 diabetic, whose mother, Holly Bennett, participates in his routine to control his condition.

"[My mom's] always ... giving me suggestions for new things to do that I don't really care about," Hoffman said.

And equally irksome for teens is the sense of worry parents can impose.

"Just the way [my mom's] thinking about [diabetes] doesn't make sense to me, and it irritates me," said Hoffman. "Like, she thinks it's more of a problem, when I'm high or low, than I do."

For others, constant food monitoring can become an issue.

"It can get really frustrating when my parents tell me not to eat something, like candy ... because I want to eat what I want to eat," said Amy Okell.

"Her thing was, 'I know what to do ... don't bug me,'" Deb Okell said.

Supervision From Afar

But Deb Okell said she has learned some helpful strategies to ensure that her daughter is keeping her condition in mind, while keeping a healthy distance.

Since teens, who strive for independence, often spend more time with friends and fewer hours at home, Deb Okell said she has tried to "enlist [Amy's] friends to encourage her to test her blood sugar ... they've grown up with her, and they understand," she said.

And while it isn't a completely problem-free arrangement, Amy said she appreciates her mother's efforts.

"Sometimes, I can get frustrated when [my mom] talks about it around them, because it makes me feel different; but it's also good, because I can be irresponsible at times," Amy said.

Bennett employs a different strategy with her son. She said she has created "a division of labor" to keep his blood sugar under control.

"Recording all the [blood sugar] numbers is just a real onerous, stupid job that he doesn't like to do, so I do that," Bennett said, adding that Aaron is "the 'pump wizard,'" taking care of his daily insulin intake with the popular device.

The plan works for Hoffman, suggesting that, by asking teens what they need help with, rather than taking over several tasks, parents may be able to avoid confrontations.

"That's definitely one reason that I don't mind having her [involved], because she does a lot of the work," Hoffman said.

A Healthy Dose of Parenting

Facilitating teamwork through proper communication is also necessary. Working together to author their 2002 study at Boston's Joslin Diabetes Center, Anderson and her colleague Lori Laffel, chief of the pediatric, adolescent and young adult section at Joslin, found that parent involvement has major health benefits.

The study concludes that patients, whose parents took on a greater role in diabetes management, were "more adherent to blood glucose monitoring, and were in better glycemic control."

"It is not an option to have parents totally uninvolved," Anderson said, adding that parents should try "not to see their teen as a blood sugar number, but as a normal adolescent who happens to have a chronic disease."

But where should parents draw the line?

"You want to provide support and a little bit of supervision," Bennett said. "But you have to kind of acknowledge that [teens] are competent and can handle it."

In the Okell household, reviewing the consequences of poor control remains an important management tool.

"Yes, it's your life, but look what could happen here," Deb Okell urged.

And Amy Okell admitted that, though sometimes hard to digest, a grim reminder can be effective. "It can be hard to think about that, because I don't want to think I'm different, [but] it's a good thing to know about all the complications," she said.

But for some teens, threats of future complications may not be enough to influence current behavior. Instead, social restrictions can be helpful.

Cindy Maher, whose 16-year-old daughter Monica has type 1 diabetes, used this tactic to deal with the ever popular sleepover.

"If [Monica] does spend the night someplace, she tests [her blood sugar] at midnight and calls with her number," she said. "If she did not call, then she would have to come home."

Getting Help When Needed

Even when dealing with cooperative teens, parents may find raising a diabetic to be an overwhelming task. If so, Anderson noted, "a health care team can do a lot to help diffuse the tension."

Trained professionals can often help parents become more informed about the condition and its treatment. And for a generation, obsessed with new technology, always being in tune with modern treatments is important.

Hoffman said that if teens know their parents are well-versed on the latest findings and technology, they may be more willing to trust them to help with diabetes control.

"It's important [for parents] to actually know what they're talking about and learn about it" said Hoffman. "If they knew more about it, they would understand."

Regardless of the strategy, parents would do best to show their teens that they are pitted against a common enemy — and not each other.

"Diabetes is very much a disease that needs to be managed with a team approach," said Gina Gavlak, diabetes program development coordinator at Lakewood Hospital in Cleveland, Ohio.

Laffel agreed. "Diabetes is not a do-it-yourself disease, no matter what your age."