Adolescence is an exciting and challenging time for all parents and teens, diabetes or not! For a family where a teenager has diabetes the period of adolescence can be difficult for both the teen and their family. Young people go through rapid physical, mental, social and emotional changes as they adjust to increased pressures and responsibilities and move towards adulthood and independence.
Food and food choices can become real areas of conflict in families where the young person has diabetes. Rapid physical and hormonal changes make diabetes management difficult and less predictable. A teenager who may have been on top of their diabetes in childhood, can suddenly find their insulin needs change and that their diabetes becomes much harder. In addition, young people who have diabetes have an extra commitment in their lives, their diabetes management, which many struggle to maintain during this period.
Diabetes thrives on routine and many young people have a more erratic lifestyle! Complex issues of “fitting in”, not wanting to be “different”, wanting spontaneity in their lives and dealing with the social pressures of junk food, drugs and alcohol, can be tough. Parents often feel anxious as teens become more independent and start to take responsibility for their own diabetes management. This is normal!
It is very important to keep the channels of communication open. Teenagers often respond best to conversation when you approach them whilst driving in the car, washing up, playing a game or kicking a ball, sitting alongside them – rather than sitting them down for a talk. Respect their move towards independence and understand that diabetes is likely to be taking a back seat for them at times – with good foundations they will move through this time and come to a balanced place with their diabetes. A few days where things are not as tight as you would like will not matter in the long run.
Importantly, allow your teenager to take on the parts of their diabetes management that they choose, whilst still providing support and being available to them. Research has shown that teenagers who take over their diabetes management all at once without any parental input, do worse than in those families where it remains a “team” effort. That said, it is also important to allow the young person to take the reins, don’t “nag” them and expect that they will sometimes make mistakes and poor choices. This is a time of learning and growth – and learning about their diabetes management and how far they can push things, is part of this.
Below are some concerns frequently voiced by parents about how to manage food with teens who have diabetes
“I’m worried that my son eats too much junk food and will develop complications”
With the busy schedule of school, sports, part¬time work, socialising social media, gaming and late night TV, it is common for teens to eat high fat convenience foods, drink sugary beverages and skip meals throughout the day. There is also peer pressure to eat certain foods and drinks. While it is recommended that teens eat a healthy diet based on whole grains, lean meats, low fat dairy and plenty of fruit and vegetables, keep in mind that the occasional take away or treat food is all part of maintaining a healthy balance. Keeping active is also important in maintaining a balance.
Here are some tips which may help them eat more of the healthy foods and maintain their diabetes care.
– Have ready to eat, easily transportable foods in the house such as muesli and nut bars (check the sugar and fat content and choose healthier options).
– Breakfast drinks, small tubs of yoghurt, nuts, custard, fruit, crackers and dip, or healthy frozen meals, can be easily taken to school, eaten on the go or quietly taken from the fridge at night. ·
– Involve the whole family in healthy eating : cook healthy food, choose healthy meals at restaurants and don’t keep junk food in the house. It is not feasible to expect your son/daughter to have healthy eating habits if the rest of the family doesn’t!
– Encourage healthier choices when getting take away – such as pasta, fish, sushi, thin crust pizzas – so that your teenager knows what to pick when they are out with friends. Help them to work out the carbohydrates of these meals, which will enable them to manage their diabetes when eating out. Carbohydrate content in take away foods tend to be difficult to estimate unless you have prior experience of the food.
– Build regular treats in each week so that they also learn how to manage these foods in a measured way and how their diabetes responds – this way they can adjust their insulin accordingly if choosing these foods when away from home ·
– Try to cook meals that everyone in the house likes or that can be modified slightly to cater to everyone’s tastes and involve your teen in the cooking and menu choices. Teaching them cooking skills is important.
– Have dinner at home as a family at least a few times a week if possible as – sitting down to a family meal can ensure that your teen eats at least one healthy meal per day and is a great family time for catching up on the day.
– If your son or daughter is going out, ask if they would like a snack before they leave the house but don’t pressure them to do this. You may like to make easy snack packs for them to carry out with them but some teens will not want to take a bag at all.
– Be open to having your teen’s friends at your home for social times so that you can offer healthier foods for all of them and also let your son or daughter feel supported. Remember that if you nag or embarrass your teen in front of their friends they are unlikely to have them over again! ·
– Pack a frozen water bottle into the lunch box; this will keep lunch fresh and also reduces the chances that they will buy soft drinks when out, and gives a better chance of keeping their water intake up.
“My daughter doesn’t wake up before midday on the weekend. I’m worried that she will have an overnight hypo.”
