I am a 16-year-old with type 1 diabetes living in a major metropolitan area in Colorado. I run for the cross-country and track teams at my high school, play flute in the band, and work in an ice cream shop. When I was diagnosed with type 1 diabetes at age 12 in 2019, I experienced a maelstrom of scary medical care, new medical terms and devices, and many new people. After two long visits to the emergency department, I spent several days in meetings and classes with health care providers, learning about how to survive with type 1 diabetes. However, surviving is not the same as thriving. Thriving involves managing my blood sugar while also getting to feel like a regular kid not limited by diabetes. Scientists and clinicians have already identified some of the protective skills that can help adolescents thrive (1–3), although there is more to learn. This essay builds on previous work by adding a first-person perspective from a teenager with type 1 diabetes. To thrive, I first had to develop strategies and learn how to access diabetes-related resources. I want to share what I have learned, with a focus on resources in my environment that helped me thrive (Table 1).
Resources to Help Adolescents With Type 1 Diabetes Thrive
| • Specialized diabetes health care team |
| • Teamwork with coaches to ensure safe exercise |
| • Adults who normalize diabetes responsibilities |
| • School resources, including engaged teachers, consistent school nursing care, and a medical 504 plan |
| • Peer support, including patience and awareness of diabetes management responsibilities |
| • Technology devices that improve blood sugar management and quality of life |
| • Specialized diabetes health care team |
| • Teamwork with coaches to ensure safe exercise |
| • Adults who normalize diabetes responsibilities |
| • School resources, including engaged teachers, consistent school nursing care, and a medical 504 plan |
| • Peer support, including patience and awareness of diabetes management responsibilities |
| • Technology devices that improve blood sugar management and quality of life |
A specialized health care team forms the bedrock of my ability to thrive with diabetes. In my case, this team includes a pediatric endocrinologist; a dietitian, who helped me think about which foods to eat based on the carbohydrate content; a certified diabetes care and education specialist, who answered 10–20 questions per day by e-mail in the first few weeks after I was diagnosed; and a social worker, who encouraged my family to minimize conflict around blood sugar management and share diabetes-related responsibilities so I wouldn’t “hate” having diabetes or feel isolated or burned out. Discussing the long-term complications of not controlling my blood sugar with each person on the health care team motivated me to follow their teachings and advice. Problem-solving in type 1 diabetes is a unique situation; the strategies my health care team taught me are not things my family would have figured out on our own.
Exercise Safety and the Importance of Knowledgeable Coaches
Exercising safely with type 1 diabetes can be like running a four-person track relay with only three runners. Because exercise can cause blood sugar to drop rapidly, it is important that high schoolers with type 1 diabetes who play sports have coaches who are informed about how to best support students with type 1 diabetes.
When I first started going to cross-country running practices, no one on the team, including the coaches, had any knowledge of how to support me as an athlete with diabetes. Unsure of roles and responsibilities or how to navigate requesting extra support, my parents initially felt the need to stay at practices themselves in case of emergency. By the next season, though, my family had learned how to better advocate for me; the solution was that the school nurse delivered an education session to the coaches so they knew the symptoms of low blood sugar and how to administer glucagon if necessary.
Training for coaches about how to support athletes with type 1 diabetes, provided by a qualified nurse or educator who works for the school district, should be mandatory, standardized, and automatically initiated every time a student with type 1 diabetes joins a sports team. Such a policy might have reduced my embarrassment over having to ask my coaches to take extra time to learn about how to help me and made the prospect of my joining a school sports team much less stressful for my family. After the training session, I also worried less about safety issues, knowing my coaches would know how to help me in an emergency. In fact, the SEARCH for Diabetes in Youth study recently showed that fear of hypoglycemia is greatest in youth with the highest levels of vigorous physical activity (e.g., high school athletes) (4), suggesting that the most physically active kids may need more support. Additional benefits of implementing this training at my school included fostering awareness and a culture of supportiveness. For example, when my blood sugar was high at a track meet, one of my coaches offered to sit with me, even though I reminded him that there were no immediate health concerns with hyperglycemia. I also am lucky to have compassionate coaches who frequently but casually check in with me about my blood sugar.
