# Non-Compliance In Teenage Diabetes



## StephenM (Apr 30, 2013)

Non-compliance in teenage diabetics has always been a problem. However for various reasons the problem seems rather worse these days. The teens are difficult years as you enter them immature physically, mentally and sexually and leave them mature (hopefully) in every way ? the transition from childhood to adulthood.  Added to this there are raging hormones, spots, exam pressures and the desire to sleep 12 hours a day.

When I was young it was not uncommon to be admitted to hospital for a spot of re-stabilisation. The fairly inaccurate urine testing of those days meant that  an infection or stomach bug could result in a few days stay in hospital as control disappeared out of the window. Somehow I managed to avoid too many stays in hospital. Whilst I did eat and/or drink to much at times this was mopre of a one off than a regular occurrence.

So why does hospitalisation (although usually for shorter periods than when I was a teenager) for teenage diabetics seem more common these days? I do wonder if it is that the tighter control achievable these days results in a greater teenage rebellion. It also seems that parents take control of their children?s diabetes for longer these days. Is it that the plan has been agreed between the consultant and the parents with the teen as a mere, possibly resentful, onlooker who has had no buy in? And what part does peer pressure pay?

What I want to do is throw this open to discussion and debate as members may have been teens in any of the last seven decades, and others parents to a diabetic child/teen in that time. Observations and thoughts please.


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## Northerner (Apr 30, 2013)

Is it more common for teens to be hospitalised these days? I don't know - what makes you feel this might be the case?


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## Caroline (Apr 30, 2013)

I think in general our expectations have changed so things are done differently. I'm not sure teens spend any longer or go there any more often than when I was a teen, but things change withthe times.


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## delb t (Apr 30, 2013)

Our son was not hospitalised- and I am thankful for that  although Our team always say that they do have more difficulies with the secondary age children.What makes you think children have been hospitalised - do you have some statistics? maybe its because parents/doctors are unaware of the symptoms- I know i was unaware  so perhaps thats a reason and just to add my son has taken a mature and responsible approach to his diabetes I am so thankful for that. I dont think you can make a sweeping statement that parents take more control over their childs diabetes -we work with our son to get the best for him. these kind of statements are not what we need in a support forum!


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## Redkite (Apr 30, 2013)

I haven't seen anything to indicate that type 1 teenagers are more likely to be hospitalised today than their counterparts in the past.  But there's no denying that the teenage years are a challenging time, and made all the more so with D in the mix!

What's different?  Better treatments (MDI and insulin pumps) have come along, together with BG meters, and with these have also come harder work and a proliferation of protocols for optimal diabetes management.  So one could argue that managing diabetes is less "easy" than it was in the 70's and 80's.  Unfortunately, most school staff (and many non-specialist medical staff) have no knowledge of these newer regimens, and view children/teens using intensive therapy as having "severe" or "badly controlled" diabetes!  This type of ignorance can leave a young person feeling criticised rather than supported.

More generally, today's generation of teens are exposed to far more pressure than was the case in my day (before the advent of the Internet, mobile phones, social media, etc.).  One hears far more stories of young people self-harming or struggling with eating disorders, and in the case of teens with diabetes, they obviously have an extra method to self-harm, ie insulin.  Cases of diabulimia seem to be reported more frequently.

As a parent, I would hope to maintain a good relationship with my son through the teen years, supporting him as he becomes independent at his own pace, and making sure diabetes doesn't hold him back.  His BGs are just data, we never speak of them as good or bad numbers, they are just data to be used to know what action to take.  Diabetes is a small part of the whole person.  His clinic team will see him alone for part of his appointment, then together with me for the other part, but even as a child the consultant has always spoken with him first, before talking to me.  We are lucky with our team, some others are appalling!

How were your teenage years Stephen?


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## Pumper_Sue (Apr 30, 2013)

> So why does hospitalisation (although usually for shorter periods than when I was a teenager) for teenage diabetics seem more common these days? I do wonder if it is that the tighter control achievable these days results in a greater teenage rebellion



You have to remember that today's advances in diabetes care mean a lot more injections and blood tests. Which to anyone is overwhelming but teenagers it would be even worse. How many teens actually want to see their results good or bad in black and white in front of them? Thus compliance would be an issue. Also the medical peeps have more awareness and can act a lot sooner so some admissions can be just a precaution.

Saying that have you any stats to show that there are more admissions in this day and age?

In yours and my day it was have your jab/s and out the door. Wee test when you got up and before bed and set carbs for meals. That was diabetes care, ie, no worries 

After 48 years on insulin I have never been admitted to hospital for any diabetes related condition


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## mcdonagh47 (Apr 30, 2013)

StephenM said:


> Non-compliance in teenage diabetics has always been a problem.
> What I want to do is throw this open to discussion and debate as members may have been teens in any of the last seven decades, and others parents to a diabetic child/teen in that time. Observations and thoughts please.



it seems to have always been the case that teenage girls have been reluctant to inject too much insulin because they fear it will lead to weight gain. They are being inundated even more today with body images that are inappropriate and unachievable for most people ( e.g. stick insect models).


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## DeusXM (Apr 30, 2013)

I don't know whether things have got worse or not. I would say there's always a high level of non-compliance in teenagers though and much of it might not be related to diabetes. I would imagine teens who are generally well-behaved and don't usually go off the rails are also less likely to be non-compliant in diabetes treatment.

As is being alluded to and tip-toed around, I would suggest (based on my own experiences and nothing else), the longer the parent is the 'responsible' one, the less likely it is that the teenager is going to be trustable on their own two feet. I'm also of the view that if a child is old enough to make a sensible lunch on their own, they're probably capable of managing their diabetes independently. Not being a parent, it's easy for me to say that.

I also think Sue has a point though. Although my experience is a little different from Sue's (when I was dxed we did have self-BG measurements and I was put on MDI within 6 months as it was clear I was already adjusting my doses according to what I was eating), the complications didn't quite seem as life and death as everyone makes out. Yes, it was clear that if I didn't look after myself I would go blind and lose a limb, and I could die in the night from a hypo, but my experience (according to my memory) was far more relaxed. I certainly don't think my parents imagined I was going to die in the night (or at least they did a very good job of keeping these emotionally affective concerns quiet). The basic message from my clinic was always as long as you keep your BG generally under control, you should be fine. I've only got 15 years under my d-belt but so far that seems to be holding true.

My own theory is that teenage rebellion in general is a way of asserting you can make your own choices. I suspect if a kid feels their life choices are limited because they have diabetes, they are far more likely to be non-compliant than the kid for whom diabetes is just a background part of life, rather than some beast that needs fighting 24/7.


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## Ivy (Apr 30, 2013)

My non-compliance as a teenager was due to an eating disorder. I don't know about other people.


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## Redkite (Apr 30, 2013)

Ragnar Hanas says that outcomes are better where parental involvement is maintained during adolescence.  Presumably as a paediatric endocrinologist and as an academic he has plenty of evidence to base that on.  "Don't hand over too soon" is his advice.


