Q: The latest trick our 11-year-old has learned to employ when he doesn’t get his way is refusing to eat after receiving his bolus. This happened the other night when he was upset over not being allowed to play video games because his homework wasn’t done. How do we end this dangerous power struggle?

A: Parenting a child transitioning into adolescence can be difficult; and adding type 1 diabetes into the mix doesn’t make things any easier. Dealing with your current situations will require a tricky mix of holding your son accountable while still making sure his blood sugar is managed.

To strike this balance, hold off on discussing the matter until a time when you’re both calm. After the heat of the moment has cooled, you might find that your son is more receptive when you explain the risks involved with not eating following an insulin bolus, and why it’s important for him to follow the rules about homework and video games.

It’s important, too, to let your son know what will happen in the future if he decides to make this kind of choice again. Because a dangerous low can develop when you bolus without eating, and because you worry about his safety, explain that the two of you will sit together for the next four hours to check blood sugars. Let him know that you’ll check his blood sugar every hour (or more frequently if there are symptoms of low blood sugar), and you’ll treat the low according to doctor’s instructions. Be matter-of-fact when explaining that he will not be allowed to play video games, use electronics or watch TV during this time. (Reading or homework could be allowed.)

You can likewise explain that since you had to take time out from your own schedule to watch him for signs of low blood sugar, your son will be responsible for helping you make up the household tasks you couldn’t get to, meaning he will have a few extra chores such as doing the dishes or folding the laundry.

At the same time, also explain that good choices your son makes will be rewarded. Show him that you value cooperation with blood sugar management and responsibility in getting homework done by setting up some small rewards. It could be a few new song downloads; one night of staying up a little later; or some other privilege or small item that he earns after a certain number of days holding up his end of the bargain. What’s key in this situation is that your son clearly sees that his behavior and choices carry consequences — either positive or negative. Because compliance with his blood sugar management plan is so important, there is no staying neutral.

Will this approach work in your family? Every child’s personality and development are unique, so it’s best to touch base with your care team to see if they have any tips on navigating these kinds of issues based on what they know about your son. For example, for an immediate short-term solution, your team may recommend temporarily adjusting the timing of his insulin dose until you can hammer out a plan for moving forward.

Whatever plan you come up with, the goal really is to help your son understand that feeling upset about not being able to play video games is simply not worth putting his health at risk. By taking on this one issue and showing your son how you respond to this kind of behavior, you are modeling for him some basic life principles that will serve him well in adolescence and beyond.

Kathy Knowlton–Kathy Knowlton, L.C.S.W., C.D.E., is the diabetes education program coordinator at Children’s Hospital & Medical Center in Omaha, Neb.

How Other Parents Deal

“I knew we had hit adolescence when my 12-year-old told me his blood sugar number, I nodded and wrote it down, and he then said to me in a very sarcastic tone, ‘You’re welcome.’ I was offended, but then I took a deep breath and really thought about it. Could I have handled having type 1 diabetes when I was his same age? I have my doubts. So instead of flying off the handle, I thanked him the next time he gave me his number. We smiled at each other. I know we’re going to have our moments, so I am just keeping my fingers crossed that we can find more ways to keep smiling.”

–Kim P., Andover, Mass., mom of 12-year-old Seth

Disclaimer: The information in these articles is not intended as medical advice. Families should check with their healthcare professionals regarding individual care.

Related topics:
People in the Know: Refusal to Check Blood Sugar
People in the Know: Sneaking Food
In the Spotlight: Discipline and Type 1 Diabetes

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