General Characteristics

Impact of Diabetes

How to Approach

Worry about appearances/self-conscious

• Not wanting others to see fingersticks, injection sites, or medical bracelet
• Worrying that hypoglycemia will happen around friends or during sports

• Offer alternatives to traditional ID tags (like shoe tags)
• Use self-consciousness as a motivator to rotate injection sites
• Use hypoglycemia as a motivator for proper blood glucose testing

Hormonal changes

• Having blood glucosefluctuations
• Increasing insulin resistance
• Mood changes can mimic hypoglycemia

• Using pre-loaded insulin pens or pre-mixed insulin to deal with rapidly changing blood glucose levels
• Modify sick day rules
• Monitor blood glucosemore often

Assert independence from family

• Skipping insulin shots
• Ignoring meal plan
• Not ready for independent self-care
• Being upset with overprotective parents

• Use “experiment” approach: teens test out behavior with support and guidance from team
• Have teen see diabetesteam alone
• Modify/simplify meal plan
• Counseling for parents on changing roles

Are rebellious and defiant

• Refuse diabetes self-care
• Hate reminders
• Take out anger on parents or school teachers

• Provide counseling
• Teach how to deal with anger

Place importance on peer relationships

• Peers take priority over self-care
• Child hides diabetes
• Child uses diabetes to establish role within group

• Discuss setting priorities
• Plan for when diabetescare comes first

Question why things happen

• Ask “why me?”
• May experience depression

• Offer counseling or find peer support
• Look into diabetescamps

Aren’t thinking about the future

• Don’t think about long-term complications of diabetes
• Focus on immediate concerns

• Avoid scare tactics

Are aware of emerging sexuality

• Wonder if they are more at risk for STDs or AIDS
• Wonder if they will be able to have children or be good parents

• Health care provider should talk with child

General Characteristics

Impact of Diabetes

How to Approach

Have increased ability to compromise

• Can make more decisions about diabetes care

• Include teens in decisions
• Negotiate and use behavioral contracting

Are more independent

• Can better understand the relationships between exercise, diet, and insulin

• Give more advanced diabetes education

Feel stressed by social, school, and family responsibilities

• Stressed teens may eat more, which can result in weight gain or less controlled blood glucose
• Teens trying to manage stress with physical activity may have low blood glucose events

• Teach stress management
• Assertive communicating training

Test boundaries and take risks

• May try drugs, alcohol, smoking, unprotected sex
• May skip medication

• Educate on teen issues
• Discuss logical consequences

Are figuring out what’s important to them

• Are determining how diabetes fits into their life

• Meet with a life coach or diabetes coach to help clarify values

Are learning to drive

• Can experience low or high blood glucose which may impair driving ability

• Educate on safety: checking blood glucose before driving, having fast-acting glucose sources in the car
• Drive with someone else in case of emergency