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## bev (Apr 30, 2013)

Redkite said:


> Ragnar Hanas says that outcomes are better where parental involvement is maintained during adolescence.  Presumably as a paediatric endocrinologist and as an academic he has plenty of evidence to base that on.  "Don't hand over too soon" is his advice.




Hi Redkite,

Your quite right - at the FFL Conference we were told that after much research it is proven that the longer an adult stays engaged with a Type 1 adolescent the better outcome they have in terms of diabetes burnout and rebelling - especially as the frontal lobe isnt fully developed until they are 25 which means they are not fully capable of taking some risk-taking decisions that give a good outcome.Bev


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## DeusXM (Apr 30, 2013)

> especially as the frontal lobe isnt fully developed until they are 25 which means they are not fully capable of taking some risk-taking decisions that give a good outcome.



Actually, it's only after the 20s when the frontal lobe is fully developed...but by that logic, parents would be caring for their kids until their 30th birthday.



> Ragnar Hanas says that outcomes are better where parental involvement is maintained during adolescence. Presumably as a paediatric endocrinologist and as an academic he has plenty of evidence to base that on. "Don't hand over too soon" is his advice.



I don't doubt this at all - did he specify what he meant by 'involvement'?


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## Redkite (Apr 30, 2013)

DeusXM said:


> I don't doubt this at all - did he specify what he meant by 'involvement'?



No, I guess that's a matter to be negotiated between the parents and the teen with advice from their team.  Some individuals will be more mature than others at an earlier age.  The goal is the same for everyone - a happy and confident young adult coming out the other side!


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## bev (Apr 30, 2013)

DeusXM said:


> Actually, it's only after the 20s when the frontal lobe is fully developed...but by that logic, parents would be caring for their kids until their 30th birthday.
> 
> 
> I don't doubt this at all - did he specify what he meant by 'involvement'?



Isnt that what I said - the age of 25? If the frontal lobe is developed at 25 why would parents still be needed until they are 30 if they are then able to make decisions that involve risk-taking at 25? Confused.


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## StephenM (May 1, 2013)

When I started this thread yesterday it was my hope and intention that it might provide help and information for those whose children are approaching or are in their teens. However, as seems to be the case to often these days people start taking things personally or bowling curved balls! The aspect of over rigid parental control was a suggestion for discussion not a statement of fact. There are studies that have shown that, for instance, children are introduced to small amounts of alcohol during family meals (at say 14 y.o.) are less likely to have issues with the use of alcohol a few years later.

Teenage non-compliance is a problem that has been the subject of at least one TV documentary and a number of newspaper and learned articles. The problem was again highlighted in the post on ?diabulima? yesterday. Eating disorders are more common amongst teenage diabetics, particular females, than non-diabetics. The increase in hospital admissions is somewhat anecdotal but born out in what a friend told me the other day. He belongs to a Patient?s Group. The senior GP of the practice (who never wants to retire) holds traditional values to care and is very much against the Monday ? Friday, 9:00 ? 17:00 attitude prevalent in many GP practices and NHS services. As such he is heavily involved in out-of-hours cover both at the patient?s home and at a local hospital. In a recent meeting non-compliance came up as one member was having severe problems with his son who had been admitted to A&E three times in six months. The GP said that his impression there had been a definite increase of people arriving in A&E as a result of non-compliance whereas when he was younger they often admitted youngsters to hospital due to loss of control and, sometimes, DKA as they did not have BG monitoring or MDI then. These days a person may be discharged from hospital direct from A&E whereas previously it was not uncommon to spend a few days on the ward.

So please can we discuss the issue of non-compliance and ways of addressing it?


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## Lauras87 (May 1, 2013)

When I was diagnosed at 15, I was admitted & the staff didn't know what to do with me as there was no DSN's on a Sunday so was dumped on mixed insulin 2 times a day & I was compliant - I just didn't know what I was doing!
The second time I was admitted was down to the fact my consultant thought I was T2 & took me off my insulin - again not my fault.

And I'd love to do what some teenagers do & not take their insulin but my mum deserves better than finding me in a bad way.

You can't address the issue unless you are going through it yourself & you can't force people to do things against their will even if it will keep them alive.

So unless all parents get power of attorney over their child's body, there will be more statistics.


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## StephenM (May 1, 2013)

Lauras87 said:


> When I was diagnosed at 15, I was admitted & the staff didn't know what to do with me as there was no DSN's on a Sunday so was dumped on mixed insulin 2 times a day & I was compliant - I just didn't know what I was doing!
> The second time I was admitted was down to the fact my consultant thought I was T2 & took me off my insulin - again not my fault.
> 
> And I'd love to do what some teenagers do & not take their insulin but my mum deserves better than finding me in a bad way.
> ...




I like many others on this forum have been a teenage diabetic - you do not have to be going through your teens now to understand issues such as feelings of isolation and peer pressure. The idea of a discussion is to get ideas on how people can be helped through this period with minimal impact on their health.

Sorry to hear that you have encountered incompetent NHS staff. I had issues when one (former for me) consultant decreed that no one should be on animal insulin these days.


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## Lauras87 (May 1, 2013)

StephenM said:


> I like many others on this forum have been a teenage diabetic - you do not have to be going through your teens now to understand issues such as feelings of isolation and peer pressure. The idea of a discussion is to get ideas on how people can be helped through this period with minimal impact on their health.
> 
> Sorry to hear that you have encountered incompetent NHS staff. I had issues when one (former for me) consultant decreed that no one should be on animal insulin these days.



I honestly don't see how you can make them inject if they don't want to.
I meant that & sorry if this comes out wrong but you are maybe in your later years. Your teens will have been different to mine, I was rejected by friends & was pressured to be normal instead of the insulin pen wielding person I am.

As long as its insulin I don't see the problem with it being animal. I'd read that those on synthetic insulin get put on animal insulin in later life, I don't know if that's true.


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## bev (May 1, 2013)

Alex is more than compliant - so no worries there - but interested to know what data you have that shows teenage non-compliance is on the increase in Type 1 diabetics?


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## AJLang (May 1, 2013)

Hi Laura

Different people have different experiences with animal and synthetic insulins.  I know at least one long- standing diabetic on this site who gets on great with animal insulin.  However I found that it was the best thing ever when I went onto synthetic insulin, especially with regard to hypo awareness. Personally I would never want to be put back onto animal insulin.  Also I think us "oldies" can still remember our teenage years with diabetes very well, it wasn't easy


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## StephenM (May 1, 2013)

Lauras87 said:


> As long as its insulin I don't see the problem with it being animal. I'd read that those on synthetic insulin get put on animal insulin in later life, I don't know if that's true.



For some people that were started on animal insulin, particularly those who have been on it for decades, there can be issues with loss of hypo awareness if switched to synthetic insulin. This is the case with me and a of number of others on this forum. Sometimes people who have lost hypo awareness on synthetic insulin are switched over (sometimes as a tempory measure) to animal insulin to increase hypo awareness.


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## StephenM (May 1, 2013)

bev said:


> Alex is more than compliant - so no worries there - but interested to know what data you have that shows teenage non-compliance is on the increase in Type 1 diabetics?



Did you read #15 the whole way through? I am happy for you that Alex is following the rules. A number do not and this is the point of the thread! As in my 'A' level exams - please discuss!


