How Can I Reach My Teenager?
My 13-year-old daughter has had diabetes for over a year. She is getting depressed about everything, and her sugar levels are staying in the 200s. She was a straight-A student until this year, but now she is starting to take it out on her teachers. I understand that it’s hard for her, and her stepdad and I try to have talks with her. How do we help her get past the depression stage? Name Withheld
Mary de Groot, PhD, responds:
The adjustment to the diagnosis of diabetes can take many forms over time. For some teens, diabetes can be “in the background” and not central to the way the young person thinks or feels about him- or herself. For others, diabetes can become an overwhelming burden that interferes with every aspect of life: relationships with friends and family, school, and extracurricular activities, such as sports. There can be feelings of resentment about having “something wrong with me” or feeling “different,” or frustration with new demands to check blood sugars, take injections, manage an insulin pump, or think about food in ways that peers never have to consider. In addition, high blood sugars themselves have a direct and temporary effect on mood, increasing irritability, frustration, or sadness. As growth hormone levels rise during puberty, blood sugars become more challenging to manage, which can frustrate teens and parents.
What to Know
Some people experience more irritable or sad moods when they have a rapid change in their blood sugars. This can be a decrease from their usual level but still in the normal range (say, 80 to 130 mg/dl) or when blood sugars are low (hypoglycemia), typically below 70 mg/dl. For others, irritability or sadness can occur when blood sugars are higher (say, above 250 mg/dl). These changes in mood tend to be temporary and will be reduced or cease when blood sugars return to the target range. Talk with your pediatric endocrinologist to find out what adjustments to diabetes management may be needed to compensate for changes in growth hormone.
Find Out More
Social support is a key ingredient to adjusting to and managing type 1 diabetes in teens and adults. Consistent communication within the family and with teachers and the health care team is important to provide support to teens. Setting and agreeing on realistic and consistent expectations for self-care (for example, checking blood sugars and insulin boluses) is an important source of support. Teens need to know what is expected of them and who will be helping them to be accountable for their choices, whether that is checking blood sugars before and after meals or studying for a math test. Helping your teen to talk about her diabetes with trusted friends is another important source of support, particularly at this point in development. Sharing information about diabetes with friends, their parents, and school staff can help to reduce misdirected helping attempts and misinformation that others may have about type 1 diabetes.
Finally, studies show that 9 to 26 percent of children or teens with type 1 diabetes may develop long-standing depressive symptoms. This may involve feeling sad, blue, irritable, or bored nearly every day, in combination with changes in sleep or appetite, low concentration, lack of energy, and feeling worthless or very guilty about everyday situations. These symptoms tend to come on gradually and may be associated with life stressors, or they may occur out of the blue but remain for an extended period of time. If you suspect that your teen has developed these symptoms, they are important to discuss with your pediatrician. Long-standing depression is associated with greater difficulty in managing blood sugars and poorer outcomes. The good news is that depression can be effectively treated with medications and/or by working with an individual or family therapist using a form of talk therapy called “cognitive behavioral therapy.”
Teens have multiple stressors with type 1 diabetes. Changes to the body during puberty, the need for more social support, and the potential for developing depression can be part of the picture. Talk with your teen about her thoughts about having diabetes, and help her build a network of social support. Talk with your pediatrician about changes in managing blood sugars and depressive symptoms that interfere with day-to-day activities. There are a variety of treatment options from which to choose.