The combination of diabetes and puberty is not exactly a marriage made in heaven. Teenagers and their parents often find themselves at odds over the subject. Parents cannot let go, and teenagers find it hard to accept any help. How can parents and their offspring manage to get on, and at the same time reach good solutions? Professor Silvia Wiedebusch offers some advice on the matter.

“It used to be just fine with the diabetes,” say the desperate parents, “until puberty arrived, and now nothing seems to work.” 
What is it about puberty that makes diabetes treatment become such a challenge? What is it exactly that youths and their parents fight about? What can parents do to try to restore communication? 

Between therapy and issues of development 
Young people with type 1 diabetes have a double whammy of issues to solve: on the one hand, they are faced with trying to integrate their condition into their daily lives as best they can, including trying to keep up with all the complexities of therapy and, on the other hand, they have to deal with all the challenges that – along with their non-diabetic peers – are typical of the onset of puberty.

Adolescence marks a phase of self-determination and the search for identity. This is not always easy. During this time, it is especially difficult for adolescents to accept advice on issues of therapy from the very people (parents!) that they are actually trying to break away from. In such situations, young people are faced with a dilemma. Hence, it is easy to understand why, at times, they are simply “fed up” with their diabetes.

At a closer glance, one can observe that the bad moods are often more directed towards familial spats to do with diabetes generally, rather than towards the therapy in particular. Parents often think that their growing child is especially volatile because of the diabetes. However, take away the diabetes, and one will find that the same old bouts of conflict remain, just as in all other families. 

A survey of the most common points of conflict between parents and their adolescent children with diabetes has shown no discrepancy when compared to parents and their adolescent children without diabetes. At the top of both lists are things like, “Lights out!” “Tidy up your room!” and, for example, “Be home by 10 o’clock”.

It gets very problematic, however, when divisions are no longer made between normal points of conflict and diabetes-related issues. For example, “If you forget to inject the bolus and come home from school with a high sugar value once more, you will not be allowed to go to the party this weekend.” It works the other way as well, for example, “If you forbid me from chatting in the Internet, I will stop measuring my blood sugar, and that’s that.” This mixing of different problem areas makes it very difficult to reach constructive solutions.

Adolescents, parents and mutual blame 
It is helpful to put oneself in each other’s shoes, and to see exactly what the main points of conflict are. In discussion groups, three main areas of conflict are constantly exposed: Firstly, adolescents are annoyed when their parents worry too much. “My parents bug me with their constant worry and won’t stop nagging me about my blood sugar levels.” This statement, from a 13-year-old, is representative of many that age. Secondly, adolescents are annoyed when parents seem to overlook who they really are and appear to be only focused on the diabetes.

“As soon as I open the door from school, the first thing my mother wants to know is my blood sugar level,” reports an offended 15-year-old girl. Thirdly, it is obvious that adolescents and parents do not share the same view of diabetes. Parents are more concerned about the prevention of future complications, whereas adolescents are more concerned with the present. “I’m not as worried about high blood sugar as I am about low blood sugar!” is a characteristic statement from a 14-year-old.

In order to clarify the problems of communication between teenagers and parents further, conversations on diabetes therapy were videoed as part of a scientific study. It was found that most conversations centred around the following themes:

Parents were mainly concerned about acute complications such as hypoglycaemia, ketoacidosis, as well as long-term effects. A typical parent says, for example, “It is difficult for me to accept the way you handle your diabetes because I am worried something will happen to you.”

Many parents also express a lack of trust. A frequent statement relating to diabetes therapy is, “If I don’t do it, nobody will!”

In many discussions, mutual blame was frequent, often taking the form of confrontations with frustration, disappointment and harsh criticism, whereby the parents state, for example, “You have to take your own responsibility!” at which the child replies, “You never notice anyway when I do something right!” 

Communication helps solve problems
This typical mutual blaming shows that listening to each other quietly, and trying to understand the anxieties, worries, and disappointments of the other, is important. A converstion should be able to take place in a calm atmosphere. This is not always easy to achieve. Tim Wysocki, an American psychologist specializing in this area, has put together some useful tips which can help parents to lead a positive and constructive discussion. 

Plan diabetes discussions in advance
Don’t discuss issues in the heat of the moment, when emotions are high. It is best to wait until things have calmed down. Plan a time to talk, and include all those involved. This raises the possibility of being able to lead a calm and matter-of-fact discussion. 

Keep to the subject
During these discussions, keep to the subject of diabetes therapy. Here is no place to discuss other daily issues. By doing this, you can avoid mixing problems of diabetes therapy with other puberty-related issues. 

Express how you feel
Avoid statements that point an accusing finger, for example, “Once again you failed to ... ” or “You never ... ”. Instead, try to use statements that express how you feel yourself, such as, “I worry because ...” or “I am angry because ...”.

Don’t interrupt
If interrupting is a problem, make some kind of ‘speech’ card. Whoever has the card, is allowed to talk until s/he is finished. Afterwards the card is passed on. In other words, whoever has the card can speak, the others must listen. 

Keep positive!
It is a drag when mistakes from the past are constantly being brought up again and again. Keep the conversation positively oriented, with constructive suggestions that can be used for the present and the future. 

Be fair and honest!
Avoid using general statements with “always” and “never”. These usually don’t apply anyway, and only serve to unnecessarily injure the other. 

Let all participants summarize the discussion 
At the end of the discussion, all participants should have the opportunity to summarize the discussion in their own words. In this way misunderstandings, that can lead to new conflicts, can be avoided. 

Diabetes discussions
Regular discussions on how to improve diabetes therapy should take place. If such discussions become routine, experience has shown that they become easier and require less time. A short briefing held once a day is, for both parties, far preferable to constant nagging and uncertainty.

In terms of diabetes therapy, help from parents is very useful and advisable for adolescents. However, all those involved, the teenagers and their parents, need to adapt to new roles and find new ways of working together. Teamwork is fair better than one-sided concern from the parents. In the long term, the transfer of responsibility for therapy can only succeed when it is done gradually, hand-in-hand with the development phases of the growing child.

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Professor Silvia Wiedebusch PhD
Diabetes Psychologist
Dept of Developmental Psychology 
Osnabrück Institute of Technology
E-Mail: S.Wiedebusch(at)fh-osnabrueck(dot)de