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## Northerner (May 1, 2013)

StephenM said:


> Did you read #15 the whole way through? I am happy for you that Alex is following the rules. A number do not and this is the point of the thread! As in my 'A' level exams - please discuss!



You haven't yet ventured your own views on how things can be improved Stephen - what do you think the problem is, and how it may be tackled?


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## bev (May 1, 2013)

StephenM said:


> Did you read #15 the whole way through? I am happy for you that Alex is following the rules. A number do not and this is the point of the thread! As in my 'A' level exams - please discuss!




Yes I did. The 'impression' of one GP that there are more non-compliance cases in teenagers really isnt accurate data. I was interested to know what figures you have that supports your theory (or the GP's theory) that figures are on the increase.


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## DeusXM (May 1, 2013)

> Isnt that what I said - the age of 25? If the frontal lobe is developed at 25 why would parents still be needed until they are 30 if they are then able to make decisions that involve risk-taking at 25?



Well I was working on the assumption that 'after the 20s' meant 'after the 20s' ie once the person was in their 30s.



> So please can we discuss the issue of non-compliance and ways of addressing it?



My belief (based purely on my own experience and bit of pop psychology) is that  if you transfer responsibility to your teenager, they'll be more inclined to take on the challenge and comply. It's like the alcohol point you mentioned Stephen - you entrust the teen with something 'grown up' and the hope is that they 'grow up' as a result. Obviously it doesn't always work but I think the point that's been made about a care situation where a teen is a passive bystander where diabetes is something that adults do to them, rather than their medical condition they have to manage, is precisely the sort of situation that inflames rebellion.

I suspect as well (if we accept there is a higher degree of non-compliance today) there is a point to be made about intensive treatment. My understanding is that 30-40 years ago, you would be on one or two injections a day without blood testing, so diabetes was in fact a small part of your life. Proportionally today, diabetes takes up more time. Probably every teenager is on MDI at the very least (so now that's a reminder at every meal) plus several blood tests. I'll be honest, the amount of work that diabetes can require depresses me from time to time, and I'm a reasonable approximation of a fully fledged adult. It is a lot harder when you're a teenager particularly if you're led to believe you're living and dying over individual results. It was only after I decided to take a rather different mental approach to my treatment that as a teen I stopped getting all bi-polar over the odd high or low, and my overall control improved dramatically as a result, not to mention my mood.

The error margin with new treatments is also much higher, I would think. If something goes wrong with a pump, that can have dramatic repercussions on overall BG, something that might have been less likely with Lente. Having said that, anyone who thinks that pumps can be a problem over night with highs or lows should try sleeping with Insulatard as a basal - five hypos in one night and then a complete failure to hold back DP is not a good way to spend an evening! But generally yes, it's far easier to make mistakes with MDI and pumps as these tools are much more powerful. I personally wouldn't ever want to go back to Insulatard or the mix insulins but I do recognise that these do to some extent make quite good 'training wheels' for before you get onto the good stuff.

So yeah, my suggestion is give teenagers the responsibility of managing their own condition with the parent as the backstop and Alamo, make sure that diabetes is just part of their life like brushing their teeth rather than making everything about their blood sugar, and teach them that they're in control and they shouldn't be beating themselves up over the odd 'bad' result. There are no 'bad' results, there's just times when you didn't treat your diabetes as effectively as you could.


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## Northerner (May 1, 2013)

I suspect there are a myriad reasons why a teenager might become non-compliant. One of the points that some members have made here in the past has been the problems with trainsition from child to adult care, sometimes as young as 16. This often places the person in an environment where they are surrounded by elderly diabetics suffering all sorts of complications whilst they wait for their appointments, and is therefore quite depressing and they wonder what they are doing there. As a result, many may be reluctant to attend. Even worse if the consultant they see when they do attend is the type to use the 'stick' approach and berate the person for getting poor results rather than looking for positive ways to improve things.

Teenagers can feel invincible also, and the vague threat of complications may not really register, as it happens to 'other people', or maybe just to 'old people' i.e. 30+. Certainly, when I was a teen, although I didn't have diabetes, I smoked like a chimney and drank like a fish even though I knew it probably wasn't doing me any good.

A while back I read about a parent who had brought up their child on MDI, but using huge numbers of injections to mimic the way a pump might operate - so multiple injections for food, and corrections when things strayed slightly out of range. Needless to say, that person rebelled once they got older, so I can certainly see that making life all about diabetes can lead a person to resent it and ignore it.


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## bev (May 1, 2013)

Hi Northerner,

As Redkite said - Ragnar Hannas (and others from FFL) recommend staying pro-active with a teenager as research shows that the longer a parent/carer is involved the better the outcome for them and less likely to rebel. In America they have changed the age of transition to adult clinic to around the age of 25 - unless the person choose's to move over earlier - simply because it is also recognised that a person might feel 'abandoned' to the adult clinic where they are given less support and where they have no history with the team and are surrounded by much older people who they cant relate to. I do think moving them at the age of 16 is too young (as do our team). Alex is now moving into the 'teenagers transition' clinic and I have asked that I stay outside the room for his Consultation so he gets more privacy and is able to learn how to get the best out of our team on his own - our team agree and said it is good practice for them to move onto adult clinic. I think sometimes a teenager just feels embarrased dealing with Consultants and DSN's so the more practice they can have the better!Bev


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## Redkite (May 1, 2013)

DeusXM said:


> So yeah, my suggestion is give teenagers the responsibility of managing their own condition with the parent as the backstop and Alamo, make sure that diabetes is just part of their life like brushing their teeth rather than making everything about their blood sugar, and teach them that they're in control and they shouldn't be beating themselves up over the odd 'bad' result. There are no 'bad' results, there's just times when you didn't treat your diabetes as effectively as you could.



I completely agree with your final paragraph, and that is exactly the approach I (and most other parents I know) am taking!

Stephen - if you are asking what "we" as a support forum can do to help with the problem of teenage non-compliance, then all we can really do is be here to support and advise when teens or their families come here for advice.  If you are thinking of effecting change at a higher level, first you need to gather some valid statistics (not just your GP mate's impression), and then campaign (perhaps in conjunction with JDRF or DUK) to improve paediatric services for type 1 kids, so that best practice becomes the norm rather than the exception.  A change of attitude is also required in schools, where support is often woefully poor.  Many parents have been lobbying for such changes for a long time, so we would welcome others to throw their weight behind this cause.


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## DeusXM (May 1, 2013)

> In America they have changed the age of transition to adult clinic to around the age of 25 - unless the person choose's to move over earlier - simply because it is also recognised that a person might feel 'abandoned' to the adult clinic where they are given less support and where they have no history with the team and are surrounded by much older people who they cant relate to.



I'd have been absolutely appalled if I was 22 and it was still regarded appropriate for me to be in a "children's" clinic - frankly I would have found that insulting and patronising. Not to mention the advice would be dreadful - what on earth could a paediatrician possibly tell me about managing hypos during sex or how to deal with alcohol? A doctor who primarily sees infants and young teenagers is not an appropriate person to provide guidance for adults. I don't know about anyone else, but at 16 the last thing I wanted was to be doted on like I was a child. I wanted to be an adult and do all the things that adults do, independent of my parents. I wanted to get out of that child clinic as soon as I could because it was always filled with children playing with Duplo. And I'm sure that if I stayed in that clinic, I would have rebelled. Every person is different but I'm a great believer in pushing people just a little bit out of their comfort zones as it makes you grow up very quickly.