Day-to-Day Help From Other Supportive Adults
Coaches are not the only adults who have helped me to thrive with diabetes. My seventh-grade English teacher did not allow anyone to eat or drink in her classroom, except for me, if I needed to treat a low blood sugar level. Once, when my blood sugar had gone low in her class and I treated it by drinking juice, one of my classmates, who did not yet know I have diabetes, asked my teacher, “Why is he allowed to drink that?” Immediately, my teacher responded sarcastically, “Because he’s my favorite.” This witty response not only protected my privacy around my new diagnosis, but also gave me early confidence in performing diabetes-related tasks in front of others. In the weeks immediately after my diagnosis, I was worried about how checking my blood sugar or giving myself insulin in public would be perceived by others. I was especially concerned about situations such as this one, in which I was granted seemingly unfair exceptions to rules. However, my teacher showed me that this was not something I needed to worry about, as long as the adults in my environment were prepared to support me.
Another kind of supportive adult are my friends’ parents. When my friends and I had our first sleepovers after I was diagnosed, the hosting parents met with my mom for almost an hour to talk about how they could help me manage my blood sugar and what to do in the event of an emergency. If the hosting parents had not been so receptive, I might not have felt comfortable going to sleepovers, and I would have missed out on a quintessential childhood experience.
The Need for Improved Continuity of School Nursing Care
School nurses have the potential to be among the most supportive adults in helping teens with type 1 diabetes thrive. My school nurse both minimizes interruptions to my learning and keeps me safe. When I leave class to go to the school nurse for a low blood sugar, it is because I am moderately symptomatic. Whether or not to go to the school nurse for a low blood sugar is a difficult decision because I do not enjoy missing class, but I am also concerned about the possibility of an actual emergency. Unfortunately, my school has had about 10 different nurses in the 2 years I have been there. Each time a new nurse starts, I have to reintroduce myself, exchange contact information, explain my philosophy and practices around blood sugar management, and develop an individualized plan for managing low blood sugars during school hours. Advocacy groups such as the American Diabetes Association (ADA) should promote continuity of school nursing care to reduce the burden on students for in-school diabetes management.
Teachers’ Engagement Could Strengthen School Care Plans
A medical 504 plan, named for Section 504 of the federal Rehabilitation Act, is a document shared with my teachers that details accommodations related to my blood sugar management and helps to ensure that I will have academic opportunities equal to those of my peers without diabetes. I review and update this document in yearly meetings with my school counselor and school nurse. This plan has been valuable in ensuring that I receive all of the classroom accommodations I need, including a “stop-the-clock” option to manage my blood sugar if it goes low during a test, the ability to eat or drink if my blood sugar goes low in class, and permission to check my insulin pump and phone during tests to see my blood sugar.
However, although the 504 plan has been a great resource, the process of implementing it could be stronger. For example, the ADA website guidance on 504 plans includes a list of typical provisions. One such provision is that “all school staff—including teachers, coaches, and bus drivers—who interact regularly with the student know how to recognize high and low blood glucose levels and respond appropriately” (5). For me, there was a breakdown somewhere between the ADA website and my initial experience with school sports.
Teachers who are prepared (i.e., those who have gained the knowledge and have a helpful attitude and behaviors) can help students with type 1 diabetes thrive. During an overnight school trip I went on as a high school sophomore, my teachers got a key to my hotel room, and we gave them my parents’ phone numbers in case of an emergency. However, as supportive as my teachers—or others—try to be, their ability to help someone with type 1 diabetes can be limited by their lack of knowledge. Although all of my teachers know I have type 1 diabetes, none of them are trained in the management of hypoglycemia—urgent or otherwise. One time, when my blood sugar went low in one of my classes, my teacher offered me a granola bar. I told her I needed juice for faster treatment. Clinicians should recommend that adolescent patients who are newly diagnosed with type 1 diabetes or their parents ask the school nurse to deliver a training session to the teachers as well as coaches. However, for such sessions to be effective, the teachers must be willing to take time to learn about the supports already in place for teens with type 1 diabetes.
Peer Acceptance and Support Resources Are Essential
Supportive peers are instrumental to me feeling comfortable with type 1 diabetes. Anyone who has met teenagers knows they can be quite ravenous. So, during lunchtime at school soon after I was diagnosed, one of my friends was quite surprised when he saw me waiting to eat. He asked me why, and when I told him I needed to wait to eat after dosing my insulin to give the insulin time to act, he began waiting with me. Now, when I am waiting to eat after dosing insulin, many of my friends do the same. This support normalizes my diabetes management and makes me feel more comfortable doing everything I need to do to keep my blood sugar in range and meet my A1C targets.