Although it is suggested that people with type 1 diabetes eat regular meals and snacks, trying to get your teen up at 7am on a Sunday for breakfast may not be a feasible option and nor would you want to get up at that time on a Sunday either! If they are using an insulin pump, this makes flexibility a lot easier, and CGM’s can help keep an eye on what is happening while they sleep. While staying up late and sleeping in can cause hypoglycemia on some insulin regimes, or if on injections, hyperglycemia if they miss their morning long acting insulin, generally speaking it is now possible to accommodate eating and insulin so that your teen can sleep in safely.
Long acting insulin and insulin pumps provide a lot more flexibility in lifestyle. If sleeping late or attending a party, encourage your son or daughter to check their blood glucose levels before bed, ideally this level should be between 7-10 mmol/L. If blood glucose levels are below 7 mmol/L it is suggested they have a small low GI snack before bed, such as 300ml of milk, 200g of unsweetened or 100g sweetened yoghurt, a slice of low GI bread or an apple or banana should be sufficient to give a sustained glucose release overnight and reduce the risks of a hypo.
**Chat with your dietitian or diabetes educator however as all young people are different.
Most teenagers benefit from a multiple injection regimen or insulin pump therapy, as it gives more flexibility to meal timing and carbohydrate quantities that can be eaten. Talk to your diabetes educator, dietitian or doctor about which insulin regimen would be best suited to your teens eating patterns and involve your teen in this discussion in a positive manner – tell them that you want to work out how they can have the lifestyle they want and fit diabetes into it, rather than the other way around.
“When, what and how do I tell my son about alcohol and drugs and the impact on diabetes?”
Alcohol and drugs pose many risks for all young adults. For people with diabetes particularly, these substances may be dangerous as they can interfere with blood glucose control and decision making. Alcohol can cause delayed hypoglycemia as it impairs the body’s ability to release stored glucose into the blood when levels begin to drop. Safe drinking of alcohol is very important, as well as snacks and knowing what a safe blood glucose level is during the time of drinking and the following hours.
Drugs also impact on blood glucose control as they can alter appetite. Smoking marijuana for example increases appetite causing what is known as the ‘munchies’ and often leads individuals to eat very large amounts in one go. Amphetamines such as ecstasy and speed on the other hand suppress appetite which can result in an extended time between meals and increased risk of hypoglycemia. Furthermore, both alcohol and drugs impair an individual’s ability to feel or respond to the symptoms of hypoglycemia.
While it is illegal to sell alcohol to teens under the age of 18 years of age in Australia and to sell and possess drugs, some teens nevertheless choose to experiment with these substances. Every teen is different and therefore there is no set age when these issues need to be addressed. Generally speaking it is best to discuss these topics earlier rather than later, so that if your teen is faced with the decision, they are capable of making an informed choice and knows how to be safe.
You should also be aware that most teens do not like to talk to their parents about drugs, smoking and alcohol, even if they never intend to take them. You can help them to feel more comfortable by acknowledging that this issue will come up and that you are there to support them in making their choices, and will not judge them. It is important they feel they can come to you if they have a problem and that they have other support people they can approach as well. You may want to ask a diabetes educator, doctor or dietitian to discuss alcohol, smoking and drugs with your teen (and don’t forget to give them some privacy).
“My 17 y.o daughter managed her blood glucose levels in the past but recently started losing weight and when we took her blood glucose readings they were very high. What’s going on? ”
There are many possible explanations for what is happening. Generally speaking high blood glucose levels occur if the amount of insulin taken is not enough to account for the carbohydrates eaten. However in adolescence high blood glucose levels can occur in relation to a range of hormones and girls in particular can struggle with this around their menstrual cycle. Be open to a range of possible reasons for the high blood glucose and do not judge your teen. One important factor to determine is whether your daughter is reducing her insulin dose intentionally. Intentional insulin omission and manipulation can happen in girls and women who have type 1 diabetes. This practice, referred to as ‘insulin purging’, can result in problems with blood glucose and an increased risk of developing diabetes complications; not to mention the mental health implications.
As a parent you should be aware that weight loss through insulin omission may be a sign of an eating disorder. If you are concerned about this possibility it is vital to get specialized support. We can provide some initial counselling via our website counselling services to work out a plan of where you can go from here. You should also be aware that teenagers often stop managing their diabetes as well as in the past, as a result of psychological factors such as low self-esteem, depression or diabetes burnout. Work closely with a psychologist, social worker, diabetes educator and dietitian in order to receive personalised support, assistance and advice regarding diabetes management in these cases.
Teenage years can be full of joy, ups and downs. Having been through 2 teenagers I can say it is a fabulous time watching a young person becoming their own person. Let your child with diabetes do the same. Have you been through this period and do you have tips? You my like to read my letter written as an adult, about my difficult teenage years with type 1 diabetes