A much better option would be to have dedicated T1 and T2 clinics for over-16s. Not only would that act as a sagely reminder to doctors and nurses that the conditions are different, it would also mean that the people in the waiting room would be far more likely to have things in common.


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## AJLang (May 1, 2013)

I valued my independence as a teenager. Went out drinking (when I was 16 oops), went on holiday abroad several times  (without parents) and bought my first house when I was 19.  I couldn't do all of this unless I managed my diabetes myself......and I haven't collapsed from a hypo since I was 16 or had DKA since I was 10.  Tough love withe diabetes allowed me the freedom to do all of the things that I've done.   Yes there was the ever constant fear of Hypos during the night and complications.....but life can't be lived worrying about these.  I nearly died in a car accident when I was 23 and my cousin was killed in a car crash at 30 - neither of these was diabetes related.  This is just me talking about my experience.


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## bev (May 1, 2013)

DeusXM said:


> I'd have been absolutely appalled if I was 22 and it was still regarded appropriate for me to be in a "children's" clinic - frankly I would have found that insulting and patronising. Firstly - as I said - it is left down to individual choice - and secondly where are you getting 'childrens' clinic from? The teams today split the age groups so for example Alex never goes to the same clinic as anyone under the age of 12 as they are held on different days. Not to mention the advice would be dreadful - what on earth could a paediatrician possibly tell me about managing hypos during sex or how to deal with alcohol? Well not sure about your team but ours actively encourage these discussions on a regular basis and have teenage discussion groups without parents present. Things have changed a lot since you were a teenager clearly as it is all done in an age-appropriate way - we dont have 2 year olds mixing with 16 year olds at clinic like you seem to have had. A doctor who primarily sees infants and young teenagers is not an appropriate person to provide guidance for adults. I disagree - they are also adults themselves and I know many teenagers at our clinic who have had these sorts of discussions with our Consultant. I don't know about anyone else, but at 16 the last thing I wanted was to be doted on like I was a child. I wanted to be an adult and do all the things that adults do, independent of my parents. Yes thats right - so does Alex and all other teenagers at our clinic - they are all independent. I wanted to get out of that child clinic as soon as I could because it was always filled with children playing with Duplo. And I'm sure that if I stayed in that clinic, I would have rebelled. Possibly - but as our teenagers dont mix with younger age groups at clinic then its not a problem - as I said things have changed a lot since you were a teenager. Every person is different but I'm a great believer in pushing people just a little bit out of their comfort zones as it makes you grow up very quickly.
> 
> A much better option would be to have dedicated T1 and T2 clinics for over-16s. Not only would that act as a sagely reminder to doctors and nurses that the conditions are different, it would also mean that the people in the waiting room would be far more likely to have things in common.




From what you have described - you had a very different experience of clinics as a teenager - thankfully things are much different now and teenagers are treated in an age-appropriate way - as young adults.


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## DeusXM (May 1, 2013)

I suspect Bev it's more to do with the hospital I was at, rather than timing - I was a teenager less than 10 years ago. You're making it sound like all this happened in the dark ages whereas I was in the child clinic as recently as 2002. We had Lantus and blood testing and pumps and everything, you know. The only major advances in T1 therapy since then (to my mind) have been the introduction of CGMS (still very rare), Levemir and loosening of funding for pumps to make them more widespread. The fact is I'm on the same treatment regime I was on 12 years ago largely because it's still the best regime according to NICE guidelines as I don't meet the criteria for a pump. So please, don't be quite so dismissive of my age or suggest my experience has no relevance - I'm sure you'll find in less populated areas they don't have all the perks you have with your clinic. I can accept my experience isn't necessarily typical of all teens with diabetes - maybe you could also accept that yours isn't necessarily the norm for everyone too?

My particular hospital did want to run a transitional clinic (which I agree is essential, the leap from child to adult clinic can be a bit jarring) but the fact was they simply had neither the staff nor enough patients to make this worthwhile.



> I disagree - they are also adults themselves and I know many teenagers at our clinic who have had these sorts of discussions with our Consultant.



'Being an adult' isn't really an appropriate qualification in its own right though. Once again, I can only speak for the clinic I went to but the care team there were paediatric specialists. I'm sure they could provide outline guidance but conversely I very much doubt they'd be particularly up to date as it wouldn't be a field they'd be expected to be current in. 

If the majority of your job is treating under-12s, you probably aren't particularly familiar with the diabetes experience of sex hypos or what vodka does to your glycogen release system to the same extent that a doctor specialising in diabetes in adults would be. 

Another flipside to this is I personally would not be comfortable discussing these matters with a consultant who's known me since I was a child, it'd feel a bit like discussing it with my parents. If my parents had a close working relationship with the care team I would be particularly concerned about patient confidentiality and the fact that my mother would be sitting outside the room wouldn't inspire me with much confidence either. Again, yes, I can only speak for myself but I'm sure plenty of teenager will have similar feelings.

I think it's great that Alex appears to have a lot of support around him to manage his diabetes and that he is the personality type that appears to respond well to that support. However, not all teenagers will respond quite so well. There is value in exploring why that is, and I'm sure your experiences and way of doing things would be beneficial for plenty of families in the same boat as you. I'm also sure that there will be teenagers and their families reading my experiences and reactions and seeing a lot of themselves in there too. Some teens benefit from having intensive support and parental involvement. Some suffer for it. It's also probably quite hard to predict which teen is which until it's a bit too late, too.


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## everydayupsanddowns (May 1, 2013)

It's interesting, in the light of these discussions, that the new NICE guidelines/updates which are currently 'in production' separate out children and teenagers from the general CG15 for adults. They are also creating a new guideline especially for pregnancy as it is recognised (rightly I think) that certain times in life require slightly different approaches.

Personally I suspect that, once again, there is not going to be a 'one size fits all'. Different people will react to T1D differently through their teen years. There may well be some 'best practice' gems that we can hope would become the standard across the country, but that still will not prevent every teen from stuggling, at some point, with their D, while others will just sail through transitioning from childhood to adult PWD without a whiff of rebellion.

I'm heartened by what I read of peer-support/camps/conferences which seems to make a big difference in some people and lets them know they are not struggling alone. But I also know that there is NO WAY I would have wanted to be involved in that when I was Dx in my early 20s. What can be done for those that really struggle to turn their relationship with their D around I really don't know.


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## Twitchy (May 1, 2013)

It's an interesting debate, but I agree, it's probably far too subjective & personal for a simple / easy answer. 

I don't actually remember going from child to adult clinics but I remember there was an aspect of being 'non compliant' simply by default until I was on mdi & did a dafne course, as noone had really explained the rules, just tutted if the numbers weren't right & suggested tweaks without explaining why they'd help. I don't think there was much on the internet to help either. 