Research studies echo my personal experience. In type 1 diabetes, emotional support from peers can help to facilitate good self-care, and this may be especially important for teenagers because we highly value our friends’ acceptance (6). Clinicians should give new patients guidance on how to tell their peers about the diagnosis and how to talk to their peers about ways they can help. You may find it interesting to hear that I don’t know any other kids with type 1 diabetes. There are peer support groups and a diabetes camp nearby, but that’s not always ideal for introverted kids like me. One thing that has helped me and my family is diabetes-related online resources (e.g., websites, social media, and podcasts). Sometimes we use these resources to get specific information, such as a travel packing list or updates on new technology, but mostly, these resources help me feel less isolated because I see that other families are struggling with the same things we are. It is important to let patients know that these resources exist and which ones provide reliable information. Health care providers may want to track these online resources to learn about teens’ authentic experiences that may not be shared in a clinic visit because of time constraints or fear of being judged.
Access to Diabetes Technology Can Make Things Easier
Technology related to my blood sugar management is an influential part of my life; in fact, I rely so heavily on technology that I have practically become bionic. Although insulin syringes and fingerstick glucose monitoring remain invaluable tools for many, teens can gain added benefit from two crucial technology devices: a continuous glucose monitor (CGM) and an insulin pump. These tools have improved not only my blood sugar control, but also my quality of life. By replacing 15–20 fingersticks per day with painless blood sugar readings every 5 minutes, the CGM has made diabetes control more convenient and straightforward and less stressful. For example, the CGM allows my family to worry less about out-of-range blood sugars when I am driving, sleeping, or distracted. Similarly, when I first started using my insulin pump, going from 10 shots per day to zero made diabetes management more automatic and painless to help me avoid burnout. As recently as 2023, new advancements allowed me to dose insulin from my phone instead of my pump, making blood sugar management less conspicuous; I no longer have to worry about questions from peers, which can sometimes still feel too personal.
The advantages of pumps and CGMs have been reported in research studies and include benefits such as feeling safer, sleeping better, being more independent, taking fewer injections, and having better overall quality of life (7). Clinicians should educate new patients on the benefits of these devices. Although I feel privileged to have access to these resources, I realize that not everyone has the same access. Advocacy groups should do more to ensure that beneficial technology devices are available to all patients who want to use them.
Diabetes Management Is A Family Affair—Even for Teens
There are many critical resources and supports inside my own home that have helped me thrive with diabetes. Some of these are my own motivation to control my blood sugar and my parents’ interest in making sure I follow all of the recommended behaviors, such as reminding me to bolus before meals. Despite having type 1 diabetes for 4 years, I still occasionally forget to dose insulin! When I begin to feel the effects of diabetes burnout, my parents step in and temporarily take over my blood sugar management. When this happens, I gratefully let my parents count carbs, bolus insulin, or bring me juice when I am low. If my parents didn’t help me prevent burnout, I might begin to lose my internal motivation to follow the recommended practices (such as premeal bolusing) that keep my blood sugar in range. My brother, who is 2 years younger than me, also does a few things to help me keep my blood sugar within range. When I was newly diagnosed, he checked on me when we were home alone. He also waits with me to eat after I take my mealtime bolus and motivates me to exercise when my blood sugar is high by going for a run with me. Clinicians should suggest that siblings be included in some of the initial diabetes education so they can better understand how to support their sibling with diabetes.
My parents, along with my endocrinologist, do a few other things to help me maintain my internal motivation to keep my blood sugar in range. When I receive positive validation for keeping my blood sugar in range from my parents or meeting my A1C goal from my endocrinologist, I associate managing my blood sugar with excitement rather than irritation and frustration. Clinicians should provide positive feedback to patients for any behaviors they want to reinforce. Furthermore, during the initial patient education after diagnosis, clinicians should encourage parents and other family members to give positive feedback for both big and small wins.
Continuing to Thrive Into Adulthood
This essay describes the external resources that have helped me thrive in early adolescence, but the types of resources I need may change over time. I wonder what new resources and strategies I’ll need when I go away to college, travel without my parents, advocate for myself in my future jobs and career, and take financial responsibility for diabetes-related expenses as I move off of my parents’ health insurance plan in the next decade. A few studies have shown that I am not the only teen thinking about these issues (8,9). More studies are needed to identify opportunities to intervene.
To survive, I require basic necessities, such as an endocrinologist, insulin, and a glucose meter. To thrive, I’ve needed and will continue to need a specialized health care team, supportive adults in all facets of my life, diabetes technology, and systems in place that enable many people to advocate for me. When I thrive with diabetes, I manage my blood sugar while still doing all of the things I love.
Article Information
Duality of Interest
No potential conflicts of interest relevant to this article were reported.
Author Contributions
As the sole author, N.J.B. wrote and revised the manuscript and is the guarantor of this work. As such, he takes responsibility for the integrity and accuracy of the content.
