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Teens with diabetes pose unique challenges for professionals working in diabetes care. Possible challenges range from the teen diagnosed with diabetes as a child who was previously a model patient and now struggles with his or her diabetes care, to a young person diagnosed with diabetes during adolescence who is struggling to integrate diabetes care into the “normal” life of a teen. We have found that many well-intending health care professionals fall back on the old strategy of “scared straight” as a means of trying to get teens to take better care of their diabetes. In essence, the scared straight approach involves lecturing teens about the likely long-term consequences of not taking care of their diabetes, including retinopathy, gangrene, and kidney failure. Yet we know that teens often are living in the now and are less worried about potential consequences down the road than adults.
The other common strategy we have observed many health care professionals using is to shift the focus to the parents and encourage them to take control of their teen’s diabetes care. Unfortunately, this approach, as most developmental psychologists know, is counter to the developmental demands of adolescence. To ask teens to accept parental control over domains they had previously controlled is akin to getting your driver’s license and then being told you cannot drive. This strategy is doomed to fail because most teens are seeking greater independence from their parents and are not receptive to handing control back to them. Any attempts by parents to take the control back are met with a high degree of resistance. A confluence of normal development, a complex medical condition, and frustrated professionals creates a perfect storm. The teens with diabetes and their families are unhappy, and the professionals working with teens with diabetes are frustrated. Ultimately, the aforementioned scenario results in poorer diabetes self-management and poorer metabolic control for teens with diabetes. Thus, we have written this book to address this very challenging population in hopes of improving care delivered to teens with diabetes and, in turn, improving the health behaviors and health status of teens with diabetes.
Collectively, our experiences with families of teens with diabetes have taught us valuable lessons. In this book, we provide professionals with a developmental framework for a better understanding of the normal developmental demands of adolescence and how those normal developmental demands may impact the management of diabetes during adolescence. Within this developmental framework, we also provide strategies for negotiating the many challenges of providing care to teens with diabetes. We identify common teenage issues (e.g., sexuality, smoking, drugs/alcohol, and depression) and discuss how they can be exacerbated by diabetes. Finally, we review subjects specific to teens with diabetes, such as insulin pumps, continuous glucose monitors, diabetes advocacy, and the transition from pediatric to adult diabetes care.
In each chapter we provide an overview of the interactions between development, diabetes, and family. We present case examples to further elucidate the issues, and then we provide suggestions for both assessment and intervention. This book is best used as a reference guide for professionals working with teens with diabetes and their families. Although some of the topics are unique to current approaches to diabetes management (e.g., technology and diabetes care), the bulk of the information provided is timeless and applicable to adolescents dealing with other complex medical conditions.
Michael A. Harris, PhD
Harold Schnitzer Diabetes Health Center
Oregon Health & Science University
Korey K. Hood, PhD
Madison Clinic for Pediatric Diabetes
University of California, San Francisco
San Francisco, California
Jill Weissberg-Benchell, PhD, CDE
Lurie Children’s Hospital