As for the transition clinics etc, I guess either you 'click' with your doc or not - I'm lucky, mine is fab & now it feels like a team effort (hence encouragement etc not rollickings). The doc I saw when at uni seemed (vague memories!) quite negative...but maybe that's more how I felt, I don't know. 

As for the more, erm, 'intimate' conversations, I don't think I would ever talk to a doc about that lol, I'd rather figure that one out for myself!


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## bev (May 1, 2013)

DeusXM said:


> I suspect Bev it's more to do with the hospital I was at, rather than timing - I was a teenager less than 10 years ago. You're making it sound like all this happened in the dark ages whereas I was in the child clinic as recently as 2002. I didnt do that you did - you likened it to having to be with children playing lego. We had Lantus and blood testing and pumps and everything, you know. The only major advances in T1 therapy since then (to my mind) have been the introduction of CGMS (still very rare), Levemir and loosening of funding for pumps to make them more widespread. The fact is I'm on the same treatment regime I was on 12 years ago largely because it's still the best regime according to NICE guidelines as I don't meet the criteria for a pump. So please, don't be quite so dismissive of my age or suggest my experience has no relevance - I'm sure you'll find in less populated areas they don't have all the perks you have with your clinic. Not being dismissive just going on what you are telling us - your clinic had a mix of ages that we dont have now. I can accept my experience isn't necessarily typical of all teens with diabetes - maybe you could also accept that yours isn't necessarily the norm for everyone too? The circles we move in this is the norm.
> 
> My particular hospital did want to run a transitional clinic (which I agree is essential, the leap from child to adult clinic can be a bit jarring) but the fact was they simply had neither the staff nor enough patients to make this worthwhile. Happily our team are able to offer this and its a great success.
> 
> ...


 I agree - which is why I asked what the data is to support this theory - and also explained that the latest research shows that the longer a parent is involved the better the outcome. There is also the question of age at diagnosis - a 10 year old will adjust better than a 16 year old in terms of the change simply due to the fact that at 16 they will have experienced the freedom that other teenagers have had whereas obviously a 10 year old wont know any different.


I would strongly recommend you attend one of the FFL Conferences - it will open your eyes to how us pro-active parents educate our young adults about diabetes so they can go on to be independent individuals who know what they are doing in terms of their health but also to give them strategies for dealing with diabetes burnout and other subjects that might create a rebellion - including depression sex and alcohol - the realities of normal life!


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## Lauras87 (May 1, 2013)

DeusXM said:


> If the majority of your job is treating under-12s, you probably aren't particularly familiar with the diabetes experience of sex hypos or what vodka does to your glycogen release system to the same extent that a doctor specialising in diabetes in adults would be.



i've never had the sex chat apart from my DSN scaring the hell out of me by saying if i got pregnant the baby would be born blind/heart defects/limbs missing etc
i just test both before & after - it kills the mood but better to be safe than sorry

what does vodka do to glycogen release system?

you've grabbed my attention!


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## Andy HB (May 1, 2013)

Lauras87 said:


> what does vodka do to glycogen release system?



My guess is that it stops/reduces it (as does all alcohol).

Andy


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## DeusXM (May 1, 2013)

> what does vodka do to glycogen release system?
> 
> you've grabbed my attention!



Mostly the same thing as any other booze - it blocks your liver releasing glycogen, generally around 4-5 hour mark after consumption. Most other Ds I know find that vodka also doesn't raise their BG initially, so generally if you primarily drinking vodka, you will need to either make adjustments to your basal or if this isn't an option, eat a carby snack. However, you'll still need to bolus for this snack which then means you need to take into account the digestion profile of the meal you're eating, the action profile of the bolus insulin you're taking, and the glycogen blocking profile of the vodka you've been drinking and then get these all to roughly match up in such a way that you don't get a BG wobble.

I'm not saying it's completely impossible for a paediatric diabetes specialist to advise in these situations but it is probably something they only deal with maybe 5-10% of their working time, compared to an adult specialist who will probably deal with this much further. There may also be a tendency for paediatric staff to be a bit more 'moral' about their advice who might simply tell a 16-year-old not to drink, which isn't helpful.

The point is as teenager I would have been far more forthcoming with the 'adult' staff than the paediatric staff on these sorts of questions - whether or not there are official rules about doctor confidentiality probably matters very little to a teenager, who is likely to be disposed to assuming adults are against them.


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## everydayupsanddowns (May 1, 2013)

DeusXM said:


> I'm not saying it's completely impossible for a paediatric diabetes specialist to advise in these situations but it is probably something they only deal with maybe 5-10% of their working time, compared to an adult specialist who will probably deal with this much further.



I wonder whether you are used to getting *much* more detailed advice than I am DM - I'm not sure I'd get much out of my team other than general principles and 'see how it goes'.

I'm also not entirely convinced about this:



DeusXM said:


> There may also be a tendency for paediatric staff to be a bit more 'moral' about their advice who might simply tell a 16-year-old not to drink, which isn't helpful.



I half wonder if a specialist who deals with teens on a much more regular basis would be more grounded/experienced in age-appropriate advice because they are more in touch with the realities/behaviours of young people whereas consultants who only ever deal with adults might be more likely to take the view of "well you shouldn't even be drinking at your age!". I guess it would depend on the individuals involved.

I think you do make important points about young people feeling they are not being treated as children though, and I'm sure for many that would be important. Though I guess others might struggle to open up to 'strangers' if they have had a good relationship with a consultant for many years and have built up a degree of trust and understanding.

As ever YDMV


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## Lauras87 (May 1, 2013)

DeusXM said:


> Mostly the same thing as any other booze - it blocks your liver releasing glycogen, generally around 4-5 hour mark after consumption. Most other Ds I know find that vodka also doesn't raise their BG initially, so generally if you primarily drinking vodka, you will need to either make adjustments to your basal or if this isn't an option, eat a carby snack. However, you'll still need to bolus for this snack which then means you need to take into account the digestion profile of the meal you're eating, the action profile of the bolus insulin you're taking, and the glycogen blocking profile of the vodka you've been drinking and then get these all to roughly match up in such a way that you don't get a BG wobble.
> 
> I'm not saying it's completely impossible for a paediatric diabetes specialist to advise in these situations but it is probably something they only deal with maybe 5-10% of their working time, compared to an adult specialist who will probably deal with this much further. There may also be a tendency for paediatric staff to be a bit more 'moral' about their advice who might simply tell a 16-year-old not to drink, which isn't helpful.
> 
> The point is as teenager I would have been far more forthcoming with the 'adult' staff than the paediatric staff on these sorts of questions - whether or not there are official rules about doctor confidentiality probably matters very little to a teenager, who is likely to be disposed to assuming adults are against them.



Awwww I was expecting a different response to what you said

I find spirits are the only booze not to raise my bloods.


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## everydayupsanddowns (May 1, 2013)

Thinking about this more generally...

The *big* thing that doesn;t seem to have entered into this discussion yet is the degree and quality of psychological support available to those who are struggling.

Not something I've ever really been offered, but it strikes me that it could be crucial to get some good counselling/support for young people who just cannot or will not engage with their diabetes.


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## bev (May 1, 2013)

everydayupsanddowns said:


> I wonder whether you are used to getting *much* more detailed advice than I am DM - I'm not sure I'd get much out of my team other than general principles and 'see how it goes'.
> 
> I'm also not entirely convinced about this:
> 
> ...



Always keeping an open mind enough to listen to your teenager is also important - not judging them if they open up to you goes a long way to building up trust with them and in turn means they have a sounding board for those times when it all just gets too much - so a real family affair! Bev


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## Redkite (May 1, 2013)

everydayupsanddowns said:


> The *big* thing that doesn;t seem to have entered into this discussion yet is the degree and quality of psychological support available to those who are struggling.



I agree with this, and not only for young people with diabetes.  Psych support is difficult to access in many areas of the UK.  A referral to CAMHS is often the last resort instead of part of the process.  But there are other support systems such as pastoral care in schools which could make a difference to a struggling T1 teen if there was more widespread education about type 1 for school staff.

DeusXM, you make some valid points about teenagers wanting their independence, and I agree that this should be encouraged, however they also need care, guidance, and boundaries to push against - in all areas of their life.  Diabetes care is just one small facet of the life skills teenagers will gradually become independent in - I don't treat it differently to anything else.  I also don't want to set him up to fail, I want to help him succeed.  I am well aware that when he fully takes over his D care, his control is likely to worsen for a while - that will be hard for me to see, but I will have to accept it and offer help when he wants help.

Stephen, the cynic in me suspects that you started this thread to basically say to parents that our dedication to supporting our type 1 teens is the cause of hospital admissions for non-compliance.  Yet you seem reluctant to actually come out and say it.  Is that your view?


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## DeusXM (May 1, 2013)

> the cynic in me suspects that you started this thread to basically say to parents that our dedication to supporting our type 1 teens is the cause of hospital admissions for non-compliance. Yet you seem reluctant to actually come out and say it. Is that your view?



I think there's certainly a case to be made that parents who are very intensively involved in their kid's diabetes care can do more harm than good. This would be more commonly known as helicopter parenting. Before anyone jumps into a rage, let me reiterate that this is not a label I'm allocating to any specific person here, it's simply a concept that needs to be acknowledged.

That's rather why I asked the question about what was meant by 'involvement' in diabetes at the very start of this thread. It's clear that there's disagreement here about what a reasonable level of involvement would be. I can only base my view on my experiences, which are obviously limited in scope. Interestingly (although obviously this is an inherent limitation of the forum), we don't have any first-hand accounts from children and teenagers with diabetes on what they think will help them.


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## Northerner (May 1, 2013)

DeusXM said:


> ...Interestingly (although obviously this is an inherent limitation of the forum), we don't have any first-hand accounts from children and teenagers with diabetes on what they think will help them.



They're probably all on Facebook!


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## everydayupsanddowns (May 1, 2013)

DeusXM said:


> I think there's certainly a case to be made that parents who are very intensively involved in their kid's diabetes care can do more harm than good. This would be more commonly known as helicopter parenting. Before anyone jumps into a rage, let me reiterate that this is not a label I'm allocating to any specific person here, it's simply a concept that needs to be acknowledged.



True, but equally it needs to be ackowledged that some pretty heavyweight thinkers suggest:



Redkite said:


> Ragnar Hanas says that outcomes are better where parental involvement is maintained during adolescence.  Presumably as a paediatric endocrinologist and as an academic he has plenty of evidence to base that on.  "Don't hand over too soon" is his advice.



Personally a lot of what is being said on both 'sides' of this conversation makes a lot of sense to me.

Yes. Too much meddling/control might be detrimental to some teens. But conversely it might be *exactly* what others need.

A lot of parenting in my experience is about guiding/nurturing/establishing good patterns and then supporting the young person as they develop into the adult they will be.

I saw a heartbreaking documentary about people growing up in care (Neil Morrissey presented) and there was a major problem for youngsters who effectively get booted out of the care system at 18 with absolutely NO support whatever. In some cases they go from a fairly institutional environment to nothing. No parent or support network to call on to ask about putting up a shelf or whatever. No one to consult about 1001 tiny (or not so tiny) things, or even just borrow a few quid off temporarily to allow a study course to be completed.

I certainly valued ongoing support in various aspect of life well into my 20s though I considered myself 'independent' in my own head.


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## Twitchy (May 1, 2013)

I suspect it might be something like a normal distribution - think something a bit like an upturned cereal bowl tapering to flat on left & right sides - some teens will need an almost totally 'hands off' approach at one extreme, most like RH says benefit from parental input of varying degrees with a few at the other extreme actually needing a touch of 'helicopter parenting'. 

I guess the bottom line is it all depends on the unique personalities, experiences, knowledge & circumstances in each case. My mum died of cancer when I was 13. My dad had clinical depression for possibly decades after. As a result, I never felt like I had the 'luxury' of kicking back & rebelling, because frankly there was noone else to give a damn if I hadn't. How things would have panned out if mum had survived, bearing in mind she was the parent who 'did' 95% of the diabetes stuff, I'll never know. But we're all different, & frankly I think this thread is a bit of a red herring, getting dragged into the parental involvement aspect...my gut feeling, for what it's worth, is self image & peer pressure are more significant, at least in acute cases of neglect / rebellion.


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## DeusXM (May 1, 2013)

I suppose the obvious point to make is it's probably worth asking those here who were teens with diabetes what they think caused them to rebel, now they have the advantage of hindsight.

Disappointingly for me, I have very little to contribute to that as I was extremely boring and never actually rebelled or stopped actively managing my diabetes.


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## cherrypie (May 1, 2013)

I think anyone can make assumptions as to what is best for parents and children with Type1 diabetes.  The plural of anecdotal is not data and people differ in their parenting and approach as to how they manage their child's condition.
Parenting in itself is not an easy task and adding diabetes to the mix makes it even harder.  There are studies that show parents sometimes develop PTSD when their child is diagnosed.  That shows how serious it can be for the family.

http://www.ncbi.nlm.nih.gov/pubmed/15968237

I tend to agree that peer pressure plays a large part in today's children's esteem.  If you don't have the right clothes, the same attitudes etc.  life can be very hard being an individual.  This was something that I never experienced as a child as most kids had the same set of parental rules.  If you don't follow the leader now then you are ostracised and all teens want to fit in, it's part of growing up.  When they get older, they usually decide what their aims, goals and aspirations are because they have outgrown peer pressure.

As to the "helicopter parenting", this article asks if it is such a bad thing.

The Myth of Helicopter parenting.
http://www.ncbi.nlm.nih.gov/pubmed/15968237

I've said it before and will say it again, Hats off to all parents of children with diabetes.  You do a grand job and should not be made to feel that someone with no experience seems to know the best way for you to parent.  Each to their own.


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## Redkite (May 1, 2013)

DeusXM said:


> Interestingly (although obviously this is an inherent limitation of the forum), we don't have any first-hand accounts from children and teenagers with diabetes on what they think will help them.



I saw this before popping out to pick up my T1 12yo from his guitar lesson, so I asked him on the way back.  The conversation went as follows:

Me: can I ask you a question?  People on my email group are wondering whether teenagers like to have their parents interfering with their diabetes all the time or if they would prefer to be left in peace to look after it themselves?

Silence

Me: so what do you think?

Him: about what?  Sorry, I wasn't really listening.

Sums it up really!!!!  He then went on to talk about something he'd been doing in English that day.

.


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## everydayupsanddowns (May 1, 2013)

Redkite said:


> I saw this before popping out to pick up my T1 12yo from his guitar lesson, so I asked him on the way back.  The conversation went as follows:
> 
> Me: can I ask you a question?  People on my email group are wondering whether teenagers like to have their parents interfering with their diabetes all the time or if they would prefer to be left in peace to look after it themselves?
> 
> ...




*Priceless!*

That genuinely made me LOL!  

Men are from Mars, Women from Venus and Teenagers are from another planet. Entirely.


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## bev (May 1, 2013)

cherrypie said:


> I think anyone can make assumptions as to what is best for parents and children with Type1 diabetes.  The plural of anecdotal is not data and people differ in their parenting and approach as to how they manage their child's condition.
> Parenting in itself is not an easy task and adding diabetes to the mix makes it even harder.  There are studies that show parents sometimes develop PTSD when their child is diagnosed.  That shows how serious it can be for the family.
> 
> http://www.ncbi.nlm.nih.gov/pubmed/15968237
> ...




Hi Cherrypie,

I couldnt have put it better myself! Thankyou for your understanding and insight into being the parent of a teenage Type 1 diabetic - it shows you are one of life's listeners and learners. It is a difficult enough job as it is without amateurs phsycho-analysing us all!

Anyway - must rush now - off to sharpen my blades.........Chopper


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## Copepod (May 1, 2013)

Redkite said:


> I saw this before popping out to pick up my T1 12yo from his guitar lesson, so I asked him on the way back.  The conversation went as follows:
> 
> Me: can I ask you a question?  People on my email group are wondering whether teenagers like to have their parents interfering with their diabetes all the time or if they would prefer to be left in peace to look after it themselves?
> 
> ...



Wish there was a "like" function for posts like this one


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## mcdonagh47 (May 1, 2013)

Redkite said:


> I saw this before popping out to pick up my T1 12yo from his guitar lesson, so I asked him on the way back.  The conversation went as follows:
> 
> Me: can I ask you a question?  People on my email group are wondering whether teenagers like to have their parents interfering with their diabetes all the time or if they would prefer to be left in peace to look after it themselves?
> 
> ...



LOL- diplomatic deafness  ? Ignoring a question he doesn't want to answer ?


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## Lauras87 (May 1, 2013)

Redkite said:


> I saw this before popping out to pick up my T1 12yo from his guitar lesson, so I asked him on the way back.  The conversation went as follows:
> 
> Me: can I ask you a question?  People on my email group are wondering whether teenagers like to have their parents interfering with their diabetes all the time or if they would prefer to be left in peace to look after it themselves?
> 
> ...



LOL - good to see he listens to his mum



everydayupsanddowns said:


> *Priceless!*
> 
> That genuinely made me LOL!
> 
> Men are from Mars, Women from Venus and Teenagers are from another planet. Entirely.



Mike teenagers aren't human, they are sleep robots.
Mmmmmm sleep, ok I want to be a teenager again!


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## bev (May 1, 2013)

Redkite said:


> I saw this before popping out to pick up my T1 12yo from his guitar lesson, so I asked him on the way back.  The conversation went as follows:
> 
> Me: can I ask you a question?  People on my email group are wondering whether teenagers like to have their parents interfering with their diabetes all the time or if they would prefer to be left in peace to look after it themselves?
> 
> ...




Hi Redkite,

Thats hilarious! Your sure you havent brainwashed him into answering like this? Maybe wait until you leave the heli-pad next time as he clearly couldnt hear you with all the noise.Bev


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## Lauren (May 1, 2013)

So this is my experience with being a child / teenager with T1:

Diagnosed in 1994 aged 6. My mum was given hardly any advice on how to treat me, just told to inject me twice a day and test twice a day. Despite this, I had good control. I insisted on doing my own injections from day 1.

I had a few bad hypos (I think about three of which ended in loss of consciousness) - I do kind of wish me and my mum were given more advice on treatment of hypos. We were just told to give me a couple of biscuits if I felt funny 

I had problems when I reached my teenage years, I think it must have been the raging hormones or something! But I couldn't get my sugars level and I ended up in hospital a lot.

This all stopped when I left that particular clinic in 2002 and moved to Wales, my new clinic was much more advanced and gave out half-decent advice (yay) and I was put on MDI which made my control a lot better. However, now my problem was that I felt that I could not inject at school, and so for over two years I did not have any insulin at lunchtime and would get home to levels of 15 or above. I wish I hadn't done that, I hate to think of what that's  done to me complication-wise, but I was really frightened that I would get knocked in the common room by all the hyper teenagers if I tried!

However when I was 17 I finally got over that and had my friends 'guard' me at lunchtime. No one even noticed. I had been totally overreacting all that time 

Then I had my problem with Dawn Phenomenon but now my pump has sorted that out 

So basically my mum made sure I tested, injected and ate, and that I recorded everything in my book, but she gave me a lot of freedom too, and I became very independent about my Diabetes from a young age. Apart from my times in hospital and my self-inflicted bad control between the ages of 15 and 17 it worked out ok. I do wish that I had more support from my Diabetes teams though, I feel these problems could have been addressed if I had had that.


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## delb t (May 1, 2013)

Lauren  thankyou for sharing your experiences -I have always felt that being able to inject in public is an important hurdle to get over I remember in the first few weeks of dx- with our son hiding behind a menu in a shopping centre whist he injected and I read a few posts on here and realised this was something he had to gain confidence with - OR WHY should he go to a toilet to inject as some do - So we made a real effort to eat out more etc - he now injects anywhere no-one ever notices and if they do who cares- in fact one waiter abroad was so interested in the carbs and cals picture of tirimasu he took it to the chef to show him.
 From what you described -It shows that the care recieved from teams needs to be of real quality and its only thanks to people/parents seeking the best for their children or by reading of others care on a forum such as this that they can find out  that there is better support out there[our support was excellent from our team and from here ]


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## Redkite (May 1, 2013)

Hi Lauren, thanks for sharing.  Sounds like your Mum got the balance right between supporting you and letting you have your independence . Shame your first clinic team were so rubbish, I do think that they are key in supporting the whole family with diabetes.


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## Redkite (May 1, 2013)

mcdonagh47 said:


> LOL- diplomatic deafness  ? Ignoring a question he doesn't want to answer ?



He doesn't do diplomatic!  I think he has reached an age where he just tunes out to my frequency . If I want his attention I have to either get eye contact first, or use a suitable keyword such as Minecraft, iPad, Temple Run, etc.


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## mcdonagh47 (May 2, 2013)

Well he successfully kicked a difficult question you asked him that required some thought, into the long grass.


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## StephenM (May 2, 2013)

Redkite said:


> Stephen, the cynic in me suspects that you started this thread to basically say to parents that our dedication to supporting our type 1 teens is the cause of hospital admissions for non-compliance.  Yet you seem reluctant to actually come out and say it.  Is that your view?




I am not saying that because it is not my view. If you care to read what I said I said that there was a problem with teenage non-compliance. I also observed that there may an issue related to the tighter control and longer parental involvement causing the problem in some cases ? as the result of a stronger rebellion in the teen. In the past I have seen articles suggesting this may be the case. I expanded on this with the example of introducing small amounts of alcohol with family meals.

I rebelled at times but maybe not that badly as I had a desire to take to the road as soon as possible and was saving hard. A few days after my 16th birthday I took to the road ? the delay was sorting insurance (a totally different topic) something I had not thought of.


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## Adrienne (May 2, 2013)

I'm not even going to begin to reply properly to the original question in this thread. I've read it all and there are only two posters who have set out to inflame a situation that one of them started anyway on another thread. I believe the original question was asked purely to ruffle feathers. There have been some great replies and heartfelt experiences but there is no answer to this at all. It is all speculative and it was indeed intended to be personal. 

I ask that this thread be closed please or indeed deleted as it has helped no-one at all but has upset people completely unnecessarily


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## Redkite (May 2, 2013)

StephenM said:


> I am not saying that because it is not my view. If you care to read what I said I said that there was a problem with teenage non-compliance. I also observed that there may an issue related to the tighter control and longer parental involvement causing the problem in some cases ? as the result of a stronger rebellion in the teen. In the past I have seen articles suggesting this may be the case. I expanded on this with the example of introducing small amounts of alcohol with family meals.



I did read what you said, but I'm unsure what you are hoping to achieve by this discussion?  I think we can all agree that there are some teenagers who have a hard time with their diabetes - however what positive productive solution are you suggesting?  My suggested solution is to be a supportive parent on my son's journey to independence (which concurs with specialists in the field such as Ragnar Hanas).


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## Northerner (May 2, 2013)

Redkite said:


> I did read what you said, but I'm unsure what you are hoping to achieve by this discussion?  I think we can all agree that there are some teenagers who have a hard time with their diabetes - however what positive productive solution are you suggesting?  My suggested solution is to be a supportive parent on my son's journey to independence (which concurs with specialists in the field such as Ragnar Hanas).



I've yet to get a response to my question of what solution Stephen would propose. Actually, I think Lauren's experience sheds light on something not considered as this thread has developed. Her hospital admissions were not as a result of non-compliance, but an inappropriate insulin regime and poor medical support from her team. I very much doubt if there are any statistics recording whether an admission is a result of non-compliance or for some other reason. I don't think there is a solution, except to examine cases on an individual basis, since each person's experience will be unique to them.


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## Redkite (May 2, 2013)

Northerner said:


> I've yet to get a response to my question of what solution Stephen would propose. Actually, I think Lauren's experience sheds light on something not considered as this thread has developed. Her hospital admissions were not as a result of non-compliance, but an inappropriate insulin regime and poor medical support from her team. I very much doubt if there are any statistics recording whether an admission is a result of non-compliance or for some other reason. I don't think there is a solution, except to examine cases on an individual basis, since each person's experience will be unique to them.


I agree.  My son is on a pump, but if he was injecting and feeling he didn't want to at school, as Lauren described, I would want to work with him, the school and his clinic team to find a solution.  Schools have a duty to provide a private place for pupils to inject if they wish (not the toilets!), and also to accommodate those children who wish to be open about injecting.  As a last resort for teens who are skipping their lunchtime insulin, there may be a place for twice daily mixes.  Health comes first, including emotional health!


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## delb t (May 2, 2013)

I think we should close this thread too now-I would hate it if newbies parents or otherwise joined and felt we wernt a supportive lot!


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## everydayupsanddowns (May 2, 2013)

Speaking for myself I've found a lot that has been interesting and of value in this thread. Combined with a couple of other recent 'parenting' conversations where differences of approach and opinion have been discussed I have found it very illuminating to understand better some of the reasons behind the decisions that parents of CWD take.

It seems we have reached a point of saying, "there probably isn't one answer - and what works for one child/teenager will probably not work for another" I can't say I'm hugely surprised by that. Is _anyone_?

Personally I think Northie and Redkite nailed it: 


> I don't think there is a solution, except to examine cases on an individual basis, since each person's experience will be unique to them.





> My suggested solution is to be a supportive parent on my son's journey to independence (which concurs with specialists in the field such as Ragnar Hanas).


 

I hope that people have not been upset by the discussion. Personally I think it's important that people are allowed to have different opinions on forums like this - as long as they respect the opinions and choices of others. That doesn't mean I have to agree with them, nor does it mean that I am compelled to try to make them think the same way I do.


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## Adrienne (May 2, 2013)

everydayupsanddowns said:


> Speaking for myself I've found a lot that has been interesting and of value in this thread. Combined with a couple of other recent 'parenting' conversations where differences of approach and opinion have been discussed I have found it very illuminating to understand better some of the reasons behind the decisions that parents of CWD take.
> 
> It seems we have reached a point of saying, "there probably isn't one answer - and what works for one child/teenager will probably not work for another" I can't say I'm hugely surprised by that. Is _anyone_?
> 
> ...



I absolutely agree with you.    When a discussion is even not what you want to hear that is fine as well but I still believe firmly that two posters literally will try and inflame and twist whatever a 'parent' will say and criticise unnecessarily.  Its been made very clear over a few threads now.  They don't have kids or kids with t1 and this was an odd thread to start by someone like that without the ulterior motive I believe there is.    I am not upset, I'm angry. 

The majority of people on this whole support board are just that, supportive, but for some reason a couple of people aren't towards a group of people because it is not what they think should be done as they 'survived' their way.   Utter poppycock quite frankly and they should be ashamed of themselves. Its a bit like a witch hunt.  They need to come back and say their piece if their children ever gets diagnosed (god forbid), I bet tunes would change rather a lot somewhat.   You cannot compare any teenager with another teenager, with or without t1, you cannot compare a teenager with t1 compliant or not with a teenager even as far back as 2002 or whatever as it was very very very different and I know this because I was in the diabetes world back then also as a parent of a child with t1 so I talk from experience.

It was started as a pointless thread and whilst some posts, as I've said, are great and some very heartfelt it was started acrimoniously with not good intentions and now I have replied and I didn't want to damn ! (see I'm angry)


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## Andy HB (May 2, 2013)

As a dispassionate observer, I agree with what Mike says about the thread. There are aspects of it which I may find of great use in the future.

I just wish that people could discuss things like this avoiding upsetting others (which in some cases is because I think certain people have possibly undeserved reputations so no matter their intentions, they are always assumed to be 'stirring').

My partner and I are beginning the process of become foster parents (she has a lot of experience in childcare). In the event that we are accepted and we end up looking after a child with Type 1 diabetes. I'd like to have an insight into the potential issues involved. Granted, every child is likely to be different, but a thread like this discussing various issues and experiences would be very helpful.

Anyway, thanks to those people who have contributed in a positive way to this thread.

Andy


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## Northerner (May 2, 2013)

OK, I think there is too much acrimony creeping into this thread and it's heading nowhere, so I will close